Lines of Motion, Lines of Sun
What Fine Lines and Wrinkles Are
Fine lines and wrinkles form three ways (repeated muscle movement, UV breakdown of collagen and elastin, and lost volume), and most people over 40 have all three, with sun-driven lines arriving a decade earlier in Scottsdale. At Aesthetica by Ashley Howarth MD, each type is matched to its cause: MOXI and HALO for early and deeper lines and texture, SkinPen microneedling for collagen year-round, Botox and Dysport for expression lines, and dermal fillers or PRF EZ Gel for volume, with laxity referred to Dr. Howarth for a surgical evaluation.
Fine lines and wrinkles, called rhytides, form in three ways: repeated muscle movement creases the skin (frown lines, forehead lines, crow’s feet), ultraviolet light breaks down collagen and elastin so the skin thins and crinkles (photoaging lines and crepey texture on the cheeks, under the eyes, and on the neck and chest), and lost volume lets the skin fold (nasolabial folds and lines around the mouth). Most people over 40 have all three. In Scottsdale, with about 300 days of sun a year, a summer UV index of 11 or higher, and afternoon humidity that often falls below 15 percent, the sun-driven lines arrive a decade earlier than they do in a humid climate and dehydration makes every line look deeper. At Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery in Scottsdale, each kind of line is matched to the treatment that addresses its cause: MOXI for early lines and texture, HALO for deeper lines and sun-damaged texture, SkinPen microneedling for collagen on any skin type and in any season, Botox and Dysport for expression lines, dermal fillers for volume lines, and PRF EZ Gel for the under-eye hollows that make fine lines there look worse.
The assessment decides the sequence. A line that disappears when the face is at rest is an expression line and responds to a neuromodulator. A line that remains at rest and deepens when the skin is pinched is a sun and texture line and responds to laser or microneedling. A fold that lifts when the cheek is pushed upward is a volume or laxity problem, and when laxity is the real issue the honest recommendation is a surgical consultation with Dr. Howarth rather than another skin treatment. Laser treatments are scheduled between October and April, when untanned skin and sun avoidance are realistic; injectables and SkinPen run year-round.
Where Lines Show First
What Patients With Fine Lines Notice
Patients who come to Aesthetica by Ashley Howarth MD for lines usually notice them first in photographs or in the harsh light of an Arizona afternoon. The common findings are these.
- Crow's feet and under-eye lines that stay after smiling
- Frown lines between the brows and horizontal forehead lines
- Fine crosshatched lines on the cheeks that makeup settles into
- Crepey, thin-looking skin under the eyes, on the neck, and on the chest
- Vertical lines around the lips
- Deeper folds from the nose to the mouth corners
Under the eyes, fine lines and dark hollows travel together. Thin skin over a hollow shows every line, and adding volume under it with PRF EZ Gel, a filler-like gel made from the patient’s own blood without additives, softens both the shadow and the lines. It is the under-eye option for patients who want a natural material and a gradual result.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs This Care
Aesthetica by Ashley Howarth MD is the medical aesthetics practice of Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. Lines are where the line between skin treatment and surgery matters most. A laser resurfaces skin; a neuromodulator relaxes a muscle; a filler replaces volume. None of them lifts tissue that has descended, and a practice that only offers skin treatments has no reason to say so. Dr. Howarth sets the protocol that laxity is graded at every assessment, that a patient whose real issue is descent is told the truth and offered a surgical consultation rather than a fourth laser, and that the injectable and laser plans are built so they complement a surgical result if one is chosen later. The same physician who would perform the surgery is the one directing the skin care, which is the reason the advice is honest in both directions.
