Turning back the clock on skin aging

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Turning back the clock on skin aging series

This is a weekly series that focuses on skin aging prevention and treatment. Today's post will provide an overview of the process of skin aging.

While aging is inevitable, the process can be slowed down tremendously with key modifications to one’s lifestyle. There are two forms of aging, intrinsic aging and extrinsic aging.

Intrinsic aging: this is the natural aging process, we are all genetically programmed to undergo intrinsic aging! Intrinsic aging begins in the mid to late 20’s, although one does not manifest the signs of intrinsic aging for decades. Therefore, the earlier we begin to incorporate anti-aging regimens and practices in our daily routine, the better. Some of the changes that occur at the cellular level are: reduction in the production of skin collagen and hyaluronic acid leading to volume loss, reduced coil action of skin elastin and elastic fibers leading to skin sagging and permanently etched skin lines, reduction in skin cell turnover and skin shedding (exfoliation) rate leading to complexion and texture problems.

Intrinsic aging eventually manifests as:

• Fine lines and wrinkles
• Thin and transparent skin
• Loss of skin volume, leading to hollowed cheeks, temples and eye sockets as well as noticeable loss of firmness on the hands and neck
• Bones shrink away from the skin due to bone loss, which causes sagging skin of cheeks and jowls
• Dry skin that may itch
• Graying hair that eventually turns white
• Hair loss
• Unwanted hair
• Nail plate thins, the half moons disappear, and ridges develops

Extrinsic aging is caused by external factors that accelerate the aging process e.g. ultra-violet radiation, cigarette smoking, air pollution, poor diet, gravity, sleeping positions, and repetitive facial expressions.

Ultraviolet radiation is by far the most important factor in this category. Repeated sun exposure leads to DNA damage in the skin, breaks down skin collagen and elastic fibers and impairs the production of new collagen. Over time, the skin loses volume and elasticity and DNA damage accumulates leading to loose, wrinkled and leathery skin. The following skin changes are linked to ultraviolet radiation: freckles, age spots, spider veins on the face, rough and leathery skin, wrinkles, loose skin, a blotchy complexion, actinic keratoses, and skin cancer.

Check out this image published in a recent issue of the New England Journal of Medicine

This unidentified 69-year-old trucker (pictured above) was on the road for 28 years and accumulated lots of exposure to ultraviolet A (UVA) radiation. The man's skin gradually thickened over the past 25 years, leading to a condition called unilateral dermatoheliosis. Note that the condition is worse on the left side of the face, consistent with sun exposure though window glass on the driver side.

Cigarette smoking causes biochemical changes in our bodies that accelerate aging. The nicotine in cigarettes causes narrowing of the blood vessels in the skin, causing impaired blood flow, oxygen and nutrient delivery to the skin. The chemicals in tobacco smoke also damage collagen and elastin. Repeated facial expression (pursing one's lips when inhaling) and exposure to the heat from burning cigarettes contribute to wrinkles.

Poor diet: diet low in vitamin A, C can impair skin cell turnover and skin collagen formation respectively. Vitamin D and Calcium is required to prevent facial bone loss (cheek bones, jaw bone). Facial bone loss can promote sagging of the skin. A diet rich in antioxidants reduces oxidative damage to the DNA from free radicals.

Facial Expressions: repetitive facial movements lead to fine lines and wrinkles. If you perform facial exercises, stop. As skin ages and loses its elasticity, the skin stops springing back to its line-free state, and the grooves made by repetitive movements become permanently etched on the face as fine lines and wrinkles.

Gravity: as the skin loses volume and underlying facial bone loss occurs, gravity pulls the skin downward causing the tip of the nose to droop, the ears to elongate, the eyelids to fall, jowls to form. Overall leading to the feeling that ”one’s face is falling”

Sleeping positions: resting your face on the pillow in the same way every night for years also leads to wrinkles called sleep lines. Sleep lines eventually become etched permanently on the skin. Women, who tend to sleep on their sides, are most likely to see these lines appear on their chin and cheeks. Men tend to notice these lines on the forehead since they usually sleep with the face pressed face down on the pillow. People who sleep on their backs do not develop these wrinkles.

Antiaging recommendation

1.     Sun protection is key

a.     Stay out of the sun between 10:00 a.m. and 4:00 p.m., when the sun’s rays are the strongest.

b.     Wear protective clothing, such as a wide-brimmed hat and long sleeves, when outdoors during the day.

c.      Apply sunscreen year round. Sunscreen should be broad spectrum (offers UVA and UVB protection) and have a Sun Protection Factor (SPF) of 30 or higher. Sunscreen should be applied 20 minutes before going outdoors to all skin that will be exposed. It should be reapplied after sweating or being in water.

d.     Avoid tanning parlors and devices

2.     If you smoke, quit

3.     Eat a balanced diet rich in vitamins and mineral. Vitamin C is essential for collagen production, calcium and Vitamin D is essential to prevent bone loss

4.     Visit your board certified dermatologist to discuss treatment regimens that are best suited to your skin needs

5.     Wear moisturizers with antioxidants (Vitamin C & E)

6.     If you are bothered by visible signs of aging, speak to your board certified dermatologist about the various treatment options available. There are many minimally invasive treatment options with virtually no downtime that can be used to treat signs of aging. Some examples are injectable fillers (Juvederm, Restylane, Belotero, Radiesse, Sculptra) and neuromodulators (botulinum toxin). Laser and IPL devices, radiofrequency  devices , chemical peels, can promote a more youthful appearance.

Join me next week as I blog about another interesting topic in this series.
Thank you. 

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