Digit ratio (2D:4D) and its relationship to foetal and maternal sex steroids: A mini-review.

The challenges of terrestrial existence may mean that the early development of tetrapod limb traits is linked to the development of the urogenital system and sex steroids. One such limb trait is the sex-dependent ratio of the lengths of the 2nd and 4th digits (2D:4D). Direct evidence for the association between early sex steroids and offspring 2D:4D can be obtained by manipulating foetal sex hormones. However, this is not ethically permissible in humans. It is widely accepted that 2D:4D is a biomarker for early foetal sex hormones in tetrapods but the link in humans remains controversial. Here we review the evidence that (i) manipulation of sex steroids in early development leads to sex-dependent changes in 2D:4D throughout the tetrapods, and (ii) maternal sex steroids cross the placenta and thus are associated with offspring 2D:4D in both non-human and human animals. We suggest a research focus on associations between human maternal sex steroids and offspring 2D:4D to clarify the link between 2D:4D and early sex steroids. A protocol is proposed to examine the correlation between 1st-trimester maternal sex steroids and offspring 2D:4D. Such an association may explain the existence and medium effect size of the human sex difference in 2D:4D.

The effects of sex, nation, ethnicity, age and self-reported pubertal development on participant-measured right-left 2D:4D (Dr-l) in the BBC internet study.

Digit ratio (2D:4D) - a proxy for prenatal sex steroids - shows sex, nationality and ethnic differences and is linked to pubertal onset. It is unclear whether right-left 2D:4D (Dr-l) also correlates with prenatal sex steroids, as evidence of these differences has been less conclusive. The present study examined the effects of sex, nation, ethnicity, age and self-reported pubertal development (i.e. the rate of physical development and age at menarche [females] or first shave [males]) on Dr-l in a large online study (the BBC internet study). Digit lengths were self-measured in 201,865 adults (110,955 males) and the sample of nations included 41 countries. Participants reported the self-perceived rate of physical pubertal development on a five-point scale (from very slow to very fast) and provided information on the age at menarche or first shave. Adult (>17 years) males had lower Dr-l than females with weak effect size across 41 nations (males-females; d = -.065, p < .0001). There were sex and ethnicity effects on Dr-l across seven ethnic groups with males < females and lower Dr-l in Whites and Middle/Near Eastern participants compared to Asian, Black and Chinese respondents. Considering age effects, the authors focused on participants >12 years; there were stable sex differences and a weak positive effect of age on Dr-l. Dr-l showed a positive relationship with the rate of physical development and a negative relationship with age at menarche or first shave. Relationships were present in males and females with stronger effects in the latter. It is concluded that Dr-l shows a weak sex difference (males < females) independent of nation, ethnicity and age, and suggest that Dr-l is a proxy for prenatal sex steroids.

Parental income inequality and children's digit ratio (2D:4D): a 'Trivers-Willard' effect on prenatal androgenization?

Income inequality is associated positively with disease prevalence and mortality. Digit ratio (2D:4D) - a negative proxy for prenatal testosterone and a positive correlate of prenatal oestrogen - is related to several diseases. This study examined the association of income inequality (operationalized as relative parental income) and children's 2D:4D. Participants self-measured finger lengths (2D=index finger, and 4D=ring finger) in a large online survey conducted in July 2005 (the BBC Internet Study) and reported their parents' income. Children of parents of above-average income had low 2D:4D (high prenatal testosterone, low prenatal oestrogen) while the children of parents of below-average income had high 2D:4D (low prenatal testosterone, high prenatal oestrogen). The effects were significant in the total sample, present among Whites (the largest group in the sample), in the two largest national samples (UK and USA) and were greater for males than females. The findings suggest a Trivers-Willard effect, such that high-income women may prenatally masculinize their sons at the expense of the fitness of their daughters. Women with low income may prenatally feminize their daughters at the fitness expense of their sons. The effect could, in part, explain associations between low income, high 2D:4D (low prenatal testosterone) and some major causes of mortality such as cardiovascular disease.

Digit ratio (2D:4D) and body mass index in the BBC Internet Study: prenatal sex steroids and a Trivers-Willard effect on body composition.