Aesthetica by Ashley Howarth MD is the med spa of a plastic surgery practice, and that changes what can be offered. Most skin concerns are treated without surgery, and most patients never need it. When skin care and nonsurgical treatment reach their limit, the conversation does not end at the door: the same physician evaluates the next step, from deep laser skin resurfacing performed by Dr. Howarth to eyelid surgery, facelift, and neck lift. A surgeon directing the plan means more tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Where to Start
Who This Is For, and What Happens First
Treatment for fine lines and wrinkles at Aesthetica by Ashley Howarth MD is for adults who see lines at rest, lines with expression, crepey texture, or early folds and want a plan that matches each line to its cause. The skin assessment comes first. A member of the physician-led team examines the face at rest and in motion, pinches the cheek skin to grade texture and elasticity, checks how much a fold lifts with gentle upward pressure, records Fitzpatrick skin type and recent sun exposure, and reviews retinoid and skincare use. Early fine lines on untanned skin usually start with a MOXI series or SkinPen. Deeper etched lines and rough sun-damaged texture go to HALO in laser season. Expression lines are treated with Botox or Dysport at the same visit if desired, and volume folds with dermal fillers. Darker skin types are steered toward SkinPen and conservative MOXI over aggressive resurfacing. When the assessment shows that skin has descended rather than creased, the team says so and offers a surgical consultation with Dr. Howarth instead of a treatment that would disappoint.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Aesthetica by Ashley Howarth MD is the medical aesthetics brand of her practice, Howarth Plastic Surgery, at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
Matched to the Line, Not the Menu
How Fine Lines and Wrinkles Are Treated in Scottsdale
MOXI for Early Lines
MOXI is a gentle non-ablative fractional laser that treats the first fine lines, crepey texture, and uneven tone with just 1 to 2 days of pinkness, typically as a series of 3 sessions.
MOXI is a gentle non-ablative 1927 nm fractional laser that treats the first fine lines, crepey texture, and uneven tone with 1 to 2 days of pinkness. It is the starting point for patients in their thirties and forties and for darker skin types, usually as a series of 3 sessions about four weeks apart between October and April.
HALO for Deeper Lines and Texture
HALO combines an ablative and a non-ablative wavelength in one pass to treat etched lines and rough sun-damaged texture, with collagen remodeling that continues for 3 to 6 months.
HALO combines an ablative and a non-ablative wavelength in one pass to treat etched lines, rough sun-damaged texture, and enlarged pores with 5 to 7 days of peeling. One to two sessions in laser season, with collagen remodeling that continues for 3 to 6 months. Deeper resurfacing options such as ProFractional are reserved for select cases.
SkinPen Microneedling, Any Season
SkinPen creates controlled micro-channels that trigger new collagen without heat, making it safe for all skin types and, with sun avoidance, for use in Arizona summers.
SkinPen creates thousands of controlled micro-channels that trigger new collagen without heat, which makes it safe for all skin types and, with sun avoidance, for Arizona summers. A series of 3 to 4 sessions spaced 4 to 6 weeks apart softens fine lines and crepey texture with 1 to 2 days of redness.
Botox, Dysport, Fillers, and PRF EZ Gel
Botox and Dysport relax the muscles behind expression lines for 3 to 4 months, while dermal fillers restore volume and PRF EZ Gel softens under-eye hollows, all year-round.
Botox and Dysport relax the muscles that crease frown lines, forehead lines, and crow’s feet, with results at about two weeks that last 3 to 4 months. Dermal fillers restore the volume behind folds around the nose and mouth. PRF EZ Gel softens under-eye hollows and the fine lines over them. All run year-round.
Planning at a Glance
Sessions, Downtime, and Season
Sessions, downtime, and the months each fine line treatment is scheduled in Scottsdale. Individual plans are set at the skin assessment.
| Treatment | Sessions | Downtime | Scottsdale season |
|---|---|---|---|
| MOXI | 3, four weeks apart | 1 to 2 days of pinkness, 3 to 5 days of fine texture | October to April |
| HALO | 1 to 2 | 5 to 7 days of peeling | October to April |
| SkinPen microneedling | 3 to 4, four to six weeks apart | 1 to 2 days of redness | Year-round with sun avoidance |
| Botox or Dysport | Every 3 to 4 months | None; possible small bruise | Year-round |
| PRF EZ Gel | 1 to 3, four to six weeks apart | 2 to 5 days of swelling | Year-round |
| Dermal fillers | 1, repeated by product | Several days of swelling or bruising | Year-round |
A Visit Built Around Cause
What to Expect at a Fine Lines Visit at Aesthetica by Ashley Howarth MD
A fine lines visit at Aesthetica by Ashley Howarth MD has three parts: an examination that sorts each line by cause, the treatment or combination that fits the day and the season, and a written plan for sun protection and follow-up. Sorting the lines is the step that prevents the wrong treatment.
Rest, motion, pinch, and lift
The team watches the face at rest and in expression, pinches the cheek to grade texture and elasticity, and lifts a fold to test whether volume or laxity is the cause. Skin type, tan, and product use are recorded. Tanned skin postpones laser; laxity prompts a surgical conversation.
