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In the discussion of the treatment of wrinkles, it is important to keep in mind how they develop. As the facial muscles contract again and again in certain regions within the framework of facial expressions, wrinkles form in the skin above them. The formation of wrinkles in young, elastic skin is initially reversible and is referred to as dynamic wrinkles. Over time, however, the recurring action of these facial muscles leads to the permanent formation of these wrinkles, known as fixed wrinkles.

In addition, our face also shows constitutionally conditioned wrinkles, such as deep nasolabial wrinkles. These wrinkles can be acquired as a result of a disposition, but also in the course of aging, due to volume loss in the face over time.


The use of botulinum toxin has established itself in recent years for the therapy and prophylaxis of mimic facial wrinkles. Botulinum toxin has been used in neurology for over 25 years to treat a variety of muscle diseases. Based on the experience gained there, it was discovered that this neurotoxin can be successfully used to treat mimic wrinkles. The effect of botulinum toxin – known in Switzerland under the product name Vistabel®’ – is based on a reversible paralysis of the mimic facial muscles, so that the tension of the muscles on the skin decreases and the formation of wrinkles is eliminated.

Dynamic wrinkles can be completely, albeit temporarily, eliminated with Vistabel®. Already fixed wrinkles visibly improve with the application of Vistabel®’, but the treatment may have to be combined with an injection into the wrinkle. Vistabel®’ is therefore suitable for both prophylaxis and therapy of existing wrinkles. In the hand of the experienced user, a residual mobility of the mimic musculature is retained during a Vistabel® treatment, so that no unnatural, mask-like facial expression is created, but the wrinkles are nevertheless effectively removed. The effect of Vistabel®’ is limited to a period of 4 – 5 months. Ideally, a treatment with Vistabel®’ is carried out twice a year to achieve a lasting, optimal effect in the treatment of wrinkles.


The injection of wrinkles with various therapeutic substances, so-called “fillers”, serves to treat fixed mimic wrinkles, as well as constitutionally conditioned wrinkles, such as deep nasolabial wrinkles. In addition, volume lost during aging can be replaced by injections. This is the typical case when filling lips in middle-aged and older patients. From a variety of therapeutic substances used for injections, hyaluronic acid has proven itself in our practice. A basic distinction is made between so-called permanent, non-absorbable fillers and absorbable fillers. Permanent fillers are not degraded by the body and remain essentially unchanged in the tissue. In recent years, these fillers have come under scrutiny and have received negative feedback. One of the most prominent representatives of this type is certainly silicone oil, which has been used primarily in Asia and the USA, but also in Europe. Permanent fillers can stimulate the body’s own immune system to a foreign body reaction, which can still occur years after implantation. Based on the experience gained, the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery now applies the principle that only resorbable substances should be used to treat wrinkles.

Resorbable fillers are usually substances related to the body or produced by the body, which are degraded more or less quickly and well tolerated by the immune system. The products currently available on the market mostly contain hyaluronic acid, but other biocompatible products are also used. What all products have in common is that their effect diminishes after a few to several months. This depends on the dosage and location of the injection. As a therapeutic substance, hyaluronic acid is absolutely harmless as it is an endogenous component of the connective tissue. Allergic reactions are extremely rare.

By injecting the skin with hyaluronic acid, the body’s own intercellular substance is regenerated or replenished, resulting in a smoothing of the skin and, in the best case, the disappearance of the wrinkle. As the body’s own substance, however, the implant is subject to the natural metabolism and is slowly broken down. At first glance, this may appear to be a disadvantage, but on closer inspection, this is precisely wherein the advantage of these substances lies. Foreign body reactions are almost impossible and you are dissatisfied with the results, the effect disappears after a few months. Therefore the dose can be adjusted individually again and again, so that you always look as good as possible after a refreshment.


A further, almost ideal possibility of permanently eliminating wrinkles and replacing lost volume is the injection of wrinkles with autologous fat, the so-called “Lipo-Filling” or Lipostructure®. This procedure is mainly used for the relining of deep nasolabial wrinkles or for volume loss in the face. The advantage of this method is that the body’s autologous fat is transplanted, which is not decomposed later. Although a minor operation the procedure itself results in a relatively extended recovery time with swelling and discoloration of the treated area.