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Ageing Gracefully

We’re never ready for it but ageing is inevitable.
We’re ageing both inside and outside but the skin, which is the largest organ in the human body, suffers from the added onslaught of environmental factors more than any of our internal organs.

Certainly, we all care more about what is visible than what is not seen. As a result, ageing of the face, neck and chest area is considerably more bothersome to most even if we may suffer from a myriad of other systemic diseases. The truth is that a healthy and beautiful exterior appearance
represents overall well-being, and looking good makes people feel better psychologically and emotionally.

An even more interesting observation is that most patients want to look ‘better’ for their age and not necessarily ‘younger’.

So yes, we’re going to age, and yes how quickly we age is largely determined by our genetic make-up, but is it worth trying slow down the inevitable?

No matter how old you are there is always something that can make a difference if you should want to do so.

Where do I start with anti-ageing?

Let’s start with Skincare
Our skin changes as we age and while most of us did very little in our youth, we will need to do more to maintain a healthy skin as we grow older. Remember that most of your efforts with anti-ageing skincare also help to protect the skin from skin cancer.

As we age our skin is more susceptible to drying and easily becomes irritated and sensitive. A dry, dehydrated skin has a more wrinkled, dull appearance.

Maintenance of the skin barrier with a suitable moisturiser prevents dehydration and penetration of organisms, allergens and irritants that can cause inflammation of the skin.

Antioxidants and calming botanicals reduce inflammation which also prevent melanocyte stimulation and resultant hyperpigmentation.

The epidermal turnover rate decreases leaving dead surface skin cells and resultant poor texture and loss of skin radiance. Chemical exfoliation with glycolic acids helps to improve epidermal turnover. There is also resultant signalling to the dermis to improve collagen and elastin formation.

Advanced skincare formulations allow penetration of selective active ingredients into the dermis where we need them to work to prevent breakdown of collagen and elastin as well as stimulate the formation of new collagen to ultimately decrease the appearance of wrinkles.

Antioxidants combined with sunscreens neutralise free radicals for optimum sun protection. There is much evidence to prove the benefits of topically applied antioxidants to reduce skin cancer risk and decrease the breakdown of collagen and elastin in the dermis by scavenging free radicals.

Vitamin C, B3 (niacinamide), and E are the best-known antioxidants with good penetration into the skin. Antioxidants have significantly greater antioxidant properties when combined than alone.

Niacinamide is a powerful anti-ageing ingredient that regulates cell metabolism and cell regeneration. It has also been shown to reduce redness, improve hyperpigmentation and skin elasticity.
The optimal concentration in skin care in 5%.

Green tea polyphenols and numerous other botanicals have varying antioxidant properties that have proven a useful benefit in anti-ageing skincare.

Retinols (Vitamin A) have often been described as the ‘gold standard’ for anti-ageing. They stimulate the formation of collagen and elastic fibres to reduce wrinkles and fine lines and improve skin elasticity as well as increase and regulate cell turnover to improve skin texture. Retinols have antioxidant effects, reduce the signs of UV induced sun damage, improve hyperpigmentation and uneven skin tone.

Retinols, peptides and growth factors have numerous benefits which include stimulating collagen production ultimately leading to a plumper dermis and a healthier younger looking skin.

Sun protection includes responsible sun behaviour and sunscreen of at least SPF30. The sun is responsible for photo-ageing which is an accelerated form of ageing visible on sun exposed areas of our skin. New sunscreens with DNA repair enzymes have been shown to reduce the number of
precancerous lesions with regular use.

Anti-ageing ingredients are often found in combination to assist with incorporating more that one ingredient in a skincare regimen.

Most dermatologists and skincare therapists make use of a skincare pyramid which can be seen as a stepwise method of introducing anti-ageing skincare, starting from the basics at the bottom of the pyramid, which include sunscreen, antioxidants and DNA repair enzymes, and gradually adding more active ingredients based on tolerance and response.
We are also guided by your individual goals as in ‘what you are looking to improve the most’.

Anti-ageing Procedures
Chemical peels may be superficial, which include alpha and beta hydroxyacid peels and 10-30% TCA (trichloroacetic acid) peels; medium depth peels like 30-50 %TCA; or deep peels which include >50% TCA and phenol peels.
Superficial chemical peels are suitable for most skin types and have minimal downtime. It is important to go to a reputable therapist as not all peels are suitable for all skin types.

Dermal needling or collagen induction therapy makes use of fine needles to penetrate the skin, to break down old collagen in the dermis and stimulate fibroblasts to produce new collagen. Active ingredients for anti-ageing may be applied to the skin and ‘needled in’ for optimal benefit.