Laser, microneedling, or injectables, often together
MOXI and HALO use a topical numbing cream for about 30 to 45 minutes before a 20 to 30 minute treatment. SkinPen takes about 30 minutes after numbing. Botox or Dysport takes 10 to 15 minutes and can be done the same day as a skin treatment. Fillers and PRF EZ Gel are placed after numbing and mapped to the volume loss.
A sun and skincare plan in writing
You leave with a mineral SPF 30 or higher to reapply every two hours outdoors, instructions for the pink or peeling days, a date to restart retinoids, hats and shade for two weeks after laser, and the date of your next session or injectable follow-up.
Clear Information. Informed Choices.
Safety and Limitations of Treating Fine Lines
Laser, microneedling, and injectable treatments for lines are safe when matched to skin type, timed around sun exposure, and performed under physician-set protocols. Most side effects are expected and short-lived. In Arizona the risk that shapes scheduling is post-inflammatory hyperpigmentation after laser on tanned or sun-exposed skin, which is why MOXI and HALO fall between October and April and SkinPen and injectables carry the summer.
Possible Side Effects Include
- Redness, warmth, and swelling for 1 to 7 days depending on treatment
- Fine sandpaper texture and peeling after MOXI and HALO
- Post-inflammatory hyperpigmentation with sun exposure or tanned skin
- Bruising, swelling, or tenderness at injection sites
- Rarely, infection, prolonged redness, asymmetry, or scarring
What Treatment Cannot Guarantee
- Removal of every line or a wrinkle-free face
- A lift of skin that has descended; that is a surgical question
- Permanent results without maintenance and sun protection
- A complete result from a single session
- A result identical to another patient's photos
What Happens After Laser
Recovery After Fine Line Treatment
After HALO the skin feels hot for a few hours and looks red and slightly swollen. Cool air and an occlusive healing ointment help. No makeup, no exercise, no heat. Mineral sunscreen goes on before leaving the office. After MOXI the same evening looks like a mild sunburn.
By day two or three the skin turns bronze and develops a fine sandpaper texture as treated tissue lifts; peeling follows through about day five to seven. Wash gently, moisturize often, do not pick. Mineral makeup is usually fine after day three. Hats, shade, and reapplied SPF 30 or higher; retinoids and acids stay paused.
Peeling is complete and the skin is smooth and noticeably brighter, with early softening of fine lines. Retinoids restart around two weeks. Strict sun protection continues through week four to prevent pigment. A second MOXI session, if planned, falls at four weeks; a second HALO waits at least three months.
Before & After
Fine Lines and Wrinkles, Before and After Treatment
Line results are best judged in photographs taken in the same light and the same expression, before treatment and three months after, because collagen keeps building after the skin heals. Aesthetica by Ashley Howarth MD maintains before-and-after galleries for MOXI, HALO, SkinPen, and injectables, and the team can show you cases that match your skin type, your kind of lines, and your age group during your visit.
Patient Case Summaries
Selected Fine Lines & Wrinkles Case Summaries
These deidentified case summaries illustrate how the physician-led team at Aesthetica by Ashley Howarth MD plans treatment for fine lines and wrinkles in Scottsdale. They include long-term residents and new arrivals, fair and darker skin types, summer and laser-season timing, single treatments and combinations, and a consultation in which the honest recommendation was surgery rather than another skin treatment. Each summary connects the patient’s concern and skin assessment with the treatment performed or the recommendation made.
Case 01
Long-term resident
Etched lines and leathery texture after thirty years of Scottsdale sun
Patient presentation
A woman in her sixties who had lived in Scottsdale for three decades described crosshatched lines on her cheeks, vertical lines around her lips, and a rough texture that made foundation look cracked by noon.
Skin assessment
The assessment found deep photoaging rhytides with coarse texture and solar lentigines on Fitzpatrick II skin, good elasticity on pinch, and only mild fold lift with cheek support. Untanned in December.
Procedure performed
A single HALO treatment in January at a depth chosen for etched lines, combined with BBL HERO for the brown spots in the same visit, followed by Botox for the crow’s feet at two weeks and a second HALO planned for the following laser season.
Clinical rationale
Deep sun-driven lines with intact elasticity are a resurfacing problem, and HALO in peak laser season allowed a full week of recovery and a month of sun avoidance without conflict.
