Everyone who has looked into the mirror and felt they were getting older (and didn’t like it!) realizes that much of our aging comes from sagging tissues (think upper eyelids and neck) and loss of tissue volume (think eye and cheek hollows and thin lips). The lifting procedures, like eyelid lift, forehead lift, and face and neck lift, and facial fillers and BOTOX Cosmetic®, can improve these aging signs significantly.

But something too many of us do not see, or ignore, are the signs of aging shown in the skin texture itself. Recently I had the pleasure of spending two days in Beverly Hills with one of the pioneers and innovators in improving skin health, Dr. Zein Obagi. It was a wonderful opportunity to refresh my knowledge of skin physiology and get ahead of the curve of current therapies by hearing Dr. Obagi’s advanced skin care concepts. To understand how you should care for your skin, you need to understand the basics of how it functions – and how this diminishes with age.

First of all, know that there are two layers to the skin, the epidermis which is superficial to the dermis. Below the skin are the fatty subcutaneous tissues. The stratum corneum is the top layer of epidermis – it continuously sheds keratin, but as we grow older the keratin hardens and thickens. This leads to “rough” skin. The use of moisturizers alone can decrease the rate at which the keratinocyte cells produce the keratin, thus decreasing exfoliation and leading to thinner and more sensitive skin. The barrier function of the epidermis is diminished, causing more unfavourable changes in the dermis below it. To reverse this process, treatment is directed at repairing the epidermis through exfoliating agents and stimulating the keratinocytes.

The upper dermis is the papillary dermis – this is where the structural protein collagen and elastic fibers elastin are found. As we age these diminish and become disorganized. In addition, the vertical anchoring fibers of epidermis to dermis become weaker, leading to skin wrinkling. These changes begin as early as 30 years of age. Rejuvenation efforts are aimed at restoring these anchoring fibers and increasing collagen and elastin production.

The subcutaneous, fatty layer of tissue provides volume and support to the skin above. With aging it decreases in volume – think of the cherubic baby face compared to the “apple-doll” look of the very old. There is evidence that minimal trauma stimulates the fat to increase, so perhaps it is a good idea to massage, pinch (even slap!) your skin to promote this activity.

With this knowledge about how your skin functions, you can see how important it is to start taking care of it as early as possible. This will not only improve your appearance and keep you looking youthful, but great skin care can also decrease the development of both benign and cancerous skin lesions. In subsequent blogs we will see how this can be accomplished.