Ep 11: The Science Behind Skin Aging
Are aesthetic treatments like toxins & fillers truly anti-aging? Are there different requirements in skin of various ages? In this episode, Dr. Teo Wan Lin breaks down the science of skin aging at every age, what ingredients help repair the skin barrier, and shares the truth about starting your anti-ageing routine in your 20s.
Chelsea: Hi everyone! Welcome to Dermatologist Talks Science of Beauty. Today we’re going to be chatting about what aging and skin aging really means.
Can you tell us a little bit about the signs of skin aging are whether or not everyone ages the same?
Dr. Teo: Aging of the skin is very much in tandem with the aging of other organ systems. It is a consequence of biological aging. The only difference of course, is that the skin being external is a visible organ. As a result, is somewhat easier for us to assess when it undergoes certain changes. I think the important thing to understand is that biological skin aging is a natural process. Of course your personal genetics can play a role. Skin-wise, individuals with more melanin, for example in asians, hispanics, or essentially skin of color, tend to age better. That has to do with the innate photoprotective abilities of colored skin.
Environmental exposures that lead to skin aging
That brings us to the second main driving factor of aging in general, and that would relate to environmental exposures. For the skin specifically, it would be ultraviolet radiation. We do know the harmful effects of UVA and UVB in terms of photodamage; and also, a lifestyle that is stressful. Chronic stress, because of the hormonal irregulation of a lot of our body systems, can lead to more rapid deterioration of the physiological process of aging. Essentially all of our environmental assaults say a 40 year old encounters the same as a 4 year old. This is because we are living in the same environment.
But the differences would be in the cumulative sun exposure. Additionally, in the ability of the individual’s personal cellular systems to repair DNA damage. For example, a 4 year old and a 40 year old is exposed to sunlight. On top of that, the 40 year old has to deal with the effects of the sunlight he or she has been exposed to in the years prior. In the 4 year old, a very efficient and healthy DNA repair system quickly gets rid of any pigmentation that may form. This is in response to the free radicals that is generated when the skin is exposed to pollutants and UV radiation. In a 40 year old, this process is much less efficient. This is when you may see the visible signs of surface aging.
Can you tell us more about the factors that influence skin aging? Are there any habits that we should avoid?
Other factors that will influence the process of aging would be disruption in the circadian rhythm. This is still under the category of lifestyle factors. Lifestyle factors include chronic sleep deprivation, and also links to your sleeping time. If you are sleeping 8-10 hours a day, and you’re always sleeping past midnight, and waking up late in the day, that is less beneficial for you than if you were to pulse it according to the natural daylight and nighttime exposure. This is the same for all living creatures physiologically. We respond to daylight, and nighttime is meant for a period of rest that helps our body recover. Being chronically sleep deprived or having irregular sleep hours due to constant travel and jet lag will present to the body as a form of cumulative stress.
Chelsea: Those are some really good tips, I think I have to start going to bed a little earlier now!
What are the different signs of skin aging in different stages of our life? How exactly is our skin different when we’re 20 compared to when we’re in our 40s?
A lot of people like to categorize the stages of aging according to your 20s, 30s, 40s, and onwards. Maybe 5 years ago, we were still talking about that. Today, I feel that it is a lot more important for both the media as well as the public to know that aging is not something to be resisted. It should not be presented in a way that could be discriminatory. I think how this came about in the first place is largely because of the proliferation of non-dermatologists practicing aesthetic dermatology. This is a worldwide phenomenon and it very much has to do with the commercial interest of aesthetic dermatology pharmaceuticals. For example, fillers, toxins, laser devices, and other forms of anti-aging aesthetic dermatology devices.
The rise of aesthetic treatments practiced by non-dermatologists
From a very honest and on-the-ground sort of approach to this matter, I would say perhaps 5 years ago, it was still relatively novel, fresh, new and people were very excited. “That means I could inject the volume that I lost over this period of time for my age and restore it? Wow that’s very impressive;” while somebody else would say, “my wrinkles can just be erased overnight”. Some time has passed and we see the widespread nature of these services being offered in clinics.
Of course, in Singapore, you have to be first certified by the dermatological society of Singapore (DSS) if you are not a dermatologist and want to practice any of these cosmetic dermatology procedures. In fact, a majority of providers of aesthetic services in Singpaore are provided are actually non-dermatologists. Simply because there are only slightly over 100 accredited dermatologists in Singapore. These are general practitioners that have gone for these courses and are exclusively offering aesthetic services.
Glogau photoaging scale
There isn’t a judgement on that obviously. But I feel that culturally and in terms of the medical community in general, we are becoming a lot more aware of skin health and the work of dermatologists in particular. We are no longer blindly focusing on reversal of skin age. I prefer to set the note of the anti-aging landscape a little differently. I have basically described in the previous parts essentially the ongoing physiological processes that are involved in aging.
We have a rather crude aging scale that has been around for decades – the Glogau photoaging scale. That’s where we would actually place an age-range for the kind of skin changes that we observe, from the 20s to the 40s and beyond. Essentially we are looking for the degree and severity of loss of skin elasticity, the precedence of surface or deep wrinkles, pigmentary spots. These are all the outward manifestations of skin age.
What can we be adding to our skincare routine at different stages in our life? For example, is there a product we should be using in our 20s that we shouldn’t be in our 40s and vice versa?
