Received: 2 September 2020 | Revised: 13 April 2021 | Accepted: 20 April 2021

DOI: 10.1111/jocd.14198

ORIGINAL CONTRIBUTION

Evaluation of skin care concerns and patient’s perception of the

effect of NanoSilk Cream on facial skin

Amanda E. Louiselle MD1 | Stephen Niemiec MD1 | Mark Azeltine MS1 |

Leela Mundra MD1 | Brooke French MD1,2 | Carlos Zgheib PhD1 | Kenneth W. Liechty MD1,2

1
University of Colorado Denver School of
Medicine, Aurora, CO, USA Abstract
Background: Skin aging is an inevitable process with one of the key features of aging
2
Children's Hospital Colorado, Aurora,
CO, USA
being dryness or flakiness of the skin. Previous in vivo and in vitro testing has high-
Correspondence lighted that a silk-­based product may be effective in improving moisture retention in
Amanda E. Louiselle, 1775 Aurora Ct,
Aurora, CO 80045, USA.
skin.
Email: amanda.louiselle@cuanschutz.edu Methods: We evaluated the safety and efficacy of our silk-­based product through a
combination of objective-­including scanning electron microscopy (SEM) and EpiDerm
Skin Irritation tests -­and subjective tests –­including direct evaluation of patient’s
own perception of their skin.
Results: In alignment with previous studies, patients reported significant concerns
about aging, wrinkling, or saggy skin. We found that our silk-­based product was safe
and effective in improving hydration and resilience of facial skin and a majority of par-
ticipants stated they would continue to use this product, when commercially available.
Conclusion: Our novel silk-­based product, NanoSilk Cosmo, is safe for use on human
facial skin and it improves skin resiliency and hydration.

KEYWORDS
Aging skin, NanoSilk Cosmo, silk, skin resilience

1 | I NTRO D U C TI O N
Skin aging is characterized by atrophy, decreased elasticity, wrinkling,
impaired strength, and altered metabolic and reparative responses.
The etiology of these changes is multifactorial and includes intrinsic
factors such as age, genetics, metabolism, and nutrition, as well as ex-
trinsic or environmental effects like Ultraviolet (UV) radiation and air
1
pollution. It has been noted that there is increased fragility of the skin
with age due to flattening of the dermo-­epidermal junction and de-
2
creased biosynthetic capacity of fibroblasts, all leading to decreased
2,3
skin resilience and an undesirable cosmetic appearance of the skin.
It has previously been shown that “young and beautiful appearance”
can have a positive effect on people's social behaviors, and aging skin
can not only hinder an individual's perceived social behavior but is
4
also more prone to a build-­up of microorganisms and water loss.
Recently, the use of silk to reverse or repair some of these
aging processes has gained significant interest. Silk is a natural
protein polymer that is approved for medical use by the U.S.
Food and Drug Administration, and Bombyx mori (B. mori) silk
is considered a non-­
a nimal product (EU Council Directive
93/42/EEC, rule 17). Importantly, it is biocompatible, non-­
c ytotoxic. 5 There are two important
inflammatory, and non-­
components of silk that are derived from the B. mori worm, both
of which are proteins—­f ibroin and sericin. 6 In simple terms, seri-
cin, which represents about 30% of the entire cocoon, functions
as a glue to hold the fibroin fibers together while blocking UV
rays and providing moisture.7,8 The fibroin, approximately 70%
of the cocoon, is composed of two proteins which interestingly
have similar amino acid compositions to Natural Moisturizing
Factor which is found in the stratum corneum of human skin
and helps retain moisture in the skin.9 The stratum corneum is
of key importance to the skin's ability to hold water and main-
tain skin integrity which is critical for maintaining a youthful
appearance. 2,3,10

J Cosmet Dermatol. 2021;00:1–11. wileyonlinelibrary.com/journal/jocd© 2021 Wiley Periodicals LLC | 1

