Fine Lines & Wrinkles
For frown lines, forehead lines, crow’s feet and lines around the mouth.
With Dr. Juliya Fisher and Dr. Shereene Idriss.
In Brief
Fine lines and wrinkles form where the face folds with expression, where skin loses collagen, and where the support beneath it thins. Each cause takes a different treatment. Botox softens lines from movement. Fraxel, Clear + Brilliant, SkinPen microneedling and PRP rebuild the skin where lines stay at rest, and filler restores lost volume. Most faces need more than one.
Diagnosis First
The line that bothers you usually has more than one cause, and there are three to look for.
- Skin and movement. Skin loses elasticity, and repeated expression creases it, so lines that came and went with movement (dynamic lines) start to stay when your face is at rest (static lines).
- Volume. The under padding beneath the skin thins, in the cheeks for example, and lines start to build in where it is lost.
- Bone. Your bone structure shapes how lines form: cheekbones with good projection age differently from a flatter face with a dainty jawline.
Collagen starts to decline in our mid 20s, by about 1% a year, and the sun adds to the toll, which is why daily sunscreen matters at any age. Lines that appear with expression and fade at rest are normal, and don’t need treating yet.
A line can be a muscle, the skin itself or a missing cushion, and often all three at once. A dermatologist works out which before choosing a treatment.
What We’d Skip
Some popular fixes for lines do nothing, and a few leave a face looking off.
Don’t start Botox before a line stays at rest
Lines that come and go with expression are normal. Botox makes sense once lines stay when the face is at rest, to keep them from getting deeper, and not years ahead of a line you may never have.
Don’t fill your smile lines
Filler in the folds beside the nose and mouth can leave you looking puffy, and the area naturally lengthens with age, so filling it can make it longer still. “I will never inject filler into my smile lines,” says Dr. Idriss, who uses PRP or PRF with microneedling instead.
Don’t Botox every line
A face with no movement looks off. Around the eyes, “a little bit of lines is better than no lines at all,” as Dr. Idriss puts it. She leaves the lower crow’s feet alone, because treating them changes your smile, and with hooded eyelids she doesn’t treat the whole forehead.
Don’t chase a fine line with an aggressive laser
A young face with a fine line doesn’t need an ablative CO2 laser, and resurfacing alone does nothing for a line that comes from movement or lost volume.
Don’t count on Botox in a bottle or face exercises
No cream relaxes a muscle the way an injection does. Facial exercises don’t replace Botox either, and they may even add lines.
“I leave a little movement in the face on purpose. You should look rested, and nobody else should be able to tell why.”
How Are Fine Lines and Wrinkles Treated?
Which treatment comes first depends on what made the line, whether movement, the skin itself or lost volume.
- Lines from movement that are starting to stay at rest. Botox relaxes the muscle that creases the skin, in frown lines between the brows, forehead lines and, selectively, crow’s feet. It softens them and slows how deep they get. Lines that formed where there is little movement are not what it treats.
- Fine lines etched into the skin, with sun damage. Fraxel Dual Laser treats microscopic columns of skin and builds new collagen while the surface stays intact. Its 1550 nm setting is the one for texture and fine lines.
- Fine lines with rough texture, without heat. SkinPen Microneedling prompts collagen with controlled micro injuries and no heat; results build gradually, with the full effect at about six months.
- Lines around the mouth, and smile lines you do not want filled. PRP & PRF with Microneedling strengthens the skin with growth factors from your own blood, gradually. Around the mouth, Dr. Idriss uses it instead of filler.
- Lines that come from lost volume. Dermal Fillers restores the support underneath, a little at a time: in the cheeks, for example, or a little in the lips to soften how deep lip lines get.
Most plans combine them, and every plan includes daily sunscreen and, once lines stay at rest, a retinoid at home.
The Treatments
Clear + Brilliant, the gentler laser, is in the side by side below.
