ImageThere are between 25 and 30 different theories of aging recognized by the NIH (National Institute of Health). There is no unified theory of aging. Otherwise, only one ingredient in only one skincare product would serve to treat all aging skins. Therefore, aging must be approached from a multi-factor point of view with multiple ingredients and products. (By Charlene DeHaven, MD, FACEP, Clinical Director).

Because skin changes are among the most visible signs of aging, before we get into the causes of aging, let’s take a look at the structure of the skin and what happens to it during the aging process:

Your skin does many things. It protects you from the environment, helps control your body temperature and fluid balance, and contains nerve receptors that allow you to feel sensations such as touch and pain.  Although the skin has many layers, it can be generally divided into three main parts:

  • The outer part (epidermis) contains skin cells, pigment, and proteins.
  • The middle part (dermis) contains blood vessels, nerves, hair follicles, and oil glands. The dermis provides nutrients to the epidermis.
  • The inner layer under the dermis (the subcutaneous layer) contains sweat glands, some hair follicles, blood vessels, and fat. Each layer also contains connective tissue with collagen fibers to give support, and elastin fibers to provide flexibility and strength.
AGING CHANGES: Aging changes in the skin are a group of common conditions and developments that occur as people grow older.  Aging skin is a natural part of getting older, and from the moment you are born your skin begins to respond to two sets of biological processes:
  • The aging skin “genes” you inherited, over which you have little control: If you are fortunate enough to know older generations of your family members, you may see patterns of aging skin in their faces and bodies. These can include:
    •  Furrows in the brow or forehead
    •  Tiny lines or crinkles around the eyes
    •  Deep creases along the sides of the nose to the mouth
    • Drooping eyelids
    • Loose skin along the jaw line
    • A “tired” look
    • The tendency to develop cellulite
    • Male pattern baldness or female pattern baldnes.

If you see any of these indicators of aging skin—or others—in your older family members, chances are that you will experience at least some of them too.  Some people choose cosmetic treatments, surgery, hair transplants, and other choices to slow the external signs of aging skin, but the fact remains that everyone ages.  If you are lucky and live long enough, aging skin will catch up to you and the years you acquire will eventually show on your face. One of the healthiest things you can do for yourself is to work on accepting your aging process with dignity…and grace…and style.

  •  The external factors that act on aging skin, over which you have a lot of control and which will be explained later.

How does the aging process work?

With aging, the outer skin layer (epidermis) thins, even though the number of cell layers remains unchanged.  The number of pigment cells (melanocytes) decreases, but the remaining melanocytes increase in size. Aging skin thus appears thinner, more pale, and clear (translucent). Large pigmented spots (called age spots, liver spots, or lentigos) may appear in sun-exposed areas.

Changes in the connective tissue reduce the skin’s strength and elasticity. This is known as elastosis and is especially pronounced in sun-exposed areas (solar elastosis). Elastosis produces the leathery, weather-beaten appearance common to farmers, sailors, and others who spend a large amount of time outdoors.

The blood vessels of the dermis become more fragile. This leads to bruising, bleeding under the skin (often called senile purpura) and cherry angiomas.

Sebaceous glands produce less oil as you age. Men experience a minimal decrease, usually after the age of 80. Women gradually produce less oil beginning after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness.

The subcutaneous fat layer thins, reducing its normal insulation and padding. This increases your risk of skin injury and reduces your ability to maintain body temperature. Because you have less natural insulation, you can get hypothermia in cold weather.

Some medications are absorbed by the fat layer, and loss of this layer changes the way that these medications work.

The sweat glands produce less sweat. This makes it harder to keep cool, and you are at increased risk for becoming overheated or developing heat stroke.

Growths such as skin tags, warts, and other blemishes are more common in older people.

Aging changes in the face

The typical appearance of the face and neck changes with age. Muscle tone may be lost, causing a flabby or droopy appearance. The jowls may begin to sag, leading to a “double chin” in some people. In some people the nose lengthens slightly and may look more prominent.

There also may be an increase in the number, size, and color of colored spots on the face. This is largely due to sun exposure.

The skin may thin, become dryer, and develop wrinkles. Although wrinkles are inevitable to some extent, sun exposure and cigarette smoking are likely to make them develop faster.