2 |
Besides the moisture retention effects noted above, one of the
theories behind the effectiveness of silk on the skin is that the silk fi-
broin nanofibers are able to promote cell adhesion and allows type I
collagen to spread within epidermal keratinocytes and fibroblasts.11
New data suggest that if a patient has a higher ratio of collagen type
I to collagen type III that these patients will have better outcomes
after aesthetic facial surgery, which highlights the key role of colla-
gen in the skin.12
Although there have been a few studies examining the role of silk
in skin care, these have been either in vivo or in vitro studies, and there
has not been a study to date evaluating the consumer's perception of
their skin before and after using a silk-­based product. A consumer's
perception of the effectiveness of a product is important for vali-
dating or refuting evidence detected in vivo or in vitro. Additionally,
of growing importance to consumers, both in the United States and
internationally, is the importance of animal welfare, including avoid-
ance of animal testing and the use of organic, natural, or non-­animal
13
products in beauty products. Therefore, it is important that any
newly developed cosmetic product adhere to the strict animal wel-
fare regulations set forth by the United States and European Union.
The primary outcome of this study is to evaluate the safety of
NanoSilk Cosmo [silk-­based product] on the skin. The secondary
outcome is to evaluate the efficacy, via subjective participant sur-
veys, of NanoSilk Cosmo on facial skin. This first study will allow us
to ensure that subjective viewpoints are thoughtfully analyzed and
will help us determine whether further testing of NanoSilk Cosmo
is warranted.
2 | M E TH O D S
2.1 | Extraction and production of silk fibroin
nanostructure
The nanosilk fibroin extraction protocol was developed in our labora-
tory and then shared with Mineralife Nutraceuticals, LLC (Colorado
Springs) for bulk production and quality analysis and was tested for a
broad range of bacteria and fungi. Briefly, silk cocoons were obtained
from Mulberry Farms (Fallbrook). Sodium carbonate and lithium bro-
mide (Sigma-­Aldrich) were used as an extraction and digestion rea-
gent, respectively. The extracted and purified silk fibroin nanofibers
were then purified via dialysis method and then combined with the
following—­purified water, pluronic gel, LipMaxTM, potassium sorb-
ate, and lavender essential oil to produce the final NanoSilk Cosmo
cream. This was packaged into 10 or 30 mL jars. Importantly, the
NanoSilk Cosmo cream was never tested on animal specimens.
2.2 | Scanning Electron Microscopy (SEM) of
human skin treated with nanosilk solution
The surface topography of untreated human skin and skin treated
with nanosilk fibroin dissolved in sterile water was obtained by
LOUISELLE et al.
SEM. Human skin samples from diabetic patients were sectioned
with an eight mm biopsy punch. Excess hair was removed with a
razor blade, and the skin samples were cleaned with an alcohol
pad. 8% nanosilk fibroin solution in water was misted onto the
samples and allowed to dry for 1 h before being sputter coated
and imaged by SEM.
2.3 | Skin irritation assay
The EpiDerm Skin Irritation Test (EpiDerm SIT) was developed and
validated for in vitro skin irritation testing of chemicals, including
cosmetic and pharmaceutical ingredients. The EpiDerm SIT uti-
lizes the 3D in vitro reconstructed human epidermal (RHE) model
EpiDerm. The procedure allows for discrimination between irritants
of The Globally Harmonized System of Classification and Labelling
of Chemicals (GHS) and non-­irritants. The test is performed over the
course of a 4 day time period, consisting of pre-­incubation, 60 min
exposure, 42 h post-­incubation, and MTT (3-­(4,5-­Dimethylthiazol-­
2-­yl)-­2,5-­diphenyltetrazolium bromide) viability assay. After tissue
receipt and overnight pre-­incubation (Day 0), tissues were topically
exposed to the test chemicals (Day 1) (DPBS (Dulbecco's phosphate-­
buffered saline) = Negative control, 5% Sodium Dodecyl Sulfate
(SDS) = Positive control, NanoSilk Cosmo and 7% nanosilk solution).
Three tissues were used for each test chemical (NanoSilk Cosmo and
7% nanosilk solution), as well as for the positive control (5% aque-
ous SDS solution), and a negative control (DPBS). Chemical exposure
lasts for 60 min, 35 of which the tissues were kept in an incubator