Digit ratio - a putative measure of prenatal sex steroids - may be related to body mass index (BMI). However, reports of correlations between 2D:4D and BMI have yielded mixed results with some studies showing no relationship while others have reported positive associations in men or women only. This study considers associations between self-reported 2D:4D and BMI in a large online survey (i.e. the BBC Internet Study). At the individual level, there was a weak positive association between 2D:4D and BMI in both sexes with greater effect sizes in women. Body mass index was positively related to age and negatively related to parental income; however, the relationship between 2D:4D and BMI was independent of both variables. At the national level, mean 2D:4D per country showed positive associations with mean national BMI but those correlations were restricted to females. It is concluded that BMI is positively related to low prenatal testosterone and high prenatal oestrogen. Parental income inequality may influence both prenatal sex steroids (through a 'Trivers-Willard' effect) and BMI such that increases in inequality result in reductions in prenatal testosterone and increases in BMI at the individual and national level.

Three-step technique for implantation of rotating hinge knee prostheses : Demonstration using the Enduro prosthesis.

OBJECTIVE: Implantation of an axis-guided knee prosthesis with consideration of the joint line and balanced flexion and extension gap to reduce the mechanical load on the prosthesis axis and to improve the movement of the prosthesis. INDICATIONS: Distinct unilateral instability due to ligament insufficiency in association with knee prostheses. Primary implantation of axis-guided knee prostheses with pronounced axial malalignment (>20-25° valgus or varus malalignment) or/and severe flexion contracture > 40°. Replacement of prosthesis with nonsignificant imbalance between flexion and extension gap. CONTRAINDICATIONS: Clearly unstable flexion gap such that the extension gap cannot be adjusted appropriately. Significant femoral bone defects requiring distal femoral replacement prostheses. SURGICAL TECHNIQUE: Reconstruction of the tibial platform with the trial prosthesis with regard to height in relation to the tip of the fibula. Determination of the femoral prosthesis size. Adjustment of the anteroposterior (AP) cutting block of the selected size, referenced anteriorly and in correct rotation. Determination of the flexion gap with spacers using the stable side of the collateral ligaments. Positioning the distal cutting block and determination of the height of the extension gap. Moving the distal cutting block until the same height of spacer as used in the flexion gap fits into the extension gap, taking into account the stable side of the collateral ligaments. The extent of the displacement D1 is noted. Reverse displacement of the distal cutting block by the distance D2 until a satisfactory bony contact surface for the femoral component in the distal femur can be created. The thickness of the required distal augments on the following chamfer-cutting guide (4-in­1 cutting block) and thus on the femoral prosthetic component is the sum of D1 + D2. The chamfer-cutting guide (4-in­1 block) with distal augments of the calculated height (D = D1 + D2) is placed in position. Definition and preparation of the posterior contact surface with positioning of any necessary posterior augments. Completion of the femoral preparation taking into account the distal and posterior augments. Assembly of the trial prostheses with a trial inlay having the height of the spacers used. Implantation of the selected prosthesis components. POSTOPERATIVE MANAGEMENT: Thrombosis prophylaxis, physiotherapy under full weight-bearing and mobility exercises. RESULTS: After implantation of 104 axis-guided Enduro™ knee prostheses (Aesculap AG, Tuttlingen, Germany) (73 knee prosthesis revisions and 31 primary implantations), the Knee Society Score increased from 42.8 ± 18.8 preoperatively to 84.8 ± 13.9 after 24 months. Complications comprised one deep vein thrombosis and one periprosthetic infection.

Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer.

BACKGROUND: Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction. OBJECTIVE: To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture. METHODS: The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant's demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded. RESULTS: The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = - 0.183, p = 0.352). CONCLUSIONS: Regardless of personnel's physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.

The effect of skin surface topography and skin colouration cues on perception of male facial age, health and attractiveness.

