#JACOB FINK NAKED SKIN#
Much of the authors' understanding of biological factors comprising skin quality has been elucidated through studies of aging, although a full discussion is outside the scope of this article. 1, 20, 26, 27 Anthropologic data also suggest that, within a society, women evolved with lighter skin than men, so that signs of attraction, such as flushing or blushing, would be more apparent.
21– 25 Variations in skin pigment evolved in response to geographic differences in ultraviolet (UV) radiation, with increased melanin content in high UV areas as a means of photoprotection, and paler skin evolving for lower-light environments and enhanced vitamin D synthesis.
20 A rich vascular network evolved to support skin's sweat glands, hair follicles, and multiplying cells, 20 while a diverse symbiotic microbiome that varies across sex, age, skin site, and geographical location influences attributes of skin quality and, in cases of dysbiosis, skin disorders. Human's relative hairlessness was an adaptation to ward off parasites 1 and combined with the development of sweat glands to allow for efficient heat dissipation. Present characteristics of skin evolved in consideration of health, disease, and sexual selection. In addition, men may perceive female skin as more attractive and healthier during the fertile (i.e., late follicular) phase of the menstrual cycle, 16– 18 although data are equivocal and suggest minor variations in chromophore distribution could be the driver. 2 Indeed, increasing evidence supports a link between immune health and facial attractiveness, 13– 15 although more research is needed to fully understand the contribution of individual skin quality attributes to this relationship. 11 Attributes of skin quality (e.g., texture and homogenous coloration) contribute to perceptions of facial attractiveness, 2 which may then correlate with mate choice and mating success, 12 potentially because of the condition of one's skin indicating the quality of his/her immune system. 4– 10 The visible condition of skin can also validate reproductive health and fertility. Skin health is intricately linked to overall well-being, and clear skin is one of the body's “visual certificates of health,” 1 reflecting general health and vitality, as well as disease and nutritional state. The appearance of one's skin provides a wealth of information about an individual.
The authors then propose a novel classification of skin quality attributes to provide clarity for both patients and physicians. Thus, the authors' goal is to elucidate the importance of skin quality to patients and aesthetic physicians, explore and understand what factors comprise it, and identify the gaps in the authors' understanding. In short, skin quality has yet to be clearly defined. The lack of a clear, comprehensive definition precludes identification of clinical indicators and evaluation tools necessary for proper assessment and treatment of undesirable skin quality. Current literature focuses heavily on age-related changes in skin quality, rather than skin quality per se, and descriptive terminology has substantial variability between investigators and geographically (See Supplemental Digital Content 1, Table S1, for levels of evidence of included literature). However, reaching a consistent, objective definition of skin quality has been difficult. Rejuvenation procedures, cosmeceuticals, and minimally invasive injectable therapies are increasingly popular. Skin quality as a concept is gaining traction in the aesthetic field worldwide. The encompassing term for this collection of desired outcomes is skin quality. 1– 3 In a recent global survey, 94% of the 14,584 people interviewed desired to improve their facial skin, and terms such as radiance and healthy, glowing skin are requested by patients seeking improvements in their appearance (unpublished data, Allergan Aesthetics). Yet, flawless skin is an important component of facial attractiveness and continues to be one of the most universally desired features. As the cornerstones of beauty include smooth, healthy looking skin, what comprises desirable skin is similarly difficult to define. According to psychologist Nancy Etcoff, 1 identification of beauty is intuitive, whereas definition of beauty is subjective, mutable, and difficult to formulate into words.
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