title: The anatomical basis for wrinkles.
abstract: BACKGROUND
  Light and electron microscopy have not identified a distinct anatomical structure associated with either skin wrinkles or creases, and a histological difference between wrinkled and adjacent skin has not been identified.
  
  
  OBJECTIVE
  The authors investigate whether facial wrinkles are related to underlying lymphatic vessels and perilymphatic fat.
  
  
  METHODS
  Lymphatic vessels with a specialized tube of perilymphatic fat were identified beneath palmar creases. Sections of skin, adipose tissue, and muscle were harvested from each of 13 cadavers. Three sites were investigated: the transverse forehead crease, lateral orbicularis oculi wrinkle (crow's feet), and the nasojugal crease. The tissue was paraffin embedded and processed. Two-step indirect immunohistochemistry was performed, and images were examined using laser confocal microscopy. Measurements were taken with software.
  
  
  RESULTS
  Every wrinkle examined was found above and within ±1 mm of a major lymphatic vessel and its surrounding tube of adipose tissue. The results satisfied our null hypothesis and were statistically significant. Lymphatic vessels were identified by positive immunofluorescence as well as histological criteria. These findings have been further validated by fluorochrome tracer studies.
  
  
  CONCLUSIONS
  An anatomical basis for wrinkles was identified among the specimens studied. Lymphatic vessels, along with the surrounding distinct perilymphatic fat, traveled directly beneath wrinkles and creases. Lymphatic dysregulation leads to inflammation, scarring, and fibrosis, but inadvertent injection of these vessels can be avoided with anatomical knowledge.
authors.affiliation: Dr Pessa is a plastic surgeon in private practice in Abilene, Texas.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Pessa
authors.forename: Hang
authors.initials: H
authors.lastname: Nguyen
authors.forename: George B
authors.initials: GB
authors.lastname: John
authors.forename: Philipp E
authors.initials: PE
authors.lastname: Scherer
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004210:Dissection; D005145:Face / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D005456:Fluorescent Dyes; D006225:Hand / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000601:surgery; D012867:Skin / Q000033:anatomy & histology*; D015595:Skin Aging / Q000502:physiology*
chemical_list: D005456:Fluorescent Dyes
keywords: facial surgery; fillers; lasers; liposculpting; resurfacing; skin redundancy; wrinkles