A Combined Approach to Predict Tobacco-Induced Facial Aging Using Dermatologist Knowledge Elicitation and Generative Models.

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.

The impact of a chronic outdoor urban pollution on skin aging-related facial signs is a poorly referenced topic. To assess, through visual grading and referential photographic atlas, possible differences in some facial signs between Chinese women, of comparable ages, living in two close cities very differently exposed to urban pollution. The faces of two cohorts of 204 Chinese women (2 × 102) of same age-groups (25-45 years), living in Baoding (a highly polluted city) and Dalian (a less polluted city), for at least 15 years, have been analyzed. Standardized facial photographs (full face and lateral views) were taken and examined, focusing on 26 signs that belong to 3 different clusters (wrinkles and skin texture, pigmentation disorders, and skin pores/skin redness). The severity of each facial sign was graded by 15 trained experts with the help of an Asian skin referential photographic Atlas that illustrates various scales of clinical severity (0-5, 0-8…). In addition, a naïve panel of 80 Chinese non-expert women was asked, while viewing all photographs, to answer to 4 questions regarding skin radiance, dullness, healthy appearance, and perceived age. The increased severity of almost all facial signs was mostly observed in the older group (40-45 years) living in Baoding. In particular, the clinical severity of eight facial signs (five related to skin structure and three related to pigmentation) was found strongly and significantly enhanced by a regular exposure to a severe chronic urban pollution. The naïve panel judged the facial appearance of women from Baoding less radiant, duller, less healthy, and found them older than their Dalian counterparts. The monthly-recorded weather conditions (UV radiance, temperature, wind, precipitations) of the two cities (of same latitude) show that these only differ by their very different Air Quality Indexes (AQI). The daily life conditions of all women (UV exposure, use of cosmetic facial products, intake of sweet or spicy food…) were found similar in all age-groups. As compared to a moderately polluted region, a severe chronic outdoor urban pollution favors the aggravation of some facial signs in Chinese women. In short, a highly polluted environment can be viewed as an additional accelerating factor of the skin aging process, when compared to a moderately polluted area.

To explore the possibility of an automatic grading algorithm to detect and quantify, from selfie pictures, the subtle changes of facial signs brought by the application of a foundation. A total of 270 Japanese differently aged women (30-54y) living in four different Japanese cities took selfies before, immediately and 5 h after having applied their own foundation, with their own routine. The analysis of 810 selfie pictures revealed (3 times × 270 women) that, prior to applications, all women presented a low grade of facial ageing. In most cases, the severities of less marked facial signs were detected and quantified, found affected by routine at different extents in all age-classes, but more intensely in the older age-class (45-54y) despite their more pronounced signs in bare skin status. In contrast, periorbital wrinkles were detected as more severe in all age-classes at both timing, that is, immediately and 5 h post-application as well as Nasolabial folds 5 h post-application. The amplitude of these positive or negative changes, although found of low amplitude, as decimals of the initial grades, was significantly detected. This automatic system appears apt at grading subtle changes in facial ageing signs brought by a foundation and could be a valuable help to the consumers of make-up products, in refining their individual procedure to obtain a more personalized desired facial appearance.

ObjectivesAging signs can be classified into four main categories: wrinkles/texture, lack of firmness of cutaneous tissues (ptosis), vascular disorders, and pigmentation heterogeneities. During a lifetime, skin will change in appearance and structure not only because of chronological and intrinsic processes but also due to several external factors such as gravity, sun and ultraviolet exposure, and high levels of pollution; or lifestyle factors that have important and obvious effects on skin aging, such as diet, tobacco, illness, or stress. The effect of these external factors leads to progressive degradations of tegument that appear with different kinetics. The aim of this study was to clinically quantify the effect of sun exposure on facial aging in terms of the appearance of new specific signs or in terms of increasing the classical signs of aging.Materials and methodsThis study was carried out on 298 Caucasian women from 30 years to 78 years old. The participants were divided into two groups according to their sun exposure history: 157 women were characterized as sun-seeking, and the other 141 were classified as sun-phobic. This division was made possible by dermatologist grading of heliodermal status on the basis of several observations of classic criteria: wrinkles, sagging, pigmentation heterogeneities, vascular disorders, elastosis, and so on. This work was an opportunity to complete clinical photographic tools by adding in our portfolio new scales for signs observed in the two groups. Thus, 22 clinical parameters were investigated by a panel of twelve trained experts to characterize each woman’s face regarding standardized photographic scales, and thus describe the aging process.ResultsBy calculating statistical correlations between the four clinical clusters (wrinkles/texture, ptosis, vascular disorders, and pigmentation disorders), and real age and apparent age on the one hand and heliodermal status on the other hand, we identified a link between each clinical cluster and aging and the photoaging process. By comparing evaluations of clinical signs between the two groups for each 10-year cluster, we demonstrated that whatever the age, a prevalence of pigmentation disorders for the sun-seeking group (ie, pigmentation) is strongly linked to ultraviolet (UV) exposure. Meanwhile, clinical signs of ptosis are linked more to chronological aging and do not present differences between the two groups, nor, therefore, photoaging. Wrinkles and texture are affected by the two aging processes. Finally, clinical signs of vascular disorders present no evolution with age.ConclusionClinical signs of aging are essentially influenced by extrinsic factors, especially sun exposure. Indeed UV exposure seems to be responsible for 80% of visible facial aging signs.

