The topic of aging—getting older and looking younger—is more and more pervasive in our society's collective consciousness. Especially now, with Hollywood stars, reality TV, and tabloids driving a widespread preoccupation with appearing as youthful as possible. Women are feeling increasing pressure not just to look good for their age, but to actually never age at all. We all get older, day by day, and there is no stopping it. However getting older doesn't mean we have to look older. Understanding facial aging and aesthetics allows dermatologists to select the proper rejuvenation treatment. Most patients demonstrate more than one of the following signs I have listed below, and you should be appropriately evaluated and your needs prioritized according to your desired outcome.
1. Inherent changes within the skin. Wrinkles? Check. Sun spots? Check. Big pores? Check. As we age, the epidermis (outer layer of the skin) begins to thin, causing the junction with the dermis (middle layer) to flatten. Our skin also loses elasticity (ability to bounce back), and becomes dry. Collagen decreases, as we age and the bundles of collagen, which gives the skin turgor, become looser and loses strength. When the skin loses elasticity, it is less able to resist stretching. Coupled with gravity, muscle pull and tissue changes, the skin begins to wrinkle. The skin is less able to resist mechanical damage and heals slower from insult. Water loss and breakdown of bonds between cells also reduces the barrier function of the skin, which can cause the skin’s pore size to increase. Abnormal cells can also accumulate in aged skin, especially if there is chronic sun damage, which can lead to pre-cancerous and cancerous lesions. In addition, the skin's normal process of rejuvenation slows as we age. When we are young, the cells of the skin turn over quickly, so every individual skin cell is young. When we are older, the process slows, so that the individual skin cells on the surface are older, and more damaged by the environment.
The above changes are influenced by intrinsic or genetic factors. These aging factors correlate highly with inherit and/or ethnic influences. Other major factors are environmental, such as sun exposure, which causes photoaging as well as habits such as smoking and alcohol, which can accelerate aging of the skin.
2. Facial muscles acting on the skin. All of our muscles become conditioned to repeated responses and will anticipate routine contractions. In the face, this means some of your muscles will begin to anticipate some of the routine actions that accompany facial expressions, including contracting the brow, squinting the eyes, and pursing the lips. Deep facial folds are also created around the mouth and smile lines. Years of muscle contraction leads to formation of permanent folds, and as the skin changes, these folds become etched in the skin.
3. Loss of tissue elasticity. Facial aging is associated with a loss of tissue elasticity, where the skin and underlying muscle can no longer rebound from the effects of gravity. Newer lasers and radiofrequency devices such as Thermage can tighten the collagen under the skin to improve texture. These devices can tighten collagen and may give a minor lift in more youthful patients; however, they cannot substitute for surgical facial rejuvenation when a face or browlift is indicated.
4. Effects of gravity. Gravity works constantly to pull everything on the body downward. This is true of the breasts (and the reason why breastlifts are such popular procedures) and it is true of the face. Over time, gravity, aided by a loss of elasticity in the skin and ligaments, can displace the tissues of the face. In the upper face, the brow and eyelids can begin to sag, creating a tired appearance. Hanging skin and fat in the lower face create jowls and loss of the definition of the chin and jawline.
5. Soft tissue and bone loss. As we age, the face loses volume, soft tissue, bone and fat. As part of this reduction in soft tissue, the face appears more hollow. With age, the body also changes its patterns of fat deposition. The face begins to lose fat, especially in the temples, the forehead and around the eyes. This is worsened by the displacement of tissues by gravity, creating a haggard, worn, or tired appearance. Where the ligaments retain their tautness, it can create facial grooves as some tissues descend while others do not.
So what does this all mean? Is it all downhill from here? The fact is (and yes, I'm allowed to say this even though I'm only in my 30's) that aging is unpredictably different for everyone. For most, it's not a steady incline or a decline. I plan on always discovering new ways to feel beautiful and confident (and yes, with the help of some of my toys) as I navigate through this beautiful life.
Dr. Cindy N. Berthelot, M.D. is a board certified dermatologist treating patients in the greater Houston community, including the Clear Lake, Webster, Friendswood, Deer Park, Pasadena, and Pearland areas. To make an appointment with Dr. Berthelot, please contact us at (281) 480-7272.