Follow-up
After a week of peeling the texture was smooth, the lines were visibly softer by six weeks and continued improving at four months; she returned the next January for the second HALO.
Case 02
New arrival
First fine lines that appeared within a year of moving from Chicago
Patient presentation
A woman in her thirties who moved from Illinois the previous year noticed fine lines under her eyes and on her cheeks that had not been there before, along with tight, dehydrated skin.
Skin assessment
The assessment showed early superficial rhytides from dehydration and a first Arizona summer, on Fitzpatrick II skin with excellent elasticity and no laxity. Lightly tanned in September.
Procedure performed
A hydrating routine and mineral SPF 30 immediately, a SkinPen session in September with sun avoidance, then a three-session MOXI series from November through January once untanned.
Clinical rationale
Early lines in a new arrival are largely dehydration and first sun damage; microneedling is safe while a tan fades, and MOXI in the cooler months corrects tone and texture before the damage compounds.
Follow-up
By February the fine lines were no longer visible in photographs, and she returns each fall for a single maintenance MOXI session.
Case 03
Darker skin type
Fine lines and crepey texture on Fitzpatrick V skin, without aggressive laser
Patient presentation
A man in his fifties with deep brown skin reported crepey texture under his eyes and fine lines across his cheeks and asked about the HALO treatment he had read about.
Skin assessment
The assessment found fine rhytides and mild textural change on Fitzpatrick V skin with a history of dark marks after minor injuries. Ablative resurfacing carried a meaningful risk of post-inflammatory hyperpigmentation.
Procedure performed
A series of four SkinPen microneedling sessions spaced five weeks apart, a topical pigment-safe retinoid started between sessions, and a single conservative-density MOXI session at the end of laser season after a test area. HALO was not used.
Clinical rationale
Microneedling builds collagen without heat and is safe across all skin types; a conservative non-ablative laser after a test area adds tone correction with far less pigment risk than a hybrid ablative treatment.
Follow-up
The texture under the eyes and on the cheeks was smoother at six months with no pigment change, and he continues SkinPen twice a year.
Case 04
Summer timing
A July request for HALO answered with Botox, SkinPen, and an October date
Patient presentation
A woman in her forties who swam laps outdoors most mornings asked for HALO in July to treat forehead lines, crow’s feet, and cheek texture before a September event.
Skin assessment
Her skin was tanned and her swimming made two to four weeks of sun avoidance unrealistic. Her forehead lines and crow’s feet were expression lines that vanished at rest; the cheek texture was sun-related.
Recommendation
Dysport for the forehead and crow’s feet in July, a SkinPen session in August with a swim cap, hat, and mineral SPF 50, and a HALO scheduled for late October once the tan faded.
Clinical rationale
Most of what she noticed was expression lines, which a neuromodulator treats in any season; the sun-related texture could wait for laser season without risking pigment on tanned skin.
Follow-up
The expression lines were smooth by the event, the SkinPen session refined the texture, and HALO in October addressed the remaining sun damage.
Case 05
Combination plan
Under-eye lines and hollows treated with MOXI and PRF EZ Gel together
Patient presentation
A woman in her forties described fine lines under her eyes that concealer accentuated, together with dark hollows that made her look tired in every photograph.
Skin assessment
The assessment found crepey under-eye skin with fine rhytides on Fitzpatrick III skin and a true tear-trough hollow, with intact elasticity and no lower-lid laxity on snap test. Untanned in November.
Procedure performed
A three-session MOXI series for the under-eye and cheek texture spaced four weeks apart, with PRF EZ Gel placed in the tear troughs after the second MOXI session and repeated once six weeks later.
Clinical rationale
Thin skin over a hollow shows every line, so treating the skin and the hollow together gives a better result than either alone; PRF EZ Gel uses the patient’s own blood and suits the delicate under-eye area.
Follow-up
By three months the hollows were softer, the fine lines less visible, and she reported that concealer no longer settled into lines; a PRF EZ Gel touch-up is planned annually.
Case 06
Honest guidance
Jowls and deep folds that a laser could not lift
Patient presentation
A woman in her sixties asked for a laser to treat the folds from her nose to her mouth corners, the lines along her jaw, and the loose skin under her chin, having had two skin treatments elsewhere with little change.
Skin assessment
The assessment found significant laxity: the folds lifted almost completely with gentle upward cheek pressure, the jawline had descended into early jowls, and the neck skin had lost elasticity. The fine lines on the cheek surface were minor by comparison.
