Like it or not, the face reveals our age which is why people
spend so much time and money trying to hide or reverse the tell-tale
signs. It is not just the skin that is affected, other structures
too are affected which combined together produce the signs we
commonly associate with ageing. To help you understand what happens
to the face, it is useful to think of the face as a three-layered
structure consisting of:-
- The foundation or the bony skeleton and cartilage.
- The support system or the muscles of facial expression. The
muscles of the face have fibrous insertions in the skin so that
we can express happiness, sadness, anger and so on. They also
support the eyebrows, eyelids, and the corners of the mouth.
- The outer covering or the skin. Normally, the skin is flexible
and elastic. It can be pulled, depressed or creased but always
returns to its original shape.
Ageing affects all three layers. The foundation decreases
in volume and this is particularly noticeable on the lower third
of the face due to loss of teeth and alveolar resorption (alveolar
tissue supports the teeth) and shrinkage of the jaw bone.Combined
with a receding hairline, this results in the upper and middle
third of the face appearing disproportionately long compared
to the lower third. If the outer covering or skin is elastic
it will still spring back against the foundation even if the
latter is reduced in volume. Unfortunately, the skin also loses
elasticity with age. This results in an excess of skin which
sags under the effect of gravity or muscular action leading to
deep wrinkles and creases along the expression lines of the face.
There is also loss of the support system due to muscle weakness
which results in sagging eyebrows and eyelids, eyebags, jowls,
downward migration of the nose and down-turning of the corners
of the mouth.
Action of the muscles of facial expression
Facial area |
Name of muscle |
Action |
Forehead |
Frontalis |
Lifts
eyebrows
Produces horizontal frown lines |
|
Auricularis |
Wriggles
ears in some individuals |
|
Procerus |
Pulls
eyebrows downwards Causes horizontal wrinkles on the bridge of
the nose |
Eyes |
Orbicularis |
Closes
eyes
Produces wrinkles on the outside of the eyes (crows feet)
and under the eyes
Causes eyebags when weakened and fat herniates out |
|
Levator
palpebrum superioris |
Raises
the upper eyelids |
|
Corrugator |
Pulls
eyebrows together Produces vertical lines, as in frowning |
Nose |
Nasalis |
Expands
the nostrils as in deep breathing
Cause wrinkles on the nose |
Orbicularis
oris |
Closes
mouth
Purses lips
Causes wrinkles on the lips |
Closes mouth
Purses lips
Causes wrinkles on the lips |
|
Levator
labii superioris |
Raises
the upper lip |
|
Levator
anguli oris |
Lifts
the angles of the mouth |
|
Zygomaticus
major |
Draws
the angles of mouth upwards and sidewards |
|
Risorius |
Draws
angle of the mouth sideways as in grinning |
|
Depressor
labii inferioris |
Draw
the corners of the mouth downwards |
|
Mentalis |
Pushes
up the lower lip
Causes the chin to wrinkle |
|
Digastric |
A
deep muscle that aids in swallowing
Partly responsible for the double chin deformity |
Cheeks |
Buccinator |
Pulls
the cheek against the teeth to aid chewing
Puffs up the cheek as in blowing |
|
Masseter |
Raises
the jaw and aids in chewing
Causes jowls when weakened |
Neck |
Platysma |
Lowers
the jaw
Causes jowls and wrinkles on the neck |
|
Sternocleidomastoid |
Turns
the head to the side
Bends the neck forward when muscles contract |
The ageing skin - its 10% genes
and 90% sun-damage
In
the past, doctors thought that skin ageing was an inevitable
and wrinkles, sagging skin and age spots were regarded as
part of the normal ageing process over which we had little or
no control. They were wrong because research has shown that the
main factor responsible for up to 90% of skin ageing is cummulative exposure to the sun, the
other 10% being due to genetic factors. Skin ageing is now thought
to occur in two ways - through the natural ageing process which
dermatologists call chronological ageing (also known as chronoageing,
natural ageing, intrinsic ageing or biological ageing) and through
sunlight accelerating the ageing process which doctors call photoageing
(also called extrinsic ageing or dermatoheliosis). Chronological
ageing is genetically determined and can only be controlled to
a small extent, through healthy habits and lifestyles. Photoageing,
on the other hand, is sun-induced ageing which is almost 100%
preventable.
The
term cummulative means that the
damage accumulates a little at a time with each exposure, often
unnoticed, until many years later. If you get a wrinkle in the
thirties or forties, it is not a result of the last weekends'
day out in the sun but the sum total of all the past exposures
to the sun. The damage has already been done which means that
the signs of sun-damage will continue to develop even if you
start avoiding the sun from this day on. This is why it is important
to take precautions early, preferably from childhood. Attitudes
need to changed from one that regards a tan as being healthy
to one that regards a tan as indicating sun-damage to the skin.
