Fitzpatrick Skin Phototype Research Articles

Validity of facial skin analysis pore detection: A comparative analysis.

Reliable, objective measures to assess facial characteristics would aid in the assessment of many dermatological treatments. Previous work utilized an iOS application-based artificial intelligence (AI) tool compared to the "gold standard" computer-based and a physician assessment on five skin metrics (British Journal of Dermatology, 2013, 169, 474). The AI tool had superior agreement for all skin metrics except pores and subsequently underwent an algorithm update for its pore detection system. This comparative analysis assessed the performance of the updated AI tool's pore scores across all Fitzpatrick skin phototypes to determine whether the AI tool more accurately represents a dermatologist's assessment of pores. Frontal facing photographs in uniform lighting conditions were taken of each participant. Percentile scores were generated by each of the four self-learning models of the updated AI tool. The pore percentile scores generated by the original and updated AI tool were used to rate "worse" pores among participant pairs. These ratings were compared to pore assessments performed by a "gold-standard" device and a board-certified dermatologist. Compared to the original pore detection tool and the computer-based program, models A and D had the highest concordance with the physician's pore assessments for Fitzpatrick skin phototypes III-IV and V-VI, respectively. The AI tool's pores detection update was successful in its ability to accurately detect pores on all Fitzpatrick skin types, improving on the performance of the AI prior to the update. Responsibly developed AI tools that can accurately and reliably detect skin metrics across diverse Fitzpatrick skin types can facilitate dermatologic evaluation, individualize treatment, and determine treatment response.

Subjective and objective assessment of color match of universal tinted sunscreens in Fitzpatrick skin phototypes I-VI.

Tinted sunscreens not only shield against UV rays but also provide protection against visible light, as opposed to traditional sunscreens. Universal tinted sunscreens are marketed to complement all skin tones. To assess color match and subject satisfaction for 7 universal tinted sunscreens across various price ranges in all Fitzpatrick skin phototypes (SPT). Products A-G were applied at concentrations of 1 and 2 mg/cm2 on the dorsal arms of 30 subjects spanning SPT I-VI. Photography, colorimetry, and subject and investigator surveys were utilized to determine color match. Using colorimetry analysis at the recommended 2 mg/cm2 concentration, two of seven products were identified as suitable matches for SPT I-II, while six out of seven were determined to be a good match for SPT III-IV. However, only one product was found to be a good match for SPT V-VI at the recommended concentration according to colorimetry results. Universal tinted sunscreens do not provide an adequate color match for all skin phototypes, especially for individuals with very fair or very dark skin tones.

52736 Assessment of Color Match of Universal Tinted Sunscreens in Fitzpatrick Skin Phototypes I-VI

52736 Assessment of Color Match of Universal Tinted Sunscreens in Fitzpatrick Skin Phototypes I-VI

An overlooked risk for skin health: Less availability and higher cost of sunscreen for people with melanated skin

BackgroundSunscreen with a skin protection factor (SPF) of 30 or greater is recommended to reduce the risk of skin cancer and improve skin health for all people regardless of skin tone. Traditional sunscreen that creates a white cast on the skin is incompatible with melanated skin. MethodsThe number of products on the shelf, SPF level, application, coloration, and cost were recorded at three beauty supply chain stores and three pharmacy, health, and wellness stores in or near Harlem in New York City in the Spring of 2023. The number of skin tones for tinted sunscreen was visually matched to the Fitzpatrick Skin Phototypes scale. ResultsA total of 385 sunscreen products were identified; 78.7 % were traditional white sunscreen, followed by sheer (15.3 %) and tinted (6.0 %) products. Beauty supply stores offered more tinted sunscreen options than did pharmacy, health, and wellness stores (n = 17,15.3 % vs. n = 6, 2.2 %, p < 0.001). Of the tinted sunscreen products, 19 brands offered only a single tone. Tinted sunscreen was significantly more expensive with an average cost of $24.59 [SD $14.71] per ounce vs. $6.85 [SD 8.66] for traditional, and $9.38 [SD 8.92] for sheer suncreen. ConclusionsSunscreen that is tinted or sheer and compatible with melanated skin is less available and more costly than traditional white sunscreen in beauty and pharmacy chain stores in NYC. Availability and affordability of sunscreen matching the spectrum of skin tones are essential for optimal sun protection and skin health.

