Comparison of age-related changes in facial wrinkles and sagging in the skin of Japanese, Chinese and Thai women

A new Chinese crow's feet grading scale based on the DermaTOP system

Many Chinese wrinkle studies continue to use non-Chinese scales because few Chinese-based wrinkle scales have been developed. The study aims to develop a crow's feet grading scale for Chinese individuals. We enrolled 608 healthy Chinese subjects and measured data through the DermaTOP system. We chose exploratory factor analysis (EFA) to reduce the dimensions of the data. A three-factor structure was obtained by using EFA, and it explained a cumulative total of 89.551% of the variance. A computational formula was obtained by calculating the total factor tilt scores and taking the variance contribution rate of three factors as the weight. Based on the computational formula, a grading map was designed and tested. The model validation was conducted using both subjective assessments from the expert panel and objective results from the model calculations. The results showed that our grading scale model is stable. This study developed a Chinese crow's feet (CCF) grading scale, which included a parameter, a grading map, and literal descriptions. The CCF grading scale is a validated tool for evaluating the effects of cosmetics or specific therapies. More importantly, the CCF scale was developed based on objective data, which may inspire new ideas for wrinkle grading scale development in the future.

Comparative analysis of original face and skin-warped average face images for the scoring of skin attributes

OBJECTIVES

Representative of a panel, an average face image could be used to analyse/display skin changes while alleviating image rights constraints. Therefore, we used landmark-based deformation (warping) of individual skin images onto their panel's average face, evaluating this approach's relevance and possible limits.

METHODS

An average front face image was constructed from images of 71 Japanese women (50-60 years old). After warping individual skin images onto this average face, the resulting skin-warped average faces were presented to three experts who graded: forehead wrinkles, nasolabial fold, wrinkle of the corner of the lips, pore visibility and skin pigmentation homogeneity. Two experts estimated subjects' age. Results were compared to gradings performed on original images.

RESULTS

Inter-expert grading shows excellent to good correlation whatever image type: from 0.918 (forehead wrinkles) to 0.693 (visibility of pores). Correlations between scoring of both image types are almost always higher than inter-expert correlations (maximum: 0.939 for forehead wrinkles-minimum: 0.677 for pore visibility). Frequencies of grades/ages are similar when scoring original and skin-warped average face images. Experts scores are similar in 90.6%-99.3% of the cases. Average deviations upon scoring both image types are smaller than average inter-expert deviations on original images.

CONCLUSIONS

Scoring facial characteristics in original images and skin-warped average face images show an excellent agreement, even for perceived age, a complex feature. This opens the possibility of using this approach to grade facial skin features, monitor changes over time, and to valorise results on a face deprived of image rights.

Establishment and validation of visual assessment for the severity of lacrimal groove wrinkles in Chinese females

OBJECTIVE

This study was undertaken to establish and validate a new wrinkle clinical assessment scale to measure Chinese Han women`s validated lacrimal groove.

METHODS

Three clinical investigators asked to rate lacrimal groove wrinkles severity one each side for 30 photographic images from 15 subjects. Five-grade rating scale has been used in this clinical assessment. Scale definitions was standardized by 6 researchers in visual and descriptive formats. Assessments were conducted independently and were repeated after 1 week.

RESULTS

For 30 photos from 15 subjects, test-retest of three investigators analyzed by Spearman's correlation were between 0.967 and 0.993 (p < 0.001), and by ICC Cronbach's α were between 0.989 and 0.997 (p < 0.001); intraobserver agreement of three investigators analyzed by Spearman's correlation were between 0.652 and 0.897 (p < 0.001), and by ICC Cronbach's α were between 0.840 and 0.959 (p < 0.001).

CONCLUSION

This lacrimal groove wrinkles visual assessment scale is a valid and reliable instrument for quantitative assessment of China woman skin folds with inter- and intraobserver consistency. This assessment scale should prove a useful clinical tool by allowing objective and reproducible grading for assessing the effectiveness of lacrimal groove area.

