Dear Dr. Z

I had the pleasure of seeing L. in the office for consultation and evaluation of her upper and lower lids as well as fine wrinkle lines. This forty-three year old white woman is noted to have her brows in good position. Upper lids show 1+ skin centrally and temporally with no residual skin nasally, no redundant fat or herniated orbital fat in her bilateral upper lids. Her upper lids marginal reflex distance is three millimeters bilaterally with good levator function and good closure. Her lower lids show 1+ skin for the horizontal extent of the bilateral lower lids and trace fat medially on her bilateral lower lids with no fat temporally or centrally. In the way of wrinkle lines she has some fine wrinkling in the bilateral upper lids, which is just the texture of the skin. No true formed lines.

Lateral canthal region shows some very mild wrinkle lines and there are a few formed deep wrinkles in the bilateral lower lids. Her cheeks show some texture irregularities, however there are no formed wrinkles in her cheek area. Along the angles of the mouth there are a few fine wrinkles as well as a few formed deeper groves.

I initially saw L. on October 28, 1994. She had previously been using the Rejuvé wrinkle reducing mask, however had discontinued its use for one months time before my initial visit. The wrinkling present was mainly observed and evaluated in the lateral canthal region just slightly superior to the lateral canthal angle showing her to have one large fold in the superior lateral right upper lid and two folds in the superior lateral left upper lid. She has two large obliquely oriented folds in the right lower lid extending from the punctum inferotemporally as well as one large fold beginning inferior to the punctum and extending inferotemporally on the left. She does have some fine wrinkling in this area as well.

I have chosen these areas because they were the most obvious to see and easiest to follow. She was told to use the mask nightly and to follow up in one months time to re-evaluate her progress.