We compared age-related changes in wrinkles in eight areas of facial skin (forehead, glabella, upper eyelid, corner of the eye, lower eyelid, nasolabial groove, cheek, and corner of the mouth) and sagging in the subzygomatic area of Caucasian females and of Japanese females. The subjects studied included 85 healthy Caucasian females (ages 20-69 years) living in Cincinnati in the U.S. and 70 Japanese females (ages 20-69 years) living in Tokyo. Photos of the face in frontal and in oblique 45 degrees views were analyzed. Wrinkles in the face and sagging in the subzygomatic area were graded on Japanese photoscales, respectively, by the same experienced observer. The wrinkle score increased with age in all eight areas of the face examined in Caucasian females as well as in Japanese females. In the group aged 20-29 years, the wrinkle score in each area was significantly higher in Caucasian females than in Japanese females. The wrinkle scores in the forehead, glabella, upper eyelid, and corner of the eye were similar at advanced ages between the two groups, while the wrinkle scores in lower areas of the face (lower eyelid, nasolabial groove, cheek, and corner of the mouth) were markedly higher in Caucasian females than in Japanese females in each age group, and reached an upper limit at advanced ages in Caucasian females. The sagging score also increased with age in Caucasian females as well as in Japanese females. The sagging score was significantly higher in Caucasian females than in Japanese females in the groups aged 40 years or more. These results suggest more marked wrinkle formation in all areas of the face in younger age groups of Caucasian females living in North America than in Japanese females living in Tokyo. In particular, Caucasian females showed marked age-related wrinkle formation in the lower areas of the face, probably due to sagging in the subzygomatic area, which suggests a higher susceptibility to sagging in the subzygomatic area of Caucasian females.