Establishment and application of perceived age prediction model for the periocular aging research of Chinese Han women.

BACKGROUND: The assessment of skin aging through skin measurements faces limitations, making perceived age evaluation a more valuable and direct tool for assessing skin aging. Given that the aging process markedly affects the appearance of the eye contour, characterizing the eye region could be beneficial for perceived age assessment. This study aimed to analyze age-correlated changes in the eye contour within the Chinese Han female population and to develop, validate, and apply a multiple linear regression model for predicting perceived age. MATERIALS AND METHODS: A naïve panel of 107 Chinese women assessed the perceived ages of 212 Chinese Han women. Instrumental analysis evaluated periorbital parameters, including palpebral fissure width (PFW), palpebral fissure height (PFH), acclivity of palpebral fissure (AX), angle of inner canthal (AEN), and angle of outer canthal (AEX). These parameters were used to construct a multiple linear regression model for predicting the perceived ages of Chinese Han women. A combined treatment using Fotona 4D and an anti-aging eye cream, formulated with plant extracts, peptides, and antioxidants, was conducted to verify the cream's anti-aging efficacy and safety. This eye cream was then tested in a large-scale clinical trial involving 101 participants. The prediction model was employed in this trial to assess the perceived ages of the women after an 8-week application of the eye cream. RESULTS: All parameters were observed to decrease with age. An intergroup comparison indicated that eyelid aging in Chinese Han women accelerates beyond the age of 50. Consequently, a linear regression model was constructed and validated, with the perceived age being calculated as 183.159 - 1.078 * AEN - 4.487 * PFW + 6.061 * PFH - 1.003 * AX - 0.328 * AEX. The anti-aging efficacy and safety of the eye cream were confirmed through combined treatment with Fotona 4D, showing improvements in wrinkles, elasticity, and dark circles under the eyes. In a large-scale clinical evaluation using this eye cream, a perceived age prediction model was applied, suggesting that 8 weeks of use made participants appear 2.25 years younger. CONCLUSION: Our study developed and validated a multiple linear regression model to predict the perceived age of Chinese Han women. This model was successfully utilized in a large-scale clinical evaluation of anti-aging eye cream, revealing that 8 weeks of usage made participants appear 2.25 years younger. This method effectively bridges the gap between clinical research and consumer perceptions, explores the complex factors influencing perceived age, and aims to improve anti-aging formulations.

Upper eyelid morphology and age-related changes in Japanese and Chinese females.

BACKGROUND: Many consumers use cosmetic eye products to counteract age-related changes in appearance. Measurements of eyelid shape in Asian women have been reported in the frontal view or 45-degree profile only. The aim of this study was to describe morphological characteristics of the upper eyelid in Japanese and Chinese females from the frontal and profile aspects and examine morphological changes with age. MATERIALS AND METHODS: Standardized digital photographs of 772 Japanese and 346 Chinese women (15-79 years of age) were acquired in frontal and 90-degree profile aspects. Eleven upper eyelid parameters (e.g., width, length, depth, aperture, and curvature) were measured using image analysis to determine age-related changes and compare by ethnicity. RESULTS: Eyelid width, area between eyebrow and eyelid, and eyelid curvature were comparable for both ethnicities under age 40, but the aging effect was more pronounced in Chinese subjects. Eyelid height, depth, and upper eyelid aperture angle were also comparable for both ethnicities under age 40, but the aging effect was more evident in Japanese subjects. Upper eyelid incline angle, eye orientation, and upper eyelid protrusion angle changed comparably with age for both ethnicities. No prominent age-related changes were evident for eyelid length or area between eyebrow and eye with the eye closed. CONCLUSION: Upper eyelid morphology changes with age in Japanese and Chinese females, starting around 40 years of age. Ethnic differences are limited in younger age groups but become more prominent with age. The findings suggest that aging affects some upper eyelid features earlier than others.

Comparison of facial skin ageing in healthy Asian and Caucasian females quantified by in vivo line-field confocal optical coherence tomography 3D imaging.

