Whereas the molecular mechanisms of skin aging are well understood, little information is available concerning the clinical onset and lifetime development of facial wrinkles. To perform the first systematic evaluation of the lifetime development of facial wrinkles and sex-specific differences using three-dimensional (3D) imaging and clinical rating. 200 men and women aged 20 to 70 were selected. Wrinkle severity of periorbital, glabellar, and forehead lines was evaluated using 3D imaging and validated assessment scales. Wrinkle severity was greater at all assessed locations with older age. In men, wrinkles manifested earlier and were more severe than in women. In women, periorbital lines were the first visible wrinkles, in contrast to the forehead lines in men. In both sexes, glabellar lines did not clinically manifest before the age of 40. The results of the present study confirm a progressive increase of crow's feet and forehead and glabellar lines in men and women. Although the development of facial wrinkles happens earlier and is more severe in men, perimenopause seems to particularly affect development in women. Clinical ratings and 3D measurements are suitable methods to assess facial wrinkle severity in men and women.
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