Influence of skin ageing features on Chinese women's perception of facial age and attractiveness

Effects of under-eye skin and crow's feet on perceived facial appearance in women of five ethnic groups

OBJECTIVE

Age-related skin changes in the periorbital region caused by intrinsic (e.g. atrophy of collagen and fat) and extrinsic (e.g. sun exposure) factors, including skin wrinkling, hyperpigmentation, dark circles and lateral canthal lines ('crow's feet'), are a concern for women. We investigated the impact of under-eye skin and crow's feet on perceptions of women's faces in different ethnic groups.

METHODS

Facial images of women (n = 180) from five ethnic groups were rated for age, health and attractiveness by naïve assessors of the same ethnic group (n = 120). Digital image analysis was used to quantify visible skin characteristics in two facial regions, that is, under the eyes (colour, gloss, tone evenness and wrinkles) and in the crow's feet region (wrinkles only). Skin image measurements were used to predict face ratings in the full sample and separately by ethnicity.

RESULTS

Ethnic differences were detected for measurements of skin colour, gloss, tone evenness and wrinkles - the latter under the eyes and in the crow's feet region. Correlational and regression analysis indicated a major role of wrinkles (both regions) in predicting rated age, health and attractiveness from the facial portraits across ethnic groups, with some variation in the types or the predictive magnitude of skin characteristics.

CONCLUSION

The predictive utility of under-eye wrinkles and crow's feet for rated age, health and attractiveness correspond to women's reported concern with under-eye bags, dark circles and crow's feet. Despite some ethnic differences in these features, their impact on women's facial appearance ratings is similar across ethnic groups.

Periocular Aging Across Populations and Esthetic Considerations: A Narrative Review

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment.

The Characteristics and Inheriting Pattern of Skin Aging in Chinese Women: An Intergenerational Study of Mothers and Daughters

Introduction

The aging of the skin, which is affected by both external and internal causes, can reflect the external age and the internal health status. While the aging characteristics differ across ethnic groups, the specific changes in skin aging within the Chinese population have been underexplored. Moreover, investigating the similarity of aging skin characteristics between parent-offspring pairs remains uncharted territory. This study aims to fill these gaps by examining the skin aging features of Chinese women and assessing the similarity in aging skin characteristics between mother-daughter pairs.

Methods

A total of 40 mother-daughter pairs were recruited and analyzed. The perceived ages of the participants were evaluated, and their aging skin traits were systematically graded. Statistical methods were employed to discern the trends of the aging skin characteristics. By introducing a novel similarity parameter, we compared whether various skin aging characteristics have similar patterns between mothers and daughters.

Results

Our findings indicate that age 50 represents a pivotal point in skin aging. Beyond this age, the increase in rhytides and laxity scores accelerated noticeably, whereas the escalation in dyschromia scores became less marked. By introducing similar parameters between mother-daughter pairs and the radar map, we discovered that the skin aging characteristics are remarkably consistent between mother-daughter pairs.

Conclusion

Understanding the main aging skin characteristics of different age groups can allow caregivers to devise treatments for preventing skin aging in women of various ages. The mother's skin aging trend is also significant for the daughter's skin aging prevention.

Facial Skin Aging Characteristics of the Old-Perceived Age in a 20-40 Years Old Chinese Female Population

Purpose

In the quest for a youthful appearance, women use a variety of anti- aging cosmetics. Defining skin problems is especially important for the selection of anti-aging solutions. However, the skin problems faced by Chinese women at different ages are different. This study aimed at Chinese women aged 20-40 years old and analyzed facial skin aging characteristics of those with old-perceived age.

Patients and Methods

The total of 400 standard facial photographs from Chinese female volunteers aged 20-40 was assessed by another 126 Chinese women. The facial areas and skin aging characteristics that influenced age estimation were collected at the same time. Skin aging characteristics, including wrinkles, skin tone, pigmentation and pores, were analyzed based on facial photographs. Groupings were made based on deviation of perceived age from chronological age, and skin aging characteristics among groups were compared.

Results

The perceived age of Chinese women aged 20-40 has a moderate correlation with chronological age. Women aged 20-30 generally had an old-perceived age. Deep skin tone was a prominent problem in this age group, with those who had the older-perceived age observed the darker and redder skin tone. Women aged 31-40 were perceived partly old but appeared with wrinkle aggravation, as well as deepening of redness, enlarged pores, and increased pigmentation at the mid-face. The perceived older women also had more visible frown lines and darker skin tone at the upper face.