Hyaluronic Acid Filler VYC-25L for Jawline Restoration Yields High Satisfaction, Improved Jawline Measurements, and Sustained Effectiveness Across Skin Types, Age, and Gender for up to 12 Months.

A randomized study was previously reported to demonstrate the safety and efficacy of hyaluronic acid filler VYC-25L for restoring jawline definition. Evaluate patient-reported outcomes (PROs), objective changes in jawline profile, and safety and effectiveness measures by Fitzpatrick Skin Phototype (FST), gender, and age following VYC-25L treatment. Adults were randomized to receive VYC-25L (n=157) or no treatment (control; n=49) for 6 months. PROs were assessed by FACE-Q Satisfaction with Lower Face and Jawline, FACE-Q Appraisal of Lines: Marionette, and participant satisfaction with treatment questionnaires. Changes in jawline profile linear depth and volume were calculated using 3D digital image analysis. Responder rates, PROs, and injection site responses (ISRs) were assessed by FST, gender, and age. At month 6, >70% of treated participants responded "somewhat/very satisfied" to FACE-Q Satisfaction with Lower Face and Jawline questions, and ≥78% of treated participants responded "satisfied/definitely satisfied" with treatment overall. For participants treated in the marionette lines, the FACE-Q Appraisal of Lines: Marionette questionnaire mean score improved by 32.6 (baseline to month 6). Mean change in linear depth in the prejowl sulcus in the treatment vs control groups was 4.6 mm vs 2.5 mm, respectively, and for jawline volume was 6.0 cc and -2.6 cc, respectively, (baseline to month 6). Subanalyses showed similar outcomes by FST, gender, and age except for a numerically higher ISR incidence in females vs males. Treatment with VYC-25L to improve jawline definition yielded high patient satisfaction, objective improvements in jawline profile, and comparable effectiveness across various demographics.

Rosacea in East Asian populations: Clinical manifestations and pathophysiological perspectives for accurate diagnosis.

Rosacea is a chronic inflammatory disorder primarily affecting the facial skin, prominently involving the cheeks, nose, chin, forehead, and periorbital area. Cutaneous manifestations encompass persistent facial erythema, phymas, papules, pustules, telangiectasia, and flushing. The pathogenesis of rosacea is associated with various exacerbating or triggering factors, including microbial infestation, temperature fluctuations, sunlight exposure, physical exertion, emotional stress, consumption of hot beverages and spicy foods, and exposure to airborne pollen. These environmental factors interact with genetic predispositions in the development of rosacea. The roles of the lipophilic microbiome, ultraviolet radiation, nociceptive responses, and vascular alterations have been proposed as significant factors in the pathogenesis. These insights contribute to understanding the anatomical specificity of facial involvement and the progressive nature of rosacea. East Asian skin, predominantly classified as Fitzpatrick skin phototypes III to IV, is characterized by relatively diminished skin barrier function and increased sensitivity to irritants. Airborne pollen exposure may particularly act as a trigger in East Asian individuals, possibly mediated through toll-like receptors. The lack of specificity in objective clinical and histopathological findings leads to diagnostic challenges for individuals with colored skin, including East Asians, particularly when erythema is the sole objective manifestation. An alternative diagnostic scheme may thus be necessary. A diagnostic approach emphasizing vascular manifestations and nociceptive symptoms potentially holds promise for individuals with darker skin tones. More research focusing on potential variations in skin physiology across different racial groups is essential to establish more effective diagnostic schemes applicable to both dark and light skin colors.

In Vivo Evaluation of Laser-Induced Optical Breakdown (LIOBS) by 1064-nm Nd:YAG Fractional Picosecond Laser With Reflectance Confocal Microscopy and Precise Histopathologic Correlation.

Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV. This study was performed on six Chilean healthy volunteers, males and females, aged 35-65 years old with Fitzpatrick skin phototypes III-IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded. Every individual developed a 10 mm2 area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis. The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.

Image Analysis of Xerosis and Atopic Dermatitis Following Prebiotic Skincare Regimen in Ethnically Diverse Patients.

