How our skin changes with age

How our skin changes with age

January 17, 2021

 

At what age does the skin begin to age?

What happens to the skin that signals the start of the aging process?


    The aging process of the skin is usually defined by key features. Fine lines and wrinkles, pigment changes including sun spots, and loss of volume.  Fine lines and wrinkles developed as a result of thinning of the skin as we get older. Pigment changes are from a combination of sun exposure and hormonal changes as well as genetics.  And, loss of volume is likely the result of a combination of factors including hormonal changes in fat distribution combined with age and sun related loss of elasticity in the skin that results in a ‘droopy’ appearance for our skin.








    The age that most people will start to see the effects of aging is usually by our mid to late 20s.  Although the effects of aging are noticeable at this age, the reality is that the foundation for premature aging of the skin is laid early in childhood.  UV exposure accelerates this process by damage to the DNA of our cells. Sunburns and chronic sun exposure in childhood and teenage years are not always immediately accompanied by the signs of aging. More often there is a delay is seeing the impact on our skin by about 10-20 years after those initial intense and/or prolonged UV exposures.



    In terms of aging, how does the skin change during your 20s?



      The main concerns that my patients in their 20s have noted with regards to aging of the skin are most often related to pigment changes and early fine lines around the dynamic portions of the face such as the mouth and eyes.  This age group is often eager to take steps to prevent or slow down the process of aging as well!


      The absolute most important way to combat their concerns is sunblock.  Getting into the habit of wearing a sunscreen every single day of the year - regardless of the chances for sun exposure is important.  We are learning more about other sources of potential UV exposure indoors through some energy efficient light fixtures as well as potentially from screen use from computers and smartphones.  Choose a sunscreen that has zinc and/or titanium as the ingredient and not chemical sunscreens. The jury is still out on chemical sunscreens. The concerns about chemical sunscreens being absorbed into the blood stream and serving as potential “endocrine disruptors” is most concerning to me for children, teens and premenopausal women.  If you are not a fan of the whitish hue to many of these sunscreens, choose a tinted one so it’s less noticeable but still effective. 


      Wearing a sunscreen on a routine basis every morning  is important to prevent and reduce discoloration that can occur.  Sunscreen use can also slow down and prevent further UV damage to our cells.



      Starting in our 20s is a great time to include Retinol in the evening routine. Retinol is the long game- its effects and benefits are reaped over time.  Ideally we start young with retinol - in our 20s to 30s to ward off the signs of aging.  If you are looking to get rid of some wrinkles by next month or by the time an event rolls around- see your dermatologist for other options.

      The best approach to take for consumers and my patients is to not look to the immediate results of these products. The overall millennial trend is to focus on natural and effective. Retinol fits perfectly into this class and if you start early, you will reap the long term benefits. Retinoids are known to improve fine lines and wrinkles by boosting collagen production in addition to retaining water in the skin. They can help actually reverse the signs of aging that comes from sun damage. They can also work to minimize discoloration in the skin and give the skin more of a glow.  


      In terms of aging, how does the skin change during your 30s?


        By our 30s,  more discoloration, freckles and pigmentation starts to develop.  This is when my patients will say “I swear I’m wearing sunscreen every day- why am I getting these spots?!”  I believe them when they say they are wearing sunscreen daily. The reality is that it’s those sunburns from our childhood, those times they went to a tanning salon to get ready for prom, those summers as a life guard - all catching up with them!  


        This is a great time to add in Vitamin C. Topical vitamin C does several things: it’s a potent antioxidant to prevent damaging our cells from UV and the environment, it inhibits an enzyme called tyrosinase in the skin to prevent hyperpigmentation, it is an anti inflammatory to help with redness in skin, and it can boost collagen production. It has been shown to improve the texture and appearance of skin overall. One note- even though vitamin C can improve pigmentation in the skin, I find the best results are from pigment as a result of sun damage. It’s mechanism of improving pigment is by blocking a specific enzyme that triggers hyperpigmentation. Although this can be a similar issue with acne scars, not all pigment  is the same and I do not always find that acne scars respond consistently as well to vitamin C compared to other options. 


        In terms of aging, how does the skin change during your 40s?


          By our 40s, we are starting to see the impact of aging in terms of more persistent pigment changes and deeper lines or wrinkles that stay at rest.  I tend to describe this as ‘I stopped smiling 5 minutes ago- why are my smile lines still there?!”