Transcriptomic Analysis of Human Keratinocytes Treated with Galactomyces Ferment Filtrate, a Beneficial Cosmetic Ingredient

Galactomyces ferment filtrate (GFF, Pitera™) is a cosmetic ingredient known to have multiple skin care benefits, such as reducing redness and pore size via the topical application of its moisturizer form. Although GFF is known to act partly as an antioxidative agonist for the aryl hydrocarbon receptor (AHR), its significance in keratinocyte biology is not fully understood. In this study, we conducted a transcriptomic analysis of GFF-treated human keratinocytes. Three different lots of GFF consistently modulated 99 (22 upregulated and 77 downregulated) genes, including upregulating cytochrome P450 1A1 (CYP1A1), a specific downstream gene for AHR activation. GFF also enhanced the expression of epidermal differentiation/barrier-related genes, such as small proline-rich proteins 1A and 1B (SPRR1A and SPRR1B), as well as wound healing-related genes such as serpin B2 (SERPINB2). Genes encoding components of tight junctions claudin-1 (CLDN1) and claudin-4 (CLDN4) were also target genes upregulated in the GFF-treated keratinocytes. In contrast, the three lots of GFF consistently downregulated the expression of inflammation-related genes such as chemokine (C-X-C motif) ligand 14 (CXCL14) and interleukin-6 receptor (IL6R). These results highlight the beneficial properties of GFF in maintaining keratinocyte homeostasis.

Facial skin characteristics and concerns in Indonesia: A cross-sectional observational study

BACKGROUND

Facial skin characteristics and appearance vary according to ethnicity. While much of this knowledge is derived from the Caucasian population, lately there have been efforts to gain such understanding in various regions in Asia.  In this paper, we have built an understanding of such features in Indonesia. In Indonesia, a section of females wears a traditional veil (hijab) to cover the scalp and part of face. The influence of the hijab on facial skin attributes was also investigated.

METHODS

In a cross-sectional observational study design involving 419 female volunteers in Jakarta, Indonesia, facial skin attributes (colour, radiance, hydration, trans-epidermal water loss [TEWL], wrinkles, fine lines, pores, and sebum levels) and conditions (melasma, post-inflammatory hyperpigmentation (PIH), solar lentigines/ senile lentigines, seborrheic keratoses and acne) were assessed by trained operators and dermatologists using standard validated instruments and scales.

RESULTS

With age, facial skin colour showed darkening in cheek; forehead on the other hand showed slight lightening. The skin evenness and radiance decreased, substantially. Aging attributes measured in terms of lines, wrinkles, and under-eye dark circles showed deterioration with age; the decline was progressively faster than colour change. Facial image data analysis corroborated these findings. Skin hydration remained similar across the age groups even though the skin barrier function measured in terms of TEWL improved with age. Sebum levels in the skin were similar up to the age of 50 but declined in the next group of 50-60 year. Pore severity increased with age. Melasma, seborrheic keratosis and PIH showed a high prevalence (>∼50%) at the young age group (20-30 years), itself. Melasma prevalence attained 100% in the age group of 41-50 year and onwards, and its severity similarly showed a steady rise with age. PIH on the other hand showed a steady decline with age. Solar lentigines prevalence (∼30%) did not change much across age groups, and the severity scores were similar in age groups up to 50 year but increased substantially in 51-60-year age groups. Seborrheic keratosis was similar (∼47%) in age groups up 20-40 year but steadily increased in upper age groups. Its severity was similar in the age groups of 20-30 year and 31-40 year but showed a two-fold increase in subsequent age groups. Acne was 10% in the age group of 20-30 year and declined gradually to 0.7% in the 51-60-year age group. Hijab wearers showed slight protection in skin colour darkening and improvement of evenness and radiance but were similar on aging (fine lines and wrinkles on crow's feet, under eye and peri-oral areas) markers to non-wearers. In general, in majority of age-groups, hijab wearers showed a higher prevalence of melasma, solar/senile lentigines, seborrheic keratosis and PIH.

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.

Target-Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology

Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian-specific strategies that correct underlying structural deficiencies and cumulative age-related changes. The presented Target-Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians. A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment. With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling. Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption-induced volume loss.

Daily Fluctuation of Facial Pore Area, Roughness and Redness among Young Japanese Women; Beneficial Effects of Galactomyces Ferment Filtrate Containing Antioxidative Skin Care Formula

Young women often complain about the daily fluctuation of their facial skin conditions. However, no objective study has been carried out on such changes. This study is aimed at quantitatively elucidating daily skin fluctuation and evaluating the efficacy of cosmetic skin care treatment. We developed the first portable and self-guided facial skin imaging device (eMR Pro) to reproducibly capture facial images at home. Two 8 week clinical studies were then conducted to analyze daily skin fluctuation of facial pore areas, roughness and redness in young Japanese women (n = 47 in study 1 and n = 57 in study 2) by collecting facial images three times a day, during the morning after wake-up, during the morning after face wash, and during the evening after face wash. After a 4 week baseline measurement period (week -4 to week -1), all subjects applied Galactomyces ferment filtrate (GFF, Pitera^®) skin care formula twice a day for 4 weeks (week 1 to week 4). These three skin conditions did exhibit different fluctuation patterns. The pore area and roughness showed the “morning after wake-up”-largest fluctuation pattern, whereas redness showed the “evening after face wash”-largest fluctuation pattern. GFF treatment significantly reduced the net values and delta fluctuation of pore area, roughness, and redness, which were consistently observed in two studies. In conclusion, the daily fluctuation of facial skin conditions is potentially a new target field for investigating healthy skin maintenance.

