LET’S KEEP IT SIMPLE

To understand skin aging is to understand the fundamental processes of how dermal tissue is built and lost. Here, I’ve pared it down to simple concepts to equip you with the basics of how skin works.

Once you understand what's really happening with your skin, you'll likely stick to regimens that work, rather than wasting resources on recommendations that do little to improve skin quality. I hope this serves as a springboard to healthier skin for your future. Let’s dive in…

THE GREAT NEWS

It’s said that 20% of our skin's aging is determined by genetic (intrinsic) factors, and up to 80% by environmental (extrinsic) factors. This translates to great news. It means our daily habits, skincare routines (or lack thereof) and aesthetic choices can greatly affect the rate in which we age. With this knowledge, we can make daily choices to slow down our skin’s aging process.

THE EXTRACELLULAR MATRIX

So what‘s our skin made of and what is its function? Our dermal tissue is a complex structural matrix, comprised of 3 main building blocks: collagen, elastin and hyaluronic acid. Collagen provides the main structure; elastin is wound around it to give stretch and flexibility; and hyaluronic acid is weaved around this collagen-elastin combo to provide hydration, drawing moisture to itself. This elastic, hydrated collagen structure is the main component which makes up the ECM or extracellular matrix of our skin, i.e. our dermal tissue.

MMPs & TIMP REGULATION: DETERMINING HOW FAST SKIN AGES

The ECM is in a constant state of both structural breakdown and renewal. It also has an internal housekeeping system to ensure that our dermis remains functional and healthy. This housekeeping system is comprised of enzymes called MMPs (metalloproteinase) which breakdown collagen, and TIMPs (tissue inhibitors of metalloproteinase ) that regulate these enzymes from "overeating" collagen structures.

The breakdown of aged collagen in the extracellular matrix makes room for new collagen to rebuild in its place. The balance between this housekeeping duo of MMPs and TIMPs plays a crucial role in the rate in which we age.

WHY HIGH FUNCTIONING SKIN MATTERS

Aged collagen/ECM structures become rigid, making biochemical communications between cells sluggish or even non-existent. A low functioning or aged ECM results in slower healing, the faster spread of disease and becomes a prime location for cancer cells to sit undetected and metastasize.

Realize the primary function of our skin is to protect our bodies from disease and infection, and a healthy ECM is quick to protect, quick to communicate and quick to heal.

THE ESSENCE OF AGING

As we approach adulthood, at around age 19, our fibroblast activity begins to slow down. However, MMP enzyme activity remains or even increases in quantity and activity. Our dermis now begins the steady process of netting a loss of 1-2% of our collagen-based ECM structure each year. This loss and thinning of dermal tissue is in fact, the essence of skin aging.

Now, the difference between 1- 2% may not seem huge, but it is double. Aging becomes increasingly significant with time.

Can we slow down this process--get from a 2% down to a 1% or less? And is it even possible to reactivate or stimulate fibroblast activity to counter or even net positive in collagen retention? The answer is: Yes.

COMMON CONTRIBUTORS TO ACCELERATED SKIN AGING

The following are the 3 most common contributors to increased MMP enzyme activity, resulting in accelerated skin deterioration: 

1. UV Radiation: Exposure to UV radiation from the sun is a major external factor that disrupts the TIMPs- MMP balance. UV radiation stimulates the production of MMPs, accelerating collagen degradation and skin aging. 

Physically blocking UV radiation daily with mineral SPF 30+ cuts off the stimulation and over-production of MMPs

2. Oxidative Stress (Free Radicals & Inflammation): Pollution, smoking, and other oxidative stressors activate MMP production, leading to increased collagen degradation and accelerated skin aging.

Antioxidants neutralize free radicals and slow down the skin’s aging process.

3. Slow Fibroblast Activity: As we age, there is a natural decline in fibroblast activity and more aged tissue for MMP enzymes to target.

Retinoids increase collagen production and cellular renewal. Contrary to belief, retinoids do not “thin the skin,” but rather prompt the build of dermal tissue.

There are other factors such as healthy diet, sleep, etc. that contribute to the health and quality of skin. However, the above contributors are often overlooked and can be combatted with consistent use of proper skincare. 