Conclusion

The perceived age of Chinese women aged 20-40 tends to deviate from their chronological age. Women aged 20-30 with old-perceived age are associated with deep skin tone, even found darker and redder in older-perceived women group, while women aged 31-40 are associated with wrinkles and deterioration at mid-face area and upper-face problems drive more attention in older-perceived women group.

Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations

BACKGROUND

In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders.

METHODS

An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure.

RESULTS

A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun.

CONCLUSIONS

Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.

Predictors of female age, health and attractiveness perception from skin feature analysis of digital portraits in five ethnic groups

OBJECTIVE

Research indicates the impact of skin colour, tone evenness and surface topography on ratings of age, health and attractiveness in women. In addition to subjective assessments, these effects have been quantified with objective measures derived from skin image analysis. Signs of skin ageing may manifest differently across ethnic groups. However, comparisons have been limited to research with two ethnic groups, preventing conclusions about an ethnicity-specific ranking of skin ageing signs.

METHODS

We report results from a multi-ethnic and multi-centre study in which faces of women (n = 180; aged 20-69 years) from five ethnic groups were imaged. Facial images were rated for age, health and attractiveness by members of the same ethnic group (each n = 120). Digital image analysis was used to quantify skin colour, gloss, tone evenness and wrinkling/sagging. We assessed associations between face ratings and skin image measurements in the total sample (i.e. all ethnic groups) and separately by ethnicity.

RESULTS

Skin image analysis revealed differences between ethnic groups, including skin colour, gloss, tone evenness, wrinkling and sagging. Differences in the relative predictive utility of individual skin features in accounting for ratings of age, health and attractiveness also were observed between ethnic groups. Facial wrinkling and sagging were the best predictors of face ratings in each ethnic group, with some differences in the type (or predictive magnitude) of skin features.

CONCLUSION

The current findings corroborate previous reports of differences between ethnic groups in female facial skin and indicate differential effects of skin features on ratings of age, health and attractiveness, within and between ethnic groups. Facial wrinkling and sagging were the best predictors of age and attractiveness ratings, and skin tone evenness and gloss had an additional role in ratings of health.

Commentary: Facial Aesthetic Dermatological Procedures and Photoprotection in Chinese Populations

The medical literature on aesthetic dermatology has primarily focused on a light-skinned patient population, yet patients of darker skin types have different needs and priorities. In Chinese individuals, key concerns include altered pigmentation, which is perceived to age the individual, and also relates to the Chinese cultural standard of beauty of fair skin; many seek aesthetic treatment for this. Non-invasive cosmetic procedures such as lasers and injections are also gaining in popularity in the Chinese market, but this population is prone to hyperpigmentation as an adverse effect of such procedures. Considered and tailored approaches, both to primary concerns of photoaging and the side effects of cosmetic treatments, are warranted.

Your face looks the same as before, only prettier: The facial skin homogeneity effects on face change detection and facial attractiveness perception

Previous studies suggested that (1) facial attractiveness perception can be increased with facial skin homogeneity improving; and (2) human's facial change detection increases along with facial skin homogeneity increases. However, it's unknown whether a face can be perceived prettier than it did before while still being considered as physically the same. It is possible that these two kinds of cognitive-aesthetic processing may have separate mathematical functions in psychophysical studies. In other words, human's facial attractiveness differentiation may be more sensitive than facial change detection. In this current study, we explored the above questions. Using three types of psychophysical techniques to manipulate facial skin homogeneity, we measured how participants' sensitivity to facial skin homogeneity and attractiveness change. Results showed a linear function curve for facial physical change detection and a logarithmic function curve was drawn in the forced-choice technique, which was the most sensitive one, indicating that participants can judge a face prettier than before without being aware of it has physically changed. Besides, two linear function curves were shown in the same/different technique and a rating technique. Taken together, this current study revealed that facial attractiveness can be enhanced and discriminated by improving facial skin homogeneity, without being realized by people with conscious awareness that the face has been changed.

A systematic review of skin ageing genes: gene pleiotropy and genes on the chromosomal band 16q24.3 may drive skin ageing

