Sagging of the cheek is related to skin elasticity, fat mass and mimetic muscle function

Background/purpose: Facial sagging is associated with aging, although the mechanism remains unclear. The aim of this study was to investigate the mechanism of facial sagging by examining the relationship of sagging severity to changes of skin elasticity, fat mass and facial muscle function at the cheek.
Methods: Faces of 108 healthy Japanese female volunteers, aged 20–60 years were photographed at an angle of 45°. Standard scores of sagging severity were established by analyzing the photographs. We examined the correlations of scored sagging levels with skin elasticity measured with a Cutometer MPA 580^®, fat content estimated by bioelectrical impedance analysis and facial muscle function (lip sealing force and occlusal force) in middle-aged female volunteers (30–40 years) with a wide range of sagging scores.
Results: Because the upper, lower and lateral areas in the cheek may show severe sagging, a six-grade score of sagging severity was separately established for each area. Each score was significantly correlated positively with age (20–60 years). In middle-aged volunteers, the sagging scores in all three areas of the cheek were significantly and negatively associated with skin elasticity. Body fat percentage was significantly and positively correlated with the sagging scores in the lower and lateral areas, although the correlation was only weakly positive in the upper area. Mimetic muscle function, measured in terms of lip sealing pressure, was significantly and negatively correlated with the sagging score only at the upper area of the cheek, but masticatory muscle function, measured in terms of occlusal force pressure, was not associated with the sagging score.
Conclusions: Sagging may be associated with the reduction of skin elasticity and mimetic muscle function and increase of fat mass, but the relationships are different in different areas of the cheek.     

日光对皮肤弹性的影响

目的观察日光和年龄对皮肤弹性的影响。方法问卷调查受试者（郊县组94例，市区组105例）的日光曝晒情况，并应用皮肤弹性测量仪测量外眦部、鼻唇沟及眶下皮肤弹性参数，包括：弹性，黏弹性，可扩展性和张力参数。比较不同年龄组间、市区与郊县组间各弹性参数间的差异。结果市区和郊县各弹性参数均与年龄有较好的相关性，随年龄增长，皮肤各弹性参数均下降。郊县组与市区组比较，弹性和黏弹性参数差异较小，而可扩展性和张力参数差异较大。结论弹性和黏弹性参数可能与内在老化有关，而可扩展性和张力参数可能与光老化有关。     

Use of Cutometer to assess dermal oedema in erysipelas of the lower legs

Background/aims: Inflammatory dermal oedema in erysipelas alters skin mechanics. The aims of this study were to determine the relationship between skin mechanical properties and changes in dermal water content in patients with erysipelas of the lower leg, and to assess the value of measuring skin elasticity in monitoring the effect of therapy. Methods: Twenty-five in-patients were studied before treatment and after 10 and 20 days. Visual scoring of oedema, measurements of limb circumference and skin elasticity with a non-invasive suction device (Cutometer) were made on the affected and unaffected lower legs. Results: Indurated skin was characterized by raised delayed distension (U_v), final distension (U_t), resilient distension (R), viscoelastic to elastic ratio (U_v/U_e) and hysteresis (H) and lower immediate distension (U_e), immediate retraction (U_r), gross elasticity (U_a/U_f) and biological elasticity (U_r/U_f). The visual score of oedema and leg circumference significantly correlated with the increase in U_v U_v/U_e and H and the decrease in U_a/U_f and U_r/U_f. The large 8 mm diameter measuring probe produced more pronounced changes than the small 2 mm probe. As a result of treatment, a significant reduction in viscoelastic parameters (U_v, U_v/U_e, R, H) and an increase in elastic parameters (U_a/U_f, U_r/U_t) were observed. Conclusion: The non-invasive method applied is suitable for objective assessment of dermal oedema and disease evolution in patients with erysipelas.     

Histological characterization of age‐related skin changes following the use of picosecond laser: Low vs high energy

Fractional lasers have become widespread in dermatology owing to their efficacy and safety. Comparative analysis of histological features after laser rejuvenation using a 1064‐nm fractionated handpiece picosecond laser with different energy fluence levels (1.1 or 2.1 J/cm²). An open‐label, study of 28 women aged 36 to 60 years with signs of age‐related photodamage and skin changes of the face and neck was conducted using a fractional picosecond 1064 nm laser in low vs high fluence. The clinical assessment at 3 weeks showed more pronounced effect on facial skin rejuvenation with the higher fluence of 2.1 J/cm² compared to 1.1 J/cm². The effect and safety of laser rejuvenation using a picosecond laser has been shown with more pronounced histological effects at higher fluences.     

