rhytides%20(wrinkles)
RHYTIDES (WRINKLES)
Rhytides or wrinkles are visible creases or folds in the skin.
Fine wrinkles is <1 mm in width while coarse wrinkles is >1 mm in width.
The decision to treat wrinkles depends on the degree that they bother the patient, the nature and severity of the wrinkles, and the patient's willingness to accept the risks and costs of treatment.
The patient should understand that protection from the sun at any age will reduce the risk of photoaging (including wrinkles), actinic keratoses and squamous cell cancer.

Evaluation

  • The decision to treat wrinkles depends on the degree that they bother the patient, the nature and severity of the wrinkles, and the patient’s willingness to accept the risks and costs of treatment
  • It is suggested that combined modalities tailored to patient’s skin type and location can be the most effective strategy in managing rhytides
  • Essential consideration in resurfacing modalities involve careful selection of appropriate patients to undergo these procedures
  • Fitzpatrick and Glogau classifications are used in assessing the patient’s degree of skin damage and its appropriate type and depth of facial resurfacing modality
  • Modified Fitzpatrick wrinkle scale is used for the assessment of degree of wrinkling in the mouth and eyes:
    • Class I: Fine wrinkles with mild elastosis
    • Class II: Fine to moderately deep wrinkles and moderate number of lines with distinct papular elastosis
    • Class III: Fine to deep wrinkles, numerous lines with or without redundant folds with multipapular and confluent elastosis
  • Fitzpatrick sun-reactive skin types describe the actinically damaged skin and used in evaluating appropriate resurfacing modalities for the patient
    • Type I: Unexposed skin is white and after 1 hour of sun exposure it always burns and never tans
    • Type II: Unexposed skin is white and after 1 hour of sun exposure it usually burns and tans less than average
    • Type III: Unexposed skin is white to olive and after 1 hour of sun exposure it burns minimally that gradually tans
    • Type IV: Unexposed skin is light brown and after 1 hour of sun exposure it burns minimally and tans well
    • Type V: Unexposed skin is brown and after 1 hour of sun exposure it very rarely burns, tans profusely
    • Type VI: Unexposed skin is dark brown to black and after 1 hour of sun exposure it never burns and tans deeply
  • Glogau classification system gives an objective assessment of the degree of photoaging, categorizing the patient’s skin damage and used in selection of appropriate treatment option
    • Group I (Mild): No wrinkles with early photoaging and no keratoses; usually occurs at age 28-35
    • Group II (Moderate): Wrinkles in motion with early to moderate photoaging and sallow color with early actinic keratoses; usually occurs at age 35-50
    • Group III (Advanced): Persistent wrinkling or moderate acne scarring with discoloration with telangiectasias and actinic keratoses; usually occurs at age 50-65
    • Group IV (Severe): Only wrinkles with severe photoaging and actinic keratoses with or without skin cancer oracne scars; usually occurs at age 60-75

Classification

Types

  • Dynamic wrinkles
    • Due to contraction of muscles that are attached to the overlying skin
    • Most common locations are between the eyebrows, forehead, and on the cheeks near the outer corners of the eyes or “crow’s feet”
  • Static wrinkles
    • Due to skin damage from sun, smoking, genetics, poor nutrition or from prolonged dynamic wrinkling
  • Wrinkle folds
    • Caused by sagging of the facial structures that results to deep grooves between the nose and mouth known as the nasolabial groove
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