Facial lines and wrinkles

Facial lines and wrinkles

source: dermnetnz.org

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 solar keratoses, often wears make-up
Severe – Severe wrinkling and furrows, solar 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:

  • Ageing processes
  • Sun damage
  • Muscle movement
  • Gravity
  • Injury
  • Surgery
  • Acne
  • Other skin diseases with a tendency to scar (e.g. discoid lupus)
  • Smoking

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.

  • Crow’s feet around the eyes are due to smiling and activity of the eyelid muscles (orbicularis oculi).
  • Worry lines on the forehead are due to contraction of the frontalis muscle when raising the eyebrows
  • Frown lines between the eyebrows are due to contraction of corrugator supercilii muscles and procerus muscle when concentrating or angry

Sags and bags

Skin laxity or drooping is caused by several factors:

  • A reduction of the fat cells under the skin (subcutaneous tissue)
  • Loss of collagen and elastin fibres in the dermis reducing cutaneous strength and elasticity
  • Gravity, which allows the lax tissue to sag

The result is:

  • Brow ptosis (the forehead sags so the eyebrows drop over the eyelids, which then feel heavy)
  • Eyelid ptosis (the upper eyelid drops, sometimes obscuring the pupil)
  • Baggy upper and lower eyelids
  • Sagging lower eyelids, revealing the reddened mucosal surface (ectropion)
  • Hollow look to the eyes
  • Tired-looking eyes with a prominent groove beside the nose (tear-trough deformity)
  • Jowls (loss of jaw line)
  • Loss of neckline
  • Elongated earlobes
  • Dropping of the tip of the nose
  • Thinning of the upper lip
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