The 4 Types of Facial Wrinkles: Match the Treatment to the Cause

This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers; all references are the author's own.

"I get Botox regularly — my crow's feet improved, but my nasolabial folds haven't budged." "I tried filler too, and my forehead lines actually look worse." These are some of the most common stories I hear in clinic. My first question is always the same: "Has anyone accurately diagnosed your wrinkle type?"

Wrinkles are not one thing. Clinically they fall into four types, and the effective treatment is completely different for each.^1,2 On dynamic wrinkles (expression lines), filler can actually look unnatural; on static wrinkles, Botox is nearly pointless; photoaging wrinkles need lasers and resurfacing first; and gravitational wrinkles need lifting. If you don't know the type and just repeat "popular" procedures, you can spend time and money without a satisfying result. In fact, a 2025 review of facial adverse effects identified misapplying Botox to Glogau Type III–IV static wrinkles as a leading cause of complications.³

1. Clinical classification — Glogau and Lemperle are the international standard

Two classification systems are widely used for diagnosing wrinkles.

• Glogau photoaging classification (1996) — grades photoaging severity in four stages: Type I no wrinkles (under 30s) · Type II wrinkles in motion (30s–40s) · Type III wrinkles at rest (50s–60s) · Type IV severe wrinkles and pigmentation (60s+).²
• Lemperle classification (2001) — a detailed system scoring wrinkle depth from 0 to 5 across 12 facial areas; the standard for before/after comparison in clinical studies.⁴
• Wrinkle Severity Rating Scale (WSRS) — a 5-point assessment using a standard photo set; the standard endpoint in HA filler studies.⁵

These matter because "which stage your wrinkle is at" completely changes the choice of procedure. In particular, misapplying Botox to Glogau Type III–IV static wrinkles is cited as a leading cause of complications.³

2. Four clinical types, by cause

To apply the Glogau and Lemperle systems clinically, wrinkles are subdivided into four cause-based types — the standard in recent reviews (2025).⁶

3. Evidence-based treatment by type — evidence grades A–C

① Dynamic — botulinum toxin A (BoNT-A) [Grade A]

First line is botulinum toxin A (BoNT-A), which cleaves the SNAP-25 protein at the nerve terminal to block acetylcholine release and relax the muscle.⁷ Effect begins 24–72 hours later, peaks at 1–4 weeks, and lasts about 3–4 months on average.⁸ A 2026 meta-analysis (10 RCTs) confirmed a significant reduction in upper-face dynamic wrinkles.⁹ Second-line adjuncts: topical retinoid [B] and BoNT-A plus collagen filler [B]. Note: Botox alone is limited for Glogau III–IV static wrinkles, where combining filler becomes necessary.³

② Static — HA filler and PLLA booster [Grade A]

First line is hyaluronic acid (HA) filler and a PLLA booster. HA restores volume instantly, while PLLA stimulates collagen to increase dermal thickness.¹⁰ HA works immediately; PLLA builds gradually over 6–12 weeks. The Sparavigna 2019 RCT and a 2024 prospective pilot study both showed improvement in static and dynamic wrinkles.¹¹ Second-line adjuncts: MTS RF / microneedle RF [A] and skin boosters (Rejuran, exosome) [B]. Repeating Botox alone on static wrinkles is limited — these need volume and collagen.

③ Photoaging — retinoid plus fractional laser [Grade A]

First line is a topical retinoid plus fractional laser. Retinoids drive epidermal renewal and collagen stimulation; fractional lasers drive dermal remodeling. Since Fisher's 2002 paper defined the mechanism of photoaging, roughly 30 years of clinical data have accumulated.¹² Second-line adjuncts: IPL / pico fractional [A], AHA/BHA chemical peel [B], topical vitamin C [A]. Note: without daily sun protection (SPF 50+), the results fade — it is essential every day.

④ Gravitational — HIFU, MTS RF, thread lifting [Grade A]

First line is HIFU, MTS RF, and thread lifting, which heat the SMAS and deep dermis to produce immediate contraction and long-term collagen regeneration.¹³ There is a partial lifting effect immediately, with collagen regeneration peaking over 3–6 months. Multiple RCTs and a 2026 integrated multi-treatment review have established these as standard.¹⁴ In our clinic we address the deep layer with Ultherapy (HIFU) and add surface tightening with Thermage (radiofrequency). Second-line adjuncts: PLLA booster / CaHA filler [A], PDO/PCL thread lifting [B]. Note: severe gravitational wrinkles have limits with non-surgical treatment, and a surgical approach should be considered.

