Creases and Coarse Rhytids

Creases and Coarse Rhytids

Lisa M. Donofrio

Dana L. Ellis


Creases and coarse rhytids are both manifestations of the aging process but have markedly different etiologies and treatment paradigms. Coarse rhytids are mostly secondary to solar elastosis, and repetitive muscular activity, whereas creases or folds are a complex end result of bony resorption and remodeling, volumetric changes in the facial fat compartments resulting in soft tissue repositioning and relative tissue excess. Although most patients display both signs in the aging face, creases and folds are more ubiquitous, as they generally occur secondary to intrinsic aging with or without sun exposure. Both entities will be discussed separately throughout this chapter.


Deep folds typically manifest in the nasolabial and melolabial regions starting in the third and fourth decades of life depending on the skin type. As aging progresses, and with muscular activity, deep creases may also present in the forehead, periorbital region, and the buccal areas.


Coarse Rhytids

Facial aging is a complicated process in which both intrinsic and extrinsic factors lead to changes in physiologic function and loss of structural integrity. Decreased dermal thickness is the hallmark of extrinsic aging, with accompanying skin laxity and changes in both pigmentation and texture.4 Chronic ultraviolet exposure and resultant solar elastosis is responsible for 80% of skin aging.5 The effects of sun exposure are many, including a dramatic decrease in collagen and an alteration of the extracellular matrix (ECM). The ECM is made up of collagen, elastin, and hyaluronic acid (HA); proteoglycans, and glycosaminoglycans.6 Support of the ECM is lost with the formation of a disorganized elastic tissue network, and there is a reduction in the production of all components of the ECM.7,8 Matrix metalloproteinases are responsible for the continual breakdown of collagen but can be downregulated via a stretch receptor in the collagen-forming fibroblasts.4,6,7,9 All of these ultrastructural changes lead to physiological changes that result in the appearance of coarse rhytids especially in areas overlying the mimetic musculature. Repetitive facial movements, especially in areas of sun exposure, give rise to the hallmark deep aging lines in the glabella, forehead, and lateral canthal areas.

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Jun 29, 2020 | Posted by in Dermatology | Comments Off on Creases and Coarse Rhytids
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