Sleep wrinkles are an often misunderstood aesthetic concern, yet they are distinct from expression wrinkles. Unlike dynamic wrinkles, which are linked to the repeated contraction of the face muscles, sleep wrinkles are caused by prolonged pressure of the face against the pillow or bedding during sleep. They are therefore mechanical and do not follow the natural expression lines of the face. They appear mainly on the cheeks, the temples, the forehead, the chin, as well as on the décolleté area in women. Often visible upon waking, they may fade during the day, but over time they become permanent. Understanding their mechanism is essential to proposing an appropriate and effective treatment. The skin, a living and dynamic organ, regenerates every night. However, when it is subjected to strong and repeated lateral pressure, its collagen and elastin fibers fold and gradually lose their ability to return to their initial shape. This phenomenon is worsened by the natural decrease in collagen with age, the loss of dermal density and skin dryness.
Two main types of sleep-related wrinkles are distinguished : compression wrinkles and nocturnal expression wrinkles.
Compression wrinkles appear when the skin is repeatedly pressed against the pillow, especially in people who sleep on their side or stomach. This prolonged pressure gradually creates wrinkles that eventually become permanent.
Nocturnal expression wrinkles are linked to involuntary facial movements during sleep. Even while sleeping, one may smile, frown or contract certain areas of the face, as in cases of bruxism.
Sleep wrinkles on the décolleté appear mainly when the skin is compressed during the night, especially in people who sleep on their side or on their stomach. In these positions, the skin of the chest becomes marked under the effect of gravity and the pressure exerted by the breasts and the pillow, creating vertical wrinkles that, over time, become permanent. The skin of the décolleté is particularly thin, low in sebaceous glands and less elastic than that of the face, which makes it more vulnerable to these repeated deformations. With age, the loss of collagen, skin dehydration and tissue laxity worsen them. Sun exposure, frequent in this area, also weakens the skin and promotes the fixation of nocturnal wrinkles. Thus, sleep wrinkles on the décolleté result from a combination of repeated mechanical pressure, skin fragility and aging factors.
Sleep wrinkles appear mainly because of the position adopted during the night. Sleeping on the side or on the stomach leads to repeated pressure from the pillow on the face, which compresses the skin asymmetrically. With repeated deformation, these wrinkles eventually become permanently etched. Unlike expression wrinkles, which are linked to muscle movements, sleep wrinkles result from passive mechanical trauma.
The quality of the skin plays an essential role in their formation, as thin, dehydrated or lax skin is more vulnerable. The gradual decrease in elastic fibers, the loss of firmness and dermal density also worsen this phenomenon. Added to this are environmental factors such as sun exposure, smoking, oxidative stress or hormonal variations (such as menopause), which weaken the skin and promote the appearance of these wrinkles.
Certain habits can accelerate the formation of sleep wrinkles : using a classic cotton pillow, sleeping with the face buried in the pillow or resting on your hands or arms during the night.
Expression wrinkles are caused by the repetition of muscle movements, such as frowning, smiling or squinting. They follow the natural expression lines of the face and respond very well to botulinum toxin injections (forehead lines, crow’s feet and frown lines).
Sleep wrinkles are not linked to muscle action ; they are perpendicular to expression lines, often oblique or vertical on the cheek, horizontal on the temple or vertical on the décolleté. They do not disappear when the skin is stretched and are not improved by botulinum toxin injections. They require a more comprehensive treatment, combining restoration of skin thickness, support of facial volumes and correction of sleep habits.
The prevention of sleep wrinkles relies mainly on modifying nighttime habits. It is recommended to favor the back-sleeping position, which reduces asymmetric pressure on the face. Using an ergonomic pillow or a silk pillowcase can also help reduce friction and the appearance of these wrinkles. Silk has the advantage of respecting the skin’s hydrolipidic film, limiting friction and preventing nighttime dehydration. Maintaining good skin hydration is essential : applying evening skincare rich in hyaluronic acid, peptides or retinoids helps promote dermal regeneration. Restorative sleep plays a fundamental role. A lack of sleep slows cellular regeneration, increases loss of elasticity and worsens skin damage. Finally, protecting the skin from external aggressions, such as UV rays or smoking, helps preserve its resilience and limit the effects of nighttime creasing.