Application of Cutometer area parameters for the study of human skin fatigue

BACKGROUND/AIM: The age-related decrease of skin elasticity results in larger fatigue of adult skin than young skin after applying multiple stress at one and the same anatomic region. The aim of this study was to compare the informativeness of Cutometer standard R-parameters with new area parameters regarding the age-related changes in human skin fatigue. MATERIALS/METHODS: A total of 40 healthy volunteers aged 12-82 years were studied. Mechanical parameters of the skin were determined using a non-invasive suction skin elasticity meter (Cutometer). Measurements were made on the temporal region and volar forearm. Skin mechanical parameters analyzed by Win-Cutometer MPA software were R3, R4 and R9 (R-parameters), and F2 and F3 (area parameters). RESULTS: The adult skin was characterized by significantly higher values of R4, R9 and F2, and lower F3 compared with young skin. R3 was not significantly altered. There were not any sex-related differences. F2 correlated positively with parameters R3, R4 and R9, while F3 correlated negatively with R4. A positive correlation within the parameters R3, R4 and R9 was established at both anatomic regions. CONCLUSION: The non-invasive method applied can be useful for objective and quantitative investigation of age-related changes in skin fatigue and evaluation of the effects of cosmetic and anti-aging topical products. The mechanical parameters R4 and F3 are most indicative of human skin fatigue.     

Influence of age and regional differences on skin elasticity as measured by the Cutometer®

Background/aim: Aging of skin is accompanied by decrease of skin elasticity. Using the noninvasive suction device Cutometer^®, we evaluated the age and regional body differences of the viscoelastic properties of human skin. The objectives of this study were to evaluate the correlation between age and the biomechanical parameters and the regional skin variations.
Methods: A total of 96 healthy women aged 20–75 years were included in this study. The biomechanical properties of the skin were measured by using the Cutometer^®. Measurements were made on the face, upper arm and back.
Results: The age of subjects showed significant positive correlation with R4 and R6, and negative correlation with R2, R5 and R7. The face showed bigger changes of elastic properties than the arm and the back. Especially, the R7 of face was most significantly decreased with aging. We could estimate the so-called 'skin age' by using a correlation equation for this parameter.
Conclusion: The viscoelastic properties were significantly influenced by aging. Also, significant regional variations in the viscoelastic properties were observed. Skin elasticity measurement is useful for the quantitative evaluation of age-related changes.     

Comparison of sagging at the cheek and lower eyelid between male and female faces

Background: Facial sagging is a well‐known morphological feature associated with aging and reduced dermal elasticity. Its morphological characteristics and mechanism have been studied in females, but it is unclear whether or not there is a gender difference. Aims: The aim of this study was to clarify the morphological characteristics of sagging and the mechanism of sagging formation in male faces as compared with female faces, focusing on changes in dermal elasticity. Methods: Faces of 98 healthy Japanese male volunteers, in their 20s–60s, were photographed at an angle of 45°. Upper and lower cheek sagging severity was evaluated by using photograph‐based grading criteria. In addition, new photograph‐based grading criteria of sagging severity at the lower eyelid were established and used. Dermal elasticity was measured using a non‐invasive, in vivo suction skin elasticity meter, Cutometer^®. Furthermore, photographs of 108 healthy Japanese female volunteers in their 20s–60s were used to compare the difference in the morphological characteristics of sagging between males and females. Results: Male facial sagging was prominent at the lower eyelid, upper cheek and lower cheek. Sagging severity in the upper and lower cheek was almost the same between males and females at all ages, whereas sagging at the lower eyelid in males was significantly more severe than that in females after middle age. Although dermal extensibility (U_f) was not related to age, total deformation recovery (U_a), ?(amount of deformation) ?(U_f?U_a), overall elasticity of the skin including creep and creep recovery (U_a/U_f), net elasticity excluding viscoelastic creep (U_r/U_e), ratio of elastic recovery to total deformation (U_r/U_f) and ?(ratio of viscoelastic to elastic distention) ?(U_v/U_e) were all significantly negatively related to age in both men and women. Furthermore, as in female faces, male facial sagging was significantly negatively related to dermal elasticity parameters, such as ?(U_f?U_a), U_a/U_f, U_r/U_e and U_r/U_f. Conclusion: These results indicate that the morphology and areas of sagging in male faces are similar to those in females in the cheek, but sagging at the lower eyelid is more severe in males after middle age. Furthermore, the dermal elasticity of male facial skin decreased with age similar to that of females, and may therefore be associated with the sagging formation in male faces.     

