Facial Aging Research Articles

RAgE: Robust Age Estimation Through Subject Anchoring With Consistency Regularisation.

Modern facial age estimation systems can achieve high accuracy when training and test datasets are identically distributed and captured under similar conditions. However, domain shifts in data, encountered in practice, lead to a sharp drop in accuracy of most existing age estimation algorithms. In this article, we propose a novel method, namely RAgE, to improve the robustness and reduce the uncertainty of age estimates by leveraging unlabelled data through a subject anchoring strategy and a novel consistency regularisation term. First, we propose an similarity-preserving pseudo-labelling algorithm by which the model generates pseudo-labels for a cohort of unlabelled images belonging to the same subject, while taking into account the similarity among age labels. In order to improve the robustness of the system, a consistency regularisation term is then used to simultaneously encourage the model to produce invariant outputs for the images in the cohort with respect to an anchor image. We propose a novel consistency regularisation term the noise-tolerant property of which effectively mitigates the so-called confirmation bias caused by incorrect pseudo-labels. Experiments on multiple benchmark ageing datasets demonstrate substantial improvements over the state-of-the-art methods and robustness to confounding external factors, including subject's head pose, illumination variation and appearance of expression in the face image.

HYALURONIC ACID BEYOND SKIN REJUVENATION: THE INTERSECTION BETWEEN BEAUTY AND SAFETY IN COMPLIANCE WITH THE NEW EU MEDICAL DEVICES REGULATION

Hyaluronic acid-based mesotherapy has become a highly popular and valuable option for facial rejuvenation, with a renowned efficacy and safety profile.The new European Regulation (EU) 2017/745 on medical devices remarks the need for post-market clinical follow-up to guarantee safety and efficacy during the entire life cycle of medical devices. In line with the new regulation, we aimed to further evaluate the clinical performance and safety of hyaluronic acid-based mesotherapy within routine practice in a period of 9 weeks. The present work is anobservational, prospective, open and non-controlled study in a cohort of patients treated with hyaluronic acid-based mesotherapy for facial aging. Patients between 30 and 75 years old, treated with hyaluronic acid 1% injections for facial rejuvenation, were included. Point-by-point and epidermal administration techniques were usedin three visits (initial, 3 weeks and 6 weeks). The outcomes were measured using GAIS for efficacy and VAS for patient satisfaction. A total of 25 patients underwent hyaluronic acid mesotherapy in the face or neck, and were followed up for 9 weeks. Throughout the study, a significant improvement (p < 0.05) in skin appearance and hydration was observed in both groups between first and last visit. No significant differences were observed between the two groups. All participants showed increased skin hydration and/or reduced fine lines. In conclusion, hyaluronic acid-based mesotherapy is effective for facial and neck skin boosting, with an excellent safety profile, highlighting the potential of linear hyaluronic acid as a non-surgical solution for skin rejuvenation.

Genetic insights into the gut microbiota and risk of facial skin aging: A Mendelian randomization study.

A growing number of experimental studies have shown an association between the gut microbiota (GM) and facial skin aging. However, the causal relationship between GM and facial skin aging remains unclear to date. We conducted a two-sample Mendelian randomization (MR) analysis to investigate the potential causal relationship between GM and facial skin aging. MR analysis was mainly performed using the inverse-variance weighting (IVW) method, complemented by the weighted median (MW) method, MR-Egger regression, and weighted mode, and sensitivity analysis was used to test the reliability of MR analysis results. Eleven GM taxa associated with facial skin aging were identified by IVW method analysis, Family Victivallaceae (p=0.010), Genus Eubacterium coprostanoligenes group (p=0.038), and Genus Parasutterella (p=0.011) were negatively associated with facial skin aging, while Phylum Verrucomicrobia (p=0.034), Family Lactobacillaceae (p=0.017) and its subgroups Genus Lactobacillus (p=0.038), Genus Parabacteroides (p=0.040), Genus Eggerthella (p=0.049), Genus Family XIII UCG001 (p=0.036), Genus Phascolarctobacterium (p=0.027), and Genus Ruminococcaceae UCG005 (p=0.012) were positively associated with facial skin aging. At Class and Order levels, we did not find a causal relationship between GM and facial skin aging. Results of sensitivity analyses did not show evidence of pleiotropy and heterogeneity. Our findings confirm the causal relationship between GM and facial skin aging, providing a new perspective on delaying facial aging.

