In my last blog I touched on the subject of addressing various facial features to enhance rejuvenation and
beauty. I mentioned how aging can affect our faces. Presently I wish to discuss a little futher what happens to our face as we age. Unfortunately we cannot stop the aging process but we can try to slow down the process or at the very least,not to accelerate it. Medical research is ongoing to try to discern the causes and
processes of aging. Why do some people live to be very elderly (in some cases over 100 years old). Some people seem to age very gracefully and do not appear their age.The opposite is also true where some people look much older than their age and die young. As mentioned in the previous blog,a variety of medical conditions can contribute to the premature aging process. Apart from disease there are genetic issues (unfortunately we cannot choose our parents) that can spare us from appearing older than our age. I mentioned the other environmental factors such as sun,cigarette,excess alcohol or drugs. Stress and anxiety,other than affecting our demeanor will result in behaviour changes that can result in premature aging. There are probably hormonal and immune changes brought about by stress and depression that can adversely contribute to skin changes. This is logical when we consider that medical studies have shown fourfold increase in heart attacks in patients who have depression after their first heart attack as compared to the non depressed patient. This is also true in recurrence of cancer in the depressed or anxious patient
as compared to the emotionally sound cancer patient.
Let us take a closer look at your skin
This is cross section of your skin with its various structures.
As we age the epidermis thins out. The stratum corneum is responsible for retaining moisture and this fuctionn weakens. This will lead to skin dehydration. The pigment cells known as melanocytes become less numerous and the remaning ones enlargen leading to pigment changes (ah those sunspots and liverspots). Deeper in the dermis, it too thins out and there is a reduction of fibroblasts and collagen resulting in loss of elasticity and tone. Thinning of the skin results in a more transparent skin.The blood vessels become more apparent and friable and can break leading to those bruises frequently seen on the arms of older patients. As well the fat under the skin diminishes preventing the body from properly controlling its temperature that can lead to further dehydration. As time passes the contractions of the underlying muscles can also lead tho changes in skin structure. As you have no doubt seen, constant squinting or frowning can lead to the presence of wrinkles (crows feet or frown line). Gravity pulls down the skin and constant pressure as in repeated crushing of skin (leaning on your hand or sleeping on the same side of your face) can also bring about skin changes and wrinkling.
Adding insult to injury
Not only does the skin change but the undferlying bones of your face also change with age. Observe in the
images od CAT scan reproduction of two differently aged skulls how the angle of the jaw widens with age.
This along with a general reduction of jaw lenght and height results in a less well defined jaw line. There is a general decline in bone mass along with reduced fat and muscle bulk that reduces the underlying structure upon which the skin rests. All this leads to further skin sagging.
I have included a few images of the facial transformations resulting from the above changes.
So what can we do?
We cannot change the bone itsel. Surgically it is possible to add implants in some areas as in the chin and mandible. Of course as time goes by,the underlying bone,muscle and fat continue to dimish but the implant remains and can result now in a strange abnormal result unless you do another correctice procedure. We can inject products such as fillers to compensate for the reduced volume under the skin (the wasted muscle and fat) or inject it into the skin to increase tone and volume of the diminishing epidermis and dermis. Theseare the 'fillers'. As to the muscle contractions causing the wrinkling this is where the 'botox' works as it modulates and reduces muscle contractions. More superficially, we can apply a chemical peel. This will allow the top layer of cells to peel away and stimulate the lower layer of regenerating cells to step up and produce newer younger cells. In so doing we are able to reduce those very fine wrinkles and at times even out skin color inconsistencies by rendering blemishes a little paler. Retinoic acid topical products have also been shown to do this. Deeper peels can be utilized (stonger chemicals) or dermabrasions of varying depth serve the same fuction. For deeper pigmented lesions or severe skin surface irregularities various laser treatments may be helpful. Naturally a combination of these treatments usually works best.
So next time we can explore what is in those injections and how they are done
Dr. Bruno Bernucci
Dr. Bernucci runs a busy medical practice. He is frequently called upon to advise on elaborating educational programs for fellow physicians and as a conference lecturer to other medical doctors. He also speaks frequently to large groups of patients as well as the general public on numerous topics. He is one of the Co-Authors of Managing My Life: Managing My Health.