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Facial rejuvenation requires a multi-modality approach to address the sun damage, volume loss, and thinning of skin that occurs with aging. With age, the collagen fibrils that provide strength become fragmented and fibroblasts connections become weak, leading to skin laxity and loss of youthful skin. Fillers can lead to a more youthful appearance by providing volumetric support. Synthetic fillers such as hyaluronic acid products, calcium hydroxyapatite, polylactic acid, and polymethylmethacralate have bio-stimulatory affects, ranging from small effects on fibroblast production to prolonged stimulatory effects on dermal thickness and blood supply. Fat grafting is also an ideal technique for facial rejuvenation because it is readily available, natural, and has regenerative effects. This review describes a new technique of fat grafting for the face called Injectable Tissue Replacement and Regeneration that specifically addresses the different anatomic compartments of the face with volume loss. With this brief review, we aim to evaluate the currents trends of fat grafting and fillers in the management of facial rejuvenation, including the cellular changes that occur with facial aging, the bio-stimulatory effects of fillers, and the anatomic replacement of tissue with fat grafting. >Level of Evidence: 4

Background It is well known that solar radiation accelerates skin photoaging. To evaluate subclinical photodamage in the skin especially from the early phase of ultraviolet (UV)-induced damage, we have focused on ultraweak photon emission (UPE), also called biophotons. Our previous study reported that the amount of long-lasting UPE induced by UV, predominantly from lipid peroxidation, is a valuable indicator to assess cutaneous photodamage even at a suberythemal dose, although it was only applied to evaluate acute UV damage. The aim of this study was to further investigate whether long-lasting UPE could also be a useful marker to assess subclinical chronic sun damage in the course of skin photoaging. Materials and methods Forty-three Japanese females in their 20s were recruited and were divided into two groups according to their history of sun exposure based on a questionnaire (high- and low-sun-exposure groups). Several skin properties on the cheek and outer forearm were measured in addition to UV-induced UPE. Results Among the skin properties measured, water content, average skin roughness, and the lateral packing of lipids in the stratum corneum were significantly deteriorated in the high-sun-exposure group as were changes in some skin photoaging scores such as pigmented spots and wrinkles. In addition, those skin properties were correlated with the UPE signals, suggesting the possible impact of oxidative stress on chronic skin damage. Conclusion Subtle oxidative stress detected by long-lasting UPE may contribute to subclinical cutaneous damage at the beginning phase of chronic sun exposure, which potentially enhances skin photoaging over a lifetime.

BACKGROUND The distinct somatic mutations that define clinical and histopathological heterogeneity in cutaneous melanoma could be dependent on host susceptibility to exogenous factors like ultraviolet radiation. OBJECTIVES Firstly, to characterize patients with cutaneous melanoma clinically and pathologically based on the mutational status of BRAF, NRAS and TERT promoter. Secondly, to elucidate the modified features due to the presence of TERT promoter mutations over the background of either BRAF or NRAS mutations. METHODS We performed a retrospective study on 563 patients with melanoma by investigating somatic mutations in BRAF, NRAS and TERT promoter. RESULTS We observed co-occurrence of TERT promoter mutations with BRAF and NRAS mutations in 26.3% and 6.9% of melanomas, respectively. Multivariate analysis showed an independent association between BRAF mutations and a decreased presence of cutaneous lentigines at the melanoma site, and an increased association with the presence of any MC1R polymorphism. We also observed an independent association between TERT promoter mutations and increased tumour mitotic rate. Co-occurrence of BRAF and TERT promoter mutations was independently associated with occurrence of primary tumours at usually sun-exposed sites, lack of histological chronic sun damage in surrounding unaffected skin at the melanoma site, and increased tumour mitotic rate. Co-occurrence of NRAS and TERT promoter mutations was independently associated with increased tumour mitotic rate. The presence of TERT promoter together with BRAF or NRAS mutations was associated with statistically significantly worse survival. CONCLUSIONS The presence of TERT promoter mutations discriminates BRAF- and NRAS-mutated tumours and indicates a higher involvement of ultraviolet-induced damage and tumours with worse melanoma-specific survival than those without any mutation. These observations refine classification of patients with melanoma based on mutational status.

