Wrinkle Scale

The optimal treatment for wrinkles and other signs of aging skin depends on several factors, including the degree of wrinkling. A "wrinkle scale" has been developed that classifies signs of aging skin. This scale has been useful for researchers when comparing different cosmetic dermatology treatments and for doctors to recommend treatment options for an individual. In many cases, a combination of treatments may be suggested to address different changes to the skin.

Other factors that may be considered when recommending a treatment regimen include skin color (Fitzpatrick scale)

Speak to your doctor about treatment options that best fit your skin type and aesthetic needs.

REMEMBER: The regular use of sunscreens and sun avoidance measures is important at ALL ages.

Type 1 Wrinkles: No wrinkles

  • Age: 20's to 30's
  • Early signs photoaging, including mild pigmentary changes, and minimal, if any wrinkles.

Possible treatment options include the following:

  • Topical retinoid creams (tretinoin)
  • Cosmeceuticals, containing alpha-hydroxy-acid (AHA), beta-hydroxy acids, and peptides.
  • Chemical peels, superficial
  • Botulinum toxin (Botox®, Dysport®, Xeomin®)
  • IPL Photorejuvenation (photo-facial)
  • Laser skin rejuvenation (non-ablative laser)

Type 2 Wrinkles: Wrinkles in Motion

  • Age: late 30's or 40s
  • Early to moderate signs of photoaging, including early solar lentigines (brown spots),   skin pores more prominent, early changes to skin texture (more rough), and early "smile lines".

Possible treatment options include those for Type 1 Wrinkles AND the following:

  • Chemical peels, intermediate
  • Microdermabrasion
  • Photodynamic therapy (PDT) skin rejuvenation
  • Dermal fillers (Juvederm®, Radiesse®, Restylane®, and others)
  • Tissue tightening of loose skin, if present
  • Laser removal of spider veins, if present

Type 3 Wrinkles: Wrinkles at Rest

  • Age: 50 and older
  • Advanced signs of photoaging, including patches of darker skin, visible blood vessels, prominent age spots (lentigines), and wrinkles, even at at rest.

Possible treatment options include those for Type 1 and 2 Wrinkles AND the following:

  • Chemical peels, medium
  • Laser resurfacing

Type 4: Only Wrinkles

  • Patient 60s or 70s
  • Severe signs of photoaging, including a yellow-gray skin color, skin malignancies, precancerous actinic keratoses (AKs) and prominent skin wrinkling throughout.

Possible treatment options include those for Type 3 Wrinkles AND the following:

  • Full-face laser resurfacing with ablative laser (CO2 laser)
  • Full-face dermabrasion
  • Chemical peel, deep

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Last updated: 5/13/2020