BACKGROUND: Quantitative biomarkers of facial skin aging were investigated in 109 healthy Asian female volunteers, aged 20 to 70 years. MATERIALS AND METHODS: In vivo 3D Line-field Confocal Optical Coherence Tomography (LC-OCT) imaging, enhanced by Artificial Intelligence (AI)-based quantification algorithms, was utilized to compute various metrics, including stratum corneum thickness (SC), viable epidermal (VE) thickness, and Dermal-Epidermal Junction (DEJ) undulation along with cellular metrics for the temple, cheekbone, and mandible. RESULTS: Comparison with data from a cohort of healthy Caucasian volunteers revealed similarities in the variations of stratum corneum and viable epidermis layers, as well as cellular shape and size with age in both ethnic groups. However, specific findings emerged, such as larger, more heterogeneous nuclei in both layers, demonstrated by an increase in nuclei volume and their standard deviation, and increased network atypia, all showing significant age-related variations. Caucasian females exhibited a flatter and more homogeneous epidermis, evidenced by a decreased standard deviation of the number of layers, and a less dense cellular network with fewer cells per layer, indicated by a decrease in cell surface density. CONCLUSION: Ethnicity-wise comparisons highlighted distinct biological features specific to each population. Asian individuals showed significantly higher DEJ undulation, higher compactness, and lower cell network atypia compared to their Caucasian counterparts across age groups. Differences in stratum corneum and viable epidermal thickness on the cheekbone were also significant. LC-OCT 3D imaging provides valuable insights into the aging process in different populations and underscores inherent biological differences between Caucasian and Asian female volunteers.

Age-related changes to characteristics of the human eyes in women from six different ethnicities.

BACKGROUND: To describe some morphological characteristics of the eyes of women of 6 different ethnicities and ages. MATERIAL & METHODS: Standard digital photographs of 3600 women of different ethnicities and ages were taken for evaluating the effects of some makeup products (eyeliners, mascaras, eyelids makeup, etc) through a before/after comparison. Photographs corresponding to pre-applications offered opportunity to quantify, through image analysis, some features of the human eyes (height, length, ellipticity, horizontality, etc) for recording their possible variations linked to ethnicities and/or age. RESULTS: Although some minor differences between ethnicities were found (inter-pupillary distance and inner canthal distance), most eyes criteria among the 11 recorded were comparable (height and length of the eyes, ellipticity, etc). The somewhat low variability of the latter more reflects individual morphologies, at comparable ages. Asian subjects significantly differ by a much more oblique orientation of their main axis versus the horizontal inter-pupillary line. In all ethnicities, the skin aging process was found significantly altering i) the height of the eyes and ii) their orientation. Whereas the decrease of height likely results from a sagging of the upper eyelid, the decrease of orientation in all ethnicities (more marked among Asian women) possibly results from a sagging of the outer corner of the eyes. Whether this sagging may be related to the progressive outcome of crow's feet wrinkles is a plausible hypothesis. CONCLUSION: The present work is an original and complementary approach to the skin aging process prone at modifying some characteristics of women eyes of different ethnicities.

Age-related changes in lip morphological and physiological characteristics in Korean women.

OBJECTIVE: Age-related changes in lip morphological and physiological characteristics are key indices for estimating age based on facial features, as reported in many studies. Yet, a majority of studies have focused on Caucasian individuals, with few studies characterizing these changes in Asian female populations. Therefore, the aim of this study was to investigate lip morphological and physiological characteristics in a cohort of Korean women. METHODS: A total of 114 volunteers participated in the study. Linear distances (length of philtrum, length of lip, width of lip, and lengths of lower and upper oral commissures), angle of the upper lip, 3D lip heights, and wrinkles were calculated and averaged for each age-group. We also measured lip color, hydration, trans-epidermal water loss (TEWL), and blood flow. Statistical analyses were performed using SPSS version 20.0 (significance level P < 0.05). RESULTS: Length of the philtrum and lip width significantly increased with age while upper and lower lip lengths and length of the lower oral commissure significantly decreased with age. The angle of the upper lip tended to decrease with age, but this finding was no significance. Three-dimensional height of the upper lip, wrinkles, and TEWL also decreased with age while hydration increased with age. Finally, redness of the upper and lower lips as well as blood flow significantly decreased with age. CONCLUSION: Lips tended to shorten in length and widen with age, resulting in a thinner and longer appearance. With regard to physiological parameters, there were important age-related changes in hydration and lip color.