Statistical analysis of age-related skin parameters

BACKGROUND

Due to the increasing interest in human anti-aging, demand for a higher quality of life, and technological advancement, the development of anti-aging skincare has great market prospects. Most cosmetic companies develop products driven by the market or focus on the mechanism of action of substances and the behavior of skin; however, little research utilizes skin parameters and large data methodology to develop skincare products.

OBJECTIVE

To instruct consumers to purchase skincare products and to guide skincare research toward the development of customer-targeted products.

METHODS

A total of 815 Chinese subjects (83 male; 732 female) from five different cities were included. We measured 14 indices in each subject, including moisture, transepidermal water loss (TEWL), and sebum levels. We performed multiple regression analysis to understand the relationship between skin indices and aging; a novel approach is shown using the R software.

RESULTS

The exact age at which changes in each skin index occurred could be demonstrated by this method of analysis: 39, 38, 48, 46, and 56 years old with respect to the L value, Melanin, Rt, Rm, and Rz, respectively.

CONCLUSION

With the use of statistical analysis, consumers can be more efficiently targeted and choose suitable products considering particular skin parameter changing points; thus, skincare companies will not only meet customer requirements but also better control budgets.

Quantitative evaluation of facial sagging in different body postures using a three-dimensional imaging technique

BACKGROUND

The possible contribution of head flexion posture while using a smartphone to the formation of "smartphone face," is an increasing concern. Smartphone face describes the facial changes in a stooped posture receiving more gravitational pull on the jowl area.

AIMS

In this study, we quantified facial sagging in different postural changes using a three-dimensional imaging technique.

METHODS

Faces of 21 young (30.45 ± 2.81 yo, n = 11) and old (59.50 ± 3.37 yo, n = 10) Korean female subjects were scanned in different body postures including standing, supine, and head flexion (30°, 45°). The landmark displacements and volumetric changes in facial areas were assessed and correlated with skin elasticity. In addition, 22 Korean female subjects (45.45 ± 3.81 yo) were recruited to test the anti-gravity effect of facial cream A, which was formulated with Stem III complex™, for 8 weeks.

RESULTS

The landmarks shifted inferior-laterally with the supine posture, while the upper face shifted more laterally and the lower face shifted more inferiorly. With a head flexion posture, facial sagging occurred mainly toward the anterior direction with more prominent changes in the lower face. The changes were greater in the older group, and skin elasticity exhibited negative correlation with the shifting distances. A significant decrease in facial sagging was noted after an 8-week treatment of facial cream A.

CONCLUSION

The use of a three-dimensional imaging technique could accurately assess the gravity-induced facial changes in different postures. The head flexion posture particularly gives more gravitational pull to the lower face, which could contribute to the drooping jawline.

Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty

BACKGROUND

Asians increasingly seek non-surgical facial esthetic treatments, especially at younger ages. Published recommendations and clinical evidence mostly reference Western populations, but Asians differ from them in terms of attitudes to beauty, structural facial anatomy, and signs and rates of aging. A thorough knowledge of the key esthetic concerns and requirements for the Asian face is required to strategize appropriate facial esthetic treatments with botulinum toxin and hyaluronic acid (HA) fillers.

METHODS

The Asian Facial Aesthetics Expert Consensus Group met to develop consensus statements on concepts of facial beauty, key esthetic concerns, facial anatomy, and aging in Southeastern and Eastern Asians, as a prelude to developing consensus opinions on the cosmetic facial use of botulinum toxin and HA fillers in these populations.

RESULTS

Beautiful and esthetically attractive people of all races share similarities in appearance while retaining distinct ethnic features. Asians between the third and sixth decades age well compared with age-matched Caucasians. Younger Asians' increasing requests for injectable treatments to improve facial shape and three-dimensionality often reflect a desire to correct underlying facial structural deficiencies or weaknesses that detract from ideals of facial beauty.

