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Author: Dr Amanda Oakley, Dermatologist, Waikato Hospital, Hamilton, New Zealand, 2004.
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
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 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.
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.
Skin laxity or drooping is caused by several factors:
The result is:
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.
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.
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 ingredients is unproven.
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.
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 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 facial surgery involves repositioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.
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