Understanding the Female African American Facial Aesthetic Patient

BACKGROUND: The patient populations seeking facial aesthetic treatments is expanding in terms of racial, ethnic, and cultural diversity. While treatment of facial aging patterns among white women is well-documented, far less information describes the aesthetic needs of the African American patient. OBJECTIVE: An online study was conducted to survey facial aesthetic concerns and treatment priorities among US-based population of African American women. MATERIALS AND METHODS: A total of 401 female African American participants ages 30 to 65 years reported their attitudes toward facial aging, current facial conditions, most bothersome facial areas and areas most/least likely to be treated first, awareness of treatment options and their consideration rates, and motives and barriers factoring into consideration of injectable treatments. RESULTS: Uneven skin tone/color (57%) and dark circles under the eyes (48%) were the most frequently-reported facial concerns. Other common bothersome facial areas affected by signs of aging were the submental area, periorbital area, forehead lines, and chin. Similarly, areas given greater priority with respect to future treatment included the periorbital area, submental area, and forehead lines. With advancing age, priorities heightened for the mid and lower facial areas, which included the nasolabial folds, chin, and oral commissures. Although the majority of participants would consider injectables, cost, and safety/side effects were cited as frequent concerns. CONCLUSION: For African American women, concerns about facial aging may be less about fine lines and wrinkles caused by increasing skin laxity, and more about pigmentary concerns and shifts in underlying soft tissue volume. J Drugs Dermatol. 2019;18(9):858-866.

Understanding the Female Hispanic and Latino American Facial Aesthetic Patient

Background: Among the growing aesthetic patient population, Hispanic/Latinos represent the largest proportion of non-Caucasians patients. While treatment of Caucasian facial aging patterns are well documented, far less information describes the aesthetic needs of the Hispanic/Latino patient. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Hispanic/Latino American women. Materials and Methods: A total of 401 participants ages 30 to 65 years reported their attitudes toward facial aging, current facial conditions, most bothersome facial areas, areas most/least likely to be treated first, awareness of treatment options and their consideration rates, and motives and barriers that factor into consideration of injectable treatments. Results: Most participants wanted to look good for their age and treatment interests reflected predominant conditions: facial wrinkles, periorbital signs of aging, and uneven skin tone. Most bothersome facial areas included the submental area, periorbital area, and forehead, which were also among the areas most-likely to treat first. The majority of participants would consider injectables. Cost and safety/side effects were cited as frequent concerns. Conclusion: An understanding of the facial aesthetic concerns and treatment priorities specific to Hispanic/Latino women will enhance the practitioner's patient-centric treatment approach. J Drugs Dermatol. 2019;18(7):623-632.

Understanding the Female Asian American Facial Aesthetic Patient

Background: As facial aesthetic procedures have become more widely accepted, the racial and ethnic diversity of aesthetic patient populations has increased. Asian Americans represent a growing segment of this population and have specific aesthetic concerns that should be differentiated from the broader Caucasian population. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Asian American women. Materials and Methods: A total of 403 participants ages 30 to 65 years reported perspectives on facial aging, current facial conditions, most bothersome facial areas, most/least likely to be treated first, awareness of treatment options and consideration rates, and motives/barriers impacting the consideration rate of injectable treatments. Results: Treatment interests reflected predominant issues; uneven skin tone, wrinkles, and sun damage. Most bothersome facial areas included the periorbital area, forehead, and submental area, and also among areas designated as most likely to treat first. The majority of participants would consider injectables. However, safety/side effects, cost, and concerns about not looking natural were primary barriers. Conclusion: Understanding the aesthetic concerns and priorities specific to Asian American women may help guide treatment plans more aligned with the goals and expectations of this patient population. J Drugs Dermatol. 2019;18(7):633-641.