at 37°C. The test substances were then removed from the tissue
surface by an extensive washing procedure. The tissue inserts were
blotted and transferred to fresh medium. After a 24 h incubation
period (Day 2), the medium was exchanged. After the medium ex-
change, tissues were incubated for an additional 18 h. At the end of
the entire 42 h post-­incubation (Day 3), the tissues were transferred
into a yellow MTT solution and incubated for 3 h. The resultant
purple-­blue formazan salt, formed mainly by mitochondrial metabo-
lism, was extracted for 2 h using isopropanol. The optical density of
the extracted formazan was determined using a spectrophotometer.
A chemical is classified as an irritant if the tissue viability relative to
the negative control-­treated tissues is reduced below 50%.
2.4 | Survey details
This was a consumer perception study utilizing two surveys, one
prior to the use of NanoSilk Cosmo and a follow-­up survey after
use. A descriptive survey research design was created to investi-
gate and assess consumer skin care concerns as well as basic demo-
graphic information (Appendix A). A second survey was developed
to assess consumer's perception of the use of NanoSilk Cosmo on
their skin as well as information about how and when they used the
product (Appendix B). The study design and surveys were approved
by our University's International Review Board (COMIRB approval
LOUISELLE et al.
19–­1700). The surveys were completed by the participant, via any
device with access to the internet with the use of online surveys via
Qualtrics (Provo, UT; Seattle, WA).
2.5 | Population and sample
The target population was both men and women, of any race or eth-
nicity, with a minimum age of 18 years who were not pregnant nor
were decisionally challenged. The survey was administered to 100
participants from October 2019 through June 2020 that were re-
cruited through local engagement at medical offices and hospitals in
the Denver metro area. The instructions were for the participants to
fill out the pre-­survey, use the product for up to four weeks, and then
complete the post-­survey. None of the data from either survey used
identifiable markers other than the same randomly generated partic-
ipation code so we could link the pre-­survey and post-­survey results.
3 | R E S U LT S
3.1 | Quality testing of Nanosilk Cosmo
Testing of the NanoSilk Cosmo product by an outside third party
was found to have negligible amounts of lead, mercury, cadmium,
and arsenic (NMT 1 ppm) in addition to negligible amounts of yeast
F I G U R E 1 SEM images of treated
versus untreated human skin at 150x,
500x, and 1500x magnification. There
is decreased skin flaking in the nanosilk
group as compared to the No Treatment
group
| 3
(<100 colony forming units/gram (cfu/g)), mold (<100 cfu/g), E.coli
(<10 cfu/g), and absent Salmonella (Absent).
3.2 | NanoSilk fibers solution forms a protective
film on the skin
We examined the appearance of skin before and after applying the
nanosilk solution using SEM analysis. Qualitative assessment of the
effect of nanosilk fibers on the appearance of skin at the microscopic
level demonstrates a dramatic improvement after topical application
of the nanosilk fibers. Without nanosilk treatment, the skin is ex-
posed and appears dry and scaly. However, after a single application,
the skin surface appears to be much smoother due to the nanosilk
forming a protective, hydrating barrier (Figure 1).
3.3 | NanoSilk Cosmo cream does not cause
skin irritation
According to the manufacturer of the EpiDerm Skin Irritation test,
a chemical is classified as an irritant if the tissue viability relative to
the negative control-­treated tissues is reduced below 50%. The test
showed that neither the NanoSilk Cosmo cream nor the NanoSilk
solution caused any skin irritation (Figure 2). These data support the
fact that throughout the course of the survey study, there were no
4 |
complaints or concerns from participants about significant irritation,
redness, or obvious outward damage to the skin.
3.4 | Pre-­NanoSilk Cosmo cream use survey
There were 97 responses for the NanoSilk Cosmo Initial Survey
(Appendix A), all of which were included in our initial analysis. Of
those, 99% identified as female and 1% identified as male. The
majority of participants were aged 30–­59; however, the entire age
range was 21–­79 years of age.
Participants were asked to rank a set of nine skin care concerns
