There are two different types of rhytids (wrinkles): static and dynamic. Static wrinkles are those lines in the face that persist after muscle tension is relieved. Examples include, glabellar lines (vertical lines between the brows), perioral lines (upper lip and smile lines), nasolabial folds, dimples at the outer corners of the mouth, and frown lines (marionette lines). Static wrinkles do not respond to treatment with Botox, but rather, to hyaluronic acid fillers (Restylane and Juvederm).
Dynamic wrinkles are those that are present only with muscle contracture. Examples include forehead ‘worry ‘lines, periorbital lines (‘crow’s feet’), ‘bunny lines’ around the bridge of the nose and occasionally glabellar creases. Dynamic wrinkles respond very well to Botox treatments.
Often, dynamic wrinkles can become static lines through many years of muscle contraction and the thinning of skin that naturally occurs with aging the effects of sun damage. The glabella and upper lip lines are good examples of this. Thus, pre-treatment with Botox is required to prevent muscle contraction from deepening the creases further. Multiple treatments of Botox before filler is best, as often these persistent lines soften with time, obviating the need for filler in this region. Another example of pre-treating a static wrinkle with Botox is the softening of the depressor anguli oris action at the outer corners of the mouth. This elevates the outer corners of the mouth as well as making the melomental fold (frown line) appear less depressed. Dermal filler can then be injected to fill-in remaining marionette (frown) lines.