Skinly: A novel handheld IoT device for validating biophysical skin characteristics.

Recent advancements in artificial intelligence have revolutionized dermatological diagnostics. These technologies, particularly machine learning (ML), including deep learning (DL), have shown accuracy equivalent or even superior to human experts in diagnosing skin conditions like melanoma. With the integration of ML, including DL, the development of at home skin analysis devices has become feasible. To this end, we introduced the Skinly system, a handheld device capable of evaluating various personal skin characteristics noninvasively. Equipped with a moisture sensor and a multi-light-source camera, Skinly can assess age-related skin parameters and specific skin properties. Utilizing state-of-the-art DL, Skinly processed vast amounts of images efficiently. The Skinly system's efficacy was validated both in the lab and at home, comparing its results to established "gold standard" methods. Our findings revealed that the Skinly device can accurately measure age-associated parameters, that is, facial age, skin evenness, and wrinkles. Furthermore, Skinly produced data consistent with established devices for parameters like glossiness, skin tone, redness, and porphyrin levels. A separate study was conducted to evaluate the effects of two moisturizing formulations on skin hydration in laboratory studies with standard instrumentation and at home with Skinly. Thanks to its capability for multi-parameter measurements, the Skinly device, combined with its smartphone application, holds the potential to replace more expensive, time-consuming diagnostic tools. Collectively, the Skinly device opens new avenues in dermatological research, offering a reliable, versatile tool for comprehensive skin analysis.

Racial Perspectives on Facelifts: Evaluating Techniques and Outcomes Across Diverse Populations.

Facial aesthetic surgery is one of plastic and reconstructive surgery's most sought-after and evolving areas. The growing diversity in both local and worldwide populations compels us to reevaluate our previous approaches and underscores the significance of departing from a singular aesthetic standard. Thankfully, the historical practice of stereotypical racial profiling has become less prevalent in the literature. Regrettably, however, the comparative terminology persists, characterizing non-Caucasian races as deviating from the "norm," which typically refers to the White or Caucasian race. Additionally, there is a lack of contemporary literature comparing the distinctive considerations relevant to rhytidectomy across multiple racial populations. The aim of this study was to succinctly outline the current body of literature examining the impact of race on facial aging and rhytidectomy, laying the groundwork for subsequent discussion on the relationship between race and facial aesthetic surgery. A comprehensive literature review was conducted using PubMed (National Institutes of Health, Bethesda, MD), identifying all studies published before 2023 discussing facial aging and rhytidectomy, specifically in non-Caucasian patients. A total of 22 publications was identified. Asians were the most described group, with 12 publications, followed by Black/African with 5 and Hispanic/Latinx with 4. In today's context, the aesthetic surgeon must possess the knowledge and readiness to provide culturally sensitive, patient-centered care guided by subtle anatomical nuances, informed by anecdotal recommendations, and ultimately, aimed at effectively addressing aging concerns within diverse populations.

Exploring facial overfilled syndrome from the perspective of anatomy and the mismatched delivery of fillers.

Facial fillers and injectables have transformed the landscape of cosmetic procedures, offering rejuvenation possibilities. However, the emergence of "Facial Overfilled Syndrome (FOS)" presents a concerning trend attributed to excessive filler use and suboptimal injection techniques. Understanding the interplay between facial aging and augmentation techniques is crucial in addressing and preventing FOS. Facial overfilled syndrome is characterized by the excessive use of fillers, resulting in a distorted and heavy appearance. It manifests in various forms, including 'flowerhorn' foreheads, 'sunset' eyes, 'chipmunk' cheeks, 'witch' chins, and 'pillow' faces. The syndrome arises from attempts to combat anatomical aging with dramatic filler treatments, causing rapid volume changes and skin tightening. Skeletal structures and soft tissue distribution across different ethnicities play a significant role in FOS development. Understanding the aging process across facial tissues is essential, as fillers cannot entirely reverse aging manifestations. Tailored assessment and treatment plans should precede filler injections, involving muscle assessment, observation of facial movements during injection, and ultrasound imaging of fat layers. Attention should be given to filler pressure and migration risks, particularly in areas with elevated pressure. Additionally, alternative approaches like energy-based devices and polymer reinforcement of facial ligaments should be considered to minimize filler use. Ethnic variations in facial anatomy require careful consideration to avoid overcorrection. FOS predominantly affects individuals of East Asian descent due to specific facial characteristics. Prevention strategies involve minimizing filler use, addressing underlying bone changes, and considering ethnic and gender differences in facial anatomy. Recent MRI and ultrasound studies challenge the notion of filler breakdown, emphasizing the importance of filler selection and injection techniques. Education, individualized treatments, and a holistic understanding of facial anatomy are key to preventing and managing FOS and ensuring natural and harmonious facial aesthetics.