prior to using NanoSilk Cosmo (1 being the most concerning, and 9
being the least concerning) (Figure 3). The topmost skin care con-
cerns were the appearance, development, or persistence of wrinkles
(Average rank = 2.42). In addition, sagging, acne, and pigmentation/
dark spots were also significant concerns (Average ranks = 4.25,
4.47, and 4.56, respectively).
When it comes to skin care products, participants reported that
active ingredients were their number one concern when purchas-
ing a product, followed closely by price, expert opinion and word
of mouth, recommendations, and/or product reviews (Figure 4).
Interestingly, there was seemingly less concern about animal testing
in our group of participants.
In addition, a majority of participants stated that they used
cleanser, moisturizer, and sunscreen seven days per week, whereas a
majority of participants said they never use toner, masks, lightening
agents, or retinoid agents (Figure 5).
F I G U R E 2 Skin Sensitivity Assay—­EpiDerm Skin Irritation test
(EpiDerm SIT). A chemical is classified as an irritant if the tissue
viability relative to the negative control-­treated tissues is reduced
below 50%. Each group was analyzed in triplicate. Bars represent
the mean, and standard deviation error bars are displayed
LOUISELLE et al.
3.5 | Post-­NanoSilk cosmo cream use survey
There were 50 responses for the NanoSilk Cosmo Completion
Survey (Appendix B) with a total survey response of 51.5% (50 post-­
use responses and 97 pre-­use responses), all of which were used
in the analysis. Most participants used the NanoSilk Cosmo cream
seven days per week for up to 4 weeks. NanoSilk Cosmo cream was
used equally in either the morning time or nighttime, and less fre-
quently used at both time points.
Most participants rated the quality and fragrance of the prod-
uct as “excellent” (Figure 6). With regard to effectiveness, a majority
of the participants reported that they found “excellent” benefit in
the following skin care concerns: overall skin appearance, hydration,
smoothness, and skin firmness. There were no effects that were
ranked as “poor” other than product texture and ease of application,
and this was a very small minority of participants. Nearly 80% of
participants said they would use NanoSilk Cosmo if it became com-
mercially available.
4 | CO N C LU S I O N
Skin aging is an inevitable process and can affect the self-­confidence
of both women and men and interfere with their social interac-
tions.14 There is encouraging promise for the use of silk fibroin for
skin rejuvenation rooted in both in vivo and in vitro studies.15 We
offer the first known study to date that examines consumer percep-
tion on how NanoSilk Cosmo, a silk fibroin-­based product, affects
skin appearance. NanoSilk Cosmo holds the potential to be the first
silk-­based product available to consumers for cosmetic use that may
improve patients’ perception of their skin.
One mechanism by which NanoSilk Cosmo cream may improve
skin appearance and reduce skin aging is through improved skin hy-
dration. Our ex vivo work with SEM analysis showed improvement
in skin barrier and less dermal flaking consistent with improved
skin resilience and increased moisture retention by creating a semi-­
permeable protective film on the skin (Figure 1). Additionally, topical
application of NanoSilk Cosmo cream did not cause any skin irrita-
tion, supported by the data from the EpiDerm Skin Irritation test
(Figure 2) and through survey participants denying any significant
adverse effects or severe allergic reactions to the NanoSilk Cosmo
product. Based on these results, combined with the objective quality
testing, we determined that the NanoSilk Cosmo is a safe product.
As highlighted by our pre-­survey results, our participants stated
that key features of aging skin were their topmost concern—­wrinkles,
pigmentation/dark spots, dryness, sagging, and decreased texture
were consistently listed as the most worrisome feature of their skin.
This makes sense given that a majority of our participants were aged
30–­59, a time when the skin begins to show signs of aging. Less of a
concern was acne, oiliness, and scarring, which is more frequently a
concern during younger years, usually teenage years to late 20 s. The
participants in our group also noted that active ingredients were a
key factor in deciding whether a product was worth using.
LOUISELLE et al. | 5