The ears may lengthen slightly in some people (probably caused by cartilage growth). Some men may find that they develop hair in their ears that becomes longer, coarser, and more noticeable as they age.

Wax glands drop in number and activity, and ear wax becomes drier. This drier wax can more easily become impacted and block the ear canal, reducing your ability to hear.

The eyebrows and eyelashes become gray. The skin around the eyelids becomes loose and wrinkled, often making a “crow’s feet” pattern. The eye socket loses some of its fat pads, making the eyes look sunken and limiting eye movement.

The lower eyelids may appear baggy, and drooping eyelids are fairly common, occasionally limiting vision. The outer surface of the eye (cornea) may develop a grayish-white ring.  The colored portion of the eye (iris) loses pigment, making most very elderly people appear to have gray or light blue eyes.

Loss of teeth can make the lips look shrunken. The jawbone loses bone material, reducing the size of the lower face. The forehead, nose, and mouth thus look more pronounced.  Gums may also recede, contributing to dental problems and changes in the appearance of the mouth.

PREVENTION (External Factors for which YOU DO have control!)

Skin changes are related to environmental factors, genetic makeup, nutrition, and other factors. The greatest single factor, though, is sun exposure. This can be seen by comparing areas of your body that have regular sun exposure with areas that are protected from sunlight.  Because most skin changes are related to sun exposure, prevention is a lifelong process.

1. UV Exposure tops every dermatologist’s list. UV rays (and lack of sunscreen) accelerate skin aging and cause hyperpigmentation and skin laxity. The best fix: prevent sunburn if at all possible, apply sunscreen every day, in every season, and wear protective clothing and hats as necessary. Sunlight can cause:

  • Loss of elasticity (elastosis)
  • Noncancerous skin growths (keratoacanthomas)
  • Pigment changes such as liver spots
  • Thickening of the skin
  • Sun exposure has also been directly linked to skin cancers, including basal cell epithelioma, squamous cell carcinoma, and melanoma.

Natural pigments seem to provide some protection against sun-induced skin damage. Blue-eyed, fair-skinned people show more aging skin changes than people with darker, more heavily pigmented skin.

2. Weight -You’ve probably waited a long time to find out when having a few extra pounds actually works to your advantage. If you’re over 40, a slightly higher Body Mass Index (about 4 points) makes you look up to 3 years younger. If you’re over 55, you’ll look even younger than that! If you’re less than 40, the reverse is true.

3. Stress -Maybe you’ve heard this expression: “Don’t frown, your face could stay that way.” Stress and worry cause frowning, and over time the muscles in the face actually conform to that movement.  Financial stress, personal problems, marital difficulties and job-related stress all take a toll. Stress is definitely inter-related with your physiology as well as your mind, and increases the free radicals in your body—which are constant scavengers of anti-oxidants. Stress causes or exacerbates acne, eczema, rosacea, wrinkles and laxity. To help reduce aging skin due to stress, be aware of your stress level, try to vary your facial expressions during the day and take time to manage your stress with yoga, exercise or deep breathing. 
4. Smoking -Many of the 4,000 toxins contained in cigarette smoke go directly to the bloodstream, and reach the skin. “Smoker’s face” is now actually a term in medical dictionaries, because people who have smoked for 10+ years have added lines and wrinkles (typically perpendicular to the lips), as well as deeper vertical lines on the cheeks. Smoking also affects the tint of the skin and reduces the efficiency of the skin’s ability to regenerate itself. Cigarette smoke depletes your body of Vitamin C, which is a key ingredient for keeping skin plump and moist.  Do you need one more reason to quit smoking?
5. Medication/Drugs -Prescription meds that relax the muscles (such as anti-depressants) may make the skin look older. The author of the Case Western Reserve study theorizes that depression may compromise the production of hormones, like human growth hormone, that contribute to healthy, plump skin. With your physician’s guidance, manage your medications. Avoid using recreational drugs as well.  Any damage to your internal organs will accelerate the aging process and will reflect on your skin.
6. Exposure to cold weather – Cold winds and low temperatures contribute to aging skin by making skin dry, so if you venture out in the cold be sure to use a good moisturizer.  It’s important to use moisturizer indoors too, as heated rooms can be very drying to skin. Consider using a humidifier to help keep your skin more comfortable and reduce the aging skin effects of heated rooms.
7. Hormones -Menopause can wreak havoc on your skin, but hormone replacement therapy can help preserve a more youthful look. According to the Case Western study that was published in Plastic and Reconstructive Surgery, a 70-year old who has had HRT for at least 16 years will look four years younger.
8. Lack of sleep -Too little sleep makes you look and feel tired. One of the first places lack of sleep shows up is on the face, with dark circles and bags under the eyes, and sagging skin. Lack of sleep is also a major factor in memory loss and symptoms of depression that include low interest in daily activities and negative thinking.  Research has shown that most adults function best with 8-9 hours of sleep each night. Reduce caffeine during the day (with none in the evening), avoid eating at least 2 hours before bedtime, and maintain a sleep routine that includes going to bed at the same time each night.  If you are having trouble sleeping, for any reason, it’s important to see your health care provider.

