What Causes Wrinkles?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

How are wrinkles formed? Their origin and nature are said to be “notoriously complex,” but current thinking is that wrinkles occur where fault lines develop in aging skin. The process has been compared to an old leather glove (made out of skin, after all) that develops creases at the joints due to repetitive stress. In the face, the repeated flexion may be due to facial expression. An eight-year longitudinal study found that you can predict the pattern of persistent wrinkles by superimposing upon your resting face the expression lines (temporary wrinkles) that form when you smile. Over time, the skin folding caused by everyday facial expressions etches the temporary grooves into permanent wrinkles. See how the smile lines around the eyes at baseline show up as permanent wrinkles eight years later?

Given that wrinkles develop from forehead furrows, and expression lines from frowns and laughter, one dermatology journal review on aging skin offered the tongue-in-unwrinkled-cheek suggestion of “[l]iving alone to minimize the use of facial expressions ….” (And while you’re at it you could live “in space to avoid the effects of gravity.”)

However, there is a way to freeze part of your face into an expressionless mask: Botox. In fact, one contraindication to getting Botox is having a job that “necessitate[s] a wide range of facial expressions.” It’s never been formally put to the test, but there was a case report of a pair of identical twins, one of whom who spent tens of thousands of dollars getting Botox treatments across multiple areas on her face a few times each year for 13 years. Compared to her non-regularly injected twin, she ended up with fewer imprinted facial lines.

A paper entitled “Sleep Wrinkles …” tried to make the case that wrinkles may result from the skin distortion from mechanical compression of sleeping on your side. Of course, the primary author also is a partner in a company selling $160 quote-unquote “wrinkle-fighting” pillows. It turns out there does not appear to be any correlation between sleep position preference and the appearance of wrinkles.

Speaking of questionable products, what about topical adhesive “antiwrinkle” pads you paste to your face at night? Product claims include “look up to 10-15 years younger,” declaring a 70 percent reduction in wrinkles. But, when actually put to the test for a month for crow’s feet, forehead, or between-the-eye wrinkles, no objective benefits were reported at all. There did appear to be a placebo effect in that subjectively, the study participants felt the wrinkles looked better, but independent blinded evaluations by facial plastic surgeons of before-and-after pictures showed no significant change.

So, what can we do to prevent wrinkling? Some of it is genetics. For example, having lighter skin color is a predisposing factor. Among light skin tones, Caucasian skin wrinkles more readily than Asian skin, for which aging is more characterized by pigmentation changes, such as freckles, blotchy patches, and liver spots. Among Asian skin types, Chinese women tend to have more wrinkles around their eyes than Japanese women, whereas Thai women tend to wrinkle more in the lower half of their faces.

There are, however, factors we have control over. For example, drier skin has also been found predictive of more persistent wrinkling, suggesting regular use of skin moisturizers may help.

When it comes to wrinkle formation, it takes two to tango. Wrinkles are formed by repetitive creasing of aged skin. Kids can scrunch their faces all they want, because the architecture of their skin has yet to be irreparably damaged. And the lack of creasing is why you don’t have wrinkles on your forearms, no matter how much sun they’ve soaked up. Rather than immobilizing your face with Botox, you can focus on preventing the underlying structural damage that makes your skin susceptible. This involves tobacco avoidance and regular sun protection. What about safeguarding against other kinds of light?

From the Journal of Biomedical Physics and Engineering: “Can Light Emitted from Smartphone Screens and Taking Selfies Cause Premature Aging and Wrinkles?” Human skin cells bathed in the light of iPhones and iPads experienced an 80 to 90 percent increase in free radicals, compared to shielded control cells, suggesting electronic device-generated light “may be harmful to skin.” On one hand, they positioned the screens unrealistically close—one centimeter—resulting in about 10 times the irradiance, compared to a reading distance of about a foot. On the other hand, the skin cells were only exposed for an unrealistically short time—only an hour. The researchers called for future studies to evaluate the impact of lower, longer doses on skin outcomes such as collagen deposition.

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• Lapière CM. The ageing dermis: the main cause for the appearance of “old” skin. Br J Dermatol. 1990;122 Suppl 35:5-11.
• Nikolakis G, Makrantonaki E, Zouboulis CC. Skin mirrors human aging. Horm Mol Biol Clin Investig. 2013;16(1):13-28.
• Zouboulis CC, Ganceviciene R, Liakou AI, Theodoridis A, Elewa R, Makrantonaki E. Aesthetic aspects of skin aging, prevention, and local treatment. Clin Dermatol. 2019;37(4):365-372.
• Vogeley C, Esser C, Tüting T, Krutmann J, Haarmann-Stemmann T. Role of the aryl hydrocarbon receptor in environmentally induced skin aging and skin carcinogenesis. Int J Mol Sci. 2019;20(23):6005.
• Anson G, Kane MAC, Lambros V. Sleep wrinkles: facial aging and facial distortion during sleep. Aesthet Surg J. 2016;36(8):931-940.
• Austin E, Huang A, Adar T, Wang E, Jagdeo J. Electronic device generated light increases reactive oxygen species in human fibroblasts. Lasers Surg Med. 2018;50(6):689-695.
• Hillebrand GG, Liang Z, Yan X, Yoshii T. New wrinkles on wrinkling: an 8-year longitudinal study on the progression of expression lines into persistent wrinkles. Br J Dermatol. 2010;162(6):1233-1241.
• Arjmandi N, Mortazavi G, Zarei S, Faraz M, Mortazavi S a. R. Can light emitted from smartphone screens and taking selfies cause premature aging and wrinkles? J Biomed Phys Eng. 2018;8(4):447-452.
• Xhauflaire-Uhoda E, Fontaine K, Piérard GE. Kinetics of moisturizing and firming effects of cosmetic formulations. Int J Cosmet Sci. 2008;30(2):131-138.
• Ganceviciene R, Liakou AI, Theodoridis A, Makrantonaki E, Zouboulis CC. Skin anti-aging strategies. Dermatoendocrinol. 2012;4(3):308-319.
• Mazzarello V, Ferrari M, Bulla A, Piu G, Montella A. Antiwrinkle effect of topical adhesive pads on crow’s feet: How long does the effect last for? J Cosmet Dermatol. 2018;17(3):484-490.
• Kligman AM, Zheng P, Lavker RM. The anatomy and pathogenesis of wrinkles. Br J Dermatol. 1985;113(1):37-42.
• Binder WJ. Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Arch Facial Plast Surg. 2006;8(6):426-431.
• Kotlus BS. Effect of sleep position on perceived facial aging. Dermatol Surg. 2013;39(9):1360-1362.
• Ryan WR, Most SP. A prospective evaluation of the efficacy of topical adhesive pads for the reduction of facial rhytids. Arch Facial Plast Surg. 2009;11(4):252-256.
• Burke KE. Facial wrinkles: Prevention and nonsurgical correction. Postgraduate Medicine. 1990;88(1):207-228.
• Foissac R, Benatar MJ. Influence of botulinum toxin type A esthetic injections on facial expressions. J Cosmet Dermatol. 2021;20(5):1405-1410.

Motion graphics by Avo Media

• aging
• skin health
• sleep
• wrinkles