Anti Ageing

ANTI – AGEING is the new mantra of today.

Every new cosmetic in the market is aimed at returning the ‘ bloom of youth ‘ to your jaded skin. Newer research has flooded both the cosmetic and the pharmaceutical market with anti aging products. The question asked by most patients is ‘ Doctor, do these things really work ?” Before we look at the science of ageing, I would like to tell all the readers , there is no sin in looking as good as possible, Why not ? It does a hell of a lot for your self esteem. and this advice is not restricted to women but also to men. After all the biology of the body is almost similar ! The only thing to keep in mind is……
1. Your budget
2. Don’t get too carried away by trying to look younger !

Ageing processes are defined as those which increase the susceptibility of the individuals as they grow older, to the factors which may cause Death. There are 2 theories……
1. ‘Extrinsic’ or ‘ Random’ hypothesis…….states that ageing is a result of the contingencies of living, i.e progressive wear & tear, accumulation of waste products in the body etc.
2. The ‘fudamentalist ‘ hypothesis states that ageing is internal, i.e it is genetically programmed by our ‘ biological clock ‘.

Skin ageing does not follow the life expectancy because of the complex interplay of Genetics, systemic influences & environmental factors. For e.g Gray Hair is seen in many a youth due to heredity or environmental influences , similarly the Sun , environment & skin protection play a large role in skin ageing. It cannot be stressed enough, particularly to the young, who are least likely to pay attention…….that sun exposure , either casual or deliberate is the most damaging accelerator of skin ageing ! Even the activities of daily life take their toll : actions such as laughing , frowning & sleeping with the face pressed to the pillow can both the no. & the depth of facial lines by stressing the skin & underlying tissue. This is Life ! It would look totally foolish if one tried to go through life without your face showing a gamut of expressions .

What I want to stress here is that accept skin ageing is inevitable, what we can do is strike a right balance between looking younger and personable without stepping into too much Plastic ! As skin ages the Epidermis……top layer of the skin….becomes thinner, dry & flaky particularly over the lower legs. Wound healing is slower & the skin becomes more susceptible to chemicals, alkali damage , allergies etc.The Dermis which is the support of the epidermis shows a multitude of changes. By the mid 30’s the rate of collagen formation and destruction slows down. There is progressive degeneration of the Elastin which causes the skin elasticity & resilience to decrease thus the skin sags, is less elastic and less ABLE TO withstand deformities.

Ageing also causes changes in the skin oil layer , hair growth & nail growth.

The most common ageing changes involving the face are:

Wrinkling – This is due to a loss of collagen & elastic tissue . Thinning of the Dermis & subcutaneous fat augment wrinkles.

Rhagades – These are the lines seen in the skin over the lips wherein the Lipsticks Bleed Into ! Frown Lines, seen on the forehead, near the nose are a result of remodeling of dermal connective tissue due to the forces of the facial muscles.

Melasma – This is the brownish pigment occurring on the cheeks, nose, forehead & upper lip. This pigment is also seen after pregnancy, oral contraceptives etc. Darkening under the eyes, seen more in dark skinned people. Dilated Blood vessels or SPIDER VEINS , seen as a network of red lines on the cheeks or bridge of the nose. These are a result of sun exposure or decreased skin support. Tumours, keratosis, skin tags, wart like growths, pigmented & non pigmented keratosis are seen in different skin types in varying amounts.

The old adage ‘ Beauty is not Skin deep ‘ should always be adhered to while going in for any sort of anti ageing therapies. Nourish the skin from inside – E.g. plenty of water to drink, diet consisting of proper vitamins, nutrients and exercise to keep not only fit & trim but to keep your hormones in peak working order. When you are feeling healthy you get that glow on your skin which cannot be bottled!

For smokers it is necessary to add Antioxidants to your intake.
What are antioxidants ……..Vit. A, C & E which help the body fight detrimental effects of an endangered environment !

The dermatologist must firstly take out the time to explain to the patients why & how changes of ageing occur . In discussing with patients the results that may be expected from a cosmetic procedure it is better to err on the side of caution than to promise too much! The most effective treatment of Ageing is of course prevention of sun exposure! Regular usage of sunscreens with the adequate SPF is a must, come what may. This in itself improves skin colour, texture & prevents further skin ageing. Nowadays the sunscreen preparations are so advanced that they incorporate within them make up bases, anti aging substances, anti acne & cosmetic covers ! Patient acceptability is high & even ‘ sensitive skin’ sunscreens are available.

With new procedures & pharmaceutical agents now available , Dermatologists can improve the looks of both sun – damaged skin & Aging skin. More & more medical & surgical procedures are being carried out by Dermatologists, which are not only safe but effective as well.

TRETINOIN has been used for over 20 years as an antiacne agent. Its anti aging properties are well established. In addition to improving the skin texture it also causes a lightening of pigmentary changes & gives you that lovely unblemished, tight shiny skin. Its drawbacks are its high irritative & intense photosensitive properties. Cost effectiveness is very good & under expert guidance of a Skin specialist Tretinoin even today holds an important place in the ‘youth always’ armamentarium.