Skin ageing is the result of intrinsic genetic and extrinsic lifestyle factors. However, there is no consensus on skin ageing phenotypes and ways to quantify them. In this systematic review, we first carefully identified 56 skin ageing phenotypes from multiple literature sources and sought the best photo-numeric grading scales to evaluate them. Next, we conducted a systematic review on all 44 Genome-wide Association Studies (GWAS) on skin ageing published to date and identified genetic risk factors (2349 SNPs and 366 genes) associated with skin ageing. We identified 19 promising SNPs found to be significantly (p-Value < 1E-05) associated with skin ageing phenotypes in two or more independent studies. Here we show, using enrichment analyses strategies and gene expression data, that (1) pleiotropy is a recurring theme among skin ageing genes, (2) SNPs associated with skin ageing phenotypes are mostly located in a small handful of 44 pleiotropic and hub genes (mostly on the chromosome band 16q24.3) and 32 skin colour genes. Since numerous genes on the chromosome band 16q24.3 and skin colour genes show pleiotropy, we propose that (1) genes traditionally identified to contribute to skin colour have more than just skin pigmentation roles, and (2) further progress towards understand the development of skin pigmentation requires understanding the contributions of genes on the chromosomal band 16q24.3. We anticipate our systematic review to serve as a hub to locate primary literature sources pertaining to the genetics of skin ageing and to be a starting point for more sophisticated work examining pleiotropic genes, hub genes, and skin ageing phenotypes.

Analysis of Multi-Part Phenotypic Changes in Skin to Characterize the Trajectory of Skin Aging in Chinese Women

Purpose

As the human body’s largest organ exposed to the external environment, the skin suffers from internal and external aging factors, leading to wrinkles, loss of elasticity, sagging, and rough appearance. However, little is known of the characteristics of skin aging of different body parts in Chinese women. Here, we study the signs of extrinsic skin aging in different body parts to identify the knowledge map of manifestations of aging in Chinese women.

Patients and Methods

Wrinkle and texture phenotypes and collagen samples from the face, neck, hands, and arms of 326 Chinese women were collected. The correlations between phenotypes and ages and the differences in phenotypes by age were evaluated.

Results

The wrinkle and texture phenotypes around the eyes and mouth and of the hands were strongly correlated with age. Ages 32 and 58 showed the largest number of differentially changed aging phenotypes. The number of aging phenotypes increased sharply between the ages of 24 and 30, suggesting that the skin was undergoing rapid aging. Eye aging was the most rapidly changing phenotype between 19 and 30 years old. Wrinkles at the corner of the eyes showed a significant difference in the older group, suggesting an early onset and long-term effects.

Conclusion

This is the first study to be performed on the characteristics of skin aging among Chinese women that takes account of multiple areas of the body. It was found that 24 years old was the time point at which the skin begins to age in Chinese women. This provides important clues for aging-related research and personalized skin care.

Spreading of Dangerous Skin-Lightening Products as a Result of Colourism: A Review

The use of bleaching products can have a medical or cosmetic purpose; in the latter case, skin whitening is most widespread in countries where darker skin tones prevail and can be driven by psychosocial, cultural and economic reasons. Skin-whitening products containing highly toxic active ingredients (in particular mercury derivatives, hydroquinone and corticosteroids) are easily found on the market; the use of these depigmenting agents can be followed by a variety of adverse effects, with very serious and sometimes fatal complications, and is currently an emerging health concern in many countries. This article concisely discusses the reasons for the current prevalence of skin lightening products and provides an overview of the skin lightening agents that pose a threat to human health. The review also reports market surveillance data on the circulation of banned skin lighteners in Europe, obtained through the Safety Gate system.

Are estimates of faces' ages less accurate when they wear sunglasses or face masks and do these disguises make it harder to later recognise the faces when undisguised?

This study examined whether our ability to accurately estimate unfamiliar faces' ages declines when they are wearing sunglasses or surgical-style face masks and whether these disguises make it harder to later recognise those faces when undisguised. In theory, both disguises should harm age estimation accuracy and later face recognition as they occlude facial information that is used to determine a face's age and identity. To establish whether this is the case, we had participants estimate the age of unfamiliar faces that were pictured wearing no disguises, sunglasses, or face masks. The participants then completed a face recognition test where they had to distinguish between the previously seen faces and new faces. Importantly, none of faces wore disguises in this latter test. Participants' estimates of the undisguised faces' ages were inaccurate by a Median of 5.15 years. Their accuracy barely changed when the faces wore sunglasses but declined by a Median of 1.30 years when they wore face masks. Moreover, subsequent undisguised face recognition was less likely to occur when the faces previously wore sunglasses or face masks, with large effects observed. These findings demonstrate the relative importance of different facial areas when estimating faces' ages and later recognising them. They also have implications for policing as they suggest it may be harder for eyewitnesses to accurately estimate the age of criminals who wear face masks during offences, and it may be harder for them to later recognise criminals in line-ups if the criminals wear sunglasses or face masks during offences.