Father figure: Study of the age progression process from old pictures and its value in forensic sciences

The application of age progression to the search for missing persons demonstrates its usefulness in being able to reconstruct the aged face based on the current age of a person who has been missing for many years. Age progression takes into account facial physiognomic elements and their changes over time. Based on these premises, the present study aims to investigate the evolution of somatic features, from childhood to adulthood, of one of the authors' father using photos at different ages of him.Sixteen photos were collected depicting an individual of Italian origin between the age of 1 and 72. The photos were processed in Adobe© Photoshop software to graphically highlight the shape development of individual physiognomic elements. The shape of the face, eyebrows, eyes, nose, mouth, and cheeks were analysed in detail using a morphological approach. The ageing processes that occurred in this case were discussed on the basis of the literature.The present study demonstrates the in-depth analysis of the dynamics of facial growth in a single case. Nonetheless, aging is different for each individual, so further studies are necessary to observe facial development on as many subjects as possible.

A review of nonsurgical facial rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1% in periorbital revitalization.

The demand for nonsurgical facial rejuvenation options is growing, yet the periorbital region remains an area of relative unmet need. This review explores nonsurgical options for facial rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1%, in treating age-related blepharoptosis as part of periorbital rejuvenation. Advisors experienced in facial rejuvenation met to discuss existing literature on the upper face and periorbital rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1%, in treating facial aging. An array of nonsurgical options exist to address the signs of aging, including minimally invasive treatments, such as botulinum toxin injections and dermal fillers, and noninvasive therapy, such as lasers, chemical peels, and microdermabrasion. However, treating age-related ptosis in periorbital rejuvenation is mainly addressed surgically. The newly approved α-adrenergic receptor agonist oxymetazoline hydrochloride ophthalmic solution, 0.1%, provides a novel non-interventional approach to blepharoptosis. Facial rejuvenation is highly sought-after in this post-pandemic era. Each nonsurgical treatment option has its advantages and drawbacks. A patient-centered approach is necessary to select the appropriate procedure considering the patient's concerns and aesthetic sensibilities. The eyes are an area of primary concern for patients, yet surgery is the gold standard for treating ptosis. Oxymetazoline hydrochloride ophthalmic solution, 0.1%, is a safe and effective nonsurgical treatment for blepharoptosis.

Using 3D Imaging to Preoperatively Plan Facelift Procedures for the Lower Third of the Face and Neck

The pursuit of youth and attractiveness is a fundamental desire in contemporary society. For many individuals, the appearance of visible signs of aging, such as skin laxity, gravitational changes in facial and neck soft tissues, and loss of harmonious proportions, can be psychologically distressing. The choice of effective methods for addressing these changes depends on their specific characteristics, the patient’s anatomical features, and the type of facial aging. The introduction of 3D imaging to determine the hyoid bone level, the volume of soft tissue structures in the cervico-mental area, ptosis of subplatysmal structures, and the volume of submandibular glands, in addition to ultrasound study of the submental projection at the preoperative stage, are key for making the best decisions regarding preoperative planning. This case report aims to illustrate how modern imaging techniques are a fundamental part of the preoperative assessment of the mid and lower third of the face to ensure the most favorable aesthetic outcomes for each patient.

Ellansé: Advanced Technology and Advantageous Selection of New Collagen Stimulating Agents for Face Rejuvenation.

