How to combat signs of aging

Mature skin is physio-logically different from younger skin, and changes in skin appearance and texture are among the most obvious signs of aging.  The plethora of anti-aging skincare products on the market attests to the fact that many women over 50 are striving to hold back the clock when it comes to developing fine lines and wrinkles.

Some of the changes that occur in the skin of women as they get older are unavoidable.  As estrogen levels drop after menopause, the skin’s natural oil production decreases and it becomes drier.  The sun is also a factor.  Sunlight damages the elastic fibers that provide support and firmness to body tissues, and skin is no longer able to “snap back.”  As we age, we also lose subcutaneous fat, giving the cheeks a flattened appearance, thinning the lips, and resulting in a general loss of fullness in the face.

The process is exacerbated by smoking. Smoking alters the structure of the epidermis and dermis of the skin, and accelerates skin aging.  Squinting to prevent smoke from a cigarette from getting into your eyes also emphasizes crows’-feet around the eyes, while pursing the lips to grip a cigarette can cause lines around the mouth.

Caring for older skin

While you can’t stop or even slow down the natural skin-aging process, you can make its effects less obvious by incorporating products that contain richer emollients, such as petroleum, cocoa butter or shea butter, into your skincare regimen.  As skin tends to be drier as one gets older, it is important to moisturize and retain water in the skin.

Research suggests that some anti-aging creams contain ingredients that may reduce the appearance of time lines and wrinkles.  These include: 

• Retinoids: These are vitamin A derivatives of which tretinoin and tazarotene are examples.  These are USA FDA-approved treatments for photoaging.  It may take, however, three to six months before you see the results.  Keep in mind that these creams can cause redness and irritation of the skin, and mention any such symptoms to your dermatologist.  Some over-the-counter anti-aging creams and richer creams to be used overnight also contain retinoids (listed as retinol, retinyl, or retinoic acid) in lower strength. 

Other active ingredients that may help combat the signs of aging include alpha-hydroxy acids (AHAs), which remove the upper layer of the skin and stimulate the growth of new skin, and peptides, small protein fragments that may stimulate collagen production.

• Alpha-hydroxy acids (AHAs):  Synthetic versions of acids derived from sugar-containing fruits that remove the upper layer of old, dead skin and stimulate the growth of smooth, evenly pigmented new skin.

• Peptides: Small protein fragments that may stimulate the production of collagen.

If you smoke, quit and eat a healthy diet with plenty of antioxidant-rich fruits and vegetables.  Antioxidants, such as vitamins A and C, encourage cell and tissue growth, helping the body to repair itself.  This may benefit the skin, which is constantly shedding and re-growing cells.  Also, drink plenty of water to keep your skin hydrated.

Resurfacing your facial skin

Resurfacing your facial skin involves removing one or more layers of the skin that have wrinkles, spots or other blemishes. When the facial skin grows back, it may be tighter and smoother. Spots or wrinkles may diminish or, in some cases, they may go away altogether.

Most resurfacing choices involve trade-off. Generally, milder therapies produce more modest results with minimal risk and discount.  Harsher therapies produce more pronounced and longer-lasting benefits, but with greater risk, discomfort, and recovery time.  Fortunately, new technologies and techniques that are less harsh but still deliver good wrinkle-erasing results are starting to change this equation.  Whether a wrinkle treatment option is worth the effort and expense — which isn’t typically covered by health insurance — is entirely up to you and how you feel about your appearance.

Diminishing wrinkles

Skin resurfacing is often done with one or a combination of the following:

• Non-wounding (nonablative) laser resurfacing. This doesn’t damage the outer layer of the skin (epidermis), but heat energy from the laser damages collagen beneath your skin and stimulates the growth of new collagen, tightening underlying skin and improving skin tone and appearance. Over a series of treatments, improvements in skin texture and pigment gradually emerge.

• Wounding (ablative) laser resurfacing. With this, a laser destroys the epidermis and heats the dermis, leading to collagen destruction and subsequent regrowth.  You’ll have a wound after this surgery.  As the wound heals, new smoother and tighter skin forms.  Ablative laser resurfacing can be harsh, but results are often dramatic and may last for many years.

• Fractional laser resurfacing (see illustration).  This relatively newer technique may use the same lasers as are used in ablative and nonablative laser resurfacing, but instead of fully destroying a broad area of the skin, the epidermis and dermis are destroyed in thin, tightly spaced columns. The remaining columns of healthy tissue help speed healing of the epidermis within the columns of destroyed tissue. If an ablative fractional laser is used, collagen is damaged and new growth of collagen is stimulated. Desired results of the skin improvement are often nearly as good as with nonfractional ablative resurfacing, but it may take several treatments to reach that level.

• Chemical peel. This involves placing a chemical on the skin to destroy the top layers. A light chemical peel removes only the epidermis. You may need several peels to improve fine wrinkles, acne, uneven skin tone or dryness. Medium to deep chemical peels remove the epidermis and some or most of the dermis. The harshness of the procedure usually correlates to the depth of treatment. Depth of treatment also usually matches results, with deep peels conferring the most dramatic long-lasting results.

• Dermabrasion. This involves using a small, motorized device with an abrasive wheel or brush to remove the outer layers of skin.  When skin heals and grows back, it’s usually smoother and younger looking.

Not for everyone

Facial resurfacing isn’t simple or risk-free.  Your doctor will likely do a review of your medical history and a physical exam to make sure you’re healthy enough for the procedure.  Heart disease, diabetes, and many other medical issues may make facial resurfacing much riskier.  There are many factors that may rule out facial resurfacing as an option.  These include having taken the acne medication isotretinoin in the recent past, active acne or facial warts, having a history of scar tissue overgrowth (keloids), or a history of radiation therapy to your face.

If you’re a candidate for facial resurfacing, it’s important to consider the risks.  They include:

• Scarring. Rarely, this may occur.

• Changes in skin color. Skin may become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation).  Changes in skin color are more common in people who have darker skin and can be permanent.  Persistent redness of the skin also may be a problem.

• Acne. Acne may develop as treatment skin heals, due to previous acne or the use of bandages and thick creams on healing and newly formed skin.

• Infection. Bacterial, fungal, or viral infections may occur.  The most common is a flare-up of the herpes virus — the virus that causes cold sores.

• Heart, kidney or liver damage. A deep chemical peel uses carbolic acid (phenol), which can harm heart muscle, the kidneys, and the liver. To limit exposure to phenol, a deep chemical peel is done in portions at 10- to 20-minute intervals.

Your attitude and expectations are also important.  Make sure you understand how many treatments you might need, how long it’ll take to heal and what your results might be.  You’re also more likely to be satisfied with results if you are happy with yourself overall and are seeking cosmetic surgery to improve your appearance in a realistic way.

If you decide to proceed with skin resurfacing, you might need to take a number of preparatory steps.  These include taking an antiviral or antibacterial medication to prevent infection, applying a retinoid skin cream to help prepare the skin, and stopping certain medications such as drugs to prevent blood clots.  If you smoke, stop.  Smoking can interfere with healing.

Results of facial resurfacing may not be permanent.  As you age, you’ll continue to acquire lines by squinting and smiling.  In addition, sun exposure can damage and age skin after facial resurfacing, just as easily as it can in anyone.  In fact, with laser resurfacing and chemical peels, you’ll need to avoid unprotected sun exposure for at least a year, or perhaps permanently, to prevent irregular pigmentation.  Limit the time you spend in the sun and always wear protective clothing and hats.  Also, use sunscreen on exposed skin, even on cloudy days.