Evaluation of facial skin age based on biophysical properties in vivo

OBJECTIVE

The evaluation of skin age, reflecting overall facial characteristics, has not been established. Previous studies focused on visual assessment or individual-specific feature such as wrinkles or skin color. We studied the evaluation model of skin age index (SAI) including the overall aging features including wrinkles, skin color, pigmentation, elasticity, and hydration.

METHODS

Total 300 healthy women aged between 20 and 69 years included in this study. Pearson correlation analysis performed to identify the key factors among the biophysical properties with aging and developed the prediction model of SAI. Statistical regression analysis and machine learning technique applied to build the prediction model using the coefficient of determination (R² ) and root mean square error (RMSE). Validation study of the SAI model performed on 24 women for 6 weeks application with anti-aging product.

RESULTS

Prediction model of SAI consisted of skin elasticity, wrinkles, skin color (brightness, Pigmented spot, and Uv spot), and hydration, which are major features for aging. The cforest model to assess a SAI using machine learning identified the highest R² and lowest RMSE compared to other models, such as svmRadial, gaussprRadial, blackboost, rpart, and statistical regression formula. The cforest prediction model confirmed a significant decrease of predicted SAI after 6 weeks of application of anti-aging product.

CONCLUSION

We developed a prediction model to evaluate a SAI using machine learning, and led to accurate predicted age for overall clinical aging. This model can a good standard index for evaluating facial skin aging and anti-aging products.

Targeting microRNA for improved skin health

BACKGROUND

In human skin, miRNAs have important regulatory roles and are involved in the development, morphogenesis, and maintenance by influencing cell proliferation, differentiation, immune regulation, and wound healing. MiRNAs have been investigated for many years in various skin disorders such as atopic dermatitis, psoriasis, as well as malignant tumors. Only during recent times, cosmeceutical use of molecules/natural active ingredients to regulate miRNA expression for significant advances in skin health/care product development was recognized.

AIM

To review miRNAs with the potential to maintain and boost skin health and avoid premature aging by improving barrier function, preventing photoaging, hyperpigmentation, and chronological aging/senescence.

METHODS

Most of the cited articles were found through literature search on PubMed. The main search criteria was a keyword "skin" in combination with the following words: miRNA, photoaging, UV, barrier, aging, exposome, acne, wound healing, pigmentation, pollution, and senescence. Most of the articles reviewed for relevancy were published during the past 10 years.

RESULTS

All results are summarized in Figure 1, and they are based on cited references.

CONCLUSIONS

Thus, regulating miRNAs expression is a promising approach for novel therapy not only for targeting skin diseases but also for cosmeceutical interventions aiming to boost skin health.

Evaluating the respective weights of some facial signs on the perceived radiance/glow in differently aged women of six countries

OBJECTIVES

To evaluate the impact of Facial radiance or Glow on the perception of age (PA) and to assess which facial signs most influence PA.

MATERIAL AND METHODS

The faces of 1058 differently aged women (18-80 years) of six different ethnicities/countries (China, Japan, Korea, India, South Africa, and Brazil) were photographed under standard conditions. These allowed to focus on 20 different facial signs that were further graded by experts, using referential Atlases dedicated to facial aging. In each of the six countries, 100 local women were recruited as naïve panels to express their perceptions on Glow and Age on each full-face photograph (blind coded) of the local studied woman.

RESULTS

A decreased Glow/Radiance appears clearly associated with an increased perceived age in all studied subjects, especially among Chinese, Japanese, and South African women. With regard facial signs, Skin texture (Wrinkles of all kinds), Ptosis/Sagging, and Pigmentation signs prevail in almost all women at the exception of South African women where Pigmentation signs and Cheek skin pores largely predominate in the perception of both Glow and PA. Pigmentation signs are of a very high weight among Chinese and Japanese women.

CONCLUSION

Despite some collective agreements, the present study shows some specificities within the women of the six ethnicities/countries. PA, a core index of antiaging strategies, goes along with facial Glow in almost all studied women. The duller the facial skin, the older it is perceived.

[Pre- and post-interventional skin care for laser and peel treatments]

Treating the signs of skin ageing or acne scars by chemical peels or ablative lasers is increasingly used worldwide. Due to their reduced invasiveness, these methods are often favored over aesthetic surgical interventions. Both procedures rely on the principle of controlled damage to the skin. The subsequent regeneration may lead to the development of new epidermal (and dermal) tissue and therefore improve the skin's aesthetic appearance. At present, there are no official guidelines in Germany concerning pre- and post-interventional skin care, which is currently based on the personal experiences and evaluations of the practitioner. It is known that an appropriate treatment regime can improve the outcome and reduces downtime pre- and post-laser as well as pre- and post-peel. The aim of this article is to present the different possibilities of pre- and post-interventional care. In most cases, priming includes intense ultraviolet (UV) protection, topical retinoids as well as skin brightening agents, and occasionally oral herpes simplex prophylaxis. In order to support post-interventional wound healing, skin care should modulate inflammation and balance skin hydration. In addition to light moisturizers, broad spectrum UV protection as well as the avoidance of sports and sweating are essential.

