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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Facial lines and wrinkles

Ageing skin droops and develops wrinkles, lines and furrows. The severity of these changes in an individual depends on genetic tendency, skin phototype and exposure to environmental factors.

Dermatologists and cosmetic surgeons often use Glogau's classification when describing these ageing changes.

Mild – Few wrinkles, requires little or no make-up for coverage
Moderate – Early wrinkling, sallow complexion, requires little makeup
Advanced – Persistent wrinkling, skin discolouration with broken blood vessels and actinic keratoses, often wears make-up
Severe – Severe wrinkling and furrows, actinic keratoses, often wears make-up but it may not hide the ageing changes

The Fitzpatrick classification of facial lines refers to the degree of wrinkling around the mouth and eyes:

Class   I: Fine wrinkles
Class  II: Fine-to-moderately deep wrinkles and moderate number of lines
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds

How do facial lines and wrinkles form?

Facial lines and wrinkles (rhytides) form because of the following factors:

There is often a degree of asymmetry to the lines, as people tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek.

Fine lines
Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the amount of water held by the epidermis. This is mainly caused by sun damage and exposure to environmental toxins particularly tobacco smoke.

Furrows
Deeper lines or furrows are classified as dynamic or static. Dynamic lines appear with movement i.e. the activity of facial muscles. Static lines are unchanged with muscle movement. Eventually dynamic lines become static.

Wrinkles
Dynamic lines in smiling teenager
Wrinkles
Static lines (crow's feet) in 40's
Wrinkles
Worry lines
Wrinkles
Extensive perioral lines
Wrinkles
Deep furrows
Wrinkles
Hollow-looking eyes
Facial lines and wrinkles

Sags and bags

Skin laxity or drooping is caused by several factors:

The result is:

What treatment is available?

Remarkable changes in facial appearance can be obtained, giving a younger appearance and improving complexion. Often combinations of different cosmetic procedures are required for the best results.

It is most important to protect the skin from the sun life-long using sunscreens on exposed areas daily, and to avoid smoking and exposure to second-hand smoke or other pollutants.

Moisturisers
Ageing skin feels and looks better when moisturisers are applied regularly. These improve the water-holding capacity of the skin. Choose one that feels nice to apply, doesn't sting or burn or provoke acne.

Anti-ageing formulas
Many face creams may include so-called anti-ageing ingredients. These may include anti-oxidants and/or exfoliants including:

With the exception of the topical retinoids, the effectiveness of many of these anti-ageing ingedients is unproven.

Resurfacing
Resurfacing refers to various techniques in which the top layers of the epidermis are peeled off using chemical or mechanical means. Peels may even out pigmentation and improve skin texture. They can improve fine lines and static furrows but have no effect on dynamic lines.

Implantation
Individual lines and furrows can be lifted up with implants, i.e. temporary or permanent fillers or grafts. They can also be used to improve the appearance of a thinning lip.

Botulinum toxin
Botulinum toxin is most useful for dynamic lines. It can be used to paralyse the muscles that are responsible for frown lines, crow's feet and forehead lines. It can also be used to change the shape of the eyebrows and to soften so-called smoker's lines around the lips, among other uses.

Cosmetic surgery
Cosmetic facial surgery involves repositioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.

Related information

On DermNet NZ:

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Author: Dr Amanda Oakley MBChB FRACP, Dept of Dermatology Health Waikato

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.