Variations in the epidemiology, clinical presentation, and disease course in atopic dermatitis (AD) patients with Skin of Color (SOC) compared with white counterparts have been reported. In this study, we evaluated the capability of a new imaging device (SkinCam) in quantifying skin texture changes in diverse patients, presenting with AD or xerosis, after using a prebiotic skincare routine over 10 weeks.&nbsp; A total of 39 subjects from diverse racial/ethnic backgrounds, aged 3 to 76 years old, with Fitzpatrick skin phototypes I to VI, presenting with mild AD and moderate to severe xerosis, were enrolled in the study. All subjects used a prebiotic cleanser on its own for 2 weeks, followed by a prebiotic moisturizer in conjunction for an additional 8 weeks. Standardized images of the subjects' legs were taken with SkinCam at several time points (baseline, week 2, and week 10), and analyzed for skin texture parameters. Our results demonstrate that both skin texture irregularity and skin color patterns significantly improve over time with a prebiotic skincare regimen in AD (n=12) and xerosis (n=24) subjects. Interestingly, image analyses showed more improvement over time in xerosis and AD SOC patients (n=18, Fitzpatrick IV-VI). Lastly, skin texture analyses from SkinCam imaging correlated with clinical assessments, showing significant improvement by prebiotic skincare regimen in all subjects by week 10. In summary, our results demonstrate that the SkinCam&nbsp;imaging device has the capability to effectively monitor skin texture parameters over time in both AD and xerosis patients with lightly and darkly pigmented skin.&nbsp;J Drugs Dermatol. 2024;23(7):557-563.&nbsp; doi:10.36849/JDD.8371.

BT06 (P034) Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment

BT06 (P034) Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment

P034 Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment

P034 Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment

Correlation of non-invasive psycho-physiological and skin-physiological measures.

Psychological stress alters epidermal barrier function. While intensive studies on the underlying mechanism have been performed in mice, human studies are limited. Non-invasive skin-physiology measures have not yet been directly linked to non-invasive psycho-physiological assessments. Standard measures of (I) transepidermal water loss prior to and after experimental barrier perturbation via tape stripping, (II) skin surface pH, (III) electrodermal activity, and (IV) heart rate function were taken over a 24h time period. To document perceived stress, a standardized stress self-assessment questionnaire, namely the Trierer Inventar zum chronischen Stress (TICS), was utilized. Twenty healthy, Caucasian (Fitzpatrick skin phototype I-II), female volunteers (21-32 years, mean age 27, SD=3.67 years) were included in this study (random sample). Significant correlations were shown for 24h delta transepidermal water loss changes, that is, barrier repair kinetics (sympathetic activity) and heart rate variability (parasympathetic activity). Further correlations were noted for electrodermal activity and skin surface pH. Perceived stress, as documented by the TICS questionnaire, did not correlate with psycho- and skin physiological parameters, respectively. The presented approaches may provide a basis for non-invasive objective research on the correlation between psychological stressors and epidermal barrier function.

JOLT: A Noninvasive Solution for the Correction of the Jowl.

Sagging and loss of elasticity of the facial skin and tissues leads to jowling and an aged appearance. Jowling is a common reason for aesthetic surgical consultations. Prospective open-label study of the JOLT (jowl lifting) technique using hyaluronic acid (HA) fillers in healthy women 40-65 years of age with Fitzpatrick skin phototypes II-IV (n = 8). To be eligible, patients had jowling grade 2-3 on the jowl appearance scale as assessed by both the physician and patient. Treatment was administered at the baseline visit and consisted of an average of 6 mL of HA filler, 3 mL per side. Efficacy was assessed at baseline, week 4, and week 12. Assessment measures included the jawline rating scale (JRS) and a five-point global aesthetic improvement scale performed by two independent observers. Success was defined as an improvement of 1-2 grades on JRS. The mean JRS was improved from 2.75 at baseline to 1.53 at 90 days, which was considered a significant improvement. Mean global aesthetic improvement scale scores at 90 days were 1.44 ± 0.66 (range 1-3), indicating a "very much improved" appearance compared with baseline on both investigator and subject ratings. The procedure was well tolerated by all patients. Injection-related side effects (bruising and localized swelling) resolved spontaneously within 1 week of treatment. No other adverse events were reported. The JOLT technique effectively uses HA fillers to lift and tighten the lower face/neck and camouflage the remaining jowl, diminishing marionette lines, defining the mandibular border, and improving jowl sagging.