CONCLUSIONS

Facial esthetic treatments in Asians are not aimed at Westernization, but rather the optimization of intrinsic Asian ethnic features, or correction of specific underlying structural features that are perceived as deficiencies. Thus, overall facial attractiveness is enhanced while retaining esthetic characteristics of Asian ethnicity. Because Asian patients age differently than Western patients, different management and treatment planning strategies are utilized. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Depiction of ethnic facial aging by forensic artists and preliminary assessment of the applicability of facial averages

Many characteristics of facial aging are common to all. The age of their onset and which characteristics tend to predominate varies among individuals depending on many factors including their genetic makeup, life experiences, environment in which they live, and the regional, ethnic, or socially perceived group to which they belong. Forensic artists are often asked to provide sketches, 2D or 3D digital renderings, or sculptures representative of how an individual may appear at an older age based on a provided photograph, victim or witness description, and/or cranial remains. The challenge escalates when the subject is a member of a regional, ethnic, or other socially perceived group to which the artist has had little or no exposure. We describe aspects of adult facial aging that are of particular relevance to the forensic artist, applicable software tools, and pertinent facial databases, especially those emphasizing non-white populations. We demonstrate that facial averaging offers two key advantages to the artistic portrayal of facial aging: first, the technique requires relatively small reference databases from groups that may present logistical challenges to collect and second, that a facial average provides a useful representation of the gestalt of the age and ethnicity cohort to which a subject belongs. The artist may use an average along with other available information such as photo reference books, eyewitness descriptions, photos of immediate family members, and cranial structure to guide production of a facial composite drawing, digital age progression, or sculpture of the subject in question.

Distinct Habits Of Sun Exposures Lead To Different Impacts On Some Facial Signs Of Chinese Men Of Different Ages

OBJECTIVE

To clinically evaluate the impacts of sun exposures on some facial signs of differently aged Chinese men with a distinct behavior vis à vis sun exposures.

METHODS

Two comparable cohorts of Chinese men (aged 18-75 years old), living in two cities (Shanghai, Hong Kong) were created according to their usual behavior towards sun exposure and through their variable use(s) of a photo-protective product, i.e. non-sun-phobic (N = 127) and sun-phobic (N = 134). Standard photographs (full-face and 45° lateral) allowed to focus on 13 facial signs that were further graded by 15 experts and dermatologists, using a referential Skin Aging Atlas. Absolute differences in the scores of each sign were used (non-sun-phobic minus sun-phobic), by age-classes, to better ascertain the impact of sun exposures and a photo-protecting product, when used.

RESULTS

Most facial signs, particularly wrinkles and skin texture, differentiated the two cohorts. Some others showed some erratic changes with age, albeit more pronounced at older ages. In contrast with previous results obtained in Chinese women, the changes observed in men were not only of a lessened severity but were undetected at early ages (<30 years old). Overall, these different behaviors with regard to sun exposures led to significant differences in the facial signs of Chinese men. The latter can be illustrated by two virtual morphings that combine the impacts of both intrinsic and extrinsic aging processes.

CONCLUSION

The present work illustrates, for the first time, some specificities of the impacts of sun exposures on the facial skin of Chinese men, more expressed at older ages, inversely to those observed in Chinese women, occurring at younger ages.

Human Skin Lightening Efficacy of Resveratrol and Its Analogs: From in Vitro Studies to Cosmetic Applications

Antioxidants are deemed useful in controlling oxidative stress associated with extrinsic skin aging and pigmentation disorders. Resveratrol is a polyphenol compound found in many edible plants such as Vitis vinifera, and its inhibitory effects on the catalytic activity, gene expression, and posttranslational modifications of tyrosinase, a key enzyme in the melanin biosynthetic pathway, provide a mechanistic basis for its antimelanogenic effects seen in melanocytic cells, three-dimensionally reconstituted skin models, and in vivo animal models. As a potent antioxidant and a modulator of nuclear factor erythroid 2-related factor 2 (Nrf2), and sirtuin 1, resveratrol can also regulate multiple signaling pathways associated with inflammation and premature aging. Recent clinical studies have supported the efficacy of resveratrol and its analogs, such as resveratryl triacetate (RTA) and resveratryl triglycolate (RTG), in human skin lightening and antiaging. These findings suggest that resveratrol and its analogs are potentially useful as skin lightening and antiaging agents in cosmetics.