BotoxRelaxes the muscles behind frown lines, forehead lines and crow’s feet
Dermal FillersRestores the support lost beneath lines, a little at a time
Fraxel Dual LaserA fractional laser for fine lines, sun damage and texture
SkinPen MicroneedlingMicroneedling with no heat, to build collagen
PRP & PRF with MicroneedlingGrowth factors from your own blood, with microneedling
Side by Side
Most plans combine two or more of these.
| Treatment | How it works | Suited to | Downtime | Sessions | Results |
|---|---|---|---|---|---|
| BotoxAlso Dysport, Xeomin and Jeuveau | A purified protein, injected in small doses, relaxes the specific muscles that crease the skin | Lines from movement: frown lines, forehead lines and crow’s feet, which Botox Cosmetic is FDA approved to treat | None; a small bruise is possible | One; repeat once movement returns | Builds over 10 to 14 days; peaks at 2 to 4 weeks |
| Dermal FillersHyaluronic acid fillers and Skinvive | Hyaluronic acid gel restores structure lost beneath the skin | Lines from lost volume; a little in the lips so lip lines form less deeply | Little; possible swelling or bruising | Built gradually; lips about 8 weeks apart | Right away |
| Fraxel Dual LaserNon-ablative fractional laser, 1550 nm and 1927 nm | A non-ablative fractional laser treats microscopic columns of skin and leaves the surface intact, prompting new collagen | Fine lines with sun damage and rough texture; FDA cleared for wrinkles around the eyes | Shorter than ablative lasers; a few days of redness and peeling | 1 to 5, set after your skin’s first response | After the first session, improving over time |
| Clear + BrilliantThe gentler laser in the Fraxel family | Treats microscopic zones in the upper layers of the skin and leaves the skin around them intact, prompting renewal | Early signs of aging, dullness and uneven texture, with little downtime | Little to none; redness usually settles in 12 to 24 hours | A series; improvement reported after 4 to 6 | Softer, brighter skin in 1 to 2 weeks |
| SkinPen MicroneedlingMicroneedling, often with PRP | Fine needles create controlled micro injuries, with no heat, prompting collagen | Fine lines and rough texture, in skin that does better without heat | 1 to 3 days of redness | More than one, 4 to 6 weeks apart | Texture from 4 to 8 weeks; builds for 6 months |
| PRP & PRF with MicroneedlingPRP and PRF from your own blood | Growth factors from your own blood, applied or placed beneath the skin during microneedling | Lines around the mouth and smile lines, instead of filler; skin quality, gradually | 1 to 3 days, like a mild sunburn | Dr. Idriss’s approach: three, a month apart, then a pause | Gradual and subtle; judged around 5 months in |
In Their Words
“
Dr. Fisher is amazing! She answered all of my questions and never pushed me onto anything. She cares about her patients. Will definitely come to her again if I need an opinion on anything relating to hair or skin.
Zubaida M.
“
I would recommend Dr Idriss a thousand times over and over. She is extremely knowledgeable, knows what will work and what won’t and will always give you an honest recommendations. You will never feel pushed into moving forward with any injections or procedures.
Hiva F.
“
I highly recommend Dr. Fisher. I followed her from her previous practice and I continue to be happy with my results. I’ve gotten fillers and laser. Whenever I’ve wanted to do more, she was always honest with me. If I didn’t need it, I could count on her to tell me
Lillian J.
“
Love Dr. Idriss and everyone on her team. I have been getting filler done for the past few years (39 y/o) and it’s always perfect/exactly what is needed to look great but not obvious – worth every penny!! She is so talented but also so personable – my appts have never felt rushed, no long waits, no pressure to get more treatments etc.
Caroline G.
Bryant Park, New York
Your Dermatologists
Founder
Dr. Shereene Idriss
Candid advice, subtle results.
Board-certified, Practicing since 2013
Dermatologic Surgeon
Dr. Juliya Fisher
Trained to work in millimeters.
Double Board-certified, Columbia Mohs fellowship
Both doctors share one philosophy, so either is a good place to start. Book online with Dr. Fisher, or call (212) 612-1520 for Dr. Idriss.