Aesthetic Durable Forehead Contouring in Asians With Fat Grafting and Botulinum Toxin.

BACKGROUND: Augmentative forehead contouring to create a full rounded smooth forehead is increasingly popular worldwide especially in East Asia where a flat and/or concave irregular forehead is considered unaesthetic. We present our outcomes performing fat transfer to the forehead in combination with botulinum toxin (Botox) corrugator-frontalis injection where indicated in East Asians. METHODS: From 2013 to 2017, 62 consecutive patients with flat and/or concave irregular unaesthetic foreheads underwent forehead fat transfer using a microautologous fat transplantation gun. Concomitant Botox injection to minimize corrugator and frontalis contraction-mediated fat displacement was indicated in 23 patients (thin forehead skin and/or excessive forehead animation or rhytides) to prevent forehead vertical crease formation. Thirty-nine subjects with a mean follow-up of 16 months (range = 3-44 months) had their pregraft and postgraft forehead contours assessed on an aesthetic grading scale. Of these 39, 17 completed forehead fat graft volumetric analysis using preoperative and postoperative 3D photography. RESULTS: Aesthetic results were durable at latest follow-up, and all patients were satisfied with their final appearance. The mean amount of fat transferred was 7.72 mL (range = 1.5-33 mL). One subject required a repeat fat grafting (with Botox) because of vertical crease formation after the index procedure (without Botox). Another 12 needed a second fat-grafting session to optimize the contour. All who received Botox did not develop vertical creases. The mean ± SD forehead contour grade improved from 2.29 ± 0.77 to 3.24 ± 0.67 (P < 0.001). The percentage mean ± SD retention of grafted fat was 46.71% ± 5.77% with Botox versus 39.12% ± 5.24% without Botox (P = 0.006). CONCLUSIONS: Fat grafting to the forehead using our technique with selective Botox administration is an effective, simple, fast, inexpensive, and safe strategy for aesthetic forehead contouring especially for flat and/or concave foreheads. Forehead fat survival rate is objectively improved with simultaneous Botox injection. There is minimum downtime and long-lasting results with high patient satisfaction rates.

A method of evaluating facial pores using optical 2D images and analysis of age-dependent changes in facial pores in Koreans.

BACKGROUND: Enlarged facial pores and changes in pore area are of concern for cosmetic reasons. To evaluate pores, measuring tools based on 3D methodology are used. Yet, these methods are limited by their measuring ranges. In this study, we performed pore analysis by measuring the whole face using 2D optical images. We further sought to understand how the pores of Korean women change with age. MATERIALS AND METHODS: One hundred sixteen Korean female subjects aged 20-60 years were recruited for this study. Facial images were taken using the VISIA-CR® adjusted light source. Images were processed using Image-Pro Plus 9.2. Statistical significance was assumed when P < .05. RESULTS: The pore area, as indicated by pixel count, gradually increased in patients through their 40s, but decreased through their 50s and 60s. Facial pores generally exhibited directionality through the patients' 30s, but this isotropic feature was more prominent in their 50s. Pore elongation increased stepwise. The first increase occurred during the transition from patients' 30s to their 40s and the second increase occurred during the transition from patients' 50s to their 60s. This indicated that the pores deformed from a circular shape to a long elliptic shape over time. CONCLUSION: A new evaluation method using 2D optical images facilitates the analysis of pore distribution and elongation throughout the entire cheek. This is an improvement over an analysis of pores over a narrow region of interest.

Relationship of hyaluronan and HYBID (KIAA1199) expression with roughness parameters of photoaged skin in Caucasian women.

