Wrinkle Scale

Photoaging ClassificationRecommended Treatment
Type 1: “no wrinkles”

  • Patient age 20s or 30s
  • Early Photoaging
  • Mild pigmentary changes
    • No keratoses
    • No wrinkles
  • Sunscreens and education
  • Topical Retin A® (tretinoin)
  • Glycolic and beta (salicylic acid) peels
  • Botox®
  • IPL™ with Lumenis
  • Jessner’s Peel
Type 2: “wrinkles in motion”

  • Patient age late 30s or 40s
  • Early to moderate photoaging
  • Early solar lentigines (brown spots) visable
    • Early keratoses
    • Parallel smile lines
  • Sunscreens and education
  • Topical Retin A®
  • TCA 30% Peels, or a series of light peels
  • Soft tissue augmentation with collagen, hyaluronic acid or silicone
  • Botox®
  • IPL™ and PDT™ for Photorejuvenation
  • Blue Light
Type 3: “wrinkles at rest”

  • Patient age 50 and older
  • Advanced Photoaging
    • Obvious dyschromia and broken blood vessels
    • Visible keratoses
    • Wrinkles, even at rest
  • Sunscreens and education
  • Topical Retin A®
  • TCA 30% Peels
  • Dermabrasion
  • Soft tissue augmentation with collagen, hyaluronic acid or silicone
  • Botox®
  • IPL™ and PDT™ for Photorejuvenation
  • Blue Light
Type 4: “only wrinkles”

  • Patient 60s or 70s
  • Severe Photoaging
  • Yellow-gray skin color
  • Prior skin malignancies
    • Wrinkled skin throughout
  • Dermabrasion
  • PDT™ Photodynamic skin rejuvenation with Lumenis IPL™ and ALA™
  • Facelift
  • Browlift
  • Blepharoplasty
  • Botox®