Evaluating hyperpigmentation: is invasion of the skin necessary?

BackgroundThe combination of long wavelength ultraviolet A1 radiation (LWUVA1) and visible light (VL) has been shown to produce photodamage and the majority of organic sunscreens lack protection against this spectrum. Currently, established testing protocols for VL photoprotection are lacking.ObjectiveTo compare pigmentation assessment methods, including Investigator’s Global Assessment (IGA) scoring, Diffuse Reflectance Spectroscopy (DRS), and immunohistochemistry, to assess the utility of each in evaluating VL + LWUVA1 induced pigmentation.MethodsAnonymized IGA, DRS, and immunohistochemistry data for 37 subjects (Fitzpatrick skin phototypes IV-VI) was retrospectively analyzed for pigment evaluation. Pigmentation was induced on the subjects’ backs with VL + LWUVA1 (0%–0.5% UVA1) irradiation at a dose of 480 J/cm2. Comparisons were made for all three assessment techniques between non-irradiated skin and VL + LWUVA1 irradiated skin, as well as between pure VL (0% UVA1) and VL + LWUVA1 (0.5% UVA1) irradiated sites. All comparisons were made for data collected approximately 24 h after irradiation to evaluate persistent pigment darkening (PPD).ResultsAmong all 37 subjects, both IGA scores and DRS detected a statistically significant difference in PPD between irradiated and non-irradiated sites, as well as between VL + LWUVA1 and pure VL irradiated sites. However, MART-1/Melan-A did not indicate a statistically significant difference in PPD between irradiated and non-irradiated sites or between VL + LWUVA1 and pure VL irradiated sites.ConclusionSubjective and objective noninvasive assessments were more sensitive in detecting VL + LWUVA1 induced pigmentation and should be preferred over invasive methods. Researchers are advised to initiate assessments with IGA and subsequently incorporate DRS for more objective and comprehensive insights in pigment evaluation.

The Influence of Skin Pigmentation on Cochlear Functioning: A Study on Individuals with Normal Hearing Sensitivity

Background and Aim: Melanocytes are cells in the skin, hair, and eyes that generate pigment called melanin, which is primarily responsible for the pigmentation of these structures. These melanocytes, known as the Cochlear Melanocyte, are also present in the human ears (especially in the cochlea) and play a significant role in fostering endocochlear potential and preventing the odds of hearing loss. The current study investigated the relationship of skin pigment with cochlear function through distortion product otoacoustic emission in Indian skin type. Methods: A total of 120 participants aged between 17 to 25 were included using a purposive sampling technique. The subjects were further grouped based on a questionnaire on Fitzpatrick Skin Phototype (FSP) developed by Thomas Fitzpatrick (1975) and categorized as type III- type VI suitable for Indian skin types. Along with routine audiometric evaluations, the cochlear functioning was assessed using distortion product otoacoustic emissions. The standard group research design was used, and as data was normally distributed, multivariate analysis of variance was used to compare across groups. Results: The results of multivariate analysis of variance (MANOVA) showed no significant differences across the four groups for both amplitude and the slope of distortion product otoacoustic emissions. Conclusion: The present study using otoacoustic emissions revealed that the skin pigmentation did not affect cochlear functioning in the Indian population (type III through type VI) as seen in type I and II. Keywords: Melanocytes; hearing loss; cochlear function; skin pigmentation