Facial injections have a comparative mature market and system in China, but all kinds of injection materials have their own advantages and disadvantages, even hyaluronic acid, as the most common injection material, can form an unnatural stiffness after injection. Currently, Ellansé, a biodegradable collagen stimulator, has shown superior aesthetic results while ensuring safety and naturalness, making it a more preferable choice for a variety of facial injections. The purpose of this review is to introduce the features and benefits of Ellansé, so that doctors in the field can better understand and learn how to use it properly and minimize the risk of complications, and have a better choice for the medical aesthetic field in China in numerous aspects. The papers with the keyword "Ellansé" is very few in number, and there is a lack of systematic overview. Ellansé itself has unique advantages for the Chinese population, as it is an attractive option for the treatment of aging face due to high patient satisfaction, long-lasting results and low side effects (Guo et al. in J Cosmet Dermatol 21(5):1959-1966, 2022). More clinical data will be available in the future to confirm its performance and longevity in various sites. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dynamic Reconstruction Using Bilateral Lengthening Temporalis Myoplasty for Facial Palsies in Patients with Hereditary Skin Laxity.

Hereditary skin laxity is a rare condition, some cases of which are also referred to as cutis laxa, and those involving facial skin are considered a target for treatment by plastic surgery as patients present with an aged face, which can reduce their quality of life. In some of these patients, the facial nerve and muscles may be affected, and cause weakness of mimetic muscles. We performed one-stage bilateral lengthening temporalis myoplasty reanimation, followed by lower facial contouring with partial lower lip excision and hammock-shaped fascia grafting in two patients with hereditary facial skin laxity coexisting with facial palsy. The patient was a 63-year-old woman with hereditary gelsolin amyloidosis and a 64-year-old man who was diagnosed with oculopharyngeal muscular dystrophy. Postoperatively, a symmetrical facial contour was achieved in repose, and smiling with and without biting was possible. To our knowledge, there are no reports of dynamic smile reconstruction for facial weakness in patients with hereditary facial skin laxity. Although these patients may experience progressive loss of function of the trigeminal nerve and its innervating muscles, the static suspension effect of lengthening temporalis myoplasty can be expected to continue even if the temporal muscles lose their function in the future. We believe that, with careful patient selection, dynamic reconstruction is an option for progressive facial paralysis. In this article, we present the chronological history of two patients who underwent multiple plastic surgery procedures and discuss the importance of the role of plastic surgery in improving the quality of life under these conditions.

Predicting the evolution of clinical skin aging in a multi-ethnic population: Developing causal Bayesian networks using dermatological expertise.

Software to predict the impact of aging on physical appearance is increasingly popular. But it does not consider the complex interplay of factors that contribute to skin aging. To predict the +15-year progression of clinical signs of skin aging by developing Causal Bayesian Belief Networks (CBBNs) using expert knowledge from dermatologists. Structures and conditional probability distributions were elicited worldwide from dermatologists with experience of at least 15 years in aesthetics. CBBN models were built for all phototypes and for ages ranging from 18 to 65 years, focusing on wrinkles, pigmentary heterogeneity and facial ptosis. Models were also evaluated by a group of independent dermatologists ensuring the quality of prediction of the cumulative effects of extrinsic and intrinsic skin aging factors, especially the distribution of scores for clinical signs 15 years after the initial assessment. For easiness, only models on African skins are presented in this paper. The forehead wrinkle evolution model has been detailed. Specific atlas and extrinsic factors of facial aging were used for this skin type. But the prediction method has been validated for all phototypes, and for all clinical signs of facial aging. This method proposes a skin aging model that predicts the aging process for each clinical sign, considering endogenous and exogenous factors. It simulates aging curves according to lifestyle. It can be used as a preventive tool and could be coupled with a generative AI algorithm to visualize aging and, potentially, other skin conditions, using appropriate images.

Age as Adventure: Restorying Later Life

<p>For many people, aging is perceived and experienced in implicitly tragic terms: as a narrative of decline, as little more than a downward trajectory toward decrepitude and death. Such a way of storying later life can set us up for (among other things) narrative foreclosure, which can fuel the mild-to-moderate depression to which older adults are susceptible in the face of aging’s many challenges. Insofar as our experience of aging is inseparable from our story of aging, this paper argues for an alternative narrative of later life. Drawing on concepts from narrative gerontology and narrative psychology, it outlines how later life can be re-genre-ated from tragedy to adventure in at least four inter-related directions: Outward, Inward, Backward, and Forward.</p>

Rejuvenation in Men Facial Aging: A Combined Approach.