Facial fold and crease development: A new morphological approach and classification

Facial folds and creases are established descriptive anatomical terms for structures of which the morphological characteristics and origins are not clearly defined. The aim of this study was to perform a morphological investigation of the nasolabial fold (NLF), mandibular fold (MF), deep transverse forehead (DTFC), infraorbital fold (IOF) and upper eyelid fold (UEF), correlating their phenotypes to differences in the superficial musculoaponeurotic system (SMAS), noting morphological differences and similarities. Full-graft tissue blocks of skin, subcutaneous tissue, and mimic muscles collected postmortem were studied histologically. Serial histological sections were stained with Azan. Location- and composition-specific morphological differences were determined. Histological serial section digitalization and three-dimensional reconstruction of the tissue blocks were performed. Three different types of SMAS architecture were identified. Type I SMAS consisted of parallel-aligned fibrous septa connecting the mimic muscles to the skin that covered the cheek, infraorbital and supraorbital, and forehead areas. Type II SMAS morphology appeared as a condensed Type I SMAS architecture with stronger fibrous septa and smaller fatty tissue compartments covering the lower and upper lip areas. Type III SMAS consisted of loose connective tissue covering the lower and upper eyelid regions. NLF, MF, IOF, and UEF are habitual primary folds induced by morphological changes in the underlying SMAS architecture. The secondary, accidental creases (DTFC) are cutaneous depressions derived from interacting dermal-skeletal-muscular changes without SMAS structure changes. The upper and lower eyelid wrinkles were tertiary, age-related undulating skin redundancy formations. Clin. Anat. 32:573-584, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

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.

Influences of age, ethnic group, and skin sites on a provisory skin marking, experimentally induced, in vivo

BACKGROUND

To study capacity of skin to being imprinted by a marking head rapidly applied (10 seconds) onto the skin under a standardized pressure (15 kPa).

MATERIAL AND METHODS

Referential photographs of skin markings, resulting from different times of application serve at grading the extent of skin imprints. The imprinting tool, equipped with 5 linear bulbs of different sizes but same thickness (1 mm), was applied onto the cheeks of 641 women of different ages (18-80 years) of 3 different ethnic groups. In the cohort of 198 Caucasian women, the marking head was pressed onto 3 different sites (outer arm, cheek, and dorsal forearm) and the kinetics of skin recovery from cheek marking was recorded on a smaller and younger part of this Caucasian cohort, ie, 141 Caucasian women, aged 18-59 years.

RESULTS

The recorded intensities of skin markings were found highly correlated with age in all 3 studied ethnic groups (Chinese, African-American, and Caucasian). Caucasian women seem more sensitive to the marking and the kinetics of recovery from such imprint was found highly dependent from its intensity, ie, the higher the grades, the slower the recovery. In Caucasian women, intensities were different between skin sites, where arm showed higher resistance to marking. Possible impact of photo-aging on the decreased skin resistance to such provoked deformation is likely of minor amplitude, as compared to the one induced by chronological aging.

CONCLUSION

This method offers a new vision on skin aging, in its variable response to a standard deformation that appears mostly driven by chronological aging.

Classification of facial wrinkles among Chinese women

It is generally recognized that Caucasians and Asians have different skin aging features. The aim of this study was to develop a facial wrinkle grading scale for Chinese women. Standard photographs were taken of 242 Chinese women. Six sets of 0 to 9 wrinkle scales with reference photographs and descriptions were selected, including grading scales for resting and hyperkinetic crow's feet, frontalis lines, glabellar frown lines, and nasolabial folds. To identify the scale by objective quantitative measurement, skin surface measurements from the Visioscan^® VC98 were used. To test the reliability and validity of our wrinkle scale, a multi-rater consensus method was used. A double-blind, randomized, vehicle-controlled 12-week study was conducted to use this clinical photo-score to evaluate the efficacy and safety of Centella triterpenes cream^® in treating crow's feet. A newly developed 10-point photographic and descriptive scale emerged from this study. The final atlas of these photographs contained a total of 6 sets with 10 pictures each. From 0 to 9, surface evaluation of smoothness (SEsm) parametric measurements decreased progressively, indicating that the scale increased inversely. Weighted kappa coefficients for intra-assessor were between 0.75-0.87. The overall Kendall's coefficient is 0.86 on the first rating and 0.87 on the second rating. Thirty-six volunteers were recruited and 35 subjects completed a 12-week trial. Clinical photo-score by investigator showed a significant difference (P<0.05) between the treatment side and control side after 4 weeks. Use of these scales in clinical settings to evaluate facial wrinkles in Asians individuals is recommended.