ABSTRACTPurposePropose and verify the efficiency of myofunctional intervention program to attenuate facial aging signs and balance the orofacial functions.MethodsThirty women, aged 50 to 60 years, randomly divided into: therapy group (TG) submitted to Orofacial Myofunctional Therapy and electromyographic biofeedback group (EBG), submitted to the same program associated with electromyographic biofeedback for chewing, swallowing, and smiling functions training. Aesthetic and oromyofunctional aspects were assessed from photographs, videos, MBGR Protocol and scales for assessing facial aging signs, described in the literature. 50-minute sessions were held weekly for nine weeks and monthly for six months after washout period. Three assessments, identical to the initial one, were performed in the tenth week, eighth week after washout and conclusion of the research. The participants responded to the Satisfaction Questionnaire on the tenth week.ResultsThe statistical analysis using the ANOVA, Tukey and Mann Whitney tests, for inter and intragroup comparison, showed that: intervention promoted attenuation of facial aging signs mainly in TG group, balance of chewing and swallowing functions in both groups; there was an impact of electromyographic biofeedback on the degree of participants’ satisfaction, greater for EBG; interruption of the program for eight weeks resulted in aesthetic losses, mainly in TG, yet not functional losses, in both groups; the six monthly sessions had a limited impact on overcoming the esthetic losses that occurred after washout.ConclusionThe proposed program resulted in attenuation of aging signs, mainly in the TG group and improvement in orofacial functions, in both groups.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43y, range 27-56y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

Purpose Propose and verify the efficiency of myofunctional intervention program to attenuate facial aging signs and balance the orofacial functions. Methods Thirty women, aged 50 to 60 years, randomly divided into: therapy group (TG) submitted to Orofacial Myofunctional Therapy and electromyographic biofeedback group (EBG), submitted to the same program associated with electromyographic biofeedback for chewing, swallowing, and smiling functions training. Aesthetic and oromyofunctional aspects were assessed from photographs, videos, MBGR Protocol and scales for assessing facial aging signs, described in the literature. 50-minute sessions were held weekly for nine weeks and monthly for six months after washout period. Three assessments, identical to the initial one, were performed in the tenth week, eighth week after washout and conclusion of the research. The participants responded to the Satisfaction Questionnaire on the tenth week. Results The statistical analysis using the ANOVA, Tukey and Mann Whitney tests, for inter and intragroup comparison, showed that: intervention promoted attenuation of facial aging signs mainly in TG group, balance of chewing and swallowing functions in both groups; there was an impact of electromyographic biofeedback on the degree of participants’ satisfaction, greater for EBG; interruption of the program for eight weeks resulted in aesthetic losses, mainly in TG, yet not functional losses, in both groups; the six monthly sessions had a limited impact on overcoming the esthetic losses that occurred after washout. Conclusion The proposed program resulted in attenuation of aging signs, mainly in the TG group and improvement in orofacial functions, in both groups.

