Sun Damage and Wrinkles

Aging of the skin is a result of internal and external factors. The internal factors are a result of genetic factors from our parents and ancestors. The external factors include smoking, excessive alcohol use, poor nutrition and sun exposure.

The signs of aging which concern us are more photodamage. Wrinkles, dark spots and redness are really a result of light damage to the skin. Other than smoking, sun damage is the greatest contibutor to the "aging" process.

1. Intrinsic aging due to Internal factors- this is your genetic constitution. For example dark skinned individuals have more protection from the sun and do not get the same wrinkling as do lighter skinned individuals. Here the gene for dark skin leads to less sun-damage.
   
   Skin that has aged without any external factors is generally smooth and unblemished. The epidermis is thinner than younger skin, as is the dermis.
   
   
2. Extrinsic aging due to external factors-cigarette smoking, excessive alcohol consumption and ultraviolet light exposure all contibute to this. About 80% of facial aging is due to sun exposure.
   
   Extrinsically aged skin is seen on the face, chest and outer aspect of the arms. Sun damage signs include wrinkles, dark spots, and depigmented areas. Other findings include loss of skin tone and elasticity, increased skin fragility, areas of bleeding-purple areas called "purpura" due to fragile blood vessels and lesions such as skin tags and keratoses.
   

Skin Changes in Aging

1. Cell turnover. The outer layer of skin, the epidermis, has a turnover of cell which begin in the lower level and proceed up to the surface about every 20 days. With aging the cell turnover is reduced by 30 to 50%. Cells going to the Stratum Corneum, the outer most layer of the epidermis, take 20 days in young adults to 30 or more days in older adults. This slow cell cycle is compounded by less effective sloughing of the Stratum Coreum which leads to heaps of cells on the surface which makes the skin appear dull and rough.
   
   
2. Changes in Dermis. The dermis is the second layer of the skin. Older individuals have 20% less thickness to this layer. there are also less blood vessels and less active cells in the dermis after age 65. Due to ultraviolet light the collagen fibers are less organized and have balls of degraded elastin.
   
   
3. Ultraviolet Light Changes. UV light increases the activity of enzymes which degrade collagen. These enzymes (MMPs or Matrix Metalloproteinases) are active within hours of UVB exposure. Elastin which gives skin its "snap back" is degraded by the enzymes triggered by UV light and is seen as clumps of protein under the microscope and gives the skin a yellow cast.
   
   
4. Moisturizing factors. Glycosaminoglycans (GAGs) can bind water 1000 times their volume. These are decreased in photodamaged skin. Hyaluronic Acid is a GAG which is seen around collagen in youthful skin, but not in photodamaged skin.
   
   
5. Pigment Changes. Melanin is a pigment which protects the skin from ultraviolet light. The number of melanin containing cells decreases by up to 20% per decade of life.


6. Vascular Changes. Blood vessels give oxygen and nutrition to the skin, primarily the dermis. Aging skin has fewer vessels and therefore decreased blood flow which can be seen as lower surface temperature and skin paleness.

Treatment

The most important start is to remove the external aging items, such as smoking and sun exposure.

1. Increase cell turnover. The skin cells, which we will call k-cytes, start their lives at the base of the epidermis and mature through the skin moving to the surface of the epidermis. This cell cycle can be speeded up with the use of Hydroxy Acids or Retinoids. This can improve wound healing after cosmetic procedures and improve the appearance of the skin.
   
   
2. Protection From UV Light Exposure. Sunscreen, sunscreen, sunscreen. We prefer sunscreen with Mexoryl or Avobenzene.
   
   
3. Laser Peels. The Erbium Laser Peel can remove Stratum Corneum and and lower Epidermis. The heat can shrink old collagen by more than 50% and stimulate the production of new collagen. The regrowth of collagen and elastin can be seen for up to 6 months and even a year in some cases. We are very pleased and excited to watch the skin of our patients blossom for the months after a laser treatment.
   
   

The Glogaw Aging Scale

1. Type 1. "No Wrinkles" Patients in their 20s to 30s may show Type 1 photoaging. This shows early changes including mild pigment changes and very minimal wrinkles.
   
   
2. Type 2. "Wrinkles in Motion" These patients are in their late 30s to 40s and have early to moderate photoaging. Smile lines and wrinkles with facial expression. Dark lentigo spots are seen.
   
   
3. Type 3. "Wrinkles at Rest" These patients are 50 and older with advanced photoaging. Much pigment change (dyschromia) and redness (telangiectasia) is seen. Wrinkles are permanent regardless of expression.


4. Type 4. "Only Wrinkles" These patients are 60 and older with severe photoaging. The skin is yellow gray. Skin malignancies seen. Make-up cakes up on the skin and seres little esthetic help.