AGE-RELATED FACIAL WRINKLING Age group 20-29 31-39 41-49 51-59 61-69 Total WRINKLE SCORE ASSESSMENT Table I Distribution of the Subject Population Caucasian 16 21 17 15 16 85 Number in Group Japanese 14 14 14 14 14 70 375 The wrinkle score in eight areas of facial skin (forehead, glabella, upper eyelids, corner of the eye, lower eyelids, nasolabial groove, cheeks, and corner of the mouth) and sagging in the lower cheek area were measured according to photo standards as previously reported (6,7). These standards were originally established from photos of various grades of wrinkling and sagging in eight facial areas of Japanese female subjects and statistically proved useful by kappa coefficient analysis (8,9), respectively. Wrinkles were graded on a scale of 5: 1 = no wrinkles 2 = mild wrinkles 3 = mild/moderate wrinkles 4 = moderate wrinkles 5 = severe wrinkles. Sagging was graded on a scale of 6: 0 = no sagging (no irregularities on the cheek) 1 = slight sagging (the relief of the nasolabial groove was distinct due to the descent of the upper cheek area) 2 = mild sagging (the relief of the nasolabial groove was distinct due to the descent of the upper cheek area, and a shallow relief formed from the anterior area of the ear toward the jaw) 3 = moderate sagging (the relief of the nasolabial groove to the corner of the mouth was clear) 4 = severe sagging (the relief of the nasolabial groove was connected to the corner of the mouth and from the anterior area of the ear toward the jaw) 5 = very severe sagging ( the cheek dropped beyond the outline of the jaw, and a silk crepe-pattern relief appeared in the cheek). Score assessment was performed by an experienced observer. STATISTICAL ANALYSIS A linear function was used to calculate the correlation coefficients between the wrinkling or sagging scores and the ages of the subjects, as shown in the tables. Differences were analyzed by Mann-Whitney's U test. RESULTS COMPARISON OF WRINKLE SCORE IN CAUCASIAN FEMALES AND IN JAPANESE FEMALES Table II shows the wrinkle scores in eight areas of the face in the 85 Caucasian females using the photoscale established for Japanese females. In the group aged 20-29 years, the score was 2 (mild wrinkles) or more in all areas, except for the upper eyelid. The wrinkle scores in all areas increased with age. The group aged 60-69 years showed high mean

Table Mean Wrinkle Grade Variation With Age (mean± SD) at Different Skin Sites (Caucasian) ---II Corner of Age group Forehead Glabella Upper eyelid the eye Lower eyelid N asolabial groove Cheek 20-29 2.50 ± 0.89 2.06 ± 1.06 1.86 ± 0.66 2.06 ± 0.68 3.25 ± 0.58 2.56 ± 0.73 2.25 ± 0.68 30-39 3.00 ± 1.00 3.05 ± 0.97 2.89 ± 0.90 3.14 ± 0.65 3.81 ± 0.68 3.19 ± 0.68 3.14 ± 0.73 40--49 3.88 ± 0.70 3.88 ± 0.70 3.50 ± 1.00 3.88 ± 0.60 4.65 ± 0.49 3.71 ± 0.99 3.65 ± 0.49 50-59 4.13 ± 0.83 3.87 ± 0.74 3.91 ± 0.83 4.00 ± 0.76 4.47 ± 0.64 4.33 ± 0.72 3.87 ± 0.74 60-69 3.81 ± 0.98 4.19 ± 0.66 4.36 ± 0.63 4.44 ± 0.51 4.88 ± 0.34 4.69 ± 0.60 4.56 ± 0.63 Average 3.44 ± 1.06 3.39 ± 1.12 3.25 ± 1.18 3.48 ± 1.03 4.19 ± 0.81 3.66 ± 1.05 3.47 ± 1.00 Correlation coefficient r = 0.516 r = 0.655 r = 0.762 r=0.769 r = 0.681 r = 0.711 r = 0.755 p 0.001 p 0.001 p 0.001 p 0.001 p 0.001 p 0.001 p 0.001 Corner of the mouth 2.25 ± 0.45 3.00 ± 0.71 3.76 ± 0.75 4.27 ± 0.80 4.69 ± 0.48 3.55 ± 1.07 r = 0.808 p 0.001 \..),) ---....J 0\ '-i 0 C � z � 0 rTj Ci 0 (FJ � b1 ,.., - Ci (FJ Ci - b1 z Ci b1