A group of melanomas characterised by predominant growth as large nests within the epidermis has been described. These cases present a diagnostic challenge, as many traditional architectural criteria for the recognition of melanoma are absent. We report the clinical, histological, immunohistochemical, morphometric and cytogenetic features of a series of 12 cases of large nested melanoma. In this series, large nested melanoma accounted for 0.2% of cases of melanoma. The majority occurred on the trunk of middle aged patients with absent or minimal solar elastosis and 42% were associated with a component of benign intradermal melanocytic naevus, speaking to classification of these melanomas as falling within the spectrum of lesions developing in skin with low cumulative sun damage. In 67% of cases invasive melanoma was present. Criteria such as asymmetry, variation in nest size and intraepidermal nests with an underlying rim of junctional keratinocytes appear to be highly specific, and are strongly predictive of typical cytogenetic abnormalities of melanoma, which were identified in 92% of cases. Conversely, in addition to features which are definitionally absent or limited, features such as solar elastosis and cytological atypia do not appear to be particularly helpful in recognition of this variant.

Photodynamic therapy (PDT) is a well-established, non-invasive treatment modality that has shown desirable effects such as improvement of fine lines, dyspigmentation, and other signs of photodamage. Many patients seek to decrease, or reverse, effects of sun damage on the skin. Hyaluronic acid (HA), a naturally occurring glycosaminoglycan found in the body, has enormous potential to bind water which allows the skin to retain moisture and maintain elasticity. Topical application of HA has been found to produce anti-wrinkle effects. We conducted a pilot case series evaluating the safety and efficacy of a commercially available 2% 5-aminolevulinic acid (ALA) gel with hyaluronic acid (ALA-HA) and light-emitting diode-red light (LED-RL) for facial rejuvenation as determined by clinical assessments and digital skin analysis of rhytides, pore size, and erythema. All patients noted improvement of their skin and experienced minimal pain during PDT. Evaluation by dermatologists demonstrated significant improvement in overall skin appearance. Digital analysis of photographs revealed improvement of skin spots, wrinkles, pores, texture, UV spots, brown spots, red areas, and porphyrins. Our findings demonstrated safety and efficacy of this novel preparation of photodynamic gel with HA and subsequent activation with LED-RL.

Fat grafting has evolved over the past two centuries and has revolutionized regenerative medicine, aesthetic and reconstructive surgery. Fat grafting provides a safe and minimally invasive technique to improve signs of aging, sun damage, and congenital and acquired craniofacial deformities. The Coleman technique for harvesting, processing, and grafting provides a reliable strategy for consistent results. However, unanswered questions remain regarding the biology of fat grafting, survival mechanisms, and regenerative properties. The future of fat grafting is bright and includes cell-based therapy and extracellular matrix-based scaffolds. This article provides an overview of the past, present, and future of facial fat grafting.

Sun exposure is the primary cause of skin cancer, and it has been suggested that most cases of melanoma could be prevented with greater understanding of sun damage and protection. Amy Noakes explains the vital role of sunscreen

Sun exposure is the primary cause of skin cancer, and it has been suggested that most cases of melanoma could be prevented with greater understanding of sun damage and protection. Amy Noakes explains the vital role of sunscreen

Acquired brachial cutaneous dyschromatosis (ABCD) is a relatively newly described, acquired disorder of pigmentation characterized by geographic-shaped, gray-brown, hyperpigmented patches and interspersed with hypopigmented macules, involving the dorsal aspects of the forearms in postmenopausal women. There is a suggested relationship with hypertension and antihypertensive medication intake, specifically angiotensin-converting enzyme inhibitors, or a cumulative effect of sun damage, as possible triggers. ABCD is benign, asymptomatic, and more of an esthetic concern. Topical depigmenting agents, chemical peels, and laser therapy may be helpful.

Ultraviolet (UV) filters such as octocrylene and oxybenzone in topical photoprotection products work effectively in absorbing UV radiation, thus minimizing sun damage to the skin. Antioxidants are incorporated into sunscreen products to enhance the photoprotection ability of the products. However, the effectiveness of the antioxidants on the sun protection factor (SPF) of UV filters is not well established. Hence in this study, the effect of caffeine, nicotinamide, β-carotene, α-tocopherol, and cactus extract on the SPF of octocrylene and oxybenzone were investigated. The UV absorbance of octocrylene (5 µg/mL) and oxybenzone (20 µg/mL) in 95% ethanol, with different concentrations of the antioxidants (0.1–100 µg/mL) and cactus extract were measured from 290-320nm. The UV absorbance values were converted to SPF values by the Mansur equation. Statistical analysis was performed by ANOVA test and Post Hoc test (Dundett T3 test) with a significance level of p

Concerns over existing sunscreen filters have reinforced the need to examine supplemental sun protection or repair of sun damage. Technology to enhance DNA repair has been available in skincare and sunscreen products for several decades, but skepticism and lack of familiarity with the supporting data remain prevalent. Here, we address six of the main questions raised by medical professionals regarding the efficacy of DNA repair enzymes in sun protection. These include the mode of delivery and mechanism of action, the effect on cellular responses and the amelioration of pre-cancers, cancers and photoaging. The conclusions are that topical DNA repair enzymes do enhance removal of DNA damage and reduce the appearance of new actinic keratoses as well as increase regression of existing lesions. Support for prevention of photoaging and skin cancer is significant but could be strengthened or disproven with additional research.

