ANTI AGING
Skin aging is a complex biological process influenced by a combination of
endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact
that skin health and beauty is considered one of the principal factors
representing overall “well-being” and the perception of “health” in humans,
several anti-aging strategies have been developed during the last years. It is
the intention of this article to review the most important anti-aging
strategies that dermatologists have nowadays in hand, including including
preventive measurements, cosmetological strategies, topical and systemic
therapeutic agents and invasive procedures.
Skin aging is a part of a natural human “aging mosaic” which becomes
evident and follows different trajectories in different organs, tissues and
cells with time. While the aging signs of internal organs are masked from the
ambient “eyes,” the skin provides first obvious marks of the passing time.
Skin aging is a complex biological process influenced by combination of
endogenous or intrinsic (genetics, cellular metabolism, hormone and metabolic
processes) and exogenous or extrinsic (chronic light exposure, pollution,
ionizing radiation, chemicals, toxins) factors.1 These factors lead together to
cumulative structural and physiological alterations and progressive changes in
each skin layer as well as changes in skin appearance, especially, on the
sun-exposed skin areas.2-12 In contrast to thin and atrophic, finely wrinkled
and dry intrinsically aged skin, premature photoaged skin typically shows a
thickened epidermis, mottled discoloration, deep wrinkles, laxity, dullness and
roughness.13-18 Gradual loss of skin elasticity leads to the phenomenon of
sagging.19 Slowing of the epidermal turnover rate and cell cycle lengthening
coincides with a slower wound healing and less effective desquamation in older
adults. This fact is important when esthetic procedures are scheduled.20 On the
other side, many of these features are targets to product application or
procedures to accelerate the cell cycle, in the belief that a faster turnover
rate will yield improvement in skin appearance and will speed wound healing.21
A marked loss of fibrillin-positive structures22 as well as a reduced content
of collagen type VII (Col-7), may contribute to wrinkles by weakening the bond
between dermis and epidermis of extrinsically age skin.23 Sun-exposed aged skin
is characterized by the solar elastosis. The sparse distribution and decrease
in collagen content in photoaged skin can be due to increased collagen degradation
by various matrix metalloproteinases, serine, and other proteases irrespective
of the same collagen production.24-28 In older skin, collagen looks irregular
and disorganized, the ratio of Col-3, to Col-1 has been shown to increase, due,
significantly, to a loss of Col-1.29 The overall collagen content per unit area
of the skin surface is known to decline approximately 1%/year.30
Glycosaminoglycans (GAGs) are among the primary dermal skin matrix constituents
assisting in binding water. In photo-aged skin, GAGs may be associated with
abnormal elastotic material and thus be unable to function effectively.31 The
total hyaluronic acid (HA) level in the dermis of skin that age intrinsically
remains stable; however, epidermal HA diminishes markedly.32
Three primary structural components of the dermis, collagen, elastin and
GAGs have been the subjects of the majority of anti-aging research and efforts
for aesthetic-anti-aging strategies pertaining to the skin, from ”anti-wrinkle
creams” to various filling agents.21
Presentation of aging of the entire face is associated with the gravity
impact, muscles action, loss of volume, diminishing and redistribution of
superficial and deep fat, loss of bony skeleton support what all together lead
to the face sagging, changes in shape and contour. Regardless of the fact that
aging is a biological inevitable process and not a pathological condition it is
correlated with various skin and body pathologies, including degenerative
disorders, benign and malignant neoplasms.
The ‘successful aging’ paradigm, focuses on health and active participation
in life, counters traditional conceptualizations of aging as a time of disease
and is increasingly equated with minimizing age signs on the skin, face and
body.33-35 From this perspective, preventative aesthetic dermatology might
supplement the request for healthy aging, treat or prevent certain cutaneous
disorders, notably skin cancer, and delay skin aging combining local and
systemic methods of therapy, instrumental devices and invasive procedures.36,37
The mainspring of any skin anti-aging therapy is to achieve a healthy, smooth,
blemish-free, translucent and resilient skin.38 In clinical practice, “to look
better” doesn’t mean to “look younger.” That is why it is so important to understand
patients’ wishes and to orientate them to the treatment modality that will give
the most satisfying results whereas knowing all available treatment
techniques.39 The age, previous procedures or surgery, general health status,
type of the skin, style of life and many other factors should be taken into
consideration before choosing the strategy for the individual case. The desired
therapeutic anti-aging effect of the skin is continuous, step-by step process,
which combines various methods of the skin bio-revitalization and rejuvenation,
augmentation, restoration of each skin layer individually and in the light of
many other factors—from a style of the life to the immune, genetic, emotional
and health status in general. This review will emphasize the most important
topical and systemic therapeutic agents and trends in the use of invasive
procedures.