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Correcting Signs of Aging Over a Lifetime

Correcting Signs of Aging Over a Lifetime

Patients, regardless of age and gender, often present looking to address their cutaneous signs of aging. Dermatologists should review the basics of correcting aging for various patient groups as well as how to market their cosmetic practice.


Cosmetic dermatology and health care providers have a responsibility to their aesthetic patients to set expectations and explain the aging process. This aging process changes with each decade and comes with different challenges. Due to current social standards, patient’s expectations of beauty may be skewed based on what they see in advertisements or marketing and on social media. The definition of beauty is more external: smooth skin free of wrinkles and discoloration, high cheek bones, full lips, slender neck, and symmetrical features that portray positive emotions.

Forehead fine lines and wrinkles pre injectionThough there are a number of factors beyond our scope of the dermatology office, certain elements of the aging process can be controlled by the patient (extrinsic factors).1 No matter their age, patients can make important lifestyle changes to “slow” the skin’s aging process, including decreasing alcohol consumption, avoiding tobacco products and smoking, consuming a balanced diet, exercising on a regular basis, and limiting their UV exposure.2-5 During the cosmetic consult, it is vital to discuss implementing lifestyle changes that will enhance the patient’s cosmetic outcome and help prevent future external damage.

Each and every individual ages differently due to those above-mentioned lifestyle choices plus even more uncontrollable factors, known as intrinsic aging.1 The role of genetics in skin aging is not completely understood, but studies have connected aging to the deregulation of various cellular processes (eg, inflammatory response, signaling) and the decline of hormones.6-8 Further, ethnicity and skin pigmentation can contribute to signs of skin aging. For example, skin of color demonstrates signs of aging later than white skin or lighter Fitzpatrick skin types.9

Forehead post injection to correct agingAs a person ages, enzymes such as collagenase, elastase, and hyaluronidase begin to break down collagen, elastin, and hyaluronic acid at increased rates. This leads to loss of elasticity, thinning of the skin, changes in texture and tone, and an increase in fine lines and wrinkles. The loss of subcutaneous fat and imbalance of fat pads will lead to areas of atrophy and hypertrophy. Downward tissue displacement can lead to temporal and mid-face hollowing as well as submental and jowl accumulation. The aging process is not just skin deep; it should be noted that as a person ages, the underlying bony structures shift, change, and atrophy. The introduction of nonsurgical aesthetics at the appropriate age can slow down the aging process and restore a youthful appearance.

Treating Patients of Different Decades of Life
Antiaging is not limited to older patients with visible wrinkles and pigmentary changes due to years of intrinsic and extrinsic influence on their skin. There are four patient types to consider in your cosmetic practice, as discussed below.

The “enhancement” patient. These patients tend to come in during their early adulthood, typically between 18 to 35 years of age. They desire to improve their youthfulness and maintain and/or enhance their natural appearance. I recommend using neuromodulators to treat dynamic rhytids as well as soft tissue augmentation to nasolabial folds, cheek, and/or lip. Essentially, the goal with the enhancement patient is to maximize youth.

The “rejuvenation” patient. This patient group, generally 35 to 55 years of age, are the primary market for nonsurgical aesthetics. Rejuvenation patients want to look as good as they feel. At this stage of life, loss and imbalance of subcutaneous fat occurs. There is also an increase in facial volume loss. Therefore, these patients are great candidates for dermal filler augmentation and products such as poly-L lactic acid (Sculptra). The dermatologist should aim to recapture their youth and maintain their appearance.

The “restoration” patient. Patients in this category are 55 years of age and older, but they look great for their age and may even fool their friends. The restoration patient should continue to be treated with skin resurfacing techniques, dermal fillers, and neuromodulators to restore and maintain a healthy appearance as they enter the next stage of their life.

The “nonsurgical” patient. These patients are also 55 years of age and older; however, their appearance is not as ideal as their restoration patient peers. They may even look older than their stated age. Realistically, persons in this group would be suited for surgical correction of their aging signs, but these patients either elect to avoid surgery or may have a medical condition that would make surgery inappropriate. Dermatologists should set realistic expectations and focus on one or two specific areas to improve in order to maximize patient satisfaction without sacrificing quality or health. 

Tips for Treating the Male Patient
While the media and marketing may lead us to believe only women desire cosmetic improvements in their appearance, men also present with concerns over their signs of aging. A recent study noted that men also undergo cosmetic procedures in pursuit of a more youthful appearance.10

Notably, male patients have a greater muscle mass and thinner adipose tissue than women, therefore they typically require more units of neuromodulators. In addition, men have deeper facial rhytids and expression lines,11 except periorally.12 Because men have lower set and flatter brows, caution should be taken not to peak or lift the brows and not to overload the frontalis with a neuromodulator, which can cause a brow ptosis.

When treating the midface, I recommend staying more medial for cheek augmentation to avoid wide lateral cheeks, which is considered a feminine characteristic.


Tips for marketing your aesthetics practice

Ms Bellomo is the owner of Allele Medical; founder and chief executive officer of Bellomo Consulting, Inc; and conference director of New Wave Dermatology and Midwest Dermatology Conferences in the Orlando, FL, area.

Disclosure: The author reports no relevant financial relationships.


References
1. Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci. 2008;30(2):87-95. doi:10.1111/j.1468-2494.2007.00415.x

2. Goodman GD, Kaufman J, Day D, et al. Impact of smoking and alcohol use on facial aging in women: results of a large multinational, multiracial, cross-sectional survey. J Clin Aesthet Dermatol. 2019;12(8):28-39.

3. Katta R, Kramer MJ. Skin and diet: an update on the role of dietary change as a treatemtn strategy for skin disease. Skin Therapy Lett. 2018;23(1):1-5.

4. Crane JD, MacNeil LG, Lally JS, et al. Exercise-stimulated interleukin-15 is controlled by AMPK and regulates skin metabolism and aging. Aging Cell. 2015;14(4):625-634. doi:10.1111/acel.12341

5. Han A, Chien AL, Kang S. Photoaging. Dermatol Clin. 2014;32(3):291-299. doi:10.1016.j.det.2014.03.015

6. Lerner T, Moll PR, Rinnerthaler M, Bauer J, Aberger F, Richter K. Expression profiling of aging in human skin. Exp Gerontol. 2006;41(4):387-397. doi:10.1016/j.exger.2006.01.012

7. Makrantonaki E, Adjaye J, Herwig R, et al. Age-specific hormonal decline is accompanied by transcriptional changes in human sebocytes in vitro. Aging Cell. 2006;5(4):331-344. doi:10.1111/j.1474-9726.2006.00223.x

8. Makrantonaki E, Bekou V, Zouboulis CC. Genetics and skin aging. Dermato-Endocrinology. 2012;4(3):280-284. doi:10.4161/derm.22372

9. Alexis AF, Obioha JO. Ethnicity and aging skin. J Drugs Dermatol. 2017;16(6):s77-s80. 

10. Montes JR, Santos E. Evaluation of men’s trends and experiences in aesthetic treatment. J Drugs Dermatol. 2018;17(9):941-946.

11. Hamer MA, Pardo LM, Jacobs LC, et al. Lifestyle and physiological factors associated with facial wrinkling in men and women. J Invest Dermatol. 2017;137(8):1692-1699. doi:10.1016/j.jid.2017.04.002

12. Paes EC, Teepen HJLJM, Koop WA, Kon M. Perioral wrinkle: histologic differences between men and women. Aesthet Surg J. 2009;29(6):467-472. doi:10.1016/j.asj.2009.08.018

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