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

Sunscald on apples (Malus domestica Borkh) is a physiological disorder that develops post-harvest in susceptible cultivars such as Granny Smith. Symptoms appear on the skin as dark brown areas over fruit sections that were sun exposed during its growth on the tree. Currently, there is no chemical control to prevent its appearance. The objective of this study was to develop a prediction model for this disorder using Vis/NIR reflectance. During 2013/14 and 2014/15 Granny Smith apples were harvest and classified according to their sun exposure in the field (shaded, sun-exposed) and sun injury symptom (mild, moderate, severe), and stored at 0–1 °C (> 90% RH) for 120 d. Every 15 d sunscald incidence was recorded, and spectral fingerprint taken using an optical portable spectrometer Vis/NIR (350–1100 nm). Multivariate analysis was performed using partial least squares discriminant analysis (PLS-R) and intervals PLS-DA (iPLS-DA) in order to develop calibration models and applied them to a prediction set. Two calibration models were developed. The first one (A; R2CV = 0.41) for fruit at harvest with no sun damage symptoms (shaded and sun-exposed, n = 161), which was able to predict the appearance of sunscald 45 d in advance. The spectral ranges responsible for discrimination (iPLS-DA) of fruit with (Class 1) and without (Class 0) sunscald postharvest were: 500–525 nm, 550–575 nm, 650–675 nm, 775–800 nm, 850–875 nm, and 925–950 nm. The second model (B; R2CV = 0.59) was developed for mild sun damaged fruit (n = 100), which predicted sunscald 30 d in advance. In this case, the spectral ranges responsible of discrimination were 500–525 nm, 650–675 nm, and 775–800 nm, related to pigments and structural properties of the tissue. The RMSEP for the independent fruit set validation models (n = 69) were 3-4-times higher than that of the calibration models, probably because biological variability. A greater number of independent fruit sets will be required to increase models’ robustness and prediction capability for the industry adoption.

Signature FeatureTM (SF) is a universal, yet highly personalized treatment approach to aesthetic facial enhancement that applies to all patients, independent of age, gender, or ethnicity. Its philosophical basis maintains that a patient's beauty is anchored by their most distinctive invariant features (invariant features like eyes, nose, cheekbones, or jawline), and preservation of such signature features should be an essential consideration in any aesthetic treatment plan. The principles central to the SF concept include: (a) identifying the patient's most distinctive signature feature, (b) matching the patient's persona to their signature feature while preserving alignment with their cultural/ethnic aesthetic, and (c) highlighting the patient's signature feature by increasing the "signal-to-noise" ratio between the strength of the signature feature and those factors that may be interfering with it (lines, wrinkles, and sun damage). Every patient represents a new combination of treatment challenges which are not only related to the patient's physical baseline characteristics but also by their subjective self-perceptions. This subjective gray area is where the SF treatment approach has the greatest contribution to the patient's positive self-perception and self-esteem, as the practitioner can help the patient realize their own personal brand through enhancement of their signature feature using an array of aesthetic options.

Phototoxicity (sunburn) and photosensitivity are the two most important forms of sunlight induced disease recognised by veterinary surgeons in the dog, cat and horse. Phototoxicity is mediated by UVB radiation and has a spectrum of presentations, ranging from sunburn to more severe actinic damage and squamous cell carcinoma. Phototoxicity is usually seen on white or non-pigmented skin, especially where there is little hair covering, and is recognised in all three species. Photosensitisation is most commonly seen in the horse and represents an abnormal reaction of the skin to light, caused by photodynamic agents in or on the skin. Sun avoidance and sun protection are important in all of the domestic species, to prevent sunlight induced disease.

