The riddle of genuine skin microrelief and wrinkles

Wrinkles result from distinct structural changes occurring in specific parts of the dermis and subcutaneous tissue. There is a need for evidenced-based cosmetology identifying and quantifying the different aspects of wrinkling. Histology allows to detect specific changes associated with particular types of wrinkles. Four main types of wrinkles can thus be recognized, including the atrophic crinkling rhytids, the permanent elastotic creases, the dynamic expression lines, and the gravitational folds. Each type usually develops on specific skin regions exhibiting distinct microanatomical characteristics. Whereas skin microrelief, expression lines and skin folds appear clearly marked at the histological level, only little dermal changes are identified under other reducible or permanent wrinkles compared with the skin immediately adjacent to them. Distinguishing different types of wrinkles brings more precision to the clinical practice. This is of importance because the different types of wrinkles respond differently to cosmetic, dermatological and surgical treatments.