Wrinkles

Last reviewed: 24 Apr 2022
Last updated: 11 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age >40 years
  • chronic sun exposure
  • smoking
  • lines on face
  • horizontal neck folds
  • lines on dorsum of hands and wrists
  • dynamic lines
  • gravitational lines
  • deep wrinkles
  • fine wrinkles
More key diagnostic factors

Other diagnostic factors

  • skin laxity
  • dyschromia
  • dermal elastosis
  • erythema
  • telangiectasia
  • textural changes
  • actinic keratoses
Other diagnostic factors

Risk factors

  • genetic susceptibility
  • age >40 years
  • white skin
  • hyperdynamic muscular activity
  • chronic sun exposure
  • smoking
  • pollution
  • low socioeconomic class
  • low BMI
More risk factors

Diagnostic investigations

1st investigations to order

  • macrophotography
More 1st investigations to order

Investigations to consider

  • skin biopsy
More investigations to consider

Emerging tests

  • profilometer
  • in vivo confocal microscopy

Treatment algorithm

ONGOING

no obvious wrinkles at rest or on animation

superficial wrinkles on animation only

deep wrinkles on animation only

superficial wrinkles at rest, deep wrinkles on animation

deep wrinkles and sagging skin at rest and deeper wrinkles on animation

Contributors

Authors

Dimitrios Dionyssiou, MD, PhD
Dimitrios Dionyssiou

Associate Professor in Plastic Surgery

Department of Plastic Surgery

Aristotle University of Thessaloniki

Thessaloniki

Greece

Disclosures

DD declares that he has no competing interests.

Efterpi Demiri, MD, PhD
Efterpi Demiri

Professor in Plastic Surgery

Department of Plastic Surgery

Aristotle University of Thessaloniki

Thessaloniki

Greece

Disclosures

ED declares that she has no competing interests.

Elisavet Lazaridou, MD, PhD
Elisavet Lazaridou

Professor

Second Department of Dermatology

Aristotle University of Thessaloniki

Thessaloniki

Greece

Disclosures

EL declares that she has no competing interests.

Peer reviewers

George Hruza, MD

Clinical Professor of Dermatology and Otolaryngology

St. Louis University

St. Louis

Director

Laser and Dermatologic Surgery Center

Chesterfield

MO

Disclosures

GH has been reimbursed by Allergan, Dermik, and Colbar Life Sciences to attend educational symposia and has also been paid to teach other physicians. GH is a consultant for Ulthera and has received equipment for research from Syneron. GH is an author of a reference cited in this topic.

Stephanos Papanastasiou, FRCSEd, MSc, EBOPRAS, FESSH

Consultant Plastic Surgeon

Lister Hospital

Stevenage

UK

Disclosures

SP declares that he has no competing interests.

  • Wrinkles images
  • Differentials

    • Cutis laxa
    • Werner syndrome (progeria or pangeria)
    • Xeroderma pigmentosum
    More Differentials
  • Guidelines

    • Guidelines for topical photodynamic therapy: update
    • Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening
    More Guidelines
  • Patient leaflets

    Wrinkles

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer