‘I’m a Cosmetic Dermatologist and This Is the Most Common Skin Concern I Treat’

Dermatology centers on skin treatments of all kinds. In your standard derm’s office, you can access medical care for things like acne, psoriasis, and skin cancer. Within the practice, there are specialists called “cosmetic dermatologists” who focus their work on aesthetic concerns. And the most common one that Caren Campbell, MD, a board-certified cosmetic dermatologist based in California, sees in her practice? Wrinkles.

Wrinkles are “the first sign of aging that most patients notice,” says Dr. Cambell. “[They appear because] we crinkle the overlying skin when we contract the muscle below. The elevens between the eyebrows that make us look angry, or the crow’s feet lines around the eyes or the forehead lines we get when we raise the brows.”

As any derm (cosmetic or otherwise) will tell you, the best way to prevent wrinkles is to use a good sunscreen daily. That said, know that they’re bound to show up no matter how diligent your skin-care routine is. “Despite strict photoprotection, we all need to make facial expressions, and lines are inevitable,” says Dr. Campbell.

When lines first appear, they’re known as “dynamic wrinkles,” and are only present when your facial muscles are moving. When your face stops moving, they disappear shortly thereafter. Over time, though, these early-stage wrinkles become etched into your skin and turn into “static wrinkles,” which are visible even when your face is at rest.

If you choose to treat your wrinkles, topical ingredients like retinol and peptides can help, but Dr. Campbell says the most sure-fire way to see a difference is with injectables. “Botox is the [entry point] to a lot of the cosmetic treatments that are performed in my office,” she says. “So most patients are doing wrinkle relaxers like Botox and Dysport, which relax the contraction of the underlying muscle so you can’t crinkle or wrinkle the overlying skin. Then, they start to add other treatments like laser, fillers, chemical peels, or micro-needling.”

For the best results, Dr. Campbell says to treat the wrinkles early on before they set in. “This is where ‘preventative’ and ‘baby botox’ came from,” she says.

But, she cautions, you also don’t want to start too early. “If lines are only present with movement, it’s likely too early,” says Dr. Campbell. So if you’ve only got dynamic wrinkles, you’re better off waiting to start an injectables regimen until they set into static form. “When the lines are present at rest… you might want to consider wrinkle relaxers,” she says.

These treatments need to be repeated every three months on average, but, over time with years of use, you may notice you can go longer between treatments.

“The vast majority of cosmetic treatments require maintenance,” says Dr. Campbell. “Just like you color your hair or get your teeth cleaned, you need to keep doing the treatment to maintain results.”

Note that when you’re getting wrinkle relaxers (or any type of injectable), it’s best to go to a cosmetic, board-certified dermatologist. While “cosmetic” dermatology doesn’t require any specific training, “it takes time to develop skill at anything and the more procedures you perform and the more cosmetic concerns your treat, the better you get at those specific issues,” says Dr. Campbell. When looking for the right fit, “you can look for dermatologists that are trainers for other physicians, you can ask what percentage of their medical practice involves cosmetic treatments, and you can ask if they do continuing education specifically in cosmetic treatments.”

And, of course, opting for any sort of cosmetic treatment—injectible or otherwise—is a totally personal decision. Our advice? Do what makes you feel good, whatever that may be.

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