IPL (Intense pulsed light), lasers and radio-frequency devices are aimed at targeting various skin structures like blood vessels, collagen and pigment to improve the appearance of ageing skin.

Hyaluronic acid fillers injected superficially into the dermis can activate and stimulate fibroblasts to produce new collagen and inhibit the enzymes that break down collagen. More robust hyaluronic acid fillers injected deep onto bone or into deficient fat pads in the face can have a significant lifting effect and improve volume loss, simulating a face lift. This is often referred to as a non-surgical face lift.

Platelet rich plasma (PRP) is derived from whole blood which is spun down in a centrifuge. The plasma contains growth factors which is injected into the skin to stimulate collagen synthesis.

Botulinum toxin is injected into muscles to stop contraction. In this way they prevent repetitive creasing of the skin which in time would lead to a permanent wrinkle or furrow. The best benefit for this treatment is seen on the frown lines, forehead lines and crow’s feet. Injections need to be repeated every 3- 4 months and in time there is significant improvement in skin wrinkling. The treatment does not work on static lines.

There are various options to include anti-ageing procedures in your skin treatment plan. Chemical peels and dermal needling are usually added as a course of treatments after preparing the skin with a homecare regimen. Filler treatments are carried out according to a pre-discussed plan.

Is anti-ageing all about products and procedures?
In general, a healthy lifestyle with responsible sun protection is important to slow skin ageing.

A well-balanced diet is a great source of nutrients and oral antioxidants which also benefit the skin.

A good exercise routine, alleviates stress which through various mechanisms not fully understood, worsen disease and make us age faster. Perhaps less stress and anxiety makes us frown less with resultant less wrinkles.

Smoking increases the breakdown of collagen and elastin in the dermis leading to a more wrinkled skin.

There is a growing body of evidence that all forms of atmospheric pollution is detrimental to the skin and body, causing premature ageing, skin cancers and hyperpigmentation.

Though this seems like an exhaustive list, it is by no means complete!
Consult with your dermatologist or skincare therapist and come up with a treatment plan that you are comfortable with.

What you are able to achieve also depends on how much time, effort and budget you are willing to invest.

Start early, start simple, start somewhere…

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The best anti ageing ingredients to use

What ingredients should you look out for in anti ageing products?
With ongoing research more and more molecules are proving beneficial.
Here we talk about a few with the best evidence.
Glycolic acid is part of the alpha hydroxy acid group. This acid is widely used for anti ageing skincare, but can also treat hyperpigmentation, acne and rough skin texture.
How does Glycolic acid work within the skin? Glycolic acid penetrates the epidermis and help loosen the bonds that prevent dead skin cells from shedding. Glycolic acid has great exfoliating efficacy, but may also cause irritation and burning of the skin.

Retinoids are the gold standard anti-ageing ingredient and have been an integral part of a comprehensive anti ageing regimen for decades. Retinoids improve cell turnover and help repair damaged cells.
In this way they help to even out dark marks/hyperpigmentation and assist in treating acne lesions. Increased cell turnover improves dullness and rough texture and reduces the appearance of fine lines and wrinkles.
Retinoids also inhibit the production of collagenase thus slowing down the breakdown of collagen and promoting collagen production resulting in a firmer healthier-looking skin . With long term regular use you see renewed radiance, a remarkably smoother appearance, and a noticeable feeling of firmness.
Though retinoids are generally applied at night, remember that they do sensitise your skin to sun, so it very important to wear a sunscreen in the daytime.

The use of antioxidants prevents damage from free radicals related to photo ageing and other cellular processes. Antioxidants reduce oxidative stress by neutralizing free radicals – unstable atoms that have an unpaired electron in their outermost shell. The antioxidants act by binding with the unstable electron and preventing attack on collagen, elastin and other elements of the skin’s architecture.

Stem cells
Stem cells are capable of self renewal. Their role is to replenish dying cells and regenerate damaged tissue. Studies show that topically applied stem cells activate regeneration of human stem cells, protect the cell from oxidative stress, and in this way decrease the appearance of wrinkles. Stem cells prevent premature skin ageing and assist with wound healing.
Skincare products with stem cells help reverse pre existing damage and protect against further environmental assault.

Hyaluronic acid
This complex sugar is a natural substance that is found in the skin. Hyaluronic acid acts as the skin’s natural “super-sponge” locking in moisture for a plumper, softer and more supple skin.
Hyaluronic acid has become quite a buzz word in the cosmetic industry over the past few years. The natural occurring form declines with ageing. It is therefore a key ingredient in skincare products to rejuvenate dehydrated skin and reduce the appearance of fine lines and wrinkles.

