“My friends tell me I'm growing old, but only on one side” was the complaint of a sixty-two-year-old woman. And her friends were so right. This woman, in her sixties, had the aged wrinkled appearance of a woman in her eighties, but only on the right side of her face, the right side of her neck, and her right hand. She had not always looked that way. Over the past year she had noticed the one-sided wrinkles appearing asymptomatically and insidiously. There had been no prior redness, swelling, or pain nor had she had any episodes of toothache, sinusitis, or parotitis (inflammation of the parotid gland), or any other infections. She had never had any trauma to the area, radiation therapy, or unusual ultraviolet light exposure to her skin (in or out of automobiles). She had never had any skin disease. There was no family history of premature aging or wrinkling of the skin. Her health had been excellent.

On close examination the affected skin, especially over her right cheek, was thin and loose, hanging in numerous deep wrinkles. The underlying fat layer felt reduced in thickness. The skin of the left side had the normal appearance for a person her age and was essentially without wrinkles. Neither side showed the aging spots or keratoses of sun damage. The skin on her right wrist and hand also had an aged wrinkled appearance. The covered parts of her body did not show any wrinkling.