Changes in facial signs due to age and their respective weights on the perception of age and skin plumpness among differently aged Korean women

OBJECTIVE

To determine the respective weights of certain facial signs on the assessment of perceived age and plumpness on Korean women of different ages.

MATERIAL AND METHODS

Photographs were taken of the faces of 112 Korean women of different ages (18-80 years) under standardized conditions. These photographs allowed to focus and define 19 facial signs, which were then graded by 15 experts and dermatologists, using standardized scales provided by a reference Skin Aging Atlas. The facial signs were dispatched into 5 clusters, namely Wrinkles/Texture, Ptosis/Sagging, Pigmentation disorders, Vascular disorders, and Cheek skin pores. A naïve panel, composed of 92 Korean women, of similar age range were asked, when viewing full-face photographs, to: (a) attribute on a 0-10 scale their perception of the skin plumpness (ie supple/hydrated/nourished) and (b) estimate the age of the subject.

RESULTS

With the exception of Vascular disorders, the severity of all 4 clusters increased with age, although at different rates. The Wrinkles/Texture or Ptosis/Sagging showed a rather regular progression. Although perceived ages and real ages were found highly correlated, half of the subjects were judged older by 2-12 years. The facial signs/clusters were significantly correlated with perceived age, with the exceptions of vascular disorders, size of pigmentary spots and cheek skin pores. The weights in perceived ages of Wrinkles/Texture and Ptosis/Sagging represent 37% each and Pigmentation disorders at 26%. Skin plumpness was logically found significantly anti-correlated with perceived age. If, surprisingly, Vascular disorders were found not impacting the plumpness aspect, Cheek skin pores presented a clear influence.

CONCLUSION

Within facial clinical clusters, Wrinkles/Texture, Ptosis/Sagging, and Pigmentation disorders are major factors in the assessment of perceived age in Korean women. The perception of a decreased skin plumpness is significantly associated with increased perceived age.

Changes in facial signs due to age and their respective weights on the perception of age, on a tired-look or a healthy glow among differently aged Chinese men

OBJECTIVE

To determine the respective weights of certain facial signs on the assessment of perceived age, tired-look and healthy glow on Chinese men of different ages.

MATERIAL AND METHODS

Photographs were taken of the faces of 420 Chinese men of different ages, under standardized conditions. These photographs allowed to focus and define 15 facial signs, which were then graded by 15 experts and dermatologists, using standardized scales provided by a reference Skin Aging Atlas. The facial signs were dispatched into 5 clusters, namely wrinkles/texture, ptosis/sagging, pigmentation disorders, vascular disorders and cheek skin pores. A naïve panel, composed of 80 Chinese women, of similar age range were asked, when viewing full-face photographs, to: (i) attribute on a 0-10 scale their perception of both the tired-look and healthy glow aspects and (ii) estimate the age of the subject.

RESULTS

With the exception of vascular disorders, the severity of all 4 clusters increased with age, although at different rates. The ptosis/sagging or pigmentation disorders showed a rather regular progression. Although perceived ages and real ages were found to be closely correlated, the vast majority of subjects were judged older by 2-10 years. The changes in facial signs (and their related clusters) were significantly correlated with perceived age, with the exceptions of skin spot density and cheek skin pores. Although the aspects of tired-look and healthy glow were logically found to be anti-correlated, tired-look was more statistically associated with perceived age for the five clusters. Signs of eye contour appear to be closely correlated with the perception of a tired-look.

CONCLUSION

Within facial clinical clusters, wrinkles/texture and ptosis/sagging are major factors in the assessment of perceived age in Chinese men. Tired-look appears to be strongly associated with perceived age.

Evaluating the respective weights of some facial signs on perceived ages in differently aged women of five ethnic origins

BACKGROUND

New gratification assessments, after skincare routines or makeup products, could benefit from innovative methods that could predict the culturally based perceptions of age.

AIMS

To determine the facial signs that most influence the perception of age in women of five different ethnic ancestries, assessed by the same ethnical naïve panel.

