Male Skin Survey - June 2017 Question Title * 1. What is your Name and Surname? Question Title * 2. Which Renewal Institute branch do you visit most often? Bedfordview Brooklyn Cape Quarter Claremont Constantia Durban Fourways Hillcrest Illovo Irene Morningside Parkhurst Stellenbosch Umhlanga West Rand Willowbridge Question Title * 3. If you would like us to update your e-mail address on our client database, please fill in your current e-mail address below? Question Title * 4. Please select your gender? Male Female Question Title * 5. 6Please select your age group: 18-25 26-35 36-45 46-55 56-65 Above 66 Question Title * 6. Did you know the exact same treatments can be done on both male & female skin? Yes No Question Title * 7. Do you suffer from any of the below skin conditions? Fine and severe lines Acne Rough texture Acne scarring Oily skin Pigmentation Sun damage Melasma (hormonal pigmentation) None of the above Other (please specify) Question Title * 8. What are the most common skin and health concerns you have: Acne Acne Scarring Razor bumps Ingrown hair Skin Tags Warts Red Cheeks Sensitive skin Sun Spots and Photoageing Excessive hair growth Hair loss Impotence Wrinkles Stubborn abdominal fat Excessive sweating None of the above Question Title * 9. Which of the following treatments have you tried? Laser hair removal for ingrown hair on the beard and neck Laser Genesis to heal inflammation from ingrown hair Laser Hair Removal for Back Hair & Course Beards Nose Waxing & Ear Waxing Male Manicures Face Peels Facials Gut Restoration Needling / Dermapen for scarring Botox Threads Fillers IPL for sunspots Laser vein removal Cryo Lipolysis for stubborn abdominal fat Carboxytherapy Velashape for body shaping None of the above Question Title * 10. How do Injectables for men differ from women? Men have stronger muscles than women and therefore need more Botox Men of thicker skin than women and therefore need more Botox The focus is on minimising the wrinkle, not removing it None of the above Question Title * 11. Have you had your skin analysed by one of the below in the last 12 months? Aesthetic Doctor Therapist Dermatologist None Question Title * 12. What is your Skin Type? Please select below: Fitzpatrick Skin Type I (pale, blonde or red hair, freckled with blue eyes and likely to experience severe sun damage from ultra-violet exposure) Fitzpatrick Skin Type II (fair with blue eyes, light or fair skin. They manage to get a light tan with repeated exposure to sun, but have a high risk for skin cancer) Fitzpatrick Skin Type III (have sensitive skin and although their skin is still white, it is slightly darker than those with skin types I and II) Fitzpatrick Skin Type IV (dark hair and light Mediterranean, olive looking skin – beige with light brown tint.) Fitzpatrick Skin Type V (olive or dark skin tone and includes light-skinned African-Americans, Indians and those of Middle Eastern decent) Fitzpatrick Skin Type VI (dark skin colour and usually of African decent) I don't know my Skin Type Question Title * 13. Do you follow a skincare routine? If yes, indicate which of the following products you use? Face wash Cleanser Toner Exfoliator Sunscreen Day cream Night cream Serum Mask Eye product No, I do not follow a skincare routine Question Title * 14. If you do not follow a skin care routine at all, please state your reason for this? I don’t have time I don’t feel I need to Skin Care routines are for women I wouldn’t know where to start Question Title * 15. Would you like a Renewal Institute staff member to contact you to discuss the survey and schedule an appointment? Yes No Done