The management of sleep wrinkles in aesthetic-oriented medicine is based on a combination of treatments aimed at restoring skin quality, filling established wrinkles and preventing their worsening.
It aims to correct the responsible factors, notably loss of facial volume, decreased skin elasticity, tissue laxity and skin fragility. Volumetric restoration, dermal densification, deep hydration and skin regeneration treatments are generally combined. The choice of technique depends on the depth of the wrinkles, the quality of the skin and the anatomy of the face.
Over time, facial volumes migrate downward, creating tension that accentuates skin creasing during sleep, particularly in the cheek and décolleté areas. Cross-linked hyaluronic acid helps reposition and support the tissues, thus limiting the mechanical pressure exerted on the skin during the night. Used according to the principles of the medical lift, it redefines the facial contours and rebalances the volumes.
Skinboosters act directly on skin quality by stimulating collagen and elastin synthesis. They thicken the dermis, improve its elasticity and make the skin less vulnerable. They are particularly suitable for superficial wrinkles of the face and décolleté ; when injected directly into the wrinkles, they soften them. One to two sessions may be necessary.
Mesotherapy provides the skin with vitamins, trace elements and a non–cross-linked hyaluronic acid, which promote microcirculation and improve cellular activity. It stimulates the natural production of collagen, optimizes hydration and increases the skin’s suppleness. This technique does not treat already formed wrinkles, but it strengthens the skin barrier, slows the worsening of sleep wrinkles and improves the overall appearance of the skin, especially as a preventive measure.
The PRX-T33 peel acts in depth without visible exfoliation. It stimulates dermal regeneration, increases the density of the skin tissue and improves the skin’s radiance and quality. It promotes collagen production without weakening the skin surface, which makes it particularly suitable for thin areas such as the décolleté. This treatment improves the skin’s resistance to nighttime compression and reduces very superficial wrinkles.
The photorejuvenation lasers stimulate fibroblasts and restart collagen synthesis, without altering the skin surface. They help strengthen dermal thickness, improve firmness and soften fine lines. This treatment is particularly suitable for thin and lax skin. It delivers better results when combined with Skinbooster injections or mesotherapy.
When sleep wrinkles are deep and visible even at rest, only ablative lasers or medium peels can truly soften or smooth them. These techniques remove a layer of skin to stimulate intense skin regeneration, with the goal of achieving denser, smoother and more uniform skin.
In the morning, the marks on the face or décolleté are due to the compression of the skin during the night. When the skin loses elasticity, hydration or firmness, these marks no longer disappear completely and eventually become permanent, turning into true sleep wrinkles.
Sleeping on the back limits the mechanical compression of the face and décolleté, but it is difficult to control your position throughout the night. Even when sleeping on the side or on the stomach, improving skin quality (density, hydration, elasticity) helps it better resist nighttime pressure.
Topical skincare can improve the skin’s hydration and suppleness, but they are not enough to erase wrinkles that are already established. Sleep wrinkles are mechanical in origin, and their correction requires treatments that act in depth (Skinboosters, laser, peeling, PRP, hyaluronic acid).
For superficial wrinkles, Skinboosters, mesotherapy and PRX-T33 improve skin quality and density. For deeper, established wrinkles, only ablative lasers or medium peels can truly smooth the skin.
Silk pillows or memory-foam pillows can limit friction and reduce skin compression, but they do not completely prevent the appearance of sleep wrinkles. They are a good complement, but they do not replace medical treatment if the skin is already marked.
It depends on their depth. Non-ablative lasers improve skin quality, but they do not erase established wrinkles. Ablative lasers, on the other hand, can smooth deep wrinkles by stimulating true skin regeneration.
There is no specific age : treatment can begin as soon as the skin starts showing marks in the morning or when certain wrinkles become permanent. Early management helps strengthen skin quality before the wrinkles become definitively established.
The duration of the results depends on the type of treatment, the quality of the skin and sleep habits. Skinboosters or mesotherapy require maintenance every 6 to 12 months, whereas ablative lasers offer longer-lasting results.
Superficial wrinkles can often disappear completely with appropriate treatments. Deep wrinkles can be significantly reduced, sometimes erased, but their management depends on skin thickness, age and the condition of the skin structure.
