Types and Causes of Wrinkles: Why Botox Alone May Not Be Enough
Hello, I am Dr. Cho So-Eun of AB Clinic.
“Can Botox get rid of wrinkles that have already formed?”
“Can Botox also work on deep wrinkles that are visible even when I am not making facial expressions?”
These are some of the most common questions patients ask when discussing wrinkle treatment.
When people think of wrinkle management, Botox is often the first treatment that comes to mind because it is widely known and relatively simple to undergo. However, Botox can be an effective treatment for dynamic wrinkles caused by muscle movement, while static wrinkles that remain visible even at rest may already involve structural changes in the skin itself, making sufficient improvement difficult with Botox alone.[1]
Therefore, when treating wrinkles, it is very important to first distinguish when the wrinkles appear, how deep they are, and whether they are accompanied by a loss of skin elasticity.
| Type of Wrinkle | Characteristics | Treatment Approach |
|---|---|---|
| Expression Wrinkles (Dynamic Wrinkles) | Wrinkles that appear when making facial expressions | Botox to reduce muscle movement |
| Early Static Wrinkles | Wrinkles that remain faintly visible even without facial expression | Botox plus treatment based on skin condition |
| Deep Static Wrinkles | Deep creases visible even at rest | Consider a combined approach involving volume restoration, regeneration, and elasticity improvement |
The Golden Time for Expression Wrinkles: Botox for Preventive Wrinkle Management
When facial muscles repeatedly contract, such as when frowning, drawing the eyebrows together, or smiling, the skin repeatedly folds in the same areas.
These are called dynamic wrinkles or expression wrinkles.
The core mechanism of Botox is to temporarily reduce the movement of overactive muscles. Therefore, in the early stage when expression wrinkles appear only while making facial expressions, Botox can be one of the most straightforward and effective preventive approaches. This is because reducing strong muscle contraction helps prevent the skin from repeatedly folding in the same area.
Why Is Botox Alone Not Enough for Wrinkles That Are Visible Even at Rest?
Wrinkles that remain visible even when the face is relaxed, without muscle contraction, are called static wrinkles.
For example, fine lines under the eyes that are present even without facial expression, fine wrinkles around the arms, or forehead creases may already be static wrinkles in which the skin surface itself has folded.
At this stage, the issue is no longer simply a wrinkle caused by muscle movement. It can involve a combination of reduced skin elasticity and damage or loss of dermal collagen, elastic fibers, and other structural components.[2]
Therefore, Botox alone may reduce muscle movement, but it does not make an already formed crease or folded area of skin completely smooth.
To improve wrinkles that have already become deeply established, a multifaceted treatment approach beyond muscle contraction control is necessary, including volume restoration and skin regeneration.
Treatment Methods According to the Cause of Wrinkles
The treatment direction for established static wrinkles should vary depending on the cause of the wrinkle and the condition of the skin.
[Treatment for Deeply Indented Wrinkles: Physical Volume Restoration of the Indented Area]
• Hyaluronic acid filler may be used to restore lost volume.
• Autologous fat grafting may also be considered to naturally restore deep areas using the patient’s own tissue.
• Skin boosters such as Re2O may be used to improve skin depression by supporting the skin itself.
• The key is to directly restore the deeply indented area and create a smoother skin surface.
[Treatment for Wrinkles Caused by Dermal Damage: Restoring Skin Elasticity Itself Is the Key]
• Stimulators such as Rejuran or Juvelook may be used to support collagen production.
• Various lifting devices such as Ulthera, Thermage, and ONDA may also be used to promote dermal collagen remodeling.
• The key is to help restore damaged dermal tissue and improve collagen and skin elasticity.
[Botox as an Adjunctive Treatment for Various Types of Wrinkles]
• Botox can play a supportive role in combination wrinkle treatment involving fillers, skin boosters, and lifting procedures.
• By reducing muscle movement in areas with deep wrinkles, Botox may help stabilize the area and prevent newly restored filler or regenerative material from shifting before it has settled.
A Smarter Wrinkle Management Strategy Based on Wrinkle Type
Ultimately, the key to wrinkle treatment is applying the appropriate procedure at the appropriate time according to the type and cause of the wrinkle.
If wrinkles are still shallow and appear only with facial expression, it is advisable to focus on preventive management with Botox.
On the other hand, if static wrinkles have already formed into deep creases, relying on Botox alone may not be sufficient. In such cases, a multidimensional treatment strategy aimed at restoring the dermal layer should be considered to achieve a more satisfactory result.[4]
Accurately identifying the type and stage of the wrinkles appearing on your skin and finding a tailored solution based on that assessment is the first step toward reducing signs of aging and maintaining healthy skin elasticity.
Wrinkle Botox FAQ
Q. Can Botox get rid of deep wrinkles?
Static wrinkles that remain visible even at rest may be difficult to improve sufficiently with Botox alone.
Q. How do I distinguish between expression wrinkles, static wrinkles, and wrinkle lines?
One useful criterion is whether the wrinkle disappears when you relax your facial expression. If a deep crease remains even after relaxing the face, it may indicate that a static wrinkle has already formed.
Q. What procedures are needed for deep wrinkles?
Because the causes of wrinkles vary, procedures such as fillers, skin boosters, and lifting treatments may be considered together depending on factors such as muscle movement, skin elasticity, and volume loss.
References
[1] Small R. Botulinum Toxin Injection for Facial Wrinkles. American Family Physician. 2014;90(3):168–175.
https://pubmed.ncbi.nlm.nih.gov/25077722/
[2] Uitto J. The Role of Elastin and Collagen in Cutaneous Aging: Intrinsic Aging Versus Photoexposure. Journal of Drugs in Dermatology. 2008;7(2 Suppl):s12–s16.
https://pubmed.ncbi.nlm.nih.gov/18404866/
[3] Proactive Aesthetic Strategies: Evaluating the Preventive Role of Botulinum Toxin in Facial Aging. Muscles. 2025.
https://pubmed.ncbi.nlm.nih.gov/40843918/
[4] Carruthers J, et al. Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices. Dermatologic Surgery. 2016;42(5):586–597.
https://pubmed.ncbi.nlm.nih.gov/27100962/
- Written by
- AB Medical Editorial Team
- Medically reviewed by
- So-Eun Cho (DERMATOLOGIST)
- Updated on
- 2026.11.13
This article is for informational purposes only and does not replace a personal medical consultation.
For more details, we recommend visiting AB Clinic and consulting with our dedicated dermatology specialists. For inquiries about treatment costs and other procedures, please check the link below and leave a consultation request. We'll get back to you as soon as possible.