PATIENTS/METHODS

The faces of 1351 women, differently aged (18-80 years), from five countries (China, France, India, Japan, and South Africa) were photographed under the same standardized conditions in the five countries. Fourteen to 24 facial signs (grouped under five clusters, ie, Wrinkles/Texture, Ptosis/Sagging, Pigmentation disorders, Vascular disorders, and Cheeks skin pores) were focused, and their respective severities were graded using referential Skin Aging Atlases by the same panel of 15 experts and dermatologists. Five naïve panels, all comprising 100 local women, allowed to collect the perceived age, assessed from blind-coded full-face photographs.

RESULTS

Although perceived ages and real ages were found highly correlated, their differences vary according to ethnicities, particularly among a large part of Indian and South African women, judged older by about 5 and 7 years, respectively. Results show that the clusters of Wrinkles/Texture and Ptosis/Sagging are predominant factors taken into account in almost all ethnicities, albeit at various extents, reaching almost 100% in French women. Pigmentation disorders appear important secondary factors in Japanese, South African, and Indian women. Vascular disorders, of a difficult grading in darker skin tones, were found of some impact in Japanese and Chinese women. Cheek skin pores were of minor or nil weight in the attribution of age, at the exception of South African women. Regarding facial areas which drive aging perception, it seems the upper-half face has prevalence for Chinese and Japanese women whereas the lower-half face has major importance for South African women.

CONCLUSION

Facial traits are differently perceived as signs of aging according to un-separable ethnic ancestries and cultural factors.

A new method for skin aging evaluation of Chinese women

BACKGROUND

With the development of cosmetic industry in China, an aging evaluation method of Chinese women is in great need.

AIMS

The aim of this study is to establish a skin aging assessment method using convenient portable machine Antera 3D.

METHODS

The quantitative approach was developed by capturing 11 areas of the face, and overall, 48 parameters were extracted for aging evaluation. Later, 297 subjects were recruited to take facial image and life style questionnaire. Evaluation of age was accomplished by establishing prediction method with detected skin traits.

RESULTS

The age prediction model was built by using the evaluated facial traits, and a R square of 0.6 is achieved by comparing to the chronological age. The crow's feet, cheek skin pigmentation, forehead skin tone, and wrinkles around the month are critical factors in evaluating Chinese women skin aging. In addition, we also explored life styles associated with important skin aging traits.

CONCLUSION

The method developed in this research provides reliable alternative in aging study of Chinese women.

Quantitative evaluation of rejuvenation treatment of nasolabial fold wrinkles by regression model and 3D photography

OBJECTIVE

With the application of 3D photography, our study aimed to quantify parameters of static nasolabial fold wrinkles and establish mathematic regression model between parameters of wrinkles and age, further to quantitatively evaluate the effect of rejuvenation treatment in terms of age.

METHODS

From October 2016 to May 2018, 433 Chinese female volunteers, aged 25-60 years old, were enrolled in this study. Antera 3D camera was used to collect four parameters of static nasolabial fold wrinkles on the left and right sides of the volunteers, including overall size, average depth (mm), average width (mm), and maximum depth (mm). For those presented a linear relationship with age, univariate linear regression fitting was performed, followed by residual analysis, goodness of fit test, and significance test.

RESULTS

The results of univariate linear regression fitting showed there was a clear linear relationship between the maximum depth, average depth, overall size of nasolabial fold wrinkles and age, and the regression equations were established. The significance test of regression coefficients showed P values were less than .0001.

CONCLUSIONS

With application of the regression model between parameters of nasolabial fold wrinkles and age, the effect of rejuvenation treatment can be quantitatively evaluated in terms of age, which has certain reference and promotion value.

Safety And Efficacy Of Princess® FILLER Lidocaine In The Correction Of Nasolabial Folds

Purpose

Nasolabial folds (NLFs) are one of the most noticeable signs of facial aging. NLFs negatively affect self-confidence and social acceptance often leading to a person’s desire to improve their appearance using dermal fillers. The hyaluronic acid injectable gel implant Princess^® FILLER Lidocaine (PFL) is a minimally invasive easy to administer the product. In this investigation, we assessed the safety and efficacy of PFL to correct moderate to severe NLFs over a 36-week period.

Methods

Adult women and men with moderate to severe NLFs received one injection of PFL to both NLFs. After 2 weeks, a touch-up treatment could be performed, if deemed necessary by the investigator. The change in NLF severity was assessed using the Nasolabial Fold Severity Rating Scale (NFL-SRS) developed by Croma-Pharma and the Global Aesthetic Improvement Scale (GAIS).