4. Self-assessment — find your wrinkle type

A simple three-step check you can do at home:

• Step 1. Expression test — in the mirror, raise your eyebrows → frown → smile broadly. Appears only with expression = dynamic; remains without expression = static.
• Step 2. At-rest observation — relax all facial muscles. Dense fine lines with sun-damage pigment on cheeks/forehead = photoaging (Type III); tissue sagging from the mouth to the jawline = gravitational.
• Step 3. Location check — glabella/forehead/crow's feet (upper face) = dynamic-dominant; nasolabial/marionette (mid–lower face) = static plus gravitational.

If several apply, you have a mixed type. Precise diagnosis is confirmed with in-clinic Glogau and WSRS assessment.

5. Myths vs clinical facts

• "Botox works on all wrinkles." → BoNT-A blocks muscle contraction, so it works only on expression (dynamic) lines. It is limited on static and gravitational wrinkles caused by volume loss and sagging.³
• "More filler looks younger." → Excess filler distorts facial proportion (the "filler face"). The current standard is natural results through combined procedures.¹⁴
• "An expensive anti-aging cream will erase wrinkles." → Only retinoids, vitamin C, and sun protection are Grade-A evidence ingredients. Without them, a costly cream has limited effect.¹²
• "One lifting session fixes everything." → HIFU/RF give an immediate effect plus 3–6 months of collagen regeneration, but re-treatment every 6–12 months is standard.¹³

6. How we approach wrinkles at Delight Dermatology

We compare before and after objectively with standard indices (Glogau, WSRS), then match combination treatment — rarely a single procedure — to the diagnosed type. We prioritize Grade-A ingredients and procedures over marketing, set realistic expectations aimed at improvement rather than complete erasure, and plan long-term maintenance on a 6–12 month cycle.

Bottom line: wrinkles fall into four types, and if you don't know the type, the procedure misses. Dynamic, static, photoaging, gravitational — different causes need different treatments. What the recent literature emphasizes is not a single procedure but an evidence-based, multimodal approach.

References

1. Glogau RG. Aesthetic and anatomic analysis of the aging skin. Semin Cutan Med Surg. 1996;15(3):134-138.
2. Zhao et al. Noninvasive Assessment Methods for the Therapeutic Effect Following Facial Rejuvenation. J Cosmet Dermatol. 2025.
3. Adverse effects of the aesthetic use of botulinum toxin and dermal fillers on the face: a narrative review. Anais Bras Dermatol. 2025;100(1).
4. Lemperle G, Holmes RE, Cohen SR, et al. A Classification of Facial Wrinkles. Plast Reconstr Surg. 2001;108(6):1735-1750.
5. Buchner L, Vamvakias G, Rom D. Validation of a Photonumeric Wrinkle Assessment Scale for Assessing Nasolabial Fold Wrinkles. Plast Reconstr Surg. 2010;126(2):596-601.
6. Coban I, Erkmen FY, Aktaş GD. Dynamic Periocular Wrinkle Patterns: An Anatomical Study on Young Adults. J Cosmet Dermatol. 2025.
7. Coetzee S, Nunez N, Belaunzaran M, et al. Beyond Wrinkles: A Comprehensive Review of the Uses of Botulinum Toxin. J Drugs Dermatol. 2024;23(3):173-186.
8. Efficacy of Botulinum Toxin Type A in Reducing Facial Wrinkles: A Comprehensive Review of Clinical Outcomes. medRxiv. 2025.
9. Safia A, Elhadi UA, Merchavy S, et al. Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis of Clinical Studies. J Cosmet Dermatol. 2026;25(1).
10. Christen MO. Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA). Clin Cosmet Investig Dermatol. 2022;15:997-1019.
11. Sparavigna A, Tenconi B, Giori AM, et al. Evaluation of the efficacy of a new hyaluronic acid gel on dynamic and static wrinkles in volunteers with moderate aging/photoaging. Clin Cosmet Investig Dermatol. 2019;12:81-90.
12. Fisher GJ, Voorhees JJ, et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol. 2002;138(11):1462-1470.
13. Liu Y, Wang L. A Randomized Controlled Trial of Botulinum Toxin Combined with Non-Cross-Linked Bovine Collagen for Improving Periorbital Wrinkles. Aesthetic Plast Surg. 2025.
14. A Multimodal Approach to Facial Rejuvenation—Integrating HA Fillers, Collagen Stimulators, Botulinum Toxin and Energy-Based Devices for Optimal Patient Outcomes. J Aesthet Med. 2026.

Medical disclaimer. This article is general information and does not replace individual consultation. Wrinkle-type diagnosis and procedure selection should be decided after an in-person consultation with a dermatologist. Botulinum toxin, fillers, and similar treatments are prescription procedures requiring a doctor's care; evidence grades reflect the published data at the time of writing, and individual results may vary.