External ageing factors.
Pollution
Air pollution is an environmental factor related to premature skin and hair ageing, via the generation of free radicals and cell damage. A recent study comparing women living in urban and rural areas showed a direct link between pollution exposure and skin ageing signs including pigmentation and wrinkles. Research has also linked pollution as a contributing factor to bone loss.
Smoking
Smoking is another independent skin ageing-inducing environmental factor, and the effect with sun exposure is additive. Many studies have confirmed an association between smoking and premature wrinkling. In vitro studies have also shown that smoking leads to a reduction in collagen and an increase in enzymes involved in the degradation of collagen and elastin. There is also a relationship between smoking and baldness in men, and premature greying of hair. Smoking has also been linked with increased bone loss in post-menopausal women and increased risk of fracture.
Diet
The role of diet in skin ageing is highly controversial with limited scientific studies. We do however know that the ingestion of sugar promotes cross-linking of collagen fibres through a process known as glycation, leading to the production of tissue-destroying advanced glycation end products (AGEs). Grilling, frying or roasting produce high levels of AGEs compared with cooking processes such as steaming.
Exercise
Like diet, there is limited scientific data on the effect of exercise on skin ageing. However, a recent study by Tarnopolsky and his colleagues looked at the effects of exercise on the skin of volunteers aged between 20 and 86. The study had 2 groups: one exercising for less than an hour per week, and one doing at least 4 hours of high-intensity aerobic exercise each week. A skin sample taken from each volunteer’s sun-protected buttock skin demonstrated that those who exercised frequently (even those over 65) had skin closer in composition to those of 20-30 year olds. Furthermore, exercise has also been shown to improve bone mass in the spine of post-menopausal women over 50.
Sleep
Unfortunately short sleep duration has become increasingly common in modern society. Poor quality sleepers have higher intrinsic ageing scores than good quality sleepers. Poor sleepers also have reduced skin barrier function and lower satisfaction with their appearance. Bad sleep quality in older people is also associated with reduction in muscle mass and function, and reduced bone mineral density.
Dental hygiene and care
The teeth support the lower third of the face, and over time that support begins to collapse if there is loss of teeth, which is frequently associated with periodontal disease. Tooth loss has a significant effect on the underlying skeletal proportions of the face, and along with fat loss leads to the formation of wrinkles and hollow cheeks, and affects the muscles of the lower face which must compensate for the absence of teeth by contracting.
Stress
Chronic stress results in activation of pathways which results in immune dysfunction, increased production of free radicals and DNA damage. Chronic psychological stress is also associated with bone loss.
Hormones
For women, decrease in oestrogen during menopause is associated with increased skin dryness, and decreased skin elasticity, dermal thickness and collagen content. Although several studies have shown that hormone replacement therapy can improve skin quality, much of the evidence is controversial. The reduction in oestrogen levels with age also increases bone resorption. Furthermore, a low dietary intake of Vitamin D and calcium hastens bone loss and osteoporosis.
Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature. Dermatologic Surgery 2017;43:475-484.
A holistic approach to anti-ageing.
Sun exposure of the skin and hair
Apply a broad-spectrum, SPF 50+ sunscreen and re-apply approximately every 2 hours, or after swimming or sweating. In addition to wearing sunscreen, seek shade, wear sun protective clothing (including hat and sunglasses) and use extra caution near water, snow and sand, as they reflect the damaging sun’s rays. Ideally combine this with a blend of topical antioxidants that provides infrared and heat protection while minimising inflammation and promoting skin repair.
Pollution
Sunscreens do not protect against pollution so the best defence is routine cleansing to remove particulate matter that can attach to the skin, a combination of topical (Vit C, E, B3, Ferulic acid) and systemic antioxidants (diet high in fruits such as blueberries, vegetables, nuts, olive oil, fish, whole grains, and legumes) to counteract oxidative stress, and barrier repair with moisturisers. Cosmetics such as foundation may also have a protective effect.
Smoking
Don’t smoke. The benefits of not smoking include healthier skin, as well as protection from hair loss and low bone mineral density.
Diet
The combination of a Mediterranean diet and a low glycaemic diet, along with food sources containing Vit C and linoleic acid (ie. a diet with high intake of fruits, vegetables, nuts, olive oil, fish, whole grains, lean protein, legumes and monounsaturated fat but a lower intake of refined carbohydrates, sugar, processed foods, butter, saturated fat, fried food, red and processed meat) can promote healthier skin and may have a protective effect on bone mineral density.
Exercise
Do at least 4 hours of moderate or high-intensity physical exercise each week to promote healthier skin. Some exercises (especially weight training) have a protective effect on bone mineral density as well as muscle structure and function.
Sleep
Try and get a good-quality sleep of 8 hours a night to improve skin barrier function, satisfaction with appearance, bone mineral density and muscle mass and function.
Dental hygiene and care
Good oral hygiene and regular dental examination are key to preventing periodontal disease that can result in tooth loss and subsequent bone resorption.
Stress
Reduce stress using mind and body approaches such as mindfulness meditation, yoga, tai chi, qi gong, progressive relaxation, and deep-breathing.
Hormones
Given the possible increased risk of breast cancer, stroke and blood clots in hormone replacement therapy users, and increased risk of endometrial cancer with unopposed oestrogen use, the risks and benefits of this therapy need to be carefully evaluated by your doctor. Make sure you consume the recommended amounts of calcium and Vitamin D from diet and supplements.
Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature. Dermatologic Surgery 2017;43:475-484.
The internal ageing process: what actually happens?
Skin and Hair
Skin’s intrinsic deterioration is related to an accumulation of damage from free radicals created during normal cell metabolism, and a reduction in the body’s ability to defend against it. This triggers chemical pathways that results in suppression of skin growth factors, up-regulation of tissue destruction enzymes, and increased inflammation. This causes breakdown of the collagen and elastin network, resulting in dry skin, loss of elasticity, thinning of the skin, and wrinkles. Our hair follicles also accumulate damage over time resulting in thinning of our hair.
Fat changes
Oxidative stress in fat cells is linked to accelerated fat ageing and DNA damage. Studies have shown that the fat compartments of our face are discretely partitioned into multiple, independent units by facial barriers. Fat loss and descent of these compartments compound the ageing appearance, giving us a deflated, sagging look.
Muscle changes
Free radicals also play an important role in the muscle ageing process. Also, as we age our facial muscles no longer have the bony support that they once had. As they try to maintain their resting tone, repetitive facial movements results in wrinkles that once were only noticeable with facial expression and soon become noticeable at rest.
Bone changes
Bone is a living tissue that is constantly remodelling. Studies have show that oxidative stress which increases with age, adversely affecting our bone homeostasis. In subjects older than 35 there seems to be a tipping of the balance in facial bones toward bone breakdown and resorption rather than bone formation. This results in changes to our facial structure and reduction in support for overlying soft tissues. Our cheeks flatten, our orbits widen, and our soft tissues head south!
Reference: Saluja SS and Fani SG. A Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the Literature. Dermatologic Surgery 2017;43:475-484.