Facelift surgery, also known as rhytidectomy, is a popular cosmetic procedure aimed at reversing the signs of facial aging. While facelift surgery is more commonly performed in women, an increasing number of men are seeking this procedure to maintain a youthful appearance. The long recovery period conflicts the overall primary outcome anticipated by men undergoing rhytidectomy, i.e., appear younger, youthful, and ready to reaffirm their value in the working environment. Anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling are three techniques that have been shown to be effective in improving facial rejuvenation outcomes in elderly male patients. However, there is little to no evidence of the safety and efficacy of these techniques when used in combination. By combining these techniques, we hypothesized that we could achieve outcomes comparable to traditional facelift surgery, but with a lower risk of complications and a shorter recovery time. We conducted a retrospective case series study of 18 male patients who underwent facial rejuvenation surgery using the combination of anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling at our institution between 2018 and 2021. All 18 patients completed the study, with an average follow-up of 12months. No major complications were observed, and all patients reported a high level of satisfaction with their outcomes.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 .

When Hyaluronic Acid Alters its Rheology: Clinical, Ultrasonographic and Pathological Correlation

Hyaluronic acid has demonstrated itself as a highly successful non-invasive medical procedure for mitigating facial aging changes. This success is primarily attributed to its biodegradable or temporary nature, the reproducibility of aesthetic results, and the potential for dissolution through hyaluronidase. Despite its virtues, changes in the rheology of the product can occur, leading to alterations in its structure, resulting in the formation of visible, palpable nodules that are challenging to degrade with hyaluronidase. We present a case series of 9 patients in whom high-resolution ultrasound detected changes in the normal echographic appearance of hyaluronic acid suggestive of pseudosolidification, including increased echogenicity, a hyperechoic band inside the periphery of the deposits, the absence of degradation changes, and persistent, well-defined oval morphology. All cases showed no inflammatory activity on Doppler. In one case, the deposit was surgically removed during blepharoplasty, and histopathological analysis provided useful information to understand the mechanisms behind such complications.

Age-API: are landmarks-based features still distinctive for invariant facial age recognition?

Age-API: are landmarks-based features still distinctive for invariant facial age recognition?

Platelet-Rich Plasma Versus Platelet-Poor Plasma for Treating Facial Photoaging: a Double-Blind Randomized Controlled Splitting Face Study.

As the demand for non-invasive esthetic procedures to maintain a youthful appearance increases, there has been growing interest in the use of autologous platelet-rich plasma (PRP) and platelet-poor plasma (PPP) for the treatment of facial aging. However, there are few studies directly comparing the efficacy of PRP and PPP for facial rejuvenation. This study aimed to compare the efficacy of PRP and PPP for facial rejuvenation. This single-center, double-blind, randomized controlled trial was conducted from January 1, 2022, to July 31, 2022, and included ten participants who completed the follow-up. The participants were randomly assigned to receive 2.5-mL injections of PRP and PPP on different sides of the face in three sessions with 1-month intervals. The outcome was primarily determined by blinded photographic assessments and secondly by scores of the VISIA® system during the follow-up. Both PRP and PPP treatments resulted in significant improvement in the Global Aesthetic Improvement Scales and Modified Fitzpatrick Wrinkle Scale for periocular Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation wrinkles, with no significant difference between the two groups. However, no improvement was observed in the Wrinkle Severity Rating Scales for nasolabial folds in either the PRP- or PPP-treated groups. Furthermore, no severe adverse events were reported. Both PRP and PPP are effective in treating facial photoaging. PRP exhibited slightly superior efficacy in enhancing overall skin condition, while PPP was slightly more effective in improving shallow wrinkles. This study provides valuable evidence for the use of PRP and PPP in facial rejuvenation procedures. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