Remember, the cosmetic consequence of sun-exposure is premature
ageing - sagging, wrinkled and unevenly coloured skin but the
medical consequence is even worse - increased risk of skin cancer.
There
are differences in gross and microscopic appearance between chronologically
aged skin and photoaged skin. Briefly, chronologically aged skin
is thinned and finely wrinkled because everything slows down
with age whereas in photoageing, the skin is metabolically more
active, presumably to repair the damage and to protect the skin
against further trauma.
Chronologically aged skin
The
rate of cell renewal slows down by about 30 - 50% between the
ages of 30 and 80 years. This means that the old stratum corneum
cells on the surface of the skin are not replaced as quickly
as they should be. These cells are less well cemented together
so the skin becomes dry and flaky. The production of natural
moisturising factors (NMFs) and sebum also decreases with age,
further contributing to the dryness. Melanocytes and the blood
vessels in the upper dermis are also reduced, accounting for
the paleness of the aged skin. The epidermis is also thinned
by about 20% by the age of 70 years and there is loss of the
rete ridges (the downward indentations of the epidermis that
anchor the epidermis to the dermis below). This results in a
decreased adherence of the epidermis to the dermis so the aged
skin is more susceptible to tearing and blister formation. However,
despite all these changes, the epidermal cells appear normal
unlike in photoaged skin (see below). Langerhan cells, the specialised
immune cells that detect abnormal proteins and process and then
pass them on the other cells of the immune system are also reduced
in number - there are 15% fewer Langerhan cells in the buttock
skin of people aged 65 years or more compared to those aged 24
years or less. This may be one reason why cancers are more common
in the elderly. The melanocytes are not only reduced in number
but also in efficiency. The elderly skin is therefore, less able
to tan and less able to protect itself from sun-damage. This
is why, even though sun-damage has been sustained during earlier
years, it is still important to protect the skin against sun-damage
in the elderly.
The
dermis underneath is also thinned due to loss of connective tissue,
fluid and mucopolysaccharides. The molecular structure of the
collagen is altered so that the fibres do not interlock with
each other as well as normal collagen, resulting in loss of firmness.
The elastin fibres are also more irregular in arrangement and
looser in texture, resulting in loss of elasticity and skin recoil.
Therefore, instead of the extensible skin which can be pulled
and pushed and yet returns to normal, the skin becomes lax and
folded. The muscles also weaken with age. A weakening of the
orbicularis oculi muscle around the eyes, for example, allows
fat to herniate through resulting in bags under the eyes. The
eyebrows may sag due to a weakening of the frontalis (forehead)
muscle and jowls may form at the angles of the jaw due to a weakening
of the platysma neck muscle. Fat is reduced, resulting in loss
of fullness and sunken cheeks.
Visible
changes caused by ageing
Signs |
Chronoageing |
Photoageing |
Wrinkles |
Fine and crinkled |
Fine or coarse |
Texture |
Smooth |
Rough and leathery |
Pigmentation |
Evenly lightened |
Mottled, with solar lentigines (liver spots) |
Thickness |
Reduced and smooth |
Increased |
Colour |
Pale |
Sallow with mottled redness due to broken veins |
Pores |
Not enlarged |
Enlarged and may contain blackheads and whiteheads |
Growths |
Senile angiomas |
Solar keratoses and skin cancers |
Microscopic
changes caused by ageing
Signs |
Chronoageing |
Photoageing |
Epidermis |
|
|
Stratum corneum |
Thinned with loss of rete ridges |
Thickened |
Keratinocytes |
Normal in appearance |
Some abnormal cells and less orderly arranged |
Melanocytes |
Reduced |
Increased and clumped |
Langerhan cells |
Slightly reduced |
More reduced |
|
|
|
Dermis |
|
|
Collagen |
Reduced |
Reduced and replaced by elastotic tissue |
Elastic fibres |
Slightly reduced and not clumped |
Increased and clumped |
|
Not disoriented |
Disoriented |
MPS |
Decreased |
Increased |
Inflammatory cells |
None |
Frequent |
Blood vessels |
Decreased |
Dilated and tortuous |
Hair follicles |
Smaller |
Dilated and filled with debris |
Sebaceous glands |
Smaller |
Enlarged |
|
|
|
Photoaged skin
Earlier
on we learnt that in chronological ageing, everything slows down.
In photoageing however, the reverse is true because the skin
has to work harder (cell renewal rate is actually increased)
to repair the damage and protect itself. The stratum corneum
layer is increased as a result of this and this results in an
increase in the amount of keratin which helps to shield off some
UV rays (60% of UV-B and 20% of UV-A). The skin also becomes
tanned as the number and activity of the melanocytes (pigment-producing
cells) increase to protect the skin against further sun-damage.