BACKGROUND: Hyaluronan (HA) is an important constituent of extracellular matrix (ECM) in the skin, and HA degradation mediated by HYBID (KIAA1199) is suggested to be implicated in facial skin wrinkling in Japanese women. Ethnic difference in skin wrinkle formation is known between Caucasian and Japanese women, but no information is available for the relations of HA and HYBID expression levels with skin wrinkling in Caucasian women. METHODS: The skin surface roughness at the eye corner of the Caucasian female subjects was measured, and the skin specimens biopsied from the same areas were subjected to microarray gene analysis, HA staining, and immunohistochemistry for HYBID. RESULTS: Among the ECM genes and those related to ECM metabolism, only HYBID expression levels positively correlated with the skin roughness parameters. When the skin sample groups with high expression of HYBID or low expression of HYBID were compared, the HA staining intensity and the ratio of HYBID-immunoreactive cells to total cells in the superficial dermis were significantly reduced and increased in the high-HYBID-expression group compared with the low-HYBID-expression group, respectively. CONCLUSION: Our data suggest that like Japanese women, HYBID-mediated reduction of HA in the superficial dermis is involved in the formation of wrinkles in Caucasian women.

Validation of digital photographic reference scales for evaluating facial aging signs.

BACKGROUND: Validated tools are essential to evaluate facial skin aging for both dermatological and cosmetic investigations. While many visual aging scales have been developed, few have been validated and none in terms of degree of distinguishability (DD). We developed and validated a series of visual scales using a novel digital interface for scoring facial skin aging in Caucasian women. MATERIALS AND METHODS: Three dermatologists independently established scales for 12 distinct aging signs from high-definition facial photographs of 400 adult women (Fitzpatrick phototypes I-IV) taken under standardized conditions. They then selected a consensus scale for each individual sign with a representative photo per grade. Scales were integrated into a digital interface allowing simultaneous viewing of all grades of each scale alongside the photograph of a test subject. Next, scales were validated by a different dermatologist, a general practitioner and a non-medical expert skin evaluator using photos of 350 women which had not been used for establishing the scales. RESULTS: Kappa estimates showed almost perfect agreement for wrinkle and skin aging scales (≥0.85) and moderate to substantial agreement for scales relating to color irregularities (telangiectasia, solar lentigines, freckles) for both inter- and intra-observer reproducibility. Intra-observer DD estimates were mostly high. Non-dermatologists performed well on reproducibility for both Kappa (from 0.6 to 0.9) and DD estimates. CONCLUSION: Our work demonstrates that the digital interface scales for 12 distinct aging features are highly suitable for use in clinical and epidemiological studies on skin aging by both dermatologists and non-dermatologists.

Relationship Between Midface Volume Deficits and the Appearance of Tear Troughs and Nasolabial Folds.

BACKGROUND: Understanding interrelationships among aging facial features is important in facial aesthetics as a global treatment approach becomes standard. OBJECTIVE: Examine empirical relationships between midface volume deficit and severity of tear troughs (TTs) and nasolabial folds (NLFs) in women and men of different racial/ethnic groups. METHODS: A web-based study was administered to health panel members (aged 18-75 years). Participants compared their midface volume, TTs, and NLFs against photonumeric scales depicting degrees of severity. Linear regressions were conducted to assess the relationship of midface volume on severity of TTs and NLFs, controlling for demographic factors. RESULTS: Of 4,086 participants (80.0% female), 3,553 had complete data. Increasing severity of midface volume deficit was associated with increasing severity of TTs and NLFs in both sexes (all p < .001). Race/ethnicity was associated with differences in severity in all 3 facial areas, although specific differences between races/ethnicities varied for women and men. Progression rates of severity differed between racial/ethnic groups. Correlations between midface volume deficit, TTs, and NLFs were positive and significant (all p < .001). CONCLUSION: Midface volume deficit was associated with severity of TT deformity and NLFs after controlling for age and other demographic variables.

Effect of Age, Gender, and Sun Exposure on Ethnic Skin Photoaging: Evidence Gathered Using a New Photonumeric Scale.

