Wrinkles

Wrinkles represent the first visible sign of skin atrophy and are related to the damage of collagen and elastic fibres. We can define a wrinkle as a permanent furrow of the skin, of varying depth. A large number of factors can cause the onset of these imperfections as a result of chronological aging and photoaging, which include: flattening of the dermal-epidermal junction and the reduction of collagen with age; alterations of the components of the extracellular matrix, the glycosaminoglycans and the variations of the adipose tissue; elastotic solar damage over time. In addition there are also connatural factors (hereditary, racial, hormonal, pathological) and environmental factors (pollution, smoking, alcohol, sun exposure, gravity).

Variations in the number and morphology of wrinkles, with the age time factor:

• No wrinkles (0-25 years)
• Primary wrinkles (25-35 years) reversible at the beginning, deeper in more emotional and more expressive subjects, they occur earlier in women and in people who are inclined to use more facial expressions: forehead, periocular, for the most past linear.
• Secondary wrinkles (35-50 years) nasolabial folds, crumpled skin from sleeping, glabellar lines between the eyes, perilabial lines caused by smoking.
• Tertiary deep wrinkles (over 50 years) glyphic on the cheeks, vertical on the décolleté, ripples and folds that affect the whole body, accentuation of all the other wrinkles.

CLASSIFICATION

Tests and exams requested: skin check-up; serum-blood tests; urinary markers; genetic profile;

The classification of photo-aging according to Mark-Rubin:

LEVEL I (epidermis)

accentuation of skin tissue texture
slightly uneven complexion, dull skin
skin “rough” to the touch
wrinkles visible only during facial expressions

LEVEL II (epidermis and papillary dermis)

uneven complexion, senile keratosis
telangiectasia
underlying mimicry muscle wrinkles at rest
some fine lines

LEVEL III (epidermis, papillary dermis, reticular dermis) 

marked wrinkles
numerous fine lines
thickened, yellowish skin
senile and actinic keratosis
“crumpled” look

Classification of photoaging according to Glogau: 

Group I: 
mild, 28-35 years old, no wrinkles, early photoaging, no keratosis, minimal wrinkles, little pigmentation change

Group II:
moderate, 35-50 years, wrinkles in motion, early to moderate photoaging, early brown spots, keratosis palpable but not visible, parallel smile lines

Group III:
advanced, 50-65 years old, wrinkles at rest, advanced photoaging, obvious discoloration, visible capillaries, visible keratosis, deep furrows

Group IV:
severe, 60-75 years, only wrinkles, severe photoaging, yellow-grey skin colour, prior skin malignancies, wrinkles throughout, cannot wear makeup