F I G U R E 3 Average Rank of Skin Concerns. Participants were asked to report their specific skin concerns with 1 being the most important
and 9 being the least important

F I G U R E 4 Relative importance of
skin care product features. The two most
important factors are active ingredients
and expert opinion

The effect that participants noticed after using NanoSilk Cosmo
on a regular basis, resulted in a majority of our participants finding
NanoSilk Cosmo to have a “good” or “excellent” effect on the fol-
lowing skin concern areas—­effect on overall skin appearance, wrin-
kles, hydration, smoothness, skin texture, and skin firmness. These
findings align with what we found with our SEM data that showed
decreased skin flaking and improved moisture. This also matches up
with data previously published that silk fibroin and sericin have many
properties that mirror skin's natural ability to restore hydration and
prevent damage.7-­9 Additionally, several comments from participants
stated that others noticed their wrinkles had lessened in addition to
noticing changes themselves.
6 |
Of note, post-­survey response was 50 participants compared with
initial survey participation of 97, which is a limitation of this study. This
was likely for several reasons—­first, given that the researchers wanted
to preserve the anonymity of the participants, so as to encourage hon-
est answers, we were unable to reach out to them to take the post-­
survey. Previous studies have documented that up to three attempts
to make contact with participants, yields improved response rates.16
Second, there was no incentive to complete the post-­survey, unlike
the initial survey where upon completion they received the NanoSilk
Cosmo product. It has been published several times in the literature
that providing incentives (monetary or otherwise) can increase survey
response rates compared with non-­incentivized surveys, like our post-­
survey.17 In the future, we may consider incentivizing both surveys to
increase our post-­use response rate.
Another limitation of the study is that we are only using sub-
jective measurements to evaluate the efficacy of NanoSilk Cosmo.
However, it is important to give significant weight to consumer
LOUISELLE et al.
F I G U R E 5 Rose plot depicting relative
usage of common skin care products
among survey participants
opinion of a product. Several studies have looked at specific regions
in the United States and internationally to try and determine what
is important in skin care and cosmetics to the consumers. In 2018,
the global skin care market was valued at $135 billion U.S. dollars
18
and consumer perception plays a key role in the success of a skin
care product. Additionally, it has been reported that consumers are
seeking out more natural or organic ingredients in their skin care
products and this is reflected in the increasing relative percentage
of skin care products purchased that are considered natural or or-
ganic.18 Our study also found that several participants highly valued
natural ingredients, whereas less important was the use of animal
testing. Again, we only tested the product on human skin, and never
on animals.
NanoSilk Cosmo moisturizing cream is a novel product that we
have tested and have shown it to be safe for use on human facial
skin. We have shown that aging skin is a significant concern for the
participants of our study, including wrinkles, sagging, and dryness
LOUISELLE et al.
F I G U R E 6 Ratings of Different Qualities of NanoSilk Cosmo
and that most users of NanoSilk Cosmo report an improvement in
these categories. NanoSilk Cosmo offers a safe and effective skin
care cream to help improve skin resiliency and improve hydration.
In the future, we plan to expand our work and perform a prospec-
tive randomized clinical trial to quantitatively assess the effects of
NanoSilk Cosmo solution on the hydration status of the skin, visco-
elasticity, stiffness of the skin, and skin surface topography using
medical-­grade, non-­invasive devices.
AC K N OW L E D G E M E N T S
The authors of this paper would like to thank the University of
Colorado, School of Medicine, and Department of Surgery as well as
Children’s Hospital Colorado for funding this research project.