Recommendation
A surgical consultation with Dr. Howarth to discuss a facelift and neck lift, with any laser or injectable treatment deferred until the surgical decision was made and planned to complement the surgical result.
Clinical rationale
Resurfacing treats the skin’s surface and injectables replace volume; neither repositions tissue that has descended. A third skin treatment would have cost her time and trust without changing what she saw in the mirror.
Follow-up
She proceeded with a surgical consultation and later planned a light MOXI series for surface texture once healed from surgery.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Aesthetica by Ashley Howarth MD
Aesthetica by Ashley Howarth MD is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Book a skin assessment directly online, or request a consultation and describe which lines bother you and when you notice them. Either path starts with the same rest-and-motion examination.
A sequence, not a single appointment
You leave your first visit with a written plan: which lines get a neuromodulator, filler, or PRF EZ Gel now; which get MOXI, HALO, or SkinPen and in which months; and the sunscreen and retinoid routine that protects the result.
Maintenance timed to the seasons
Most Scottsdale fine line plans repeat annually: a laser season treatment, Botox or Dysport every 3 to 4 months, SkinPen through the summer, year-round mineral sunscreen. A-List members have the next season scheduled before they leave the last one.
Your Questions, Answered
Fine Lines & Wrinkles Frequently Asked Questions
It depends on the line. Expression lines respond to Botox or Dysport, early fine lines and crepey texture to MOXI or SkinPen microneedling, deeper etched lines and sun-damaged texture to HALO in laser season, and volume folds to dermal fillers. Aesthetica by Ashley Howarth MD in Scottsdale sorts each line by cause at the assessment and usually combines two of these.
MOXI is a gentle non-ablative fractional laser for early fine lines, crepey texture, and tone, with 1 to 2 days of pinkness and a series of 3 sessions. HALO is a hybrid laser that adds an ablative wavelength for deeper etched lines and rough sun-damaged texture, with 5 to 7 days of peeling and 1 to 2 sessions. Both are scheduled between October and April.
Partly. Botox and Dysport relax the muscles that crease the skin, so lines that appear with expression soften fully and lines that have begun to etch in at rest soften over several treatment cycles. Lines from sun damage and thin skin that remain at rest need a laser or microneedling to rebuild collagen; the two treatments are often combined.
Ultraviolet light breaks down collagen and elastin, and Arizona delivers about 300 days of sun a year with a summer UV index of 11 or higher, so sun-driven lines and crepey texture arrive years earlier than in a humid climate. Afternoon humidity that often falls below 15 percent dehydrates the skin and makes every existing line look deeper.
Yes, with the right tools. Botox, Dysport, dermal fillers, and PRF EZ Gel run year-round, and SkinPen microneedling is safe in summer with sun avoidance because it uses no heat. MOXI and HALO are deferred to October through April because they require untanned skin and two to four weeks of strict sun protection afterward.
Most patients need 3 to 4 SkinPen sessions spaced 4 to 6 weeks apart to soften fine lines and crepey texture, with results building for several months as collagen forms. It is safe on all Fitzpatrick skin types and causes 1 to 2 days of redness. Many Scottsdale patients continue with a session every few months for maintenance.
Under-eye lines are usually a combination of thin, crepey skin and a hollow beneath it. MOXI or SkinPen rebuild collagen in the skin, and PRF EZ Gel, a gel made from the patient’s own blood, fills the hollow so the shadow and the lines both soften. Botox treats crow’s feet at the outer corner. The assessment checks lower-lid laxity first.
Both begin working in 3 to 7 days, reach full effect at about two weeks, and last about 3 to 4 months before muscle movement gradually returns. Regular treatment every 3 to 4 months keeps expression lines from etching deeper. Dysport may spread slightly more and suit larger areas such as the forehead; the injector chooses by area and history.
When the issue is descent rather than creasing. Folds that lift almost completely with gentle upward cheek pressure, jowls along the jawline, and loose neck skin are laxity, and no laser, neuromodulator, or filler repositions tissue. At Aesthetica by Ashley Howarth MD those patients are offered a surgical consultation with Dr. Howarth rather than another skin treatment.
Established patients can book online. New patients can book online or request a consultation through this page; the team responds usually the same day. Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery, is located at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253, and can be reached by call or text at 480.535.5021.
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