Results

Out of 60 analyzed subjects, 59 (98.3%) had improved their NLF severity by at least 1 grade on the NFL-SRS at week 4, 58 subjects (96.7%) at weeks 24 and 36. All subjects showed aesthetic improvement (GAIS), at weeks 4 and 24. The investigator judged the aesthetics as very much improved (score of 1) in 45 (75.0%) at week 4, 48 (80.0%) at week 24, and in 39 of 60 subjects, respectively (65.0%) at week 36. Thirty-six weeks post-initial treatment, 56 of 60 subjects (93.3%) were very satisfied or satisfied with the treatment. Adverse device effects (ADEs) were mild or moderate and resolved at latest 25 days post-onset. The most commonly reported ADEs were injection site hematoma and injection site pain.

Conclusion

PFL was safe and effective in reducing the severity of NLFs. Most subjects were (very) satisfied with the treatment outcome throughout a 36 weeks investigation period.

Aging in skin of color

Ethnic skin is quickly emerging as the norm in the United States, and as the population becomes more diverse, there is also a projected rise in the number of aging adults. Given the paucity of data regarding aging in ethnic skin, the authors have consolidated available information for this population. Literature examining structural and functional variation of aging in ethnic skin types was primarily found through PubMed and supplemental textbook chapters. Aging is comprised of two synergistic processes, intrinsic or chronologic aging, and extrinsic aging. Caucasian, African American, East Asian, and Hispanic skin each have distinguishing features of aging, but all populations share dyspigmentation, rhytides, and skin laxity. Increased melanin content predisposes skin of color to a greater degree of hyperpigmentation, but skin thickness may protect against the formation of rhytides. Tailored prevention and treatment are also paramount in attaining favorable outcomes for this growing cohort.

Appearance of aging signs in differently pigmented facial skin by a novel imaging system

Background

Facial wrinkles, pores, and uneven skin tone are major beauty concerns. There is differential manifestation of aging signs in different ethnic groups. In this regard, studies on Black Africans from the African continent are scarce.

Objective

To investigate facial wrinkles, pores, and skin tone in Black African women from Mauritius Island and elucidate the differences to Caucasian women from France.

Methods

Facial images were taken using the imaging system ColorFace^®. Wrinkles and pores were measured by their length, depth, surface, volume, and number; for skin tone, we measured L*a*b* and calculated ITA, IWA_Newtone, and color homogeneity.

Results

We found good correlations of wrinkle and pore scores with expert ranking done on ColorFace^® images for Caucasians (Spearman's rho = 0.78 and 0.72) and Black Africans (Spearman's rho = 0.86 and 0.65). Caucasians showed more advanced facial signs of aging than Black Africans. Exceptions were vertical lines on upper lip and the depth of pores which were greatest for the Black African subjects. Black Africans had higher heterogeneity scores indicative for uneven skin tone. Luminance (L*) was significantly higher in Caucasians but a* and b* values were significantly higher in the Black African subjects. ITA and IWA_Newtone were significantly higher for Caucasians.

Conclusions

The high correlation between expert ranking and wrinkle and pore measurements prove ColorFace^® a valid imaging system to study skin aging. Our results show that Africans from the African continent show delayed signs of aging compared to Caucasians. Some exceptions suggest that ethnic differences in facial aging are a complex phenomenon.

Association Between Facial Rejuvenation and Observer Ratings of Youth, Attractiveness, Success, and Health

IMPORTANCE

Surgical procedures for the aging face-including face-lift, blepharoplasty, and brow-lift-consistently rank among the most popular cosmetic services sought by patients. Although these surgical procedures are broadly classified as procedures that restore a youthful appearance, they may improve societal perceptions of attractiveness, success, and health, conferring an even larger social benefit than just restoring a youthful appearance to the face.

OBJECTIVES

To determine if face-lift and upper facial rejuvenation surgery improve observer ratings of age, attractiveness, success, and health and to quantify the effect of facial rejuvenation surgery on each individual domain.

DESIGN, SETTING, AND PARTICIPANTS

A randomized clinical experiment was performed from August 30 to September 18, 2016, using web-based surveys featuring photographs of patients before and after facial rejuvenation surgery. Observers were randomly shown independent images of the 12 patients; within a given survey, observers saw either the preoperative or postoperative photograph of each patient to reduce the possibility of priming. Observers evaluated patient age using a slider bar ranging from 30 to 80 years that could be moved up or down in 1-year increments, and they ranked perceived attractiveness, success, and health using a 100-point visual analog scale. The bar on the 100-point scale began at 50; moving the bar to the right corresponded to a more positive rating in these measures and moving the bar to the left, a more negative rating.