These melanocytes, however, are working beyond capacity such
that their efficiency eventually declines resulting in too much
pigment being produced in some areas (causing age spots or solar
lentigines) and too little in others (causing idiopathic guttate
hypomelanosis - the reverse of age spots). Because of rapid cell
renewal rate and the direct effect of UV rays on deoxyribose
nucleic acid or DNA (the cells genetic blueprint), abnormal
cells are produced, which if unchecked, can develop into solar
keratoses (skin precancers) and eventually, skin cancers. The
number of Langerhan cells which help to detect abnormal proteins
are even more markedly reduced in number compared with chronologically
aged skin and this may be one of the reasons why cancers develop
on sun-exposed skin.
Skin
through the decades of life
We
will know that we will grow old eventually but how are you faring
at the moment? Is your skin good or bad for your age? To help
you answer this question, here's a diary of how our skin changes
as we age.
How
the skin changes as we age
Childhood |
The fifties |
The skin is relatively clear and smooth and heals well after
injury. Apart from the occasional birthmark or milia (tiny whitehead-like
cysts), there are usually very few cosmetic problems. However,
severe sunburns resulting from a failure to use sunscreens during
this critical period may increase the risk of skin cancers, especially
malignant melanomas developing later on in life. |
Deep wrinkles and folds of skin may develop and the foundation
tends to cake on the skin because it is too wrinkled. Loose skin
on the jaw droops down giving rise to a jowly appearance and
the lax skin on the neck may cause a turkey gobbler deformity.
The eyelids and eyebrows begin to droop. The skin becomes drier,
rougher and paler in colour. Age spots (solar lentigines) and
age warts (seborrhoeic keratoses) may appear. Individuals heavily
exposed to the sun may develop solar keratoses which are precancerous
(see skin cancers, Page ). The lips thin out and become less
pouting because of the loss of tissue and the corners of the
mouth also turn downwards. Cosmetics can no longer camouflage
these changes and more drastic measures such as face-lifts, chemical
peels, dermabrasion and laser resurfacing may be necessary. |
Adolescence |
The sixties |
Adolescence marks a period of increased production of sex hormones
and increased growth. The sex hormones stimulate the sebaceous
glands to produce oil, resulting in oily skin and sometimes,
prominent or "open" pores. The skin pores may also
get clogged up, causing acne vulgaris (pimples), which if severe
and neglected, can lead to scarring and loss of self-esteem.
Moles commonly appear during this period and birthmarks may enlarge
and cause concern at a time when the person is forming relationships
with the opposite sex. Adolescence also represents a period during
which individuals may indulge in unhealthy habits such as smoking
and drinking, all of which may affect the health of the skin.
Adolescents are also likely to increasingly expose themselves
to the sun in the course of their recreational activities or
through the habit of sun-tanning. |
The bony foundation shrinks, resulting in loss of fullness and
sunken cheeks and further aggravating the laxity of the skin.
Wrinkles and expression lines become very prominent. The skin
thins and there is loss of support for the blood vessels. Telangiectasias
(broken capillaries) and spider veins may develop. |
The thirties |
The seventies |
With good genes and careful attention to healthy living, some
individuals may reach the thirties without wrinkles, sagging
skin or age spots (solar lentigines). More often, however, subtle
signs of ageing are present such as the fine lines around the
eyes and mouth when the person smiles and maybe even a hint of
eye bags and grey hair. There is more reliance on cosmetics to
hide some of these imperfections and a greater tendency to visit
salons for facials. The thirties is a good time for action -
start making changes to your lifestyle (see Chapter 5) and institute
appropriate skincare measures before matters really get bad |
All the earlier changes become accentuated and the first impression
the onlooker gets is a face full of wrinkles. |
The forties |
|
This is the time when the signs of ageing become obvious and
unmistakable. Expression lines become deeper, frown lines appear
on the forehead and wrinkles become obvious. The skin becomes
more lax and pores become more pronounced, especially on the
nose and adjacent areas. The neck skin slackens and becomes crepe-like.
Crow's feet and lines around the mouth occur even at rest. Eye-bags
become more prominent and a double chin may start to develop.
Greying of the hair becomes more prominent. |
|
If
these changes sound all too familiar, don't feel despondent because
modern medicine has a lot to offer. It is not much fun looking
old but if you could look better for your age, just imagine what
a boost that will give to your self-esteem. Naturally, if the
changes are already severe, more drastic treatments will be necessary.
This is why early treatment is recommended. Refer also to the
section on wrinkles
in Skin A to Z.
The
main areas that show laxity:-
- Outside
of the eyes (crows feet)
- Under
the eyes (wrinkles and eye bags)
- Jaw
(jowls)
- Neck
(turkey gobbler deformity and crepe-like skin)
|
The female hormone, oestrogen stimulates the production
of the hyaluronic acid, one of the main water-attracting substances
found in the dermis and may also retard the decrease in collagen
that occurs with age. This may be one reason for the dryness
and loss of skin firmness after the menopause. Hormone replacement
therapy (HRT) after the menopause may help to retard this so
it is discussing the pros and cons of this with your gynaecologist. |