INTRODUCTION
Skin is at once the largest and the most visible organ of the human body, and it can also provide an all-too-accurate reflection of internal health. Changes in skin quality attributes, such as those associated with aging, systemic disease, or injury, can substantially degrade self-image, self-esteem, and overall quality of life.1 It is therefore unsurprising that a seemingly limitless selection of commercially available products hold out the promise of skin quality improvement and/or restoration.
Interest in the improvement of body skin (as distinct from facial skin) quality is increasing, driven in part by the growing use of noninvasive body contouring (NIBC) procedures, which employ thermal, electromagnetic, or ultrasonic energy to induce apoptosis of subcutaneous adipocytes, and consequent recontouring of subcutaneous fat deposits. NIBC procedures, because they reduce the volume of fat deposits, often lead to skin laxity, and may also affect other skin properties. Interest in NIBC procedures has increased greatly in recent years as patient outcomes have been optimized and recovery time reduced.2
In this narrative review, we present approaches to the restoration or improvement of body skin quality. We first describe a multidimensional characterization of the elements that define high-quality skin with respect to visual, tactile, and biomechanical properties. We then explore the key physiological and signaling pathways critical to restoring or improving skin quality, as well as the potential to modulate those pathways; and finally, we review published clinical studies of topical products for skin quality improvement.
Skin Quality: In Search of an Elusive Goal
The improvement of "skin quality" is the objective of a wide range of aesthetic procedures, and an even wider selection of topical products, aimed both at correcting extant problems (eg, those associated with aging) and at recovery following injury or cosmetic procedures.3-8 An initial challenge was to implement a conceptual framework that properly captures the parameters that help define skin quality.
Numerous terms (many poorly defined at best) are employed to describe components of skin quality: tone, radiance, elasticity, oiliness, uniformity, pigmentation, wrinkling, crepiness, erythema, roughness, and many others.9 Many negative terms are applied to age-related changes arising from intrinsic or extrinsic factors; for these terms, the absence of the attribute in question (eg, wrinkles, hyperpigmentation, roughness) denotes skin of higher quality. Importantly, few of these terms have been
Interest in the improvement of body skin (as distinct from facial skin) quality is increasing, driven in part by the growing use of noninvasive body contouring (NIBC) procedures, which employ thermal, electromagnetic, or ultrasonic energy to induce apoptosis of subcutaneous adipocytes, and consequent recontouring of subcutaneous fat deposits. NIBC procedures, because they reduce the volume of fat deposits, often lead to skin laxity, and may also affect other skin properties. Interest in NIBC procedures has increased greatly in recent years as patient outcomes have been optimized and recovery time reduced.2
In this narrative review, we present approaches to the restoration or improvement of body skin quality. We first describe a multidimensional characterization of the elements that define high-quality skin with respect to visual, tactile, and biomechanical properties. We then explore the key physiological and signaling pathways critical to restoring or improving skin quality, as well as the potential to modulate those pathways; and finally, we review published clinical studies of topical products for skin quality improvement.
Skin Quality: In Search of an Elusive Goal
The improvement of "skin quality" is the objective of a wide range of aesthetic procedures, and an even wider selection of topical products, aimed both at correcting extant problems (eg, those associated with aging) and at recovery following injury or cosmetic procedures.3-8 An initial challenge was to implement a conceptual framework that properly captures the parameters that help define skin quality.
Numerous terms (many poorly defined at best) are employed to describe components of skin quality: tone, radiance, elasticity, oiliness, uniformity, pigmentation, wrinkling, crepiness, erythema, roughness, and many others.9 Many negative terms are applied to age-related changes arising from intrinsic or extrinsic factors; for these terms, the absence of the attribute in question (eg, wrinkles, hyperpigmentation, roughness) denotes skin of higher quality. Importantly, few of these terms have been
