Wrinkles are age-related changes in the skin. They appear as lines or furrows on the skin surface and can result from folding of the epidermis and dermis or from loss of volume in deeper structures followed by descent of more superficial tissue.

To understand how wrinkles form, it helps to look at the structure of the skin. The uppermost layer is the epidermis, which renews itself regularly. Beneath it lies the dermis with sweat glands, sebaceous glands and scent glands. It is supported by a network of collagen and elastin fibres that keeps the tissue supple, stable and able to bind water. Beneath the dermis is superficial fatty tissue, followed by fascia and muscle layers, deeper fat and bone.

Up to young adulthood, these structures usually function efficiently. The skin stores moisture well, appears vital and plump and shows few wrinkles.

Over the years, the skin layers change and many of their functions slow down. Collagen and elastic fibres decrease, less moisture can be retained and the blood supply becomes less abundant. The skin becomes thinner and drier and gradually loses firmness.

Wrinkles and tissue laxity are the visible consequences of these processes.

Wrinkles can broadly be divided into three groups according to how they develop:

• Dynamic wrinkles
  These are expression lines caused by repeated movement of facial muscles. As muscles repeatedly contract, the skin folds in the same places. Over time, fine lines can develop into deeper furrows. Examples include frown lines, crow’s feet and horizontal forehead lines.
• Static wrinkles
  These develop when skin and underlying tissue lose elasticity, firmness and moisture and gradually descend under the influence of gravity. Examples include deeper nasolabial folds, marionette lines and lax tissue around the chin and neck.
• Actinic wrinkles
  These are fine crepey lines associated particularly with excessive UV exposure and drying of the skin. Radial lines on the cheeks are one example.

Chronological ageing is related to biological age and individual lifestyle. It is the natural ageing process that affects everyone.

Photoageing, by contrast, is caused or accelerated by repeated exposure to UV radiation, particularly sunlight. It can make visible signs of ageing and wrinkle formation appear earlier or more pronounced.

Genetics can influence how old a person appears. Researchers have found that certain variants of the MC1R gene may affect perceived facial age independently of the number of wrinkles or pigmentation spots. Some variants have been associated with a face being perceived as up to around two years older.

MC1R is primarily involved in pigmentation of the skin and hair, but research suggests that it may also influence skin ageing because it plays a role in inflammatory reactions, wound healing and repair of DNA damage. In the studies cited on the German page, the effect appeared stronger in men than in women.

Researchers assume that other genes may also contribute to differences in visible ageing.

Natural skin ageing is a normal process that begins gradually from around the mid-twenties. Its pace is influenced by genetic predisposition, which means that every woman and man ages differently.

Certain factors can accelerate this process so that wrinkles, lax tissue and pigmentation changes appear earlier than average. These include excessive UV exposure, smoking, high alcohol consumption, inadequate nutrient intake, an unbalanced diet, insufficient sleep and chronic stress.

A number of medical conditions can contribute to unusually rapid skin ageing. These include hormonal disorders or major hormonal changes, diabetes, cardiovascular disease, thyroid, liver or kidney disease and congenital connective-tissue disorders. Side effects of certain medications and radiotherapy used in cancer treatment can also accelerate changes in the skin.

A health-conscious lifestyle can help slow visible skin ageing. A balanced and varied diet supports not only general health but also the appearance of the skin. Adequate fluid intake is important because water and unsweetened tea help support normal moisture balance.

Regular cleansing and skincare products adapted to the individual skin type are also useful. Exercise, sufficient sleep and reducing chronic stress can support healthy skin. Smoking has a negative effect on skin quality, so stopping smoking is recommended. Moderate alcohol consumption is preferable to frequent or excessive intake.

UV protection is particularly important. Use an appropriate sunscreen consistently and remember to reapply it when necessary.

To a certain extent, a sun protection factor appropriate for the skin type can help reduce UV-related wrinkle formation. Sunscreens form a protective layer that absorbs or blocks part of the ultraviolet radiation before it reaches deeper skin structures. Protection should cover both UVB and, particularly with regard to photoageing, UVA radiation.

Facial massage cannot permanently remove existing wrinkles, but it can have a temporary positive effect on the appearance of the skin.

Massage stimulates circulation and can therefore improve the supply of nutrients to the skin. Skincare products may also be distributed and absorbed more effectively. At the same time, gentle massage can support lymphatic drainage and temporarily reduce swelling, for example around the eyes.

Another benefit is relaxation: facial muscles loosen and stress decreases, which can make the face look more relaxed and temporarily smoother.

Aesthetic dermatology offers different methods that can improve skin structure and reduce wrinkles. They work through different mechanisms:

• Renewal of the upper skin layer
  Removing superficial skin cells stimulates natural regeneration so that smoother skin can form. One example is chemical peeling.
• Stimulation of deeper tissue layers
  These methods stimulate collagen and elastin formation in the dermis and deeper fascial layers. Examples include Ultherapy PRIME®, ATTIVA® and BTL Exilis Elite™.
• Laser treatment
  Fractional laser procedures combine controlled renewal of superficial skin with stimulation of collagen production in deeper layers. More information: laser treatment.
• Treatment from within: fillers, botulinum toxin and skin boosters
  Hyaluronic-acid fillers can restore lost volume and smooth static or gravitational folds. Botulinum toxin relaxes selected muscles that contribute to expression lines. Skin boosters such as Belotero® Revive can be distributed beneath the skin to improve hydration and skin quality; the combination of hyaluronic acid and glycerol provides an immediate moisturising effect.

A facelift is a surgical procedure in which facial and/or neck tissue is repositioned and tightened to create a marked rejuvenating effect. Surgery is not always necessary, however.

For mild to moderate signs of ageing, injections and device-based treatments such as Ultherapy PRIME® or ATTIVA® may provide meaningful improvement without surgery. With very pronounced tissue laxity, non-surgical methods reach their limits and a surgical facelift may be considered.

Our general approach is to preserve and support tissue early rather than wait until major correction is required. Starting suitable anti-ageing measures at an appropriate time can help maintain a fresher appearance for longer.

Some women notice changes in their skin after stopping an oral contraceptive. Hormonal contraceptives can have effects on the skin, for example reducing acne in some patients, influencing water retention and affecting collagen, elastin and blood circulation.

When the pill is discontinued, these hormone-related effects can diminish and the complexion may temporarily change. The extent of this varies considerably from woman to woman, so stopping the pill does not automatically mean that the skin will age faster.

Sunlight contains different forms of ultraviolet and heat radiation. UV radiation, particularly UVA, can accelerate structural skin ageing and therefore wrinkle formation.

UV exposure promotes the formation of free radicals that can damage cellular structures in the skin. It can also damage collagen fibres and activate enzymes known as matrix metalloproteinases (MMPs), which contribute to the breakdown of collagen, elastin and hyaluronic acid. Repeated exposure therefore weakens important components of the skin’s supporting structure.

Cigarette smoking exposes the body to nicotine and numerous substances in tobacco smoke. Nicotine narrows blood vessels and can therefore reduce blood flow and nutrient supply to the skin. It also promotes processes associated with the breakdown of collagen and elastin, which can reduce skin firmness. Moisture retention in the skin may also be impaired.

Tobacco smoke itself additionally contains free radicals, carbon monoxide and fine particles that can negatively affect skin quality.

Smoking can also promote expression lines around the mouth because the repeated pursing of the lips when drawing on a cigarette contributes to characteristic perioral wrinkles.