384 JOURNAL OF COSMETIC SCIENCE Table V Comparison of Wrinkle Score and Sagging Score in Different Facial Skin Sites: Level of Caucasian Scores Compared With Japanese Scores Wrinkling Age Upper Corner of Lower Nasolabial Corner of group Forehead Glabella eyelid the eye eyelid groove Cheek the mouth Sagging 20-29 t t t t t t t t 30-39 t t t t t t t 40-49 t t t t t t t t 50-59 t t t t t t 60---69 � Q q t t t t t : Significantly higher scores than the Japanese females. : Higher scores than the Japanese females (not significantly). q : Level equal to that of the Japanese females. � : Lower scores than the Japanese females (not significantly). observed the same wrinkle levels in 40-year-old females in Kagoshima and 48-year-old females in Akita, suggesting the influence of UV exposure on wrinkle formation. Hu­ man skin is classified according to UV sensitivity into phototypes I-IV (13). One study, which evaluated the severity of wrinkles by scoring according to four skin types in 230 Japanese males and females aged 40 years or more, showed that subjects with skin types highly sensitive to UV tended to develop deep wrinkles due to photoaging (14). There­ fore, the amount of UV exposure and skin type may be closely associated with wrinkle formation. In addition to the skin, the skeleton and facial muscles have been reported to be closely involved in the aging of the face (15). We previously obtained wrinkle replicas in eight areas of the face from 136 Japanese females living in Tokyo in ten-year age groups ranging from 18 to 83 years of age, and we evaluated age-related changes in the depth and coarseness of wrinkles by 3D analysis. Although the entire face had been exposed to UV, the degree of wrinkle development differed among areas. We speculated that factors other than UV, namely, mechanical factors such as facial movements and sensitivity to transient wrinkle formation, are the primary causes of wrinkle formation (16). Loth (17) reported differences in anatomical morphology and incidence of facial muscles among races. Therefore, in addition to the amount of UV exposure and skin type, differences in the facial muscles and skeleton may have caused higher wrinkling and sagging scores in the Caucasian females than in the Japanese females. Resolution of this speculation will require further study. This study compared age-related changes in wrinkling and subzygomatic sagging be­ tween Caucasian females living in North America and Japanese females living in Tokyo.

AGE-RELATED FACIAL WRINKLING 385 The Caucasian females showed significantly higher wrinkle scores than the Japanese females in the eight evaluated areas of the face in the groups aged 20-29 years marked increases in wrinkles in the lower eyelid, and especially marked increases in wrinkles in the nasolabial groove, cheek, and corner of the mouth, which are considered to be due to subzygomatic sagging, in the groups aged 40--49 years or more and a significantly higher sagging score in the groups aged 40--49 years or more. REFERENCES (1) P. G. Agachi, J. Mignot, and S. Makki, "Microtopography of the Skin and Aging," in Cutaneous Aging, (University of Tokyo Press, Tokyo, 1988), pp. 475-499. (2) G. L. Grove and M. J. Grove, "Objective Methods for Assessing Skin Surface Topography Noninva­ sively," in Cutaneous Investigation in Health and Disease, J. L. Leveque, Ed. (Marcel Dekker, New York and Basel, 1989), pp. 1-32. (3) J. L. Leveque and P. Corcuff, "The Surface of the Skin," in Noninvasive Methodr for the Quantification of Skin Functions, P. J. Frosch and A. M. Kligman, Eds. (Springer-Verlag, Berlin, 1993), pp. 223-240. (4) C. E. M. Griffiths, T. S. Wang, T. A. Hamilton, J. J. Voorhees, and C. N. Ellis, A photonumeric scale for the assessment of cutaneous phorodamage, Arch. Dermatol., 128, 347-351 (1992). (5) C. Larnier,J. P. Ortonne, A. Venot, B. Faivre,]. C. Beani, P. Thomas, T. C. Brown, and E. Sendagorta, Evaluation of cutaneous photodamage using a photographic scale, Br.]. Dermatol., 130, 167-173 (1994). (6) K. Tsukahara, Y. Takema, H. Kazama, Y. Yorimoto, T. Fujimura, S. Moriwaki, T. Kitahara, and M. Kawai, A photographic scale for the assessment of human facial wrinkles,]. Cosmet. Sci., 51, 127- 139 (2000). (7) K. Tsukahara, Y. Takema, T. Fujimura, S. Moriwaki, T. Kitahara, and G. Imokawa, Determination of age-related changes in the morphological structure (sagging) of the human cheek using a photonu­ meric scale and 3-dimensional surface parameters, Int.]. Cosmet. Sci., 22, 247-258 (2000). (8) J. Cohen, A coefficient of agreement for nominal scales, Educ. Physiol. Meas., 20, 37-46 (1960). (9) J. D. Fleiss and J. Cohen, Large sample standard errors of kappa and weighted kappa, Psycho!. Bull., 72, 323-327 (1969). (10) Y. Shirakabe, Aging and rejuvenation of Japanese face from the aspect of cosmetic surgery,]. Jpn. Cosmet. Sci. Soc., 25, 100-103 (2001). (11) V, Gartstein and S. A. Shaya, Image analysis of facial skin features, Proc. Int. Soc. Optic. Eng., 626, 284-288 (1986). (12) G. G. Hillebrand, K. Miyamoto, B. Schnell, M. Ichihashi, R. Shinkura, and S. Akiba, Quantitative evaluation of skin condition in an epidemiological survey of females living in northern versus southern Japan,]. Dermatol. Sci., 27, S42-S52 (2001). (13) T. B. Fitzpatrick, The validity and practicality of sun-reactive skin types I through VI, Arch. Dermatol., 124, 869-871 (1988). (14) H. Nagashima, K. Hanada, and I. Hashimoto, Correlation of skin phototype with facial wrinkle formation, Photodermatol. Photoimmunol. Photomed., 15, 2-6 (1999). (15) M. S. Zimbler, M. S. Kokoska, and]. R. Thomas, Anatomy and pathophysiology of facial aging, Facial Plast. Surg. Clin. N. Am., 9, 179-187 (2001). (16) Y. Takema, K. Tsukahara, T. Fujimura, and M. Hattori, Age-related changes of 3-dimensional morphological changes in the human facial skin, Skin Res. Tech., 5, 145-149 (1996). (17) E. Loth, ''L'Anthropologie Speciale des Parties Molles," in Anthropologie des Parties Molles (Masson Cie, Paris, 1931), pp. 14-70.