Wrinkles Treatments Overview


The approach to wrinkles is based on the severity of the wrinkles, where they are located on the face, and whether they are caused by facial expressions or excessive sun exposure. Wrinkles can be prevented with Botox, lessened with laser peels and hidden with fillers.

Sunscreens and limiting sun exposure is the best way to prevent fine wrinkles and texture issues caused by the sun. Modern treatment of fine wrinkles caused by the sun usually involves hi-tech creams and laser peels.

Wrinkles caused by facial expression are best treated by muscle relaxants such as Botox, Dysport or Xeomin. Wrinkles caused by expression that are too deep to completely fade away with relaxing agents, most commonly “eleven” frown lines and upper lip lines, can be further smoothed with fillers.

NOTE: Deep crevices such as the parenthesis lines around the mouth are not caused by either the sun or expression, but by the sagging of muscles and skin that drops tissue downward. See Face and Neck Sagging treatments.

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The best way to prevent wrinkles caused by expression is with Botox or the other recently developed alternatives Dysport and Xeomin. The administration of Botox to the frown area is the most common cosmetic procedure performed in every developed nation.


When this derivative from food poisoning was first introduced in the 1980′s, Dr. Degnan advised his listeners on his weekly Palm Springs radio show to hold off on using Botox until more time had passed to prove its safety. In fact, Dr. Degnan made a regular point of advising against most of the cosmetic procedures that were being performed in the 1980′s and most of the 1990′s.

While Dr. Degnan feels he was correct in advising listeners to shy away from the commonly used chemical peels and wrinkle fillers of that era, such as collagen injections (derived from cow hides), he admits he was wrong in his presumption that Botox would be hard on the human immune system. Dr. Degnan now feels that Botox has been more than adequately time-proven to be safe. In fact, when used for wrinkles on the face as FDA approved, a Botox treatment is safer than swallowing a tablet of aspirin.

NOTE: While Dr. Degnan uses all three of the available relaxing agents, for ease of discussion here, we will simply use the term “Botox.”

Botox has two main downsides. It needs to be repeated about every 3 months and it is “addicting.” Very few people who receive Botox want to ever go without it. Botox is best used for the frown lines above the nose, the wrinkles going across the forehead and crows feet. Botox should ideally be first started in a given individual at the age when these wrinkles are first starting to appear. Botox is superb at preventing the worsening of these wrinkles at any age, but if a person waits until the wrinkles are already deep, such as the “elevens” in the frown area, then fillers may be needed to obtain ideal results.

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The best way to lesson acne scars or facial wrinkles caused by too much sun, is with laser peels. Dermatologists have learned over recent decades that the best way to improve the surface texture of the skin is to frankly burn off the outer layers. This is akin to removing the dead wood out of a tree in that the new skin that re-grows will be healthier and totally replace the former outer layer.


The new skin will return to normal thickens and have less wrinkles, age spots, and pre-cancerous changes (called actinic keratosis). An additional benefit of the laser peel is that large pores become smaller. 

During his long career in Palm Springs, Dr. Degnan was adamantly opposed to most of the methods being used to burn off the outer layers of skin. The lasers, chemical peels, and mechanical devices being widely used by his skin colleagues were commonly scarring patients, and even at best, required a long healing time. The reason these methods were troublesome and even dangerous had to do with the fact that they were not precise in targeting the outer layers of the skin and thus the deeper layers would be inadvertently injured as well. Injuring the deeper layers is what caused the disturbing long healing times, swelling, oozing, and too-often, scarring.

While these methods gave good results when nothing went wrong, Dr. Degnan wanted nothing to do with any procedure that might scar a person’s face. Thus, despite his large multiple-office Palm Springs practice, he did not get into the field of “skin resurfacing” until the Sciton laser was invented in Palo Alto, California, that generated heat in a significantly faster fashion (chemical peels and the older lasers cause a “slow burn”), thus allowing for a more controlled burn that only affected the desired outer-most layers. With the deeper layers thus protected, there is much less chance of scarring. Most importantly, Dr. Degnan has operated Sciton lasers at both his Palm Desert and Lake Tahoe offices, and has never scarred a single patient. The healing time is much shorter and the entire experience is extremely improved upon relative to older lasers. Besides being known for its improved ability to rapidly generate heat, the Sciton is also revered for its ability to be precisely tuned or adjusted for different skin variables. Dr. Degnan will often laser deeper around advanced mouth wrinkles, for example, than around the sides of the face where the skin is thinner and typically less wrinkled.

After a Sciton laser peel, one needs to apply Vaseline and avoid the sun. The depth of the peel selected by the patient and Dr Degnan will vary from 2 to 7 days depending upon the severity of the patients’ needs, and how long they are willing to apply Vaseline and avoid the sun. You do not need stay home or avoid most activities. It is recommended that most patients have about 2 such peels yearly.

Dr. Degnan’s prices for Sciton laser peels are some of the lowest in the United States. We keep prices very affordable because we want to encourage patients to have these peels when needed. Dr. Degnan feels laser peels are as imperative to the face as routine teeth cleaning is towards dental hygiene.

The results of deep peels are permanent. To give a perspective, up to three peels might be given to provide and 85% improvement in severely sun damaged skin or sever acne scars. Laser peels are performed mainly during the non-sunny months (i.e., November to April).


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“Filler” is to the cosmetic dermatologist as putty is to a carpenter.
Juvederm is the perfect filler for filling in wrinkles, especially the “eleven lines” in the frown area and the vertical “lip stick bleeder lines” and above the upper lip in women.

Dr. Degnan refers to Juvederm as the “soft sexy filler” for its ability to be molded into needed areas that are relatively small. This also makes it easy for even beginner cosmetic physicians and nurses to use, and thus it is the most prevalent filler used int he US. the FDA approved it to last one year (the time for every molecule to disappear), so touch-ups are given about every 6 months.

See Lip treatments for details on Juvederm’s history and use in enlarging.

The parenthesis lines that start at the sides of the nose and go down to the sides of the mouth are not really wrinkles per se, but larger creases caused by sagging of the cheek skin and muscle. Dr. Degnan has treated many hundreds of patients’ parenthesis lines, and is most proud of his own technique he developed in 2009 which uses the longer lasting Voluma and provides far more effective and natural results for the parenthesis than the traditional method of going directly into the lines using Juverderm. Please refer to Face and Neck Sagging treatments for details on Voluma and Sculptra.