Categorizing facial creases: A review

Ensuring uniformity in the nomenclature standardization of facial creases is important to enable the scholarly community to follow and debate the advancements in research. This review highlights the prevailing disparity in the nomenclature that refers to the same facial crease by researchers and laypeople, and suggests uniform names for the facial creases based on available literature. The previous and current trends in facial crease classification are also discussed. The nomenclature of the facial creases considered for this review include the following: the nasolabial fold, corner of the mouth lines, upper and lower lip creases around the mouth region, the mandibular folds, the bifid nose, the transverse nasal line, the vertical glabellar line, chin crease, the mental crease, four type of creases around the eyes, forehead creases, and periauricular creases. A figure illustrating the above facial creases is included as reference. It is hoped that the proposed standardization of nomenclature would ensure a more scientific referencing of facial creases enabling more effective scientific interaction among the scholarly community as well as the laypeople interested in the research and application of facial creases.

The effects of continuous application of sunscreen on photoaged skin in Japanese elderly people - the relationship with the usage

Since photoaging of skin is caused by chronic sun exposure, it is well-recognized that regular sunscreen use can help prevent photoaging of skin in fair-skinned people. Therefore, application of sunscreen is recommended for the prevention of photoaging in many countries. However, the relationship between UV exposure and photoaging has rarely been investigated in clinical studies in Japan. In addition, there have been almost no long-term interventional studies in Japanese people. We have previously conducted a study where Japanese actinic keratosis patients were instructed to continuously apply sunscreen. The results indicated that long-term application of sunscreen is effective in suppressing actinic keratosis progression and generation. In the present study, we investigated the effects of sunscreen on photoaged skin in 14 elderly Japanese people. Skin conditions such as water content, transepidermal water loss, the number of spots, wrinkles, and skin color tone uniformity were measured and compared before and after the study. A statistically significant difference was observed only in skin surface hydration. There were large inter-individual differences in amount of sunscreen used throughout the study. The changes in the number of spots and skin color tone uniformity during the 18 months showed good correlation with amount of sunscreen being used. These results suggest an increase in the number of spots and deterioration in skin color tone uniformity in the 18-month non-sunscreen application period, and that such skin conditions improved with increasing use of sunscreen. In this study, we suggested an inhibitory effect on photoaging symptoms such as spots and skin color tone non-uniformity, by application of the appropriate amount of sunscreen over a long period of time in Japanese people, similar to Caucasians.

Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty

BACKGROUND

Asians increasingly seek non-surgical facial esthetic treatments, especially at younger ages. Published recommendations and clinical evidence mostly reference Western populations, but Asians differ from them in terms of attitudes to beauty, structural facial anatomy, and signs and rates of aging. A thorough knowledge of the key esthetic concerns and requirements for the Asian face is required to strategize appropriate facial esthetic treatments with botulinum toxin and hyaluronic acid (HA) fillers.

METHODS

The Asian Facial Aesthetics Expert Consensus Group met to develop consensus statements on concepts of facial beauty, key esthetic concerns, facial anatomy, and aging in Southeastern and Eastern Asians, as a prelude to developing consensus opinions on the cosmetic facial use of botulinum toxin and HA fillers in these populations.

RESULTS

Beautiful and esthetically attractive people of all races share similarities in appearance while retaining distinct ethnic features. Asians between the third and sixth decades age well compared with age-matched Caucasians. Younger Asians' increasing requests for injectable treatments to improve facial shape and three-dimensionality often reflect a desire to correct underlying facial structural deficiencies or weaknesses that detract from ideals of facial beauty.

CONCLUSIONS

Facial esthetic treatments in Asians are not aimed at Westernization, but rather the optimization of intrinsic Asian ethnic features, or correction of specific underlying structural features that are perceived as deficiencies. Thus, overall facial attractiveness is enhanced while retaining esthetic characteristics of Asian ethnicity. Because Asian patients age differently than Western patients, different management and treatment planning strategies are utilized.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Analysis of the complementary measurement of nasogenian wrinkles using Radiocef 2.0® software in the evaluation of facial chronoaging among women of different age groups