C O N FL I C T O F I N T E R E S T
Brooke French, Carlos Zgheib, and Kenneth Liechty hold financial
interest and stock in Le Ver Cosmetics that commercially markets
NanoSilk Cosmo under the name Le Ver ScaffoldTM . The remaining
authors report no significant financial or other conflicts of interest.
AU T H O R C O N T R I B U T I O N S
Amanda Louiselle, Stephen Niemiec, Leela Mundra, Mark Azeltine,
Brooke French, Carlos Zgheib, Kenneth W. Liechty: Study composi-
tion and design. Amanda Louiselle, Stephen Niemiec, Leela Mundra,
Mark Azeltine: Data gathering and analysis. Amanda Louiselle,
Stephen Niemiec: Paper writing. Amanda Louiselle, Stephen
Niemiec, Carlos Zgheib: Revision of manuscript.
| 7
E T H I C A L S TAT E M E N T
This is an original manuscript that has neither been published
nor is currently being considered for publication by another
journal. All authors have read and support the content of this
manuscript.
ORCID
Amanda E. Louiselle https://orcid.org/0000-0003-3997-3144
REFERENCES
1. Zhang S, Duan E. Fighting against skin aging: the way from bench to
bedside. Cell Transplant. 2018;27(5):729-­738.
2. Khavkin J, Ellis DA. Aging skin: histology, physiology, and pathol-
ogy. Facial Plast Surg Clin North Am. 2011;19(2):229-­234.
3. Constantin MM, Poenaru E, Poenaru C, Constantin T. Skin hy-
dration assessment through modern non-­invasive bioengineering
technologies. Maedica. 2014;9(1):33-­38.
4. Zhang S, Duan E. Fighting against skin aging. Cell Transplant.
2018;27(5):729-­738.
5. Naskar D, Barua RR, Ghosh K, Kundu SC (n.d.). Introduction to
silk biomaterials. In Silk Biomaterials for Tissue Engineering and
Regenerative Medicine (pp 3-­4 0). Woodhead Publishing.
6. Mondal M, Trivedy K, Kumar SN. The silk proteins, sericin and fi-
broin in silkworm, Bombyx mori Linn. -­a review. Caspian J Env Sci.
2007;5(2):63-­76.
7. Wong J, Chan H-­K , Chrzanowski W (n.d.). Silk for pharmaceutical
and cosmeceutical applications. In SC, Kundu (ed.), Silk Biomaterials
for Tissue Engineering and Regenerative Medicine (pp 519-­ 545).
Woodhead Publishing.
8. Vepari C, Kaplan DL. Silk as a Biomaterial. Prog Polym Sci.
2007;32(8–­9):991-­1007.
8 |
9. Daithankar AV, Padamwar MN, Pisal SS, Paradkar AR, Mahadik
KR. Moisturizing efficiency of silk protein hydrolysate: silk fibroin.
Indian J Biotechnol. 2005;4:115-­121.
10. Verdier-­Sevrain S, Bonte F. Skin hydration: a review on its molecular
mechanisms. J Cosmet Dermatol. 2007;6(2):75-­82.
11. Min B-­Y, Lee G, Kim SH, Nam YS, Lee TS, Park WH. Electrospinning
of silk fibroin nanofibers and its effect on adhesion and spreading of
normal human keratinocytes and fibroblasts in vitro. Biomaterials.
2004;25:1289-­1297.
12. Manurova NE, Smirnova GO, Stupin VA, Silina EV. The ratio of col-
lagen types I/III as a marker of skin aging and prognosis of aesthetic
facial surgery results. J Pharma Sci Res. 2018;10(10):2543-­2546.
13. Hennigs N, Karampournioti E, Wiedmann K-­P. Do as You Would Be
Done by: The Importance of Animal Welfare in the Global Beauty Care
Industry. Green Fashion; 2016.
14. Bogle M, Arndt K, Dover J, Kaminer M. Evaluation of the Aging
Face. In MS, Kaminer(eds). Atlas of cosmetic surgery. Philadelphia:
Saunders Elsevier; 2009:37-­43.
15. Farokhi M, Mottaghialab F, Yousef F, Khademhosseini A, Kaplan D.
Overview of silk fibroin use in wound dressings. Trends Biotechnol.
2018;36(9):907-­922.
LOUISELLE et al.
16. Phillips A, Reddy S, Durning SJ Improving response rates and eval-
uating nonresponse bias in surveys: AMEE Guide No. 102. Medical
Teacher, 2015;217-­228.
17. Cosgrove JA. Using a small cash incentive to increase sur-
vey response. Adm Policy Ment Health Ment Health Services Res.
2018;45:813-­819.
18. Garcia A. The skincare industry is booming, fueled by informed con-
sumers and social media. 2019. Retrieved from https://www.cnn.
com/2019/05/10/busin​ess/skinc​are-­indus​try-­trend​s-­beaut ​y-­socia​
l-­media/​index.html.
How to cite this article: Louiselle AE, Niemiec S, Azeltine M,
et al. Evaluation of skin care concerns and patient’s
perception of the effect of NanoSilk Cream on facial skin. J
Cosmet Dermatol. 2021;00:1–11. https://doi.org/10.1111/
jocd.14198
LOUISELLE et al. | 9

