Why you still look your age after the wrinkles are gone

If you show a facial photograph to a number of people and ask them to estimate the age, you get an average. This is called perceived age. It can differ from actual age, and that difference is exactly what the phrase “looking old” refers to.

The value holds up better than you might expect. In a 2024 study of 1,997 Korean subjects (aged 29–58), the correlation between actual age and perceived age was r = 0.857. And the facial photograph was a far stronger variable than information such as age, sex or body mass index.

At the same time the error is clear. In the same study the mean error of the best model predicting from photographs alone was 2.29 years, and in a 2024 study rating 400 Chinese women the estimated age matched the actual age in only 25.5% of cases.

In the study of 112 Korean women, about half were judged to be 2 to 12 years older than they were. So the feeling of “looking old” is generally not a misperception.

This is the study this article starts from. 112 Korean women (aged 18–80) were photographed under standardised conditions, 15 experts including dermatologists graded 19 facial signs, and then 92 Korean women estimated the ages in those photographs. The contribution of each sign to perceived age was then calculated.

There are three things to read out of this table.

First, wrinkles and sagging are exactly the same. This data gives no ground for saying that either matters more.

Second, treating wrinkles alone is 37%. The remaining 63% is left untouched. That is where the sentence “I do not really have wrinkles, but I look old” comes from.

Third, pores had no association with perceived age. This is a concern that comes up often in consultations, but at least from the standpoint of ‘why a face looks old’ the data does not support it. That does not mean pores are not bothersome; it means they are a different axis from the impression of age.

In a survey by the same group of 1,351 women across five countries, the weights differed by ethnicity. In French women wrinkles and sagging were almost the whole story, whereas in Japan · India · South Africa pigmentation was an important secondary factor. Even the region of the face driving the perception of ageing differed — the upper face in China · Japan, the lower face in South Africa. This is why Western data should not simply be transposed.

If we cited only the data above, this article would read much more smoothly. We are not going to write it that way.

There is an experiment carried out in the United Kingdom. Frontal photographs of 50 women (aged 40–74) were digitally manipulated into four conditions, and 200 raters estimated the ages.

This result gives an overwhelming margin to wrinkles. 10.84 years against 1.05 years is roughly a tenfold difference.

So the sentence “elasticity matters more than wrinkles” is supported by no data at all. In the Korean data they were level, and in the British experiment wrinkles were far larger. We had intended to title this article ‘elasticity over wrinkles’ and changed it.

How to read the two results together

They are not contradictory; they measured different things.

The British experiment erased the surface of a photograph. ‘Sagging’ was therefore not among the things manipulated. What was compared was topography against colour, not wrinkles against sagging.

The Korean study graded signs on real faces. Sagging therefore entered as an independent item, and the result was that it came out level with wrinkles.

Reading the two together gives this — treating pigmentation alone changes the impression of age very little; wrinkles and sagging each account for a large share; and which of those two dominates has not been established.

A 2024 study in which 126 female raters assessed photographs of 400 Chinese women (aged 20–40) split the analysis into two age bands.

That last sentence is interesting. What people say is important and what they actually use to judge were different. Emphasising “elasticity” to someone in their twenties does not fit this data.

So what to address differs by age. Recommending lifting first to someone in their twenties, or working only on tone for someone in their fifties, is a sequence at odds with the data.

‘Elasticity’ is not a feeling; it is measured with an instrument. The skin is drawn up by negative pressure and released, and how far it returns is measured. A 2019 study that measured the cheeks of 129 East Asian women (aged 15–77) produced a table of values by age band.

Do not pass over that last sentence. At the same site, in the same people, some parameters fell markedly while others had nothing to do with age. It means “elasticity falls” does not reduce to a single value.

So we do not convert anything into “your skin age is such-and-such”. Cutometer values change with probe aperture · negative pressure · site · room humidity, so absolute comparison between institutions is not possible. The table above is a reference range, not a diagnostic standard.

Many people understand ‘losing elasticity’ as ‘becoming soft’. The measured data points the other way.

• The complex elastic modulus of aged skin was 43% higher than in the youngest group (10.7 kPa against 7.2 kPa). That is, it becomes stiffer.
• The density of elastin fibres actually increases with age. This is the accumulation of elastotic fibres altered by photoageing. The simple statement that “elastin decreases” is inaccurate.

So the accurate phrasing is not “elasticity is lost” but “the ability to return after being stretched declines”. That is exactly what R7 in the table above measures, and it is why R7 falls most steeply.

A 2025 study that measured the periorbital area of 65 Korean women layer by layer shows a slightly different picture — wrinkles correlated with elasticity of the dermis (3 mm), while sagging correlated with hydration of the epidermis (0.5 mm). The sample is small and the correlation coefficients are in the 0.3 range, so no strong conclusion can be drawn, but it suggests the possibility that wrinkles and sagging are problems of different layers.

This sentence is everywhere. We traced the original source.

The original does exist. It is a study published in a British dermatology journal in 1975, covering 72 men and 76 women (aged 15–93). Later reviews summarised it as “a linear decline of about 1% per year throughout adult life”.

But two things differ from the usual citation.

Other figures we could verify do exist. In skin from people over 80, collagen synthesis was about 68–75% lower than at 18–29, and collagen bundle density fell from 81% in young tissue to 58% in aged tissue.

This is why we rarely use a sentence like ‘1% a year’ in clinic material. It is less that it is wrong than that it has been carried across with its conditions changed. We think that if you are going to use a number, you should also write down where and how that number came about.

Clinics do not talk about this part much, because it is not territory that treatments address. Still, there is real data, so we are writing it down.

1.69 years from dyeing and 1.3 years from adjusting contrast look like small numbers, but you should read them alongside the fact that they carry almost no cost and no risk.

And there is data pointing the other way as well. In a study with blinded assessment of before and after facelift surgery (60 patients), the overall gain was about 7.2 years, but the group who had the lift alone showed the smallest effect and the group who also had periorbital procedures the largest. Reversing sagging alone did not change the impression of age as much as one might think.

Taking the data above together, what we do in consultations comes out like this.

• We look at three things separately — whether the problem is wrinkles · texture, whether it is sagging, or whether it is unevenness of tone. In the Korean data the weights of these three were 37 · 37 · 26, so addressing only one leaves the rest exactly as they were.
• We look at age alongside it — what was significant in the twenties was tone and pigmentation, and wrinkles became significant from the late thirties. There is a sequence.
• We set pores aside — they are a genuine concern, but they had no significant association with perceived age. If you have come in with the concern of ‘looking old’, the priorities are different.
• We do not give expectations as numbers — there is no basis for saying “you will look this many years younger”. In blinded assessment, surgery gave 7.2 years, and non-surgical treatments are smaller than that.

This is why Miso Clinic keeps six boosters of differing composition and three lifting devices together. 37 · 37 · 26 cannot be covered by a single tool.

The conclusion of this article is not “elasticity matters more”. It is “treating wrinkles alone addresses half”. What that other half consists of differs from face to face, and that is why the work of separating it out in consultation is necessary.

Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.