title: Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada.
abstract: OBJECTIVE
  Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA.
  
  
  METHODS
  Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18-75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I-III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.
  
  
  RESULTS
  Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.
  
  
  CONCLUSIONS
  Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.
authors.affiliation: Monash University, Melbourne, Victoria, Australia.|Skin & Cancer Foundation Inc, Melbourne, Victoria, Australia.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Goodman
authors.affiliation: Skin & Cancer Foundation Inc, Melbourne, Victoria, Australia.|The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Armour
authors.affiliation: Allergan plc, Irvine, CA, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Kolodziejczyk
authors.affiliation: Santangelo Consulting, Singapore, Singapore.
authors.forename: Samantha
authors.initials: S
authors.lastname: Santangelo
authors.affiliation: Allergan plc, Irvine, CA, USA.
authors.forename: Conor J
authors.initials: CJ
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002170:Canada; D005145:Face; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D057566:Self Report; D015595:Skin Aging; D006113:United Kingdom; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Caucasian; Fitzpatrick phototype; facial ageing; facial lines; mid-face ageing; photoageing; volume-related ageing