In terms of what skincare products that one can add to their routine at different age groups, the main thing to understand is that the needs of skin at the age of 40 vs when you are in your 20s, are actually pretty much the same. For example, an individual who has neglected their skincare routine in their 20s, and now at the age of 40, already has the physical changes associated with photo aging. Such as deep wrinkles, increased pigmentary spots, dehydrated skin, loss of skin elasticity. Suddenly you are thinking, do I have to use something different? I prefer to address the main principles because these are alot more sound to work with.
Universal requirements of skin
But in order to understand this, we first have to know what the requirements of skin are. If you start at the age of 25, it’s best to approach it this way. First of all, your skin needs to maintain its primary function – which is the barrier function of skin. It protects your inside from the external environment. Which is achieved via an intact skin barrier that is primarily composed of ceramide molecules produced by your personal genetic mechanisms. These act as cement in the outermost layer of your skin. When that fails, either in somebody with innate atopy, or what we call atopy eczema, or sensitivity, that is genetically deficient. But it can also be acquired by use of very harsh cleansers and soaps.
In somebody who is 40 vs somebody who is 25, both categories of individuals require the skin to fulfill this very basic barrier function. But of course, with increasing age, there is an increasing chance of the failure of the skin barrier. That’s when you may think that the needs of somebody who is in their 40s is different that somebody in their 20s. But the reality is not as simple as that. It also should not be saying to us a different cream for a 40 year old.
The difference in skin in your 20s vs 40s
At the end of the day, if you were to simplify the concepts we have discussed of the barrier function, in somebody who is younger, you’re going to expect a higher production of oil or sebum. This is the core difference if you’re talking about the difference in youthful vs aging skin. This production of sebum certainly declines significantly as you grow older. An individual who is suffering from acne or seborrhea in their 20s or 30s, they will certainly find that their problem goes away.
Are there 40 year olds who continue to have oily, greasy, seborrheic skin? Yes, but the general trend is that your skin produces less oil as you grow older. In this regard, you should consider using more moisturizing products when you’re in your 30s and 40s. Not that it should be greater in the types that you use, but in the amount that is applied. The skin is very efficient at absorbing whatever is applied on it. That’s the beauty of it because it’s very accessible.
Dermatologist recommended skincare ingredients
When you’re looking at someone who has significantly drier skin than another person who has seborrheic skin, you’re going to look at the different types of moisturizing active ingredients. Someone in their 20s with seborrheic type skin, would do well with a serum based type of moisturizer, and an emulsion-base delivering separate ingredients. We always advocate the presence of ceramides. This is best carried in an emulsion formula in somebody with slightly greasier skin. As opposed to in a cream or ointment formula, as that tends to be a little too heavy.
Polyglutamic acid and hyaluronic acid molecules are naturally present in the dermis. They also function as humectants – meaning they trap water under the skin. These are very helpful for regulating sebum production and overall, maintaining the skin barrier function. In an individual who is in their 40s, and really suffering from very dry dehydrated skin, one must not confuse that with the presence of wrinkles. We shouldn’t say that one should add more moisturizer to address the wrinkle problem.
Skin is a composite of functions
We’ve only talked about the barrier functions so far. However, when we talk about wrinkles, we’re referring to the overactivity of the muscles under your skin. That, of course, is the result of age. So the more times you activate your muscles, the higher chance of hypertrophy. It’s just like you working out in the gym. So if you’re frowning all the time, by the time you’re 40, you’re sure to have these active corrugator and frontalis muscles which will show up in terms of your forehead wrinkles. Not to say that somebody in their 20s won’t have that. But they are much less likely to develop it as opposed to somebody in their 40s, who’s had over 2 decades of overactivity.
Chelsea: Ah I see, that makes a lot of sense.
Tell us a little bit about your experience when it comes to your skin in different milestone of your life. How has your skin changed, and what have you done to maintain it?
Moving on to what the true differences are in terms of addressing the conditions of the skin. If I may just share from my personal experience. In my 20s, I was very diligent with skincare, and was also using a retinoid. When I entered my 30s, I found that I was no longer able to tolerate the retinoid formulas. I got a lot of irritation, and that’s a common thing that occurs with alot of my patients as well. Then, I switched to a pure peptide formula, and antioxidant cosmeceuticals which are hydroquinone and retinoid-free. I haven’t had botox or fillers done.
Now, I’m 36 years old, and I basically attribute my anti-aging regimen to primarily cosmeceuticals, preventive skincare routine, and a healthy lifestyle. I exercise almost everyday, I’ve done that for most of my life. Additionally, I also sleep sufficient hours and go to bed by 11 everyday, and wake up by 8. For someone who has not gone through this for example, and is in their 40s, suddenly sees all this signs of photoaging, it is not possible to revert back to the 20s stage with skincare alone, no matter the number or types of antioxidant ingredients they use.
So the truth is, the damage has already occured, and you’ll actually need physical intervention to reverse it. That’s when treatments such as fillers address the loss of tissue volume and toxins which relax the overactive facial muscles. High intensity focused ultrasound (HIFU) help to lift up the smas layer for your face. If you imagine a curtain system, the smas is essentially the reel that pulls it up. With that, I think we can thoroughly understand the premise of the various types of recommendations at different age groups that is truly consistent with our understanding of dermatological science.
Chelsea: That’s really insightful. I think that our listeners will be fascinated to know that there is such a complex interplay of various factors involved in skin aging. Thank you all for joining us. Dermatologist Talks: Science of Beauty is a podcast that keeps you updated on the various developing perspectives in the field of dermatology, skincare, and beauty related topics. You may follow Dr. Teo Wan Lin on her instagram at @drteowanlin, and remember to click on the subscribe button to stay updated on the latest episodes. We’ll see you in the next episode.
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