OBJECTIVE: Previous studies investigating the effects of skin surface topography and colouration cues on the perception of female faces reported a differential weighting for the perception of skin topography and colour evenness, where topography was a stronger visual cue for the perception of age, whereas skin colour evenness was a stronger visual cue for the perception of health. We extend these findings in a study of the effect of skin surface topography and colour evenness cues on the perceptions of facial age, health and attractiveness in males. METHODS: Facial images of six men (aged 40 to 70 years), selected for co-expression of lines/wrinkles and discolouration, were manipulated digitally to create eight stimuli, namely, separate removal of these two features (a) on the forehead, (b) in the periorbital area, (c) on the cheeks and (d) across the entire face. Omnibus (within-face) pairwise combinations, including the original (unmodified) face, were presented to a total of 240 male and female judges, who selected the face they considered younger, healthier and more attractive. RESULTS: Significant effects were detected for facial image choice, in response to skin feature manipulation. The combined removal of skin surface topography resulted in younger age perception compared with that seen with the removal of skin colouration cues, whereas the opposite pattern was found for health preference. No difference was detected for the perception of attractiveness. These perceptual effects were seen particularly on the forehead and cheeks. Removing skin topography cues (but not discolouration) in the periorbital area resulted in higher preferences for all three attributes. CONCLUSION: Skin surface topography and colouration cues affect the perception of age, health and attractiveness in men's faces. The combined removal of these features on the forehead, cheeks and in the periorbital area results in the most positive assessments.

Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver type B1 fractures using a cementless, modular, tapered revision stem.

AIMS: To evaluate the hypothesis that failed osteosynthesis of periprosthetic Vancouver type B1 fractures can be treated successfully with stem revision using a transfemoral approach and a cementless, modular, tapered revision stem with reproducible rates of fracture healing, stability of the revision stem, and clinically good results. PATIENTS AND METHODS: A total of 14 patients (11 women, three men) with a mean age of 72.4 years (65 to 90) undergoing revision hip arthroplasty after failed osteosynthesis of periprosthetic fractures of Vancouver type B1 were treated using a transfemoral approach to remove the well-fixed stem before insertion of a modular, fluted titanium stem which obtained distal fixation. These patients were clinically and radiologically followed up for a mean 52.2 months (24 to 144). RESULTS: After a mean of 15.5 weeks (standard deviation (sd) 5.7) all fractures had healed. No stems subsided and bony-ingrowth fixation had occurred according to the classification of Engh et al. The mean Harris Hip Score increased from a pre-operative score of 22.2 points (sd 9.7) to 81.5 points (sd 16.8) 24 months post-operatively. All hips had obtained an excellent result according to the classification of Beals and Tower. CONCLUSIONS: The technique described here for stem revision provides reproducibly good results in the treatment of failed osteosynthesis for Vancouver types B1 periprosthetic fractures of the hip. Cite this article: Bone Joint J 2017;99-B(4 Supple B):11-16.

[Diagnostic Algorithm for Failure Analysis of Painful Total Hip Arthroplasties]. / Diagnostischer Algorithmus der schmerzhaften Hüfttotalendoprothese.

Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1.9 to 40.9 % of cases in some series. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful THA still remains a challenge for the surgeon. They can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. The onset of the pain after the operation and the differentiation between pain in motion and at rest are helpful to distinguish between mechanical and non-mechanical problems. An infection should be the first diagnosis to be ruled out in a painful THA. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. Method: In this review a practical diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful THA includes a detailed history with an extended analysis of the type of pain, thorough clinical examination including the spine and knee joints, radiographic and laboratory analysis, as well as invasive examinations like joint aspiration and biopsies. Conclusion: This diagnostic algorithm offers an important tool for a sufficient failure analysis in almost all patients with painful THA.

[Tripolar cups]. / Tripolare Pfannen.

Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these cups. The indications for dual-mobility cups are recurrent dislocation and situations where the risk of dislocation is increased.

Revision arthroplasty in periprosthetic fractures of the proximal femur.