A practical guide to over‐the‐counter treatments for hyperpigmentation

AbstractHyperpigmentation of the skin, defined as increased melanin in the epidermis, is a common condition associated with psychosocial impairment and decreased quality of life. Prescription options are often not covered by insurance and can be cost prohibitive. As such, many turn to over‐the‐counter (OTC) products for treatment. However, a plethora of options are available, which can be confusing. This review aims to evaluate the evidence for common ingredients found in OTC products for management of hyperpigmentation and provide guidance for optimal use to clinicians and consumers. To perform this review, a comprehensive literature search utilizing PubMed and Google Scholar was conducted to identify relevant studies on the clinico‐epidemiological aspects of hyperpigmentation, including postinflammatory hyperpigmentation (PIH), melasma and maturational hyperpigmentation, as well as on relevant OTC treatments. The efficacy and safety of OTC products were assessed based on available evidence, clinical trials and expert recommendations. Our results showed hyperpigmentation is more prevalent among individuals with darker skin types (Fitzpatrick skin phototypes III–VI). Due to limited insurance coverage and the high cost of prescription options, over‐the‐counter (OTC) treatments are widely used for managing postinflammatory hyperpigmentation (PIH). However, the lack of strict regulation by the US Food and Drug Administration (FDA) raises concerns about the safety and efficacy of these products. By critically evaluating the existing literature, this review offers practical, evidence‐based guidance for the selection and utilization of OTC products for the treatment of hyperpigmentation.

Metatypical BCC of The Ear: Partial Amputation of The Auricle as Adequate Dermatosurgical Approach

Non-melanoma skin cancer is the most common cancer in the world (1). Basal cell carcinoma (BCC) is the most common malignant neoplasia of the skin, accounting for approximately 80% of all cutaneous tumors (2). High cumulative ultraviolet (UV) light exposure and the presence of Fitzpatrick skin phototype I or II are pathogenetic risk factors (3). UV radiation induces mutations in the tumor suppressor PTCH1 gene, leading to increased Hedgehog (XX/Hh) signaling pathway activity (4). Dysfunction or abnormal activation of the Hedgehog signaling pathway is associated with disorders of embryonic development and the development of cancers such as Goltz–Gorlin syndrome for example (5). BCC has the characteristics of a locally invasive, slow-growing skin cancer, with a metastatic incidence between 0.0028-0.5%, with areas in the head and neck most commonly affected (6). Metatypical basal cell carcinoma (MTBCC) is a rare variant of BCC that has histopathological characteristics of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (7).

Hyper- and Hypopigmentation in a Subject with Fitzpatrick Skin Phototype VI: A New Treatment Option.

Background: Laser therapies can cause hyper- and hypopigmentation of the skin. There is little evidence in the literature of effective treatments for these types of problems in Fitzpatrick skin phototypes IV-VI. The main aim of this retrospective study is to evaluate the effects of a new therapy that combines the application of electromagnetic fields and vacuum on a subject with Fitzpatrick skin phototype VI, who presented extensive, laser-induced facial dyschromia. The secondary aim is to test the effectiveness of a free imaging software for assessing skin pigmentation. Methods: The level of improvement after therapy was evaluated, with a 5-point Likert scale, one month after the end of the treatment by the subject and by the doctor who performed the treatment, and by two blinded dermatologists. With the free software, a three-dimensional reconstruction of the treated area and the evaluation of the color distribution were performed. Results: Both the subject and the doctors involved in the study positively evaluated the effects of the treatment. The image analysis highlighted the homogenization of the skin color in the treated area. Conclusions: The combination of electromagnetic fields and vacuum for dyschromia treatments appears promising. The new method of assessing melanin levels resulted particularly efficient.

Discrepancies in Non-Mohs Micrographic Surgery for Non-melanoma Skin Cancer Between Lighter-Skinned and Darker-Skinned Patients.

Non-melanoma skin cancer (NMSC) is highly prevalent in the United States, with darker-skinned patients (DSP) exhibiting lower incidence but increased morbidity and mortality. The purpose of this study is to elucidate NMSC disparities between DSP (Fitzpatrick skin phototype IV or more) and lighter-skinned patients (LSP, Fitzpatrick skin phototype III or less), focusing on surgical features of non-Mohs micrographic surgery-treated NMSC. This retrospective cohort study included LSP and DSP diagnosed with either basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) in an academic dermatology setting. Variables collected included age, gender, type of NMSC, location, staging, time-to-diagnosis (TTD), pre-operative lesion size, and post-operative defect size. Categorical variables were reported as counts and percentages, while the association between categorical variables was assessed using a two-tailed Fisher's test. A paired t-test was used to determine the association between continuous variables. P-values <0.05 were considered statistically significant. A total of 27 patients with NMSC were identified, of which 9 (33.3%) were DSP. Patients of darker skin were predominantly female (n=7; 77.8%), while no gender predilection was found in LSP (n=9; 50.0% female; p=0.23). Time-to-diagnosiswas significantly longer inDSP than in LSP (61.3 weeks vs 25.1 weeks, respectively; p = 0.02). Despite this, there was no statistical difference in terms of staging, pre-operative lesion size (11.89 mm in DSP vs 10.76 mm in LSP, p=0.75), and post-operative defect size (45.56 ± 29.21 mm in DSP vs 31.22 ± 19.60 mm in LSP; p=0.33). Darker-skinned patients had a longer TTDwithout staging differences. Our study confirms the need for reducing TTDs for NMSC in DSP. Action initiatives include continued educational efforts to increase awareness of NMSC risk in DSP and more rigorous routine skin cancer screening.

