Cosmetic Medicine by Dr Eddie Roos

COSMETIC MEDICINE
THE
AGEING
FACE
Facial hollows and gauntness due to loss of volume, shrinkage of the bone
structures, loss of collagen and elasticity and the effects of gravity are all
manifestations of the ageing face. While some of the skin-related factors can
be reined in with healthy lifestyle choices and a good skincare regime, many of
the characteristics of ageing are a matter of genetics.
INTRINSIC & EXTRINSIC AGEING
Cutaneous ageing is caused by two distinct processes – intrinsic and extrinsic
factors. Intrinsic, or chronological ageing, is the inevitable genetically determined
process that naturally occurs. Intrinsic ageing is determined by each person’s
genetic clock and is affected by the degenerative effects of free radicals and the
body’s inability to perfectly repair their damage.
Over time, cells, tissues and vital organs deteriorate. These internal changes
to the muscle, fat and bones are not as visible as the signs of ageing on the
external organ – the skin. Skin shows the wear and tear of extrinsic ageing,
which is environmentally induced and manifests in age-associated skin changes
including thinning, laxity, fragility and wrinkles. In addition, sun-exposure leads to
pigmentation, premature wrinkling, spider veins and photoageing.
Intrinsic ageing is a continuous process that usually begins in the mid-20s but
may not become evident for decades. At this time collagen production slows and
elastin loses its ‘spring’. Dead skin cells do not shed as quickly and turnover of
new skin cells decreases.
The apparent signs of intrinsic ageing include the loss and descent of underlying
fat leading to hollowed cheeks and eye sockets, as well as loss of fi rmness and
sagging skin as the bones shrink away from the skin due to bone loss.
Genes control how quickly the normal ageing process unfolds. At a cellular
level, ageing is thought to be related to the shortening of telomeres (the terminal
portions of chromosomes) with each cell cycle, resulting in cell-cycle arrest or
apoptosis once a critical length is reached.
The preventable environmental factors that magnify intrinsic ageing, often
act together with the normal ageing process to prematurely age skin. Most
premature ageing is caused by sun exposure, though others are repetitive facial
expressions, gravity, sleeping positions and smoking.
Lines and creases form over major and minor joints as a result of skin
contractions that lie perpendicular to the underlying muscular vector force.
However, relaxed skin tension lines (RSTL) are formed during relaxation and are
created by the natural tension on the skin from the underlying structures.
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