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Chapter 47: Extrinsic Aging

INTRODUCTION

KEY POINTS

  • Extrinsic and intrinsic aging can vary across racial and ethnic populations.

  • In lighter skin, signs of aging include facial volume loss, rhytides, seborrheic keratoses, and photodamage including solar lentigines and mottled pigmentation.

  • In darker skin, volume loss and rhytides tend to occur at more advanced ages. Other components of aging in darker skin include the development of dermatosis papulosis nigra, seborrheic keratoses, idiopathic guttate hypopigmentation, and maturational dyschromia.

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FIGURE 47-1.

Facial rhytides, both superficial and deep, which are more prominent periorally along with facial lentigines, superficial telangiectasias, and infraorbital hollowing, with loss of skin elasticity in a woman with lighter skin. Also note the deeper prominence of her nasolabial folds and marionette lines. (Reproduced with permission from Alam M, Bhatia AC, Kundu RV, et al. Cosmetic Dermatology for Skin of Color. New York, NY: McGraw Hill; 2009, Figure 9-2A.)

A photo shows the face of a light skinned woman with severe photoaging, wrinkles, and saggy bags below the eyes, cheeks, and jawline.
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FIGURE 47-2.

Superficial and deep rhytides, including prominent nasolabial folds and glabellar and marionette lines in a Black woman. Note also the loss of mid-face volume with infraorbital hollowing. (Reproduced with permission from Avram MR, Avram MM, Ratner D. Procedural Dermatology. New York, NY: McGraw Hill; 2015, Figure 58-5.)

A photo shows facial skin aging in skin of color. There is a descent of the malar fat pads, tear trough deformity, infraorbital hollowing, and deepening of the nasolabial folds.
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FIGURE 47-3.

In contrast, the signs of aging visible in this Asian woman include facial lentigines, superficial rhytides, and less prominent nasolabial folds. (Reproduced with permission from Alam M, Bhatia AC, Kundu RV, et al. Cosmetic Dermatology for Skin of Color. New York, NY: McGraw Hill; 2009, Figure 9-2B.)

A photo shows the face of an Asian woman with actinic lentigines, flat pigmented seborrheic keratosis, and dark hyperpigmentation. She has lesser creases and saggy skin on her face.
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FIGURE 47-4.

Prominent nasolabial folds in an elderly African American woman with loss of mid-face volume. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 19-1.)

A patient with brown skin with creases along the nasolabial folds.
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FIGURE 47-5.

Facial lentigines, seborrheic keratosis, and superficial and deep rhytides are visible, along with infraorbital hollowing. Note sagging of the skin secondary to loss of elasticity. (Reproduced with permission from Tannous Z, Avram MM, Tsao S, et al. Color Atlas of Cosmetic Dermatology, 2nd ed. New York, NY: McGraw Hill; 2011, Figure 1-4A.)

A light skinned elderly patient exhibits multiple tan, flat spots all over the face, and minor creases in the forehead, lateral canthus, cheeks, and jaw regions.
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FIGURE 47-6.

Large, flat, light-brown patches and papules consistent with pigmented seborrheic keratoses on a background of skin with fine wrinkles in a Chinese person. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 77-3B. Reproduced with permission from the National Skin Centre, Singapore.)

A patient with light brown skin exhibits hyperpigmented brown patches and papules on the left cheek.
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FIGURE 47-7.
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