BACKGROUND: African-Americans are less affected by photoaging than lighter skin individuals. Although scales for photoaging have been developed for Caucasians and Asians, no scale exists for African-Americans. AIM: To develop a photonumeric scale for photoaging and to determine factors that contribute to photoaging in African-Americans. METHODS: Five participants' photographs were selected as standards to create a 9-point photonumeric scale (0 = none, 8 = most severe). Three blinded dermatologists used the scale to grade the remaining participants' photographs. RESULTS: Interrater reliabilities were 0.775 (95% CI: 0.635, 0.880) for trial 1 and 0.832 (0.747, 0.883) for trial 2. Intrarater reliabilities, assessed over a 1 week interval, were 0.863 (0.727, 0.940), 0.928 (0.890, 0.954), and 0.866 (0.739, 0.935) for the three graders, indicating strong agreement. Photoaging scores were then correlated with participants' survey on lifestyle factors, which yielded age as a significant predictor (r = 0.91, p < 0.001). Furthermore, multiple regression model to predict facial photoaging (adjusted R2 = 0.849) selected age (b1 = 0.111, p < 0.001), sun exposure (b2 = 0.206, p = 0.014), and gender (b2 = -0.388, p = 0.063) as the most important variables. CONCLUSIONS: A reliable photonumeric scale for photoaging in African Americans was developed. Age, sun exposure, and male gender were found to be contributory factors to photoaging.

In vivo evaluation of some biophysical parameters of the facial skin of Indian women. Part I: variability with age and geographical locations.

BACKGROUND: India is a large country (a subcontinent) of about 3.3 million km2 that covers large ranges in latitude and longitude. The last Indian census counted about 1.21 billion of inhabitants of many origins, creating a vast human diversity and skin types, the variability of which having been previously established. The present study aimed at deepening this knowledge through a set of biophysical measurements to describe, along the skin ageing process, the specificities of various Indian subjects living in different geographical locations. METHODS: A total of 1204 women, aged 18-84 years, of all socio-economic status, were recruited in four Indian cities (Mumbai, Kolkata, Chennai and Delhi). Measurements of face skin colour properties, elastic properties, sebum production, skin pores and microrelief roughness were performed. RESULTS: With regard skin colour, this study indicates, with age, a darkening of very low amplitude that leads to an increased skin colour heterogeneity. In all subjects, at all ages, the ocular region (dark circles) presents a much darker pigmentation than the cheeks, creating a contrast that appears constant at all ages. In addition to an increased skin colour heterogeneity, a progressive alteration of the skin surface relief, increased sizes of skin pores, a loss of skin elasticity and a drop in sebum production, post-menopause, are observed. CONCLUSIONS: This study confirms, in Indian women, some skin ageing measurements found on women from other ethnic groups (i.e. sebum, firmness, wrinkles and pores size) and also identifies some Indian specificities: a high and constant contrast between the ocular region and the cheek colour, associated to a very slow darkening effect along the lifespan.

Facial skin photo-aging and development of hyperpigmented spots from children to middle-aged Japanese woman.

BACKGROUND/PURPOSE: Facial skin hyperpigmention caused by chronic sun exposure is a major skin complaint, however, its characteristics and influential factors are still limitedly known. METHODS: A cross-sectional survey in healthy Japanese women aged from 6 to 62 years (n=169) was conducted using a facial image analyzer VISIA™ for knowing onset age of hyperpigmented spot formation, its chronological changes, and influence of environmental factors. RESULTS: UV Pigmented Spot (PS) Score was positively correlated with age (R=.487, P=.000). Hyperpigmented spots appeared first around 18 years old in most subjects, and PS score remarkably increased at 20s then gradually increased by ages. The subjects with Skin Type I, one of the three grades of Japanese Skin Type (JST), whose melanin formation is genetically lower, showed higher PS score. A woman aged 31 years was subjected a weekly VISIA measurement for 2 years, and found no changes in the number, place, size and intensity of the pigment spots in this duration. CONCLUSION: Hyperpigmented spots developed in women over 20 years of age due to chronic sun exposure without sun protection during childhood and adolescent and it was stable afterwards, whose intensity was influenced by age and skin type.

Different Glabellar Contraction Patterns in Chinese and Efficacy of Botulinum Toxin Type A for Treating Glabellar Lines: A Pilot Study.