          Our skin is getting thinner over time and less able to hold onto hydration.  This is a great time to look at adding in topical formulations of hyaluronic acid (HA).  These are seen in anti- wrinkle creams and any product targeting skin hydration. (It is important to note that when applied topically, it does not penetrate deep into the skin to give the effect of an injectable filler.)  


          The goal of HA topically is to increase improve skin hydration, elasticity and decrease wrinkle depth. HA can strongly attract and retain moisture in the skin. When applied topically it is not reversing the signs of aging long term or treating sun damage the way other anti aging preps work. 


          Technically it's topical effect is based on drawing moisture to the skin when applied to improve the overall appearance of the skin while it is used. It improves the turgor of the skin. This is a good thing- many people cannot tolerate anti aging topicals that contain alpha hydroxy acids and retinol.  They can be too irritating or drying for the skin. It’s a welcome option to have a product that works by really hydrating the skin. 


          Our 40s is also when many start to seek other options.  For deeper lines and wrinkles present at rest, toxins and fillers tend to be the next step to intervene.  I do spend more time to help my patients understand their options and to help navigate the choices by keeping things in perspective.


          From a cosmetic perspective, I break down cosmetic procedures as Restorative, Enhancing or Transformative. 


          Restorative cosmetics focus on ‘restoring’ our looks- these are patients that come in and say “where did this line come from” or ‘I look tired all the time’. Most of my patients fall under this category where they are not asking to look like someone else - they truly just want to look like they did when they felt the most confident.  These patients of mine do not have unrealistic expectations and are wonderful to work with because they define beauty as confidence. They define beauty as feeling good in their skin and wanting to look like their best self.


          Enhancing cosmetic procedures are ones where we define or augment a feature. Common examples are lips, cheeks and chin.  In this category of patients, they have a lot of confidence and find that better defining features will only contribute to this.  Many do these for ‘functional” (loosely medical) purposes. For example, we lose lip volume over time. This leads to fine lines and furrows around the mouth.  These lines cause lipstick to bleed into them. They also lead to recurrent cases of perleche- cracked inflamed corners of the mouth. Beauty here is defined as confidence in addition to symmetry.  Most beauty studies have shown that beauty is not defined by a feature but by symmetry. You may be surprised to know that many of those first two categories do not necessarily define “youth” as beauty.


          For my transformative cosmetic patients, the goal these patients have is to achieve a look that they have defined as beautiful in someone else.  They may bring in photos or routinely reference a celebrity seeking this ‘look’. Here beauty is defined by the patient to be one applied by the general public/media/ celebrity. Many celebrities viewed as “beautiful” often hold true to the rule of symmetry as well. I will say from a practical perspective it can be a bit harder to attain satisfaction as one procedure or type of procedure is often not enough…


          In terms of aging, how does the skin change during your 50s?


            There is this frustrating tissue paper like wrinkling or ‘crepey’ quality to the skin that starts to appear in our 50s.  This is just difficult because it is a true change in the quality of skin that takes effect. This is the result of loss of collagen combined with loss of elasticity in the skin.  In terms of OTC optio
            ns, peptides in serums are thought to work by stimulating collagen production in the skin. These are small molecules that are believed to stimulate receptors in the skin to result in collagen synthesis. This effect along with the hydrating effects of the numerous oils and anti oxidants improve the overall appearance of fine lines and wrinkles quickly with this product. Remember to use a moisturizer on top to make it more effective.


            In terms of aging, how does the skin change during your 60s?



              Let’s talk about the neck.  The neck starts to stand apart and reveal our age even when we are being really good about caring for our faces!  This type of loose, excess skin can be difficult to address. I have more patients saying to me “I’m fine with my face, it’s aging gracefully- but my neck!”  Aside from surgical interventio
              n, radiofrequency tightening of the skin has been very successful to help in improve the crepey appearance of this skin.


              In terms of aging, how does the skin change during your 70s and beyond?


                The most common issue for this age group beyond the above is quite simply easy bruising on the arms and hands.  It is probably the most common new ‘cosmetic’ concern I see by this age. It is frustrating, can be unsightly, and difficult to manage as a result of easy tearing that can accompany it.  It is truly the result of thinned atrophic skin over years of sun damage and aging. It can be worsened by blood thinners commonly taken in this age group but not always caused by them (and not a reason to stop taking them!).  I recommend focusing on thicker moisturizers to really create more turgor to the skin to help it withstand shearing forces from friction and minor bumps and hits our skin is exposed to. Wearing long sleeves or athletic sleeves when active can help reduce the impact on the skin by behaving almost like second skin. 
                 


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