OBJECTIVE: Hip revision arthroplasty of a loose stem in the case of Vancouver type B2 and B3 periprosthetic fractures and cerclage wiring of the femoral shaft. INDICATIONS: Vancouver type B2 and B3 periprosthetic fractures of the proximal femur. CONTRAINDICATIONS: Periprosthetic joint infection. Interprosthetic femoral fractures between the ends of hip and knee prosthetic stems that require total replacement of the femur. SURGICAL TECHNIQUE: Extended posterolateral approach to the tip of the fracture. Exposure along the septum intermusculare laterale with ligation of the perforating vessels below the fracture. Longitudinal osteotomy of the proximal fragment above the linea aspera using an oscillating saw under cooling. Ventral proximal osteotomy at the corner of the vasto-gluteal sling after short muscular incision using an osteotome chisel. Opening of the proximal fragment with lifting up of the bony flap like a transfemoral approach. Removal of the loosened prosthetic stem and possibly the cement. Preparation of the distal fixation zone of the modular cementless revision stem in the isthmus of the femur distal of the fracture. Implantation of the distal component of the modular cementless revision stem. Use of additional distal interlocking screws in cases of destroyed isthmus with a fixation zone of less than 3 cm for the distal prosthetic component. Trial reposition after combination with the proximal trial component in situ. Assembly with the original proximal component in situ. Reposition with the original proximal component. Wound closure. POSTOPERATIVE MANAGEMENT: Thrombosis prophylaxis, physiotherapy, gait training with partial loading of the limb at 10 kg for a period of 6 weeks with hip flexion limited to 70°. Then, free range of movement and increased loading by 10 kg per week. RESULTS: In all, 23 patients with periprosthetic fractures of Vancouver type B2 (15 patients) and type B3 (eight patients)-in 15 women and eight men in the age range of 70.7 ± 12.2 (42-88) years-were followed up for at least 5 years. All fractures healed with a mean time of 14.4 ± 5.3 weeks. No cases of subsidence of the stem were observed and, according to the classification of Engh et al. concerning the biological fixation of the stem, there was bony ingrowth fixation in 21 cases and two cases of stable fibrous fixation. One dislocation occurred and there were no cases of intraoperative fracture. The Harris Hip Score rose continually following the operations: from a 3-month postoperative score of 65.0 ± 16.8 points, it rose to 86.9 ± 16.2 points after 24 months and to 89.0 ± 14.3 points after 5 years. According to the classification of Beals and Tower, all results were rated as excellent, i.e., the prefracture functional status was restored in all cases.

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement.

We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips. The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection. At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed. We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised.

[A diagnostic algorithm for painful total knee replacement]. / Diagnostischer Algorithmus der schmerzhaften Knietotalendoprothese.

UNLABELLED: Total knee arthroplasty (TKA) is one of the most common procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patients' satisfaction and pain. Despite the clinical success of primary TKA with 10-year survival rates as high as 95 %, about 20 % of the patients after TKA are not completely satisfied with their outcomes for several reasons. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. Failure can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. The onset of the pain after the operation and the differentiation between pain in motion and at rest are helpful to distinguish between mechanical and non-mechanical problems. An infection should be the first diagnosis to be ruled out in a painful TKA. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior to considering revision surgery. METHOD: In this review a practical diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes a detailed history with an extended analysis of the type of pain, thorough clinical examination including spine, hip and ankle, radiographic and laboratory analysis, as well as invasive examinations like joint aspiration and biopsies. CONCLUSION: This diagnostic algorithm offers an important tool for a sufficient failure analysis in almost all patients with painful TKA.

[Arthroplasty of the Femoropatellar Joint - What Data are Available?]. / Patellofemoraler Ersatz - welche Datenlage haben wir?

BACKGROUND: Osteoarthritis of the knee joints is rarely seen only in the femoropatellar joint. In isolated severe osteoarthritis of the femoropatellar joint an isolated prosthetic joint replacement of this joint is indicated. To achieve good results, correct patient selection with no arthritis in the femorotibial joint and absence of maltracking and instability of the patella are crucial. Modern prostheses with a femoral onlay component and a proper surgical technique with correct alignment of the prosthetic component and prevention of an overstuffing of the patella are essential. PATIENTS AND METHODS: Fifty-three Vanguard Prostheses (Biomet GmbH, Warsaw, IL) were examined after a follow-up of 3.7 ± 2.8 (1-8) years. RESULTS: The Knee Society score increased from 117.3 points preoperative to 181.2 points at the follow-up. One knee was revised because of neuropathic pain. Two patients suffered from periprosthetic patellar fractures after falling. CONCLUSION: In well indicated cases with isolated osteoarthritis of the femoropatellar joint, good clinical results with a femoropatellar prosthesis can be expected.

Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring.

Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.

[Extended approach in hip revision and preservation of the muscles. Is that possible?]. / Erweiterte Zugänge bei Hüftprothesenwechseln und Muskelschonung. Geht das?

For revision of hip prostheses several standard and extended approaches can be used. The goal of these approaches is a good visualisation with minimal trauma of the bone and its vascularisation as well as of the muscles. Of the extended approaches we prefer the transfemoral approach in a modified technique. This approach is indicated when the stem of the endoprosthesis is broken, when the femoral axis has shifted because of stem loosening, or when the bone has become noticeably thin, which by itself or in combination would greatly increase the risk of an intraoperative fracture or perforation. Similarly, it is indicated in cases in which the cement mantle was stable, when a periprosthetic fracture of Vancouver B2 or B3 type is present or when a loose cementless stem with a coarsely porous surface cannot be removed in an endofemoral manner. In a published study of 68 patients with hip revisions using this modified transfemoral approach, we could see a continuous increase of the Harris hip score from 41.4 points preoperatively to 85.9 points 24 months postoperatively. Healing of the bony flap was seen in 98.5 % of the cases. Two postoperative non-dislocated trochanter fractures could be treated conservatively. The transfemoral approach is an extended approach with sparing of the gluteal muscles and the vasto-gluteal sling. Reproducible good clinical results can be achieved.

[Resurfacing of the humeral head : sensible indications]. / Oberflächenersatz des Humeruskopfs : Sinnvolle Indikationen.

Cup resurfacing of the humeral head is one of the possible prosthetic solutions for severe destruction of the glenohumeral joint. Because neurological complications are not uncommon after total shoulder arthroplasty using surface replacement, these cups are indicated when hemiarthroplasty is possible. The advantages of humeral head resurfacing are bone preservation and the technically easy exchange if revision is necessary; therefore, young patients are candidates for this type of endoprosthesis. At present humeral head resurfacing is indicated for osteoarthritic destruction of Walch types A1 and C, for rheumatic destruction with deficient cuff in younger patients, cuff arthropathy in younger patients with Seebauer types 1A and 1B, humeral head necrosis with normal glenoid and necrotic bone in less than one third of the humeral head and dislocation arthropathy in younger patients.

[Minimally invasive posterior approach for total hip arthroplasty]. / Minimal-invasiver posteriorer Zugang für die Hüfttotalendoprothesenimplantation.

The mini-posterior approach for total hip arthroplasty (THA) belongs to the mini-incision approaches. In comparison to standard approaches, less muscle trauma resulting in less pain, less blood loss and faster rehabilitation in the early postoperative period are attributed to this approach, as known for all other minimally invasive approaches. In a prospective study of 100 cases of THA it could be shown that this is true when comparing the mini-posterior approach with the posterolateral approach. Lower levels of muscle enzymes as a parameter for muscle trauma, could not be seen.

Visible skin colouration predicts perception of male facial age, health and attractiveness.

Although there is evidence that perception of facial age, health and attractiveness is informed by shape characteristics as well as by visible skin condition, studies on the latter have focused almost exclusively on female skin. Recent research, however, suggests that a decrease in skin colour homogeneity leads to older, less healthy and less attractive ratings of facial skin in both women and men. Here, we elaborate on the significance of the homogeneity of visible skin colouration in men by testing the hypothesis that perception of age, health and attractiveness of (non-contextual) digitally isolated fields of cheek skin only can predict that of whole facial images. Facial digital images of 160 British men (all Caucasian) aged between 10 and 70 were blind-rated for age, health and attractiveness by a total of 147 men and 154 women (mean age = 22.95, SD = 4.26), and these ratings were related to those of corresponding images of cheek skin reported by Fink et al. (J. Eur. Acad. Dermatol. Venereol. in press). Linear regression analysis showed that age, health and attractiveness perception of men's faces could be predicted by the ratings of cheek skin only, such that older men were viewed as older, less healthy and less attractive. This result underlines once again the potent signalling role of skin in its own right, independent of shape or other factors and suggests strongly that visible skin condition, and skin colour homogeneity in particular, plays a significant role in the perception of men's faces.