To describe the progressing severity of facial signs and their links with perceived age, of Chinese men and women. Full-face photographs of 438 Chinese subjects (220 men, 218 women) differently aged (18-80years) were taken. These photographs afforded a zoom on 5 facial signs of aging: forehead and crow's feet wrinkles, nasolabial fold, marionette lines and ptosis of the lower face. A panel of 15 experts graded each sign, using the Asian skin aging atlas reference. A naïve panel of 80 Chinese women (20-60years) was asked to attribute an apparent age. Despite slight differences in severity between genders, men and women share in common a rather regular progression rate, correlated with perceived ages. 15% of men were judged older by more than 10years, and all 5 signs were found more severe than the means of the other 85%. Forehead and Crow's feet wrinkles appear more pronounced in men. Ptosis is slightly more pronounced in women. Nasolabial fold does not differ. Marionette lines show distinct changes: those of men show a lessened severity and a slower rate of progression. In contrast with changes in facial signs with real ages, the upper face seems privileged in the perception of ages in women whereas the latter seems more focusing on its lower part in men. The facial skin aging process in Chinese subjects presents an almost linear progression with perceived ages, common to both genders, at the exception of marionette lines that are more marked and more rapidly progressing in women.

To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of ten facial signs in Japanese women and their changes due to age and sun exposures. A three-step approach was conducted, based on self-taken selfie images. At first, to check on 310 Japanese women (18-69years) enrolled in the northerner Hokkaido area (latitude 43.2°N), how, on ten facial signs, the A.I-based automatic grading system may correlate with dermatological assessments, taken as reference. Second, to assess and compare age changes in 310 Japanese and 112 Korean women. Third, as these Japanese panelists were recruited according to their usual behavior toward sun exposure, that is, non-sun-phobic (NSP, N=114) and sun-phobic (SP, N=196), and through their regular and early use of a photo-protective product, to characterize the facial photo-damages. (a) On the ten facial signs, detected automatically, nine were found significantly (P<.0001) highly correlated with the evaluations made by three Japanese dermatologists (Wrinkles: r=.75; Sagging: r=.80; Pigmentation: r=.75). (b) The automatic scores showed significant changes with age, by decade, of Wrinkles/Texture, Pigmentation, and Ptosis/Sagging (P<.05). (c) After 45years, a significantly increased severity of Wrinkles/Texture and Pigmentation was observed in NSP vs. SP women (P<.05). A trend of an increased Ptosis/Sagging (P=.09) was observed. This work illustrates, for the first time through investigations conducted at home, some impacts of aging and sun exposures on facial signs of Japanese women. Results significantly confirm the importance of sun avoidance coupled with photo-protective measures. In epidemiological studies, the AI-based system offers a fast, affordable, and confidential approach in detection and quantification of facial signs and their dependence with ages, environments and lifestyles.

To assess the agreement, after 1-month application of a popular and efficient anti-aging product, between self-perceived facial signs of aging and those detected and graded by an automatic A.I-based system, using smartphones' selfie images. Of 1065 Chinese women, aged 18-60years, from eight different Chinese cities were recruited. They were asked to apply daily, for 1month, a referential anti-aging product onto their whole face. Selfie images were taken by all subjects at D0 and D28 and sent to our facilities for being analyzed through 10 different facial signs. At D28 , all subjects were asked to fill a questionnaire on the status of their faces, through six general statements. A global agreement between both approaches is reached, particularly among women older than 40years where the severity of facial signs is already more pronounced or among younger women who present at least facial signs scored above one grading units. This limit becomes, therefore, a prerequisite in the recruitment of Chinese subjects in the case of anti-aging applied studies and possible automatically based on automatic grading system. When respecting such conditions, the positive effects of the product on most facial signs can be demonstrated after 28days of successive applications. Such methodological approach paves the road in fulfilling the need of consumers of a better transparency in the claims of an anti-aging product.

(a) To assess and compare the changes in five facial signs with age between genders of Caucasian subjects and (b) to evaluate their links with perceived ages and tiredness. Once zoomed from standardized digital photographs, five facial signs of 518 Caucasian French subjects of both genders and different ages (18-69years) were graded by 15 experts, using a referential Skin Aging Atlas. A large naïve panel of 1000 French subjects (500 men and 500 women) was asked to attribute a perceived age and a degree of tiredness to 200 subjects (among the 518). The severity of the facial signs increases with time at a linear-like rate. The changes in marionette lines significantly differ between genders, much more pronounced in women, and nasolabial fold was found more pronounced in men at older ages (>50years). Before 50's, Forehead wrinkles present a slightly higher severity in men whereas at 50's women present more severe ptosis. Crow's feet wrinkles did not show significant changes. Perceived ages were found significantly correlated with the severities of the facial signs and the perception of tiredness was associated with perceived ages in men, but not in women older than 40years. The gender-related perceptions from the naïve panel in both perceived ages and tiredness showed a low discrepancy. Interestingly, as for changes in facial signs, the upper-half face seems more affected for men and lower-half face for women; after 40years, the naïve panel seems more focusing on the same areas to predict a perceived age. As compared to the previous Chinese study, the present work reveals some slight ethnical-related differences, indicating that the facial signs of the lower face play a major role in the assessment of perceived age of both genders from different ethnicity.

