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Area of involvement is scored from 0 to 6 Darkness and homogeneity are scored from 0 to 4
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TABLE 39-5 Glogau Photoaging Classi cation TYPE I NO WRINKLES Usually ages 20s 30s Early photoaging Mild pigmentary changes No keratoses Minimal wrinkles TYPE II WRINKLES IN MOTION Usually ages late 30s 40s Early to moderate photoaging Early senile lentigines Palpable but not visible keratoses Parallel smile lines beginning to appear lateral to mouth TYPE III WRINKLES AT REST Usually age 50 or older Advanced photoaging Obvious dyschromias, telangiectasias Visible keratoses Persistent wrinkling TYPE IV ONLY WRINKLES Usually age 60 or above Severe photoaging Yellow-gray skin Prior skin malignancies No normal skin
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The Glogau Classification, known in the lay media as The Wrinkle Scale, was designed for the assessment of generalized facial photoaging It is based on four major criteria consisting of no wrinkles (Type I), wrinkles in motion (Type II), wrinkles at rest (Type III), and only wrinkles (Type IV) (Table 39-5)
Fitzpatrick s Classi cation of Facial Wrinkling (Perioral and Periorbital)
Dr Richard E Fitzpatrick s classification of facial wrinkling is directed toward skin elasticity and generalized wrinkling and was designed for perioral and periorbital rhytides (Table 39-6) It was originally designed for establishing the effects of laser resurfacing of wrinkled skin
COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
Adapted from Glogau RG Chemical peeling and aging skin J Geriatric Dermatol 1994;2(1):31
TABLE 39-6 Fitzpatrick s Classi cation of Facial Wrinkling CLASS I II SCORE 1 3 4 6 WRINKLING Fine wrinkles Fine to moderate-depth wrinkles, moderate number of lines Fine to deep wrinkles, numerous lines, with or without redundant skin DEGREE OF ELASTOSIS Mild ( ne textural changes with subtly accentuated skin lines) Moderate (distinct papular elastosis, individual papules with yellow translucency, dyschromia) Severe (multipapular and con uent elastosis, thickened, yellow, and pallid cutis rhomboidalis)
Hamilton described a classification of contour changes of facial skin It is based on four variables: clinical morphology (laxity, furrows, or wrinkles); tissue location (muscular, musculocutaneous, or cutaneous); clinical location (cheeks, neck, eyelids, forehead, etc); and etiology (genetic, repeated facial expression, or photoaging) Each type of change is then presented with a proper procedural treatment, such as rhytidectomy, soft tissue augmentation, resurfacing with lasers or chemical peels, or a combined approach (Tables 39-7A and B) III 7 9
Adapted from Fitzpatrick RE, Goldman MP, Satur NM, et al Pulsed carbon dioxide laser resurfacing of photo-aged facial skin Arch Dermatol 1996;132:395 (Table 39-8) It was originally designed to evaluate treatment response with injectable fillers This classification addresses specific wrinkles on different anatomical areas The wrinkles assessed on this scale are horizontal forehead furrows, glabellar frown lines, periorbital lines, periauricular lines, cheek lines, nasolabial folds, radial upper lip lines, radial lower lines, corner of the mouth lines, marionette lines, the labiomental crease, and horizontal neck folds
Larnier Photographic Scale
The Larnier Photographic Scale was designed to rate photoaging of skin based on photographs4 It is a six-point photographic scale, with each point consisting of three separate photos to illustrate each level of severity Therefore, the scale consists of six grades of photoaging severity, with grade 1 corresponding to mild and grade 6 to very severe Larnier s scale has been validated for assessing photodamage in Caucasian subjects, but not other ethnic groups
The Lemperle Scale is another approach to assessing facial wrinkles3
TABLE 39-7A Hamilton Classi cation Changes in Facial Contours Occurring with Age FACIAL AGING A B C D CLINICAL MORPHOLOGY Folds Furrows Wrinkles Combination TISSUE LOCATION Muscular Musculocutaneous Cutaneous CLINICAL LOCATION Nasolabial folds, neck, eyelids Forehead, smile lines Cheeks, crow s feet, perioral ETIOLOGY Loss of tone, gravity Repeated facial expressions Intrinsic aging, photoaging OPTIMAL TREATMENT Rhytidectomy, blepharoplasty Filler substances, injectables, implants Resurfacing, laser, chemical peel Combined approach
Adapted from Hamilton DG A classi cation of the aging face and its relationship to remedies J Clin Dermatol Summer 1998:35
TABLE 39-7B Appropriate Treatments According to Hamilton Classi cation TYPE OF CHANGE A OPTIMAL TREATMENT Rhytidectomy (with or without implants); blepharoplasty Filler substances: injectables/ implants Resurfacing: laser, chemical peel Combined approach
TABLE 39-8 Lemperle Scale CLASS 0 1 2 3 4 5 DESCRIPTION No wrinkles Just perceptible wrinkles Shallow wrinkles Moderately deep wrinkles Deep wrinkles, well-de ned edges Very deep wrinkles, redundant fold