Personal protective clothing (PPC) is mandatory in hazardous industrial workplaces, but can increase thermophysiological strain, causing fatigue, reduced productivity, illness and injury. We systematically reviewed the literature on PPC and heat stress, focusing on research relating to working conditions of high temperature and humidity. PPC must protect industrial workers from a wide variety of hazards, including sun damage, abrasion, chemical spills and electrical burns; these competing demands inevitably compromise thermal performance. Fiber type, textile material construction and treatment need to be considered alongside garment fit and construction to design functional PPC providing wearers with adequate protection and comfort. Several approaches to materials and PPC testing—objective benchtop evaluation, mathematical modelling, and physiological testing—can be combined to provide high-quality thermal and vapor performance data. Our review provides a foundation and directions for further research in low-level risk PPC, where current research in fabrics and clothing in this category is very limited, and will help designers and manufacturers create industrial workwear with improved thermal management characteristics.

Background Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author's approach and the cases assessed. Methods The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. Results The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients' defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence. Conclusions Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients. Clinical question/level of evidence Therapeutic, IV.

Background Chronic sun damage in the background is common in pigmented actinic keratoses and Bowen’s disease (pAK/BD). While explainable artificial intelligence (AI) demonstrated increased background attention for pAK/BD, humans frequently miss this clue in dermatoscopic images because they tend to focus on the lesion. Aim To analyse whether perilesional sun damage is a robust diagnostic clue for pAK/BD and if teaching this clue to dermatoscopy users improves their diagnostic accuracy. Methods We assessed the interrater agreement and the frequency of perilesional sun damage in 220 dermatoscopic images and conducted a reader study with 124 dermatoscopy users. The readers were randomly assigned to one of two online tutorials; one tutorial pointed to perilesional sun damage as a clue to pAK/BD (group A) the other did not (group B). In both groups, we compared the frequencies of correct diagnoses before and after receiving the tutorial. Results The frequency of perilesional sun damage was higher in pAK/BD than in other types of pigmented skin lesions and interrater agreement was good (kappa = 0.675). The diagnostic accuracy for pAK/BD improved in both groups of readers (group A: +16.1%, 95%‐CI: 9.5–22.7; group B: +13.1%; 95%‐CI: 7.1–19.0; P for both

Sunscreen application to UV-exposed skin is promoted to prevent skin cancer and sun damage, within a comprehensive photoprotection strategy that also includes sun avoidance and wearing UV protective clothing. The benefits of sunscreen are verified in preventing sunburn but appear to be largely presumptive in skin cancer prevention. Contemporary science establishes UVA as a primary driver of melanoma and photoaging. Consequentially, the traditional UVB-skewed protection of sunscreens provides an intellectual and logical explanation for rising skin cancer rates and, in particular, their failure to protect against melanoma. Better protection could be achieved with more balanced UVB/UVA sunscreens, toward spectral homeostasis protection. Greater balanced protection has another advantage of attenuating fewer UVB rays, which aid synthesis of vitamin D and nitric oxide. Percutaneous absorption of Soluble Organic UV Filters leads to systemic exposure, which becomes the relevant safety consideration. It is minimized by selecting Insoluble UV Filters with low absorption potential from a molecular weight above 500 Da. The filters must also be very hydrophilic, very lipophilic, or consist of particles. The risk-benefit ratio is a medical imperative, more so for cosmetics or sunscreens, since in principle there should be no risk from their use. The production of ideal sunscreens that mimic the effective, balanced UVB/UVA attenuation of textiles and shade is now possible, while maintaining an acceptable therapeutic margin of safety in humans and a favorable ecologic profile. Sunscreens with a favorable risk-benefit ratio and good esthetic properties or other consumer-friendly attributes will improve compliance and may achieve substantial clinical benefits.

Actinic keratoses (AKs) represent a premalignant skin condition due to chronic sun damage that dramatically increases in prevalence in the aging population. Currently, animal models of AKs utilize photocarcinogenesis, chemical carcinogens, or targeted gene modulation, and each method possesses unique strengths and weaknesses. Models using photodamage most comprehensively describe methods for preferentially selecting AK lesions, while replicating the pathogenesis of AKs with greater fidelity than models utilizing other carcinogenic methods. The following review of current murine models of AKs will aid in the selection of mouse models appropriate for future in vivo studies to test the efficacy of novel therapeutic agents for the treatment of AKs.

‘A picture is worth a thousand words’. While the concept of imaging the skin to understand its condition may seem obvious, used effectively it can be an extremely powerful tool for the researcher. We are used to observing the world with visible light, but changing our perspective and moving outside of that range to ultraviolet or infrared, or by using light produced as a result of fluorescence, can provide insights into skin condition impossible to view in other ways. These approaches present some challenges which are different to those experienced with traditional visible light imaging; however skin scientists and dermatologists can use the available techniques outlined in this chapter to examine and diagnose a wide range of skin conditions and pathologies, including sun damage, dry skin and atopic dermatitis, and bacterial and fungal infections.