APPENDIX A

W H AT I S YO U R AG E ?
o 18-­20

o 21-­29

o 30-­39

o 40-­49

o 50-­59

o 60-­69

o 70-­79

o >80

I | identify as:
o Male

o Female

o Transgender Male

o Transgender Female

o Other

D O YO U FO L LOW A S K I N C A R E R O U T I N E ? I F Y E S , W H I C H O F T H E FO L LOW I N G P R O D U C T S D O YO U U S E A N D
H OW O F T E N D O YO U U S E T H I S P R O D U C T ?

No—­I do
Yes—­1 day Yes—­2 days Yes—­3 days Yes—­4 days Yes—­5 days Yes—­6 days Yes—­7 days not use this
per week per week per week per week per week per week per week product

Cleanser o o o o o o o o
Exfoliator (BHA: Salicylic o o o o o o o o
Acid or AHA: Glycolic/
Lactic Acid)
Toner o o o o o o o o
Moisturizer o o o o o o o o
Sunscreen o o o o o o o o
Night Cream o o o o o o o o
Serum o o o o o o o o
Mask o o o o o o o o
Lightening Agents o o o o o o o o
(Hydroquinone,
Vitamin C, Azelaic
Acid, Niacinamide,
etc.)
Retinoid Agents (retinol, o o o o o o o o
tretinoin, etc.)
10 | LOUISELLE et al.

W H E R E D O YO U T Y P I C A L LY P U R C H A S E YO U R S K I N C A R E P R O D U C T S ?
o Medical Spa/Aesthetician

o Dermatologist/Plastic Surgeon

o Retail Store (ie, Target, Sephora, Nordstrom)

o Online

I N O R D E R O F I M P O R TA N C E , W H I C H O F T H E FO L LOW I N G I N FLU E N C E S YO U R D EC I S I O N TO P U R C H A S E P R O D U C T S
(1–­1 0 )?
______ Active Ingredient(s).
______ Fragrance.
______ Price.
______ Brand.
______ Word of Mouth, Recommendations and Product Reviews.
______ Expert Opinion (doctor, aesthetician).
______ Animal Testing.
______ Packaging/Marketing.
______ Availability/ Convenience.
______ Natural Ingredients.
In order of importance, what concerns you most about your skin (1–­10)?
______ Wrinkles.
______ Sagging.
______ Acne.
______ Pigmentation/Dark Spots.
______ Oiliness.
______ Dryness.
______ Redness and Sensitivity.
______ Spider Veins.
______ Texture.
______ Scarring.

APPENDIX B

H OW LO N G D I D YO U U S E N A N O S I L K C O S M O?
o <7 days (<1 week)

o 7-­13 days (1-­2 weeks)

o 14-­20 days (2-­3 weeks)

o 21-­27 days (3-­4 weeks)

o 28+ days (>4 weeks)

H OW FR EQ U E N T LY D I D YO U U S E N A N O S I L K C O S M O S ?
o 1 day per week

o 2 days per week

o 3 days per week

LOUISELLE et al. | 11

o 4 days per week

o 5 days per week

o 6 days per week

o 7 days per week

o I did not use the product

W H E N D I D YO U N A N O S I L K C O S M O?
o Morning

o Nighttime

o Morning and Nighttime

P L E A S E R AT E T H E FO L LOW I N G C H A R AC T E R I S T I C S O F N S C O S M O

Excellent Good Average Fair Poor

Quality
Fragrance
Product Texture
Ease of Application
Effect on overall skin
appearance
Effect on wrinkles
Effect on hydration
Effect on smoothness
Effect on redness
Effect on skin texture
Effect on irritation
Effect on skin firmness
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o

WO U L D YO U U S E N A N O S I L K C O S M O R EG U L A R LY S H O U L D I T B EC O M E C O M M E R C I A L LY AVA I L A B L E ?
o Yes

o No