BACKGROUND: Published research studies have described the existence of 5 glabellar contraction patterns. Botulinum toxin A (BoNTA) has been an approved and effective treatment of glabellar lines. OBJECTIVE: To study the pattern and frequency of glabellar contraction patterns in the Chinese population. To compare injection patterns and doses of BoNTA in Westerners within China. METHODS: Four hundred fifty-six healthy volunteers were randomly recruited. Photographs both in static and in frown state were taken and classified based on the method of 5 glabellar line patterns. The severity of the glabellar lines both at repose and during forced contraction was assessed by the Facial Wrinkle Scale (FWS). Subsequently, 75 of them were treated with BoNTA. RESULTS: The frequency of the various glabellar line patterns differs greatly between Chinese and Westerners with the "Converging arrows" pattern being the most common type and the "V" pattern being the least common when compared with the Westerners. Lower doses of BoNTA significantly improved the static and dynamic glabellar lines in the Chinese. CONCLUSION: The classification of 5 glabellar patterns is compatible for the Chinese population despite different proportions. The dosage of BoNTA should be less than 20 U during treatment in China with lowered incidence of complications.

Ethnicity and Aging Skin.

Aging is a complex process influenced by both extrinsic and intrinsic factors. Premature signs of aging due to cumulative UV exposure represent a major concern of the cosmetic patient. Skin of color is less susceptible to photodamage and thus signs of aging are less pronounced and occur later than in Caucasians. Understanding structural and functional differences among different racial/ethnic groups is important to achieve favorable treatment outcomes when addressing aging concerns.

Objective Evaluation of Eyebrow Position After Autologous Fat Grafting to the Temple and Forehead.

BACKGROUND: Fat grafting can be used to correct age-related volume loss in the face. However, the degree of rejuvenation is difficult to be evaluated. OBJECTIVES: The author sought to objectively verify the change in patients' eyebrow position after fat grafting to the upper face. METHODS: The charts of 175 consecutive patients who underwent autologous fat grafting to the forehead and temple were reviewed. Perioperative changes in the heights of medial, middle, and lateral segments of the eyebrow and the eyebrow slant were recorded and compared. Key prevention strategies to avoid potential complications were discussed. RESULTS: The eyebrow slant was increased by 2.4° after the operation which was statistically significant (p < 0.05). On the other hand, the medial eyebrow height was decreased, while the middle and lateral eyebrow heights were increased after the surgery which were of no significance. No major complications such as vision loss or vascular compromise were noted. CONCLUSIONS: Simultaneous autologous fat grafting to the temple and forehead significantly increased the slant of the eyebrows and corrected the loss of upper facial fullness as well. Collectively, these changes made the patient look younger and aesthetically more pleasant. LEVEL OF EVIDENCE IV: 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Morphological, structural and biophysical properties of French and Brazilian photoaged skin.

BACKGROUND: Knowledge of skin biology and its alterations in different populations is very important for the development of appropriate skincare strategies. OBJECTIVES: To evaluate and compare morphological, structural and biophysical properties of photoaged skin in French and Brazilian populations, using biophysical and skin-imaging techniques. METHODS: Forty-one French and 41 Brazilian healthy, female volunteers aged between 40 and 65 years were enrolled. Each participant completed a questionnaire concerning habits related to cosmetic use, sun exposure and sun protection during different life periods. Skin on the face and volar forearm was evaluated using noninvasive techniques, to determine skin colour, transepidermal water loss (TEWL), stratum corneum water content, skin microrelief, skin viscoelasticity and dermis structure. Reflectance confocal microscopy was used to measure epidermal layer thickness and epidermal morphological and structural characteristics. RESULTS: Compared with Brazilian skin, French skin was more hydrated, had a lower TEWL and presented a distinct viscoelastic profile on the forearms and face. Brazilian facial skin was more wrinkled, and the dermis was less echogenic on the forearms and face. The French participants had thicker stratum corneum. Brazilian facial skin presented a higher prevalence of rete ridge effacement, low interkeratinocyte reflectance, huddled collagen and solar elastosis. CONCLUSIONS: Morphological, structural and biophysical differences were found when assessing the skin of the Brazilian and French participants, who were exposed to different environmental factors.