9. Alcohol use – Alcohol contributes to aging skin by dilating small blood vessels in the skin and increasing blood flow near the skin’s surface. Over time, these blood vessels can become permanently damaged, creating a flushed appearance and broken vessels on the skin’s surface.
10. Lack of exercise – Living a sedentary life contributes to aging skin because exercise helps to tone your muscles and get your blood flowing. Exercise should be an important part of every anti-aging skin care program.  In addition to the physical benefits of exercise, the benefits of a regular exercise program will show on your face. Having a bright smile and lots of energy will help you look and feel younger, at any age.
With all this said, I’d still like to address four scientific theories of the aging process because I believe that we can be more aware of what external factors could lead to these theories of aging and be more holistic in our prevention.  According to these 4 theories, these processes apply to the entire organism and every cell within it. However, keep in mind that the skin is unique in that is the organ that shields the interior of our body from the environment, and therefore will reflect our internal health.
(The following material was developed by Charlene De Haven, MD, FACEP, Clinical Director of INNOVATIVE SKINCARE ® | i S C L I N I C A L ®)
Theory 1 — Oxidative Stress
This theory is more commonly known as the free radical theory of aging. All cells need energy to perform their particular function. This energy is a very “hot” process and uses free radical generation to burn fuel. In this process, extra free radicals are created. These extra free radicals bounce around inside the cell, damaging all cellular structures they contact. Over a lifetime, these free radical “hits” gradually accumulate leading to a physiologic decline in structure and function. We label this decline as “aging.” In relationship to sun exposure, depending on whether the sunscreen chosen is physical or chemical, these solar free radicals can be blocked or neutralized. Antioxidants are helpful because they combine with free radicals and prevent the ongoing cascade of free radical damage. Only about one percent of oral antioxidants reach the skin so topical antioxidants are also critical.  Smokers have huge amounts of free radicals floating about in their bodies.
Theory 2 — Inflammation
A certain amount of inflammation is required for health. Through its inflammatory response the body combats infections, clears away damaged tissue and heals sunburn and other oxidative processes. Excess inflammation results in accelerated rates of aging, scarring and destruction of normal tissue architecture. Free radical damage is well-known to trigger excess inflammation. The inflammatory response is elevated in those having higher levels of oxidative stress byproducts.
Theory 3 – Glycation

The process of attaching a sugar to a protein is called glycation. Oxidative damage is an intracellular process, i.e. occurs inside the cell, whereas glycation is an extracellular process and occurs outside the cell. Glycation occurs in protein-rich tissues that contain large amounts of the protein collagen such as the skin, blood vessels, joints and lens of the eye. 
Theory 4 — DNA Damage
DNA is contained inside chromosomes in the nucleus of the cell. This DNA contains our genetic material and also directs the function of the cell in which it resides. A cell with
damaged DNA cannot properly function and may even become cancerous. Increased DNA damage in skin occurs with photoaging and high oxidative stress. DNA is subject to free radical damage so antioxidants improve rates of DNA damage.

An important part of any anti-aging skin care program is to know what you may be doing that is harming your skin and speeding up your skin’s aging process.  While some signs of aging skin are inevitable, there’s a lot you can do to look your best at any age.  Attacking the processes of aging in younger years is preferable. But even though “younger is better”, any time is better than never. Taking good care of yourself is the most important step in your anti-aging skin care program.

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