Telangiectasias are defined as broken or widened small blood vessels sited underneath the surface of the skin (or mucous membrane) creating a visible pattern of red-violet lines, virtually anywhere on the body, often occurring in fair-skinned patients with long-term sun damage.

Knowledge about the damage of grapevine berries in the vineyard is important for breeders and farmers. Damage to berries can be caused for example by mechanical machines during vineyard management, various diseases, parasites or abiotic stress like sun damage. The manual detection of damaged berries in the field is a subjective and labour-intensive task, and automatic detection by machine learning methods is challenging if all variants of damage should be modelled. Our proposed method detects regions of damaged berries in images in an efficient and objective manner using a shallow neural network, where the severeness of the damage is visualized with a heatmap.

BACKGROUND Visual imagery has been shown to improve adherence to health messages but has scarcely been investigated in sun protection campaigns. OBJECTIVE To determine the effectiveness of pictorial- and textual-based sun protective messages in a largely Hispanic population. METHODS One hundred and forty-five participants received standard of care (SOC) as defined as sun protective counseling and were then randomized to receive either (a) images of sun damage, (b) a textual pamphlet about sun damage, or (c) no further messages. Analysis-of-variance tests for repeated measures were used to estimate the effects of the different stimuli on participants' knowledge and intention to sun protect. RESULTS All stimulus groups demonstrated an improvement in perceived effectiveness of sun protective habits (p

BACKGROUND Car drivers are generally exposed to direct sunlight during commuting hours, which may lead to irreversible skin damage; however, topographical analysis for different facial areas has not been reported. METHODS Facial areas were divided topographically into 11 areas based on esthetic units. We performed a preliminary study to identify the delivery pattern of solar energy on the face in the car during commuting time; subsequently, 15 drivers aged above 50 years were enrolled. Statistical evaluation was performed to investigate topographical differences between the left and right sides of the face and between sexes. RESULTS The left side of the face was different from the right side for L*, a*, and b* on the infraorbital area and L* and b* on the temporal area. Differences were found for L*, a*, or b* between sexes on the central and right face, but not on the left. The left side had more severe hyperpigmentation and wrinkles than the right on average. CONCLUSION The left facial area, especially the infraorbital and temporal areas, of Korean automobile commuters was vulnerable to sun damage. Therefore, automobile drivers should care about these areas while driving to prevent long-term effect from chronic solar damage.

Objective This study was aimed to examine patients’ knowledge, behaviours and attitudes regarding actinic keratosis (AK) lesions and the impact of the disease on patients’ quality of life (QoL). Methods Observational study of patients with AK lesions in Spain. QoL was evaluated with the validated version of Spanish AKQoL questionnaire. Skin self-examination, sun-exposure, habits and attitudes towards AK's treatment were recorded using different questionnaires. The adherence was assessed by means of the Morisky-Green test. Among other variables, QoL and adherence to treatment were compared by using Pearson's χ2 test and one-way ANOVA tests. Inferential analysis regarding such factors and length of treatment were also performed. Results A total of 1240 patients (73.6 [10.5] years old) were recruited. Overall, patients that showed higher levels of concern were also showed a higher impairment on QoL. AK had greater effects on women's QoL and those who performed skin self-examination, think that AK is a disease and/or believe that moisturizers can prevent skin aging (P Conclusions Concerns due to AK are mainly related to sex and to the consideration of AK as a disease. More concerned patients tend to have lower QoL and good adherence to treatment. Short length of treatment was associated with better adherence and complete remission of AK lesions.

Pear fruit are subject to sun damage from high fruit surface temperature (FST). Shade netting has been shown to decrease FST and sunburn damage of apples but also decreased fruit colour. The aim of this study was to investigate the effects of netting on FST, fruit sunburn and fruit colour of the red-blushed pear cultivar ‘ANP-0131’. FST was measured using fine-wire thermocouples inserted into 54 fruit in a netted block of trees and into 56 fruit in adjoining rows of non-netted trees. Netting reduced the maximum FST by 10%. FST under netting did not exceed the reported sunburn damage threshold of 47°C despite air temperature reaching 38.6°C. The maximum FST in the non-netted site regularly exceeded the sunburn damage threshold and reached a maximum of 50.3°C. Assessments of sunburn damage showed a clear decrease in sunburn (amount and severity) for fruit from the netted trees; however, netting negatively affected colour intensity and coverage.