…And of course the number 1 anti ageing ingredient is sunscreen. No anti ageing regimen would be complete without optimal sun protection. Remember the best sunscreen is the one you are happy to use!

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What happens at a cellular level when we age?

– Gradual loss of elasticity:
Collagen and elastin in the dermis keep the skin supple and firm in youth.
Loss of elasticity occurs with degeneration of collagen and elastic fibres of the skin with age. Old fibres accumulate and are fragmented and disorganized. The accumulation of these old fibres inhibits the production of new collagen and elastin. Fibroblasts respond by producing more metalloproteases that further break down the existing collagen. The result is that the skin thins and starts to sag and wrinkle.

-Dehydration and moisture levels:
The ageing skin loses its ability to maintain hydration, due to a decrease in molecules that help the skin retain moisture, such as Hyaluronic Acid and glycosaminoglycans (GAGs). There is also a decline in the lipid production of the skin.
These changes can start in the early 40’s. In addition to this loss of moisture there is also a reduction in sebum production. The result is a dry and dehydrated skin which accentuates the appearance of fine lines and wrinkles.
The suppleness and plumpness of the skin also decreases with loss of moisture in the dermis.
The use of moisturisers and exfoliating ingredients can assist with restoring moisture and lipid content for a healthier appearance.

-Thinning of the skin:
The perception of most people is that the skin becomes thinner and almost papery with age with associated easy bruising. The decrease in thickness of the dermis is one cause. However there is also a thinning of the epidermis which is due to a decrease in proliferation of the epidermal cells. The epidermal thinning is accelerated in women compared to men and is due to a decrease in oestrogen levels as women age.

– Slowing of epidermal turnover rate
Declining cell turnover means that dead skin cells accumulate on the surface. The skin therefore appears dull and the texture is rough. Another consequence is that healing of wounds on the skin is slower.

-Pigmentary alterations
Darker skin types are prone to hyperpigmentation as a result of reactive melanocytes. Cumulative sun exposure over time leads to the appearance of solar lentigenes (sun spots). These factors contribute to the mottled pigmentation which occurs as a consequence of photo ageing.

-Yellowing / sebaceous hyperplasia
Sebaceous hyperplasia occurs when the sebaceous glands become enlarged and prominent. This creates shiny yellow bumps on the facial skin which are entirely benign. Degeneration of elastic tissue in ageing skin is also know as solar elastosis. If extensive, it can give a waxy yellow appearance to the affected skin.

-Poikiloderma of civatte:
Poikiloderma of Civatte is a common, benign skin condition that occurs as a result of long term sun exposure It typically affects the skin on the sides of the neck and upper chest and affects more women than men. The area under the chin is typically spared. The affected skin is red-brown with prominent hair follicles.

How can we defy time and the elements? By protecting our skin from an early age and making healthy lifestyle choices we can indeed ensure that we age well.
It’s not too late for those who have not taken the best care in the past. Anti ageing research has come a long way to provide us with strategies to reverse previous damage and promote optimal skin health.

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Ageing- The changing face of time

Ageing, or “maturing,” is a natural process that happens to all of us and in fact begins the moment we are born!
It affects all our organs including the skin. Sooner or later we start to notice this, particularly on our skin as it is the organ that we are most aware of. How we age is what makes the difference, and this depends on how you look after yourself and your skin from a very young age.
Skin ageing is a complex biological process influenced by a combination of intrinsic and extrinsic factors.

Intrinsic ageing is the type of ageing that we cannot really control. It is also known as chronological ageing and occurs as time passes. The genetic make up, cellular metabolic processes and hormonal influences of an individual determines how the passage of time will affect us. Intrinsic ageing is greatly influenced by external or extrinsic factors.

Extrinsic ageing is caused by external factors and is really the only aspect of ageing that we can control. We can do this by using the right skincare products and supplements and by modifying our behavior. Smoking, sun exposure, air pollution, poor nutrition, chemicals and toxins are examples of extrinsic factors. The biggest contributor to skin ageing is sun exposure. We call this photo ageing.

Extrinsic and instrinsic factors cause ageing but both these processes overlap particularly in the sun exposed areas and are difficult to distinguish.
Chronologically aged skin appears thin and dry with fine wrinkles.
Photo-aged skin appears leathery and lax with coarse wrinkles, broken veins and uneven pigmentation.

So, as we age, we need to bear all of the above factors in mind when choosing the right skincare products, and change our behavior to ensure the signs of ageing are kept to a minimum.