AESTHETIC AND SURGICAL TREATMENTS: DO THEY SLOW DOWN AGING?

BBL: THE UNDER-VALUED “FOUNTAIN OF YOUTH”

BBL (Broadband Light) by Sciton is probably the most underestimated aesthetic treatment for anti-aging. The reason for this, I believe, is because BBL is so effective in correcting unwanted pigmentation issues, that once those corrections have been made, it's common to halt treatment. One of the great benefits to BBL is that it changes the gene expression of cells to prompt skin to behave like young skin again.

With BBL, fibroblasts cells are activated to function like they did in your 20's. What this means is, BBL treatments actually initiate new collagen, elastin and hyaluronic acid production, slowing down or even reversing skin aging. 

Regular BBL treatments spaced out evenly to keep the fibroblasts activated throughout the years show a decrease in fine lines and wrinkles and a decrease in dermal tissue loss. Skin also remains highly functional with a brightness that reflects light, looking both youthful and healthy. BBL can actually reverse skin aging from the inside out. It is a great fundamental treatment to continue with consistency each year to slow down, or even reverse skin aging.

Botox & Other Neurotoxins

One must make the distinction between true skin health and improved skin appearance. Although often related, the two aren’t always indicative of each other when it comes to aesthetic and surgical treatments.

Let's take Botox for example--and I'm using the term "Botox" as a general term for all the botulinum toxins. It is lovely for skin appearance as it smooths out fine lines and wrinkles and makes the skin appear younger. 

But here's the thing about Botox: It doesn't actually slow down skin aging or improve ECM quality. However, Botox is preventative in stopping dynamic wrinkles (wrinkles made with movement) from becoming static wrinkles (wrinkles that appear on the face even when your face is at rest) as well as deep-set crevices due to repetitive movements over many years.

Repetitive movements in areas such as the “11’s” (furrowing between the eyebrows) can certainly change the dermal structure in that area, causing deep set , static wrinkles and crevices if left untreated. 

So although Botox improves skin appearance, and does not actually repair skin quality, it is helpful as a preventative measure in the structural integrity of skin. Repetitive creasing and folding of the ECM in areas, over time, can compromise structure and the way new tissue forms around those expression points.

Filler

The days of filling your face as the go-to anti-aging solution are over. Filler can be beautiful if administered judiciously.

Society is finally seeing the long-term effects (thanks to celebrities) of what years of overusing filler can do to alter the natural look of the face. 

Fillers made up of hyaluronic acid are, in essence, creating volume as a form of soft implant into the dermis. Your body may or may not metabolize the filler quickly, it could last many months or maybe many years before it is metabolized. In some cases, there have been indications that filler may never be fully metabolized.

Where one lacks structural integrity due to receding bone, filler can be helpful in rebuilding that structure. Well administered filler for thin lips can be beautiful. But filler to fill in nasolabial folds and chisel out what you feel is the "ideal" structure of the face can risk looking unnatural and strange.

Administering filler is an art. But remember, art by humans is manufactured and can look artificial. Even some of the most talented injectors in the world have fallen victim to overfilling their own face without even realizing it.

Filler does not contribute to skin quality or anti-aging. It is exactly what it says it is: FILLER.

Plastic Surgery

There is beautiful, surgical work with innovations beyond what we understood as a simple "face lift." Surgical lifting of skin and facia to eliminate sag are certainly an alternative to restoring a youthful look to the face.

However, remember, these surgical procedures Do Not Fix The Collagen Problem. They don't improve skin quality in the ECM.

Skincare and treatments that slow down MMP activity or activate new collagen production are what truly slow down the process of skin aging. Seek to improve the health of your skin by protecting it from accelerated deterioration. Anti-Oxidants, SPF and retinoids are your best and most effective items to aid in the slowing down of skin aging.

When it comes to aesthetic treatments, remember to differentiate between improving skin health and pure “aesthetic” benefits. The best-case scenario is to use both, hand-in-hand, to meet your personal aesthetic goals.

Written by Jennifer Puzsar, lead aesthetician and founder of Emmanuel Skinscience Medspa in West Bloomfield, Michigan.