ObjectiveTo 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.MethodsTwo 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.ResultsMost 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.ConclusionThe 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.

To assess the impacts of sun exposures on some skin signs on the faces and hands of differently aged Japanese women, according to their distinct behaviours towards vis à vis sun exposure. Two comparable cohorts of Japanese women (aged 18-83years) were created according to their usual behaviour towards sun exposure i.e. non-sun-phobic (N=495) and sun-phobic (N=516) and through their regular use(s) of a photo-protective product. Standard photographs (full-face and 45° lateral) allowed to focus on 18 facial signs that were graded by 15 experts, using a referential skin ageing Atlas. From these two cohorts, two sub-cohorts (114 and 122 women) were created with regard to the similar clinical aspects of the dorsal side of their hands (Left vs. Right) that were further graded. Absolute differences in the scores of each sign were used (non-sun-phobic minus sun-phobic), by age-ranges, to better ascertain the impact of sun exposures and photo-protection. Facial signs related to skin wrinkles/texture and pigmentary spots were found significantly more accentuated among non-sun-phobic women and show an early onset (20-30years). Facial sagging and crow's feet wrinkles appear delayed (30-40years). The severity of vascular disorders was found to be similar in the two cohorts. The absolute differences in the grading's of almost all signs were unsurprisingly found increased with advancing ages, illustrating the combination of chronological and photo-ageing processes. With regard to hands, differences in skin texture and pigmentary disorders are of a late onset (40-50years) and were found much increased at older ages. The cutaneous signs of the hands of Japanese women can hardly be taken as reliable markers of their photo-ageing status. The present work illustrates, for the first time, some specificities of the impact of sun exposures on the facial skin of Japanese women, pinpointing the fact that some facial signs are of an early onset. Results significantly confirm the importance of both sun avoidance coupled with photo-protective measures.

The objective of this study is to assess the correspondence, in live conditions, between clinical gradings of facial aging signs by three dermatologists and those afforded by an automatic AI-based algorithm that analyses smartphones' selfie images of Chinese subjects. In total, 125 Chinese subjects of both genders, aged 18-62y, took a selfie using their own smartphones and were immediately viewed by three dermatologists. The latter graded the severity of 15 facial signs in women and 9 in men, using the standardized values afforded by a Skin Aging Atlas referential dedicated to Asian skin. The data issued by both methodologies were then statistically compared. The absolute gradings of the automatic system were found highly correlated with clinical assessments, with lower values in most cases. In women, large differences in absolute values were found on the gradings for size of isolated spot, cheek fold, spread macules, and texture of mouth contour women. Analysis of the Mean Absolute Errors (M.A.E) revealed that these rarely exceed 0.6 grading units in women and to a lesser extent in men. The present study confirmed the value of the automatic system towards an extended use towards large human cohorts as a surrogate of clinical evaluations and allowed to detect the points where improvements must be brought to the system.

Background: the skin displays the most visible manifestations of aging. Research interest in aging process has grown and people are becoming obsessed with looking young. The face has received most of the attention and generated most of the studies related to beauty and aging because it is the most expressive part of human body. Aim of the Work: to assess the different clinical patterns of facial wrinkles and signs of skin aging among different age categories of Egyptian females. Subjects and Methods: this cross-sectional study was carried out in the Dermatology, Venereology and Andrology department of Ain Shams University Hospitals after Institutional Review Board approval. The study included included 100 adult females ranged from 20-60 years old. Results: the mean age was (38.570±11.634) with a range of 20-60 years. Skin phototype was Fitzpatrick Type III in 8 patients (8%), IV in 55 females (55%) and V in 37 females (37%). Glogau classification for severity of skin aging signs was type I in 39 cases (39%), Type II in 20 (20%), Type III in 26 (26%) and type VI in 15 (15%). All patients reported history of excessive sun exposure for extended hours; 32 cases reported sunscreen use but not regular, while 68 cases didn’t use sunscreen. Conclusion: skin Type IV showed more wrinkles indentation index, roughness, melanin concentration, melanin heterogeneity and HGB heterogeneity. There was a significant correlation between the sunscreen use and average melanin concentration, where cases that used sunscreen showed lower average melanin concentration. The relation between sun screen use and severity of wrinkles (Indentation index) was non-significant.