Age‐related changes in skin mechanical properties: a quantitative evaluation of 120 female subjects

Background/purpose: The most commonly used method to determine the mechanical ability of skin is the creep test using suction chamber devices. Until now, there is no scientific consensus upon which skin deformation parameters and which body sites are particularly suitable to describe age‐related changes in human skin mechanics. The aim of this study was to find those mechanical skin parameters best representing influence of aging at five different body sites. Methods: A total of 120 healthy women aged 18–65, divided into four similar age groups, were included in this study. The biomechanical properties of the skin were measured using the Cutometer^® MPA 580 on five body sites: cheek, neck, cleavage, volar forearm and back of the hand. In order to analyze parameters referred to 1 mm skin thickness, we also used 20 MHz sonography (DUB 20). Results: A high average correlation with age was found for the parameters U_a/U_f, U_r/U_e, U_r, U_r/U_f and U_a. Only low correlation with age was found for the parameters U_v/U_e, U_f‐U_a, U_f5/U_f, U_d/U_f and U_a5. The localizations cheek, forearm and neck showed the highest correlation with age, while cleavage showed only low correlation. Conclusion: According to the results of our study, we recommend the parameter ratio of elastic recovery to distensibility (U_r/U_f) as well as the gross elasticity (U_a/U_f) for evaluation of aging effects on the mechanical properties of skin. Their high correlation with age makes them particularly applicable to represent the influence of aging onto skin mechanical properties. Most suitable localizations to evaluate skin aging are cheek, forearm and neck.     

Skin texture parameters of the dorsal hand in evaluating skin aging in China

Background/purpose: There are various non‐invasive methods in skin morphology for assessing skin aging. The use of digital photography will make it easier and more convenient. In this study, we explored some skin texture parameters for evaluating skin aging using digital image processing. Methods: Two hundred and twenty‐eight subjects who lived in Sanya, China, were involved. Individual sun exposure history and other factors influencing skin aging were collected by a questionnaire. Meanwhile, we took photos of their dorsal hands. Skin images were graded according to the Beagley–Gibson system. These skin images were also processed using image analysis software. Five skin texture parameters, Angle Num., Angle Max., Angle Diff., Distance and Grids, were produced in reference to the Beagley–Gibson system. Results: All texture parameters were significantly associated with the Beagley–Gibson score. Among the parameters, the distance between primary lines (Distance) and the value of angle formed by intersection textures (Angle Max., Angle Diff.) were positively associated with the Beagley–Gibson score. However, there was a negative correlation between the number of grids (Grids), the number of angle (Angle Num.) and the Beagley–Gibson score. These texture parameters were also correlated with factors influencing skin aging such as sun exposure, age, smoking, drinking and body mass index. In multivariate analysis, Grids and Distance were mainly affected by age. But Angle Max. and Angle Diff. were mainly affected by sun exposure. Conclusion: It seemed that the skin surface morphologic parameters presented in our study reflect skin aging changes to some extent and could be used to describe skin aging using digital image processing.     

Measurement of skin elasticity on the foot

BACKGROUND/PURPOSE: The Cutometer 580 MPA is a device that is designed to measure the viscoelastic properties of skin in response to the application of negative pressure. The aim of this study was to test the Cutometer 580 MPA for the repeatable, quantitative measurement of the specific indices of elasticity of pedal skin. The device was used to measure and compare these indices at weight-bearing and non-weight-bearing skin sites on the foot. METHODS: The relationship between the pressure application and skin displacement was determined. The inter- and intra-tester repeatability was tested. These series of experiments were conducted on 20 individuals. Data were then collected from a group of 87 healthy people for the measurement of elasticity, viscoelasticity and plasticity on several sites on the foot. The possible influences of physiological variables such as age and sex on the indices of elasticity were analysed. RESULTS: The Hookian elastic behaviour of the skin was confirmed. The pressure application did not remain constant during the collection of displacement data, resulting in an error in these readings of between 1.71% and 3.73%. Intra-tester and variability was minimal (CV<7%). The elasticity, viscoelasticity and plasticity indices were significantly greater (P<0.001) in dorsal skin compared with skin from medial longitudinal arch (MLA) and plantar aspect of the third metatarsophalangeal joint (PMA) sites. There was a negative correlation between age and elasticity on the dorsum and MLA skin sites (r=-0.216 and -0.261, respectively). Female skin exhibited greater plasticity than male skin on all three sites on the foot (P<0.05). CONCLUSION: Under well-controlled conditions, the Cutometer 580 MPA has the ability to measure accurately the viscoelastic properties of pedal skin. Such non-invasive measurements may be useful for the evaluation of changes in the skin in response to therapeutic interventions and for monitoring the progression of dermatological conditions associated with the foot.