MAIN OUTCOMES AND MEASURES

A multivariate mixed-effects regression model was used to understand the effect of face-lift and upper facial rejuvenation surgery on observer perceptions while accounting for individual biases of the participants. Ordinal rank change was calculated to understand the clinical effect size of changes across the various domains after surgery.

RESULTS

A total of 504 participants (333 women, 165 men, and 6 unspecified; mean age, 29 [range, 18-70] years) successfully completed the survey. A multivariate mixed-effects regression model revealed a statistically significant change in age (-4.61 years; 95% CI, -4.97 to -4.25) and attractiveness (6.72; 95% CI, 5.96-7.47) following facial rejuvenation surgery. Observer-perceived success (3.85; 95% CI, 3.12-4.57) and health (7.65; 95% CI; 6.87-8.42) also increased significantly as a result of facial rejuvenation surgery.

CONCLUSIONS AND RELEVANCE

The data presented in this study demonstrate that patients are perceived as younger and more attractive by the casual observer after undergoing face-lift and upper facial rejuvenation surgery. These procedures also improved ratings of perceived success and health in our patient population. These findings suggest that facial rejuvenation surgery conveys an even larger societal benefit than merely restoring a youthful appearance to the face.

LEVEL OF EVIDENCE

NA.

Facial Contrast Is a Cross-Cultural Cue for Perceiving Age

Age is a fundamental social dimension and a youthful appearance is of importance for many individuals, perhaps because it is a relevant predictor of aspects of health, facial attractiveness and general well-being. We recently showed that facial contrast-the color and luminance difference between facial features and the surrounding skin-is age-related and a cue to age perception of Caucasian women. Specifically, aspects of facial contrast decrease with age in Caucasian women, and Caucasian female faces with higher contrast look younger (Porcheron et al., 2013). Here we investigated faces of other ethnic groups and raters of other cultures to see whether facial contrast is a cross-cultural youth-related attribute. Using large sets of full face color photographs of Chinese, Latin American and black South African women aged 20-80, we measured the luminance and color contrast between the facial features (the eyes, the lips, and the brows) and the surrounding skin. Most aspects of facial contrast that were previously found to decrease with age in Caucasian women were also found to decrease with age in the other ethnic groups. Though the overall pattern of changes with age was common to all women, there were also some differences between the groups. In a separate study, individual faces of the 4 ethnic groups were perceived younger by French and Chinese participants when the aspects of facial contrast that vary with age in the majority of faces were artificially increased, but older when they were artificially decreased. Altogether these findings indicate that facial contrast is a cross-cultural cue to youthfulness. Because cosmetics were shown to enhance facial contrast, this work provides some support for the notion that a universal function of cosmetics is to make female faces look younger.

Safety and Effectiveness of Juvéderm Ultra Plus Injectable Gel in Correcting Severe Nasolabial Folds in Chinese Subjects

Background:

Hyaluronic acid dermal fillers are effective in correcting severe nasolabial folds (NLFs) in non-Asian populations. We assessed safety and effectiveness of Juvéderm Ultra Plus in a Chinese population.

Methods:

This double-blind study randomized Chinese subjects with severe NLFs to Juvéderm Ultra Plus (24 mg/mL) in 1 NLF and Restylane injectable gel (20 mg/mL) in the other NLF. NLFs were evaluated using the validated 5-point photonumeric Allergan NLF Severity Scale (0 is “no wrinkle” and 4 is “very deep wrinkle”). Investigator-assessed responder rates (primary outcome at 6 months), NLF mean improvements, and subject-assessed responder rates and preference were assessed.

Results:

Of 124 subjects randomized, 122 completed the 6-month visit. NLFs treated with Juvéderm Ultra Plus required less volume than those treated with Restylane (median [range]: 0.80 [0.3–2.0] vs 1.00 [0.3–1.9]; P<0.001). Investigator-assessed responder rates were 90.4% for Juvéderm Ultra Plus and 89.6% for Restylane, establishing noninferiority of Juvéderm Ultra Plus. Mean (SD) improvements in NLF Severity Scale scores from baseline at 6 months were 1.5 (0.75) for Juvéderm Ultra Plus and 1.6 (0.73) for Restylane. Subject-assessed responder rates were similar to investigator-assessed rates (87.3%, Juvéderm Ultra Plus; 83.9%, Restylane). Of subjects reporting a preference, 62.1% preferred Juvéderm Ultra Plus. The most common treatment site responses were swelling and tenderness; most were mild or moderate in severity and resolved without intervention. Juvéderm Ultra Plus had fewer severe treatment site responses than Restylane.

Conclusion:

In this study in Chinese subjects, Juvéderm Ultra Plus was safe and effective for correcting severe NLFs.