Skin Cleansing using the right type of soap , cleansers, milk etc is a must. Oily skin types can use normal or dryng soaps whereas dry skin types need to be very particular of their cleansers. Makeup should be wiped clean of the skin before retiring and a light moisturiser or cream used at night. Those with oily skins can use moisturiser sprays or light nourishing lotions. Note : These moisturisers dont penetrate the skin in actuality unless they contain some pharmaceutical substances. How they act is by sealing in the moisture into the skin thus imparting a suppleness & smoothness. No flaky dry appearance is noted & the skin feels ‘ refreshed’!

Buffing or Epidermabrasion should be done once or twice in 10 days to gently exfoliate the skin. Scrubs, Buff Puffs or even plain grains can do the job. Be careful however to avoid blemished areas & acne eruptions as the skin will get even more irritated. Don’t exfoliate more often because the ‘ Dead Skin ‘ as is referred to by Beauticians, is actually a protective layer of the skin which seals the epidermis & Dermis from the harm caused by external factors.

Depigmenting agents such as Hydroquinone or Alpha hydroxy acids can be used as home maintenance but please dont overuse them as irritations are known. All anti aging applications should follow the skin’s biology closely and should be supervised. Alpha Hydroxy Acids or fruit acids have been known since the time of Cleopatra who used to bathe in sour milk to maintain her skin. These acids are mild acids which when used with care and within limits improve the Texture, Color & Resilience of the skin. Every cosmetic company worth its salt has atleast one product today containing this acid. These can successfully be used by Dermatologists in conjunction with the stronger Acid peels that are to be done only under medical supervision ! The FDA has stipulated a certain percentage of the acids that can be used by Beauticians and higher percentages are best left to Medical personnel.

Chemical Peels….using Trichloroacetic acid, Jessners solution, Alpha hydroxy acid peels are very much a part and parcel of a Dermatologist’s & Plastic surgeons therapies today. Here the main considerations are Skin Colour of the patient and the prevailing skin condition. Based on this we are called upon to decide the depth of the peel & follow up care of the patient. Deep peels and drastic measures sound good but if they go wrong it is one of he most terrible trauma a patient has to face so once again I stress that it is better to err on the side of Caution than to promise too much. Acid peels differ in their strength of penetration & actual burning away of the skins layers. Deeper the peel better the result but also more the complications, especially in Asian skin types ! Sun avoidance, daily care etc are part & parcel of all peeling procedures. Soft peels are less likely to cause complications & recovery time is almost instantaneous. But soft peels take repeated sessions to show results and can strain the patients Patience ! If the doctor takes the time to explain all this from the very outset it saves a lot of heartburn & the results are very satisfying.

Implants…….the most popular being Collagen, gelatin matrix injections, Hyaluronic Acid & Autologous Fat Implants.
These are utilised to fill up small defects, wrinkles, Rhagades, Frown Lines, restructure the Lip etc. Each has its own wonders and its own drawbacks. Better to aquaint yourself with all aspects before subjecting oneself to any of them. Done by highly specialised doctors they give wonderful results and are invaluable in cosmetic surgery ! Cosmetic Surgeries……include Dermabrasions, Fat sculpting, Liposuction, Removal of ‘Bags Under the Eyes’, chin pads, Face lifts, Brow Lifts , Blepharoplasty etc are all aimed at improving a persons appearance .These are best done by Qualified Cosmetic surgeons & in a proper setup.

Lasers….the latest craze to invade the populace ! These are used for skin Resurfacing, removal of pigments etc all of which shows a reversal of Ageing processes. It all sounds wonderful, but how many people really sit down & think of all the implications. Where skin types 1 To 3 are concerned i.e the European communities the risks are minimal BUT talk about asian skins & the story is very different. Serious post operative pigmentation & is a reality which has to be faced. Sun exposure is also detrimental. Doctors are not God , but a little less of economics & more dedication to a patients welfare can prevent these complications. It is necessary not to give an unrealistic view of the procedure to the patient a nd at the same time to review both the benefits and the risks involved, both of which the patient should be well appraised of, …see which way the balance tips & then decide on the course of action. There are cosmeticians who do Laser peeling & claim Beauteous results. They fail to mention that there are repeated sessions & the results are comparable to chemical peels the only advantage being that the Laser is less messy …….a fact which is balanced by it being 100 times more expensive ! Where indicated & done by absolutely trained Doctors Lasers are an invaluable asset to Aesthetic surgery & should be used as such !

In general this write up tries to present both sides of the Ageing coin to you’ll. Whether to Age gracefully or to ‘Let Go’ is ultimately your choice. But it is also important to weigh our priorities in life & act accordingly……. after all how many of us need & to what extent present a youthful exterior to get on in our chosen careers & life in general !

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