defined operationally in ways that permit objective assessment, making clinical evaluations of effects on skin quality dependent on subjective patient- or physician-reported outcomes.
Humphrey and colleagues recently proposed a conceptual framework for skin quality that, while still in need of refinement, provides a useful foundation for clinical assessments and for developing more precise definitions of the components of skin quality. The framework postulates 3 fundamental dimensions that define skin quality: visual, topographical, and mechanical (Figure 1).9 Some primary skin attributes involve more than 1 dimension: radiance/reflectivity and oiliness/dryness involve both visual and topographical sensations, and dryness/hydration involves all 3 categories.9 Scars also possess elements of all 3 categories; however, as secondary skin lesions rather than basic attributes of body skin, they were excluded from the proposed framework.
Purely visual aspects of skin quality (ie, those observable via illumination of, and light reflection from, the skin with no consideration of topographic or textural variations) include overall pigmentation (ie, melanin content), hyper- and hypopigmentation, erythema, and dullness/sallowness.9-18 Purely topographical aspects of skin quality include texture (smoothness/roughness), coarse and fine lines (wrinkles), crepiness, laxity/looseness, and pore size.9,13,16,19 Skin mechanical attributes arise primarily from the intradermal scaffold of dermal elastic fibers; the most readily observable is elasticity, which is often measured as recoilability.9,18 Other prominent mechanical attributes include skin firmness, which impacts elasticity, and skin thickness, which varies naturally across anatomic sites and may be affected by genetic factors, aging, and lifestyle choices, including exercise and sun exposure.9,10,14,18-20
A similar approach to the components of skin quality has recently been published, based on the findings of a consensus panel of dermatologists and aesthetic physicians.4 The framework proposed by the consensus panel is broadly similar to that described above, with 4 emergent perceptual categories (skin firmness, skin surface evenness, skin tone evenness, skin glow), analogous to the 3 dimensions proposed by Humphrey et al. The descriptors for individual skin attributes are nearly identical between the 2 frameworks, with some minor terminology and grouping differences.4,9
Because they help define the key attributes contributing to our perception of skin quality, and are potentially applicable to all anatomic sites, these proposed frameworks are important contributions. Moreover, by also providing available objective methods for assessing these attributes (a topic beyond this article’s scope), the authors have laid the groundwork for better clinical evaluations of products used for skin quality improvement.4,9
Body Skin Quality: Special Considerations
Skin quality is a key component affecting perception of facial attractiveness, which, in turn, influences perceptions of health and vitality, personality, age, and emotional and psychological well-being.9,21-26 Aesthetic medicine, including treatments aimed at repair/restoration of skin quality, has been focused primarily on the face and attributes of facial skin. However, a growing desire to address cosmetic issues below the face has led both clinicians and researchers to consider the special characteristics of body skin.27,28 Key characteristics of body skin compared with
