What are the definitions of the various skin features and how are the features detected?
Spots : Spots are typically brown or red skin lesions including freckles, acne scars, hyper-pigmentation and vascular lesions. Spots are distinguishable by their distinct color and contrast from the background skin tone. Spots vary in size and generally have a circular shape.
Pores : Pores are the circular surface openings of sweat gland ducts. Due to shadowing, pores appear darker than the surrounding skin tone and are identified by their darker color and circular shape. The VISIA system distinguishes pores from spots based on size; by definition, the area of a pore is much smaller than a spot.
Wrinkles : Wrinkles are furrows, folds or creases in the skin, which increase in occurrence as a result of sun exposure, and are associated with decreasing skin elasticity. This skin feature has the greatest variability from image to image as it is highly dependent upon the facial expression of the client. Wrinkles are identified by their characteristic long, narrow shape.
Texture :Texture is primarily an analysis of skin smoothness. Texture measures skin color and smoothness by identifying gradations in color from the surrounding skin tone, as well as peaks (shown in yellow) and valleys (shown in blue) on the skin surface that indicate variations in the surface texture.
Porphyrins : Porphyrins are bacterial excretions that can become lodged in pores and lead to acne. Porphyrins fluoresce in UV light and exhibit circular white spot characteristics.
UV Spots : UV spots occur when melanin coagulates below the skin surface as a result of sun damage. UV spots are generally invisible under normal lighting conditions. The selective absorption of the UV light by the epidermal melanin enhances its display and detection by VISIA.
Red Areas : Red Areas represent a potential variety of conditions, such as acne, inflammation, Rosacea or spider veins. Blood vessels and hemoglobin contained in the papillary dermis, a sub-layer of skin, give these structures their red color, which is detected by the RBX Technology in VISIA. Acne spots and inflammation vary in size but are generally round in shape. Rosacea is usually larger and diffuse compared to acne, and spider veins usually are short, thin and can be interconnected in a dense network.
Brown spots\ : Brown Spots are lesions on the skin such as hyper-pigmentation, freckles, lentigines, and melasma. Brown Spots occur from an excess of Melanin. Melanin is produced by melanocytes in the bottom layer of the epidermis. Brown Spots produce an uneven appearance to the skin, and are detected in VISIA by RBX.
What factors influence the results of the image session?
A number of factors contribute to the actual scores generated by the VISIA complexion analysis algorithms, including the condition of the skin (cleaned vs. fresh make-up, old make-up, time-of-day), head registration within the booth, facial expression (particularly for wrinkles), stray hair, glare areas resulting from oily skin, etc. Note that the percentile scores were generated for subjects with cleaned skin prior to their imaging session, so results may vary if make-up is NOT removed prior to a patient's VISIA session.
What is the definition for each of the three types of skin conditions? How does VISIA use this information?
"Clean" is defined as skin that has been recently cleansed and without make-up or skin conditioners applied, "Fresh Make-up" is defined as make-up recently applied (roughly within the past hour), "Other" covers all other cases. No change is made in terms of either taking the photo or in the analysis process based upon the skin condition selected.
This information is recorded in the patient's record for each session and allows scores to be properly interpreted if images were captured under different conditions session-to-session (i.e., one time image taken with clean skin, the next time with make-up). Also, images that are "clean" can be considered as valid input to further build the database.
Which data display option is best for our practice to use?
Three data display options are available depending upon the needs and preferences of the practice, and can either be selected from within VISIA's Session Options tab or by right clicking on any data display bar or graph.
Feature Counts : Feature Counts provide a count of the number of discrete instances of the feature being evaluated, without regard to the size or intensity of each instance. Feature Counts can be used to track treatment progress when a reduction in the number of discrete instances of a particular feature is desired.
Absolute Scores : Absolute Scores provide a comprehensive measurement of the impact that the feature has on the client's complexion. Absolute Scores factor in the total size and area as well as intensity of detected instances of the feature being analyzed. Absolute Scores can be used to track treatment progress when the size and intensity of instances of a feature are the most relevant indicator of treatment effectiveness.
Percentiles : Percentiles provide a context in which to evaluate a client's complexion analysis results by presenting a comparison of the individual's Absolute Scores to those of people with similar characteristics. Percentiles are useful in providing a baseline assessment of the overall condition of the client's complexion.
What clinical methods were used to validate VISIA?
The Procter & Gamble complexion analysis software used in VISIA was developed in the late 1990s and has undergone extensive lab and field-testing. Since 1998, P&G has deployed their complexion analysis software as a sales tool to promote their Olay and SKII brands of cosmetic products. As such, the P&G software was never intended for clinical trials. However, the VISIA complexion analysis algorithms themselves are supported by an extensive set of research papers describing the analysis techniques and results across various skin types.
What is the wavelength used for the UV photography?
The wavelength used by the UV flashes is 365 nm (peak).
Should the patient's eyes be open or closed when the picture is taken?
It is strongly recommended that the eyes be closed for the UV photos given the intensity of the UV flashes. For standard photos, the eyes can be either open or closed, although more aesthetically pleasing images are achieved with the eyes open. Because the mask is created using the standard photo (in which the patient's eyes are typically open), there is no need to be concerned that eyelashes will be included inadvertently in UV analysis, even though the patient's eyes are closed.
Why isn't the porphyrin count reduced after cleansing?
There are several potential reasons why the porphyrin count for a particular patient may not be reduced-or worse case, increase, after cleansing his/her skin. First, certain types of paper/tissue that might have been used to dry the face after cleansing could have a high content of lint particles. Lint will actually fluoresce under UV light. Subject matter expert Greg Hillebrand, Ph.D., offers the further explanation that "in some situations, the true porphyrin fluorescence of an initial image could be quenched by something that the subject had on his/her unclean face, and then after removal of this interfering quenching agent, a higher level of fluorescence could be observed. Finally, the simple cleansing of the skin with a normal everyday facial cleanser is probably not going to change the true number of pores that show porphyrin fluorescence. It has been reported that washing with a cleanser containing benzoyl peroxide will, over time, reduce the number of pores. Also, using strips or other devices to physically remove the contents of the pores will help to reduce the fluorescence as well."
Is there correlation between porphyrins and sun damage?
According to subject matter expert Greg Hillebrand, Ph.D., there may be a real correlation between the amount of porphyrins and skin aging as described in the following technical excerpt that offers the best understanding we have today on the matter: "In pilosebaceous follicles, porphyrins are produced by propionibacterium acnes (P. acnes) that are normal inhabitants of the human skin and the pilosebaceous ducts. Porphyrins are highly fluorescent pores containing P. acnes and the associated porphyrins appear red-orange when facial skin is illuminated with long wavelength UVA radiation. The intensity of the follicular fluorescence and its extent of facial involvement is known to be proportional to the density of P. acnes. Porphyrin fluorescence appears first on the nose and chin, and then increases in incidence through adulthood and declines after the age of 50, possibly reflecting the rate of sebum secretion. Porphyrins may also have cytotoxic and comedogenic potential. With exposure to the sun, porphyrins can release singlet oxygen that in turn can oxidize lipids (lipid peroxidation) in the skin yielding irritating and cytotoxic lipid peroxides that can cause skin damage. Thus, the presence of porphyrins in the follicular pores may enhance or accelerate hyperpigmentation, wrinkling and other signs of photo-aging by sun exposure."