Objective : To evaluate the facial aging of women of different ages using a software program to assist in the classification of wrinkles and sagging in the nasogenian region. Method : A descriptive observational study of 100 female volunteers was performed. The women were aged between 20 and 70 years old and were sorted by age group into five groups of 20 volunteers each. The instruments used were the Facial Assessment Protocol, a cephalostat for the standardization of photos, a 14.1 megapixel Sony digital camera, and the Radiocef 2.0® software program. The Kolmogorov-Smirnov (KS) test was used for confirmation of normality and all data was statistically analyzed using ANOVA and Tukey's post hoc analysis. The Chi-squared and Pearson's correlation tests were also performed. A significance level of 5% and a p value of ≤0.05 were adopted. Results : It was observed that all age groups had wrinkles in the nasolabial fold region. There was an association between age and the Goglau, Lapiere and Pierard scale. This incidence increased progressively with aging. A moderate correlation (r=0.67) was observed between age and distance from the nasolabial folds, while angle represented only a weak correlation (r=0.3), with the most significant age group that with the shortest distance and the widest angle. Conclusion : The present study demonstrated the importance of the Radiocef 2.0® software program in providing a more detailed analysis of the nasolabial folds. It is therefore a complementary assessment to the Facial Assessment Protocol, representing a research protocol for identifying the effectiveness of treatments and improving the evaluative procedure.

Demographic Estimation from Face Images: Human vs. Machine Performance

Demographic estimation entails automatic estimation of age, gender and race of a person from his face image, which has many potential applications ranging from forensics to social media. Automatic demographic estimation, particularly age estimation, remains a challenging problem because persons belonging to the same demographic group can be vastly different in their facial appearances due to intrinsic and extrinsic factors. In this paper, we present a generic framework for automatic demographic (age, gender and race) estimation. Given a face image, we first extract demographic informative features via a boosting algorithm, and then employ a hierarchical approach consisting of between-group classification, and within-group regression. Quality assessment is also developed to identify low-quality face images that are difficult to obtain reliable demographic estimates. Experimental results on a diverse set of face image databases, FG-NET (1K images), FERET (3K images), MORPH II (75K images), PCSO (100K images), and a subset of LFW (4K images), show that the proposed approach has superior performance compared to the state of the art. Finally, we use crowdsourcing to study the human perception ability of estimating demographics from face images. A side-by-side comparison of the demographic estimates from crowdsourced data and the proposed algorithm provides a number of insights into this challenging problem.

Solar exposure(s) and facial clinical signs of aging in Chinese women: impacts upon age perception

A new reference clinical atlas of facial signs dedicated to photoaging was applied to 301 Chinese women of various ages through standardized photographs. Such approach aimed at better describing the facial changes induced by both real/chronological age and sun exposure and their respective impact on two subcohorts of different behavior with regard to sun exposure. A total of 28 various facial signs were individually graded according to their severity by a panel of experts, and a perceived apparent age of each subject was assessed. Results showed that the severity of major signs significantly increased rather linearly with age, with a higher rate in sun-exposed subjects as compared with subjects who regularly avoid sun exposure. The severity of facial signs, all impacted by sun exposure, better correlated with perceived apparent age than real/chronological age. The protocol used in the present work, similar to that previously applied to two cohorts of French women, assigned a greater impact of sun exposure in the facial aging signs of Asian women – all clinical signs are influenced by extrinsic factors – as compared with Caucasian women of comparable ages, likely related to much more intense ultraviolet (UV) radiation.

Microrelief suppresses large wrinkling appearance: an in silico study

BACKGROUND AND PURPOSE

Extensive skin wrinkling during facial expressions is one of the considerable problems in aesthetic dermatology. Although a few in silico studies have been performed with the aim of revealing the mechanism of a wrinkled appearance, there have been few studies that take into account the influence of skin roughness (i.e. microrelief), which exists on human skin in vivo. In this study, finite element simulations were performed using multilayer skin models with microrelief to investigate how extensive wrinkling appears on human skin, especially focusing on the role of surface roughness in the wrinkling mechanism.

METHODS

Linear and post-buckling analyses were performed on soft elastic laminate models using the finite element method. A simplified multilayer model of human skin was employed to examine the contribution of skin's multilayer structure to the large-wrinkle mechanism. Microrelief was included in the model to assess its effect on the mechanism.

RESULTS

A large wrinkle was observed as dermal buckling following a number of buckling events on the stratum corneum. The existence of microrelief had an effect on the suppression of dermal buckling.

CONCLUSION

Skin's multilayer structure should play a major role in the appearance of large wrinkles on human skin via its post-buckling behavior. This study suggested that fine microrelief on the skin surface hampers large wrinkles. These findings should be valuable for the development of cosmetic or medical treatments to prevent unfavorable skin deformations.

The post-mortem resilience of facial creases and the possibility for use in identification of the dead

The post-mortem resilience of facial creases was studied using donated bodies in order to establish the efficacy of crease analysis for identification of the dead. Creases were studied on normal (pre-embalmed) and bloated (embalmed) cadavers at the Centre for Anatomy and Human Identification (CAHID) to establish whether facial bloating would affect facial crease visibility. Embalming was chosen to simulate the effects produced by post-mortem bloating. The results suggested that creases are resilient and changes were only detected for creases located on the periphery of the face, particularly at areas where the skin is thick, such as at the cheeks. Two new creases not previously classified were identified; these creases were called the vertical superciliary arch line and the lateral nose crease. This research suggests that facial creases may be resilient enough after death to be utilised for human identification.