THE INFLUENCE DENTAL HEALTH EDUCATION ON BEHAVIOR AND DEBRIS INDEX OF STUDENTS

Dental caries is an infectious disease resulting from the demineralization of enamel and dentin, closely linked to the consumption of cariogenic foods. Typically, children entering school age face a heightened risk of caries due to their inclination toward snacking on sweet foods and drinks. The implementation of Dental Health Education (DHE) plays a crucial role in enhancing students' comprehension of dental and oral health. Specifically, educating children on proper teeth-brushing techniques should include practical examples and applicable methods. This study aims to assess the impact of dental health education on the behavior and fecal index of students at SDN Mesjid Lheu in Aceh Besar District. Employing a quasi-experimental design, the research follows a control group equivalent to pre-test and post-test. The total population of 60 children was divided into two groups: the intervention group and the control group. Quantitative data analysis involved the paired sample t-test and the independent t-test. Significant differences were observed in the mean values of knowledge, attitudes, and actions, as well as the OHI-S scores immediately after and one month following the intervention between the treatment group and the control group (p<0.05). To reinforce children's dental health habits at home, it is advisable to involve parents in dental health education programs, as their information and resources are integral to providing support and monitoring.

Masked face age and gender identification using CAFFE-modified MobileNetV2 on photo and real-time video images by transfer learning and deep learning techniques

One of the most challenging factors related to masked face age and gender identification (MFAGI) is developing a technique to quickly carry out identification and maintain accuracy without needing people to remove their masks. The eyes, forehead and important frontal features including the ears were the main focus of this investigation. In this study, we evaluated and compared ten (10) different MFAGI techniques, which include traditional methods such as MobileNet, MobileNetV2, ResNet101, DenseNet169, DenseNet201, EfficientNetB0, ResNet152V2, InceptionV3, Xception and our one proposed approach. These 10 models were used to classify masked faces of people among sixteen (16) classes. Combining the convolutional architecture of fast feature embedding (CAFFE) with the modified MobileNetV2 (MNV2) model developed a novel method known as the “CMNV2” model. To achieve the goal of model performance and classification accuracy for MFAGI of people’s faces, this work introduces a unique CMNV2 model by developing a pre-trained model with eight (8) different layers. Using deep learning (DL) and a transfer learning approach, we developed a unique novel approach to image feature extraction that outperforms the nine (9) traditional methods for masked face classification (MFC), masked face age identification (MFAI) and masked face gender identification (MFGI). This approach developed a Python model that was trained and evaluated on 12,160 masked face images. This study demonstrates that an efficient CMNV2 method can be achieved by combining transfer learning with deep neural network (DNN) development. This proposed CMNV2 model achieved 96.54% accuracy and 3.46% error rate with less parameters and computational time exceeding the other 9 different traditional masked identification methods. It also shows that our proposed CMNV2 strategy is more successful than the other 9 models and can identify masked people’s faces age and gender in photo and real-time video images. Overall, the results of this research indicate that DL methods have the capability to improve the accuracy and speed with which masked face classification and identification is performed. The artificially masked faces of images dataset created by us utilized in this work is publicly made available on the Kaggle website https://www.kaggle.com/datasets/banilkumar20phd7071/masked-face-age-and-gender-identify-artificial-masking.

Development of an epigenetic clock to predict visual age progression of human skin.

Aging is a complex process characterized by the gradual decline of physiological functions, leading to increased vulnerability to age-related diseases and reduced quality of life. Alterations in DNA methylation (DNAm) patterns have emerged as a fundamental characteristic of aged human skin, closely linked to the development of the well-known skin aging phenotype. These changes have been correlated with dysregulated gene expression and impaired tissue functionality. In particular, the skin, with its visible manifestations of aging, provides a unique model to study the aging process. Despite the importance of epigenetic age clocks in estimating biological age based on the correlation between methylation patterns and chronological age, a second-generation epigenetic age clock, which correlates DNAm patterns with a particular phenotype, specifically tailored to skin tissue is still lacking. In light of this gap, we aimed to develop a novel second-generation epigenetic age clock explicitly designed for skin tissue to facilitate a deeper understanding of the factors contributing to individual variations in age progression. To achieve this, we used methylation patterns from more than 370 female volunteers and developed the first skin-specific second-generation epigenetic age clock that accurately predicts the skin aging phenotype represented by wrinkle grade, visual facial age, and visual age progression, respectively. We then validated the performance of our clocks on independent datasets and demonstrated their broad applicability. In addition, we integrated gene expression and methylation data from independent studies to identify potential pathways contributing to skin age progression. Our results demonstrate that our epigenetic age clock, VisAgeX, specifically predicting visual age progression, not only captures known biological pathways associated with skin aging, but also adds novel pathways associated with skin aging.