Frequency of the prominent transverse nasal root vein in children.

The presence of a vascular, blue linear discoloration on the nasal root of infants and young children is a frequent incidental feature, rarely reported in the medical literature. It is related to the trajectory of the transverse nasal root vein (TNRV). To study the frequency and clinical characteristics of the vascular discoloration of the nasal root in children. A prospective study was performed to address the presence or absence of vascular discoloration of the nasal root in all children under 6 years of age attending a pediatric dermatology clinic from November 2022 to November 2023. Data on age and skin phototype (Fitzpatrick classification I-VI) were also collected. Of 701 patients examined, 345 (49.2%) presented with a vascular discoloration of the nasal root. This was present in 97 of 193 (50.3%), 127 of 261 (48.7%), and 121 of 247 (49.0%) patients for the age groups 0-1, 1-3, and 3-6 years, respectively. The presence of vascular discoloration of the nasal root was more frequent in patients with lighter Fitzpatrick skin phototypes: 49 of 69 (71.0%) phototype II, 157 of 290 (54.1%) phototype III, and 137 of 337 (40.7%) phototype IV. A vascular discoloration of the nasal root is a frequent skin feature in infants and children, persisting at least until the age of 6. It does not constitute any medical problem aside from cosmetic concern and parents can be reassured of its benign nature. We propose the medical term "prominent TNRV" to describe this condition.

A Retrospective Analysis of Safety in Participants Treated with a Hybrid Hyaluronic Acid and Calcium Hydroxyapatite Filler.

Limited long-term safety data are published on HA/CaHA/L, a hybrid dermal filler combining hyaluronic acid (HA), calcium hydroxyapatite (CaHA), and lidocaine (L). This retrospective multicenter study assessed treatment-emergent adverse events (TEAEs) in adults treated with HA/CaHA/L. The full analysis set (FAS) included eligible consented adults (N = 403); the long-term safety analysis (LTSA) set included FAS participants with greater than or equal to 12-months HA/CaHA/L exposure (n = 243). Participants were majority female (94.0%), with Fitzpatrick skin phototypes II/III (80.1%) and a mean age of 50.1 years. Most participants (86.4%) received one HA/CaHA/L treatment. The median time between participants' first HA/CaHA/L treatment and chart review was 15.4 months. Participants received a mean of 2.2 mL (0.5-8.9 mL) filler per treatment. Treated areas were predominantly malar (71.2%) and mandible (69.7%) regions. Most participants (95.0%) had one or more aesthetic treatments other than HA/CaHA/L [eg, other dermal fillers (84.1%), botulinum toxin (63.3%)]. Nineteen (4.7%) FAS participants had 20 documented TEAEs; most (3.5%, n = 14 participants) were mild in severity. Twelve TEAEs in 11 participants (2.7%) were related to HA/CaHA/L: induration (three, 0.7%), edema (3, 0.7%), and implant site nodules (five, 1.2%), which were noninflammatory and likely related to product placement. Among the LTSA, 15 (6.2%) participants had 16 documented TEAEs (six edema, five implant site nodules, one inflammation, three skin induration, one hypersensitivity); most were mild in severity. Nine TEAEs in eight participants (3.3%) were HA/CaHA/L-related. No treatment-emergent serious AEs were reported. The data from this noninterventional retrospective study support the favorable longer term (>12 month) safety profile of HA/CaHA/L.