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Skin Analysis

How many skin types are you?

Like our fingerprints, skin types and conditions are unique

First name

Last name

Consultation Option

Phone

Zoom

Age this is not necessarily how old you are but how aged is YOUR skin?

20-30

30-40

40-50

50-60

60-70

70-80

Which skin group do you belong to using the Fitzpatrick scale?

Skin always burns, very white freckles, usually light eyes, blonde or red hair

Skin usually burns, tans with difficulty, white/fair skin, blue,grey, or green eyes

Sometimes burns, average tanning, white/golden/olive tone, hazel or brown eyes

Rarely burns, brown/olive tone, light brown or dark brown hair, brown eyes

Very rarely burns, brown/dark brown tone, brown or black hair, brown eyes

DESCRIBE YOUR SKIN- The skin barrier consists of the skin’s microbiome and is the first area we look at

Thick outer layer?

Yes

Thin outer layer?

Yes

Reacts easily to anything?

Yes

Balanced (the goal)

Clear

No Pigment

No Blemishes

Oily?

Ance

Breakouts

Inflamed

Oily in certain areas (combination skin)

Blackheads

Whiteheads

Wrinkled?

Wrinkled

Expression lines

Deep wrinkles

Dehydrated (lacking moisture)

Dry?

Flaky

Tight feeling

Gets red easily

Sensitive?

Itchy (including eyelids)

Blotchy

Burns Easily

Fragile

Pigmented (where?)

Pigmented (why?)

Pregnancy

Sun

Malasma

If you have sun damage, how much?

Do you have rosacea?

Yes

Do you have excema?

Yes

Do you have large pores?

Yes

Do you have broken capillaries?

Yes

Do you have black heads underneath your skin?

Yes

Do you have whiteheads underneath your skin?

Yes

Is your skin rough to the touch?

Yes

Does anything else stand out in your skin that you would like to share?

Thanks for submitting!

RealBeauty@AntiAgeingAesthetics.com

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