Characterization of Chinese body skin through in vivo instrument assessments, visual evaluations, and questionnaire: influences of body area, inter-generation, season, sex, and skin care habits

BACKGROUND/PURPOSE

The varying influence of multiple factors (e.g., aging, sex, season, skin care habits) on skin structure and function necessitates study within ethnic groups to fully characterize their skin.

METHODS

Men and women aged 40-50 years (n = 43) and their consanguineous same-sex children, aged 18-25 years (n = 43), living in Chengdu, China were enrolled in this single center, non-interventional study. Volunteers attended two study visits (summer, 2010 and winter, 2011) at which dermatologists measured transepidermal water loss (TEWL), skin hydration, sebum secretion, fine lines/roughness, melanin/erythema, temperature, and color, and clinically graded participants' skin. Participants answered a questionnaire, indicating their perceived skin type/condition. Data were analyzed using t-test/anova or Friedman/Wilcoxon test.

RESULTS

Objective measurements demonstrated statistically significant inter-generational differences in skin condition, with aged skin more wrinkled at most sites, having reduced oil/colder facial and décolletage skin, darker/more erythematous skin in exposed areas, and less hydrated/rougher heel skin; similarities were detected in skin melanin, erythema, and TEWL. There were also statistically significant differences between seasons and sexes. The intersection between instrument measurements and subjective perceptions of skin revealed notable differences.

CONCLUSION

Objective measurements and their intersection with subjective perceptions demonstrate the influences of inter-generation, season, sex, and living habits on Chinese body skin.

Influence of season on some skin properties: winter vs. summer, as experienced by 354 Shanghaiese women of various ages

The facial skin of 354 women, aged 18-80, living in Shanghai, was investigated over two successive 6-month periods, summer and winter. Results from clinical assessments indicate that aging signs, such as wrinkling and sagging, are unaffected over such period. However, physical measurements revealed alterations in some functional criteria of the skin, such as sebum output, skin colour, melanin content of pigmented spots, skin hydration, all being increased during summer. The relationships between all criteria, as well as technical or applied inferences/consequences from this study, are discussed.

Influence of subcutaneous adipose tissue mass on dermal elasticity and sagging severity in lower cheek

BACKGROUND

Subcutaneous adipose tissue lies just beneath the dermal layer, but the interaction between the two is not well understood. Recently, we showed that the subcutaneous adipose layer affects dermal properties in an obese rodent model.

OBJECTIVE

To explore the influence of the subcutaneous adipose layer on dermal properties and morphology in humans.

METHODS

Subcutaneous adipose mass was measured by ultrasound using a Prosound alpha 5, dermal elasticity was measured using an in vivo suction skin elasticity meter (Cutometer MPA 580, and sagging severity were evaluated morphologically using photograph-based grading criteria at the lower cheek in 70 Japanese female volunteers (age; 31-59, BMI; 17.1-36.2). The correlations among the results were examined.

RESULTS

Thickness of the subcutaneous adipose layer was significantly and negatively correlated with dermal elasticity parameters, i.e., elastic deformation, elastic deformation recovery, extensibility, total deformation recovery, ratio of viscoelasticity to elastic distention and overall elasticity, including creep and creep recovery. Furthermore, we investigated their influence on facial morphology, such as sagging. The subcutaneous adipose mass was significantly and positively correlated with sagging severity at the lower cheek (R=0.442, P<0.001), and there was a significant negative correlation between dermal elasticity and sagging severity (R=-0.358, P<0.01).

CONCLUSION

These results indicate that increment of subcutaneous adipose mass impairs dermal elasticity, which in turn exacerbates sagging severity.

Nutrition and aging skin: sugar and glycation

The effect of sugars on aging skin is governed by the simple act of covalently cross-linking two collagen fibers, which renders both of them incapable of easy repair. Glucose and fructose link the amino acids present in the collagen and elastin that support the dermis, producing advanced glycation end products or "AGEs." This process is accelerated in all body tissues when sugar is elevated and is further stimulated by ultraviolet light in the skin. The effect on vascular, renal, retinal, coronary, and cutaneous tissues is being defined, as are methods of reducing the glycation load through careful diet and use of supplements.