Dermatologists Weigh-In on the Trends in Skin Aging

Aging skin is a common compliant among many individuals seeking aesthetic treatments. This article discusses some of the latest trends in treatment for skin aging, the importance of patient education, and offers advice for new dermatologists entering the field.

Skin aging is a complex biological process influenced by combination of endogenous or intrinsic (eg, genetics, metabolic process) and exogenous or extrinsic factors (eg, chronic light exposure, toxins).1 However, social and print media, infomercials, reality television, and the 24-hour news cycle has put skin aging under the microscope. More individuals are seeking treatment of aging skin and therapies including sun protection, neurotoxin injections, soft-tissue fillers, chemical peels, laser treatments, and surgery. 

Market research indicates that the demand for antiaging products and procedures will continue to increase, and the total global market2 for all antiaging therapies has been projected to reach $216.52 billion in 2021. A 2017 survey from the American Society of Dermatologic Surgery (ASDS) showed that nearly 70% of consumers were considering a cosmetic treatment.3 “Cosmetic procedures continue to increase in popularity, much to the credit of technological advancements made for minimally- and non-invasive techniques,” said ASDS President Thomas E. Rohrer, MD, in a press release on the survey findings. “Patients trust their dermatologists to offer advanced procedures and a variety of treatment options to help them look and feel their best.”

To learn more about the latest trends in skin aging, the importance of education for both dermatologists and patients, and pearls of wisdom for new dermatologists entering the field, The Dermatologist spoke with 3 dermatologists for their insights on these topics.

Skin Fitness and Demographics

Dr. Kirby

Figure. Will Kirby, DO, FACOD.

“I don’t advocate antiaging and instead recommend the entire industry focus on skin fitness,” said Will Kirby, DO, FACOD, who is in private practice in Hermosa Beach, California, and chief medical officer for LaserAway (www.LaserAway.com). “Aging is an incredibly natural process. When I teach residents, the phrase I use is skin fitness because you can always be more fit no matter your age or health level. You can always work on improving your fitness, where you can’t work on changing your age.”

Doris Day, MD, who is in private practice in New York City and specializes in laser, cosmetic, and surgical dermatology, said that the term antiaging is “set in our dialogue.” “I try to use more positive words such as aging beautifully and looking more attractive rather than younger.”

The industry has seen a shift in the demographics of individuals seeking treatments. The American Academy of Facial Plastic and Reconstructive Surgery (AAFRS) annual survey found that 56% of AAFPRS members saw an increase in cosmetic surgery or injectables with patients younger than 30 years and more than four-fifths of treatments in 2017 were cosmetic nonsurgical procedures.4

“This emerging segment is knowledgeable about high tech skin care and sun prevention and starts with facial injectables before they turn thirty,” said William H. Truswell, MD, and president of AAFRS in a press release. “As more millennials come of age and gain disposable income for aesthetic treatments, our members have seen steady growth in the demand for cosmetic procedures.”4

“In the early days, it was patients who were at the end of the line with their wrinkles and frustrated,” said Bobby Buka, MD, JD, founder of Bobby Buka MD Dermatology (bobbybukamd.com) in New York City. However, both men and women are seeking treatments much earlier than 10 years ago, he said.

In her practice, Dr Day, who is also a clinical associate professor of dermatology at NYU Langone Health, said that the demographic is mostly women, but more men have been coming in on own their volition and not because their spouse, partner, or significant other suggested it.

The one demographic that remains true is that the core patient population is female, according to Dr Kirby, who is also an associate clinical professor of dermatology at Western University of Health Sciences and Nova Southeastern University. He noted, however, that “the age does not matter, what matters is the clinical need.” 

Dr. Day

Figure. Doris Day, MD.

Procedure Trends

Patients are looking to improve any visible areas of the bone structure around the chin, neck, forehead, and back of hands, said Dr Buka. Currently, he said platelet-rich therapy (PRP) with microneedling is popular. Microneedling, which first gained attention in the 1990s, is an effective therapy for skin rejuvenation. Recently, dermatologists have incorporated the use of PRP with the aim of augmenting cosmetic outcomes. PRP works by taking a small sample of the patient’s own blood; the sample undergoes centrifugation to allow the separation of the blood into 3 layers: platelet-poor plasma, PRP, and erythrocytes.5 After the plasma and platelets are separated from the rest of the blood, they are injected into the areas of the skin.

PRP also has high concentrations of growth factors, including platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, and epithelial growth factor. A 2017 study found that PRP appears to augment the cosmetic outcomes of microneedling without increasing the risk of adverse events.5

In addition to more lasers and other treatments being used together, the practice of lifting the face with threads is new and improved and here to stay, according to Dr Day. Thread-lifts are one of the newest approaches to nonsurgical face tightening and primarily marketed for the neck, jowls, and lower face, but can be used anywhere. This newer technology uses absorbable sutures, made from biodegradable polymers that dissolve over time and do not need anchoring.

It has been noted that thread-lifts have better outcomes and greater patient satisfaction when combined with fillers, radiofrequency, fractional lasers, and neuromodulators.6

Dermal fillers and neuromodulators remain popular aesthetic treatments. However, there is still a lot of confusion between neuromodulators vs dermal fillers. “While they are both injectables, the products are vastly different even though both are clear substances,” said Dr Kirby. “My caution with dermal fillers is they are overused and complications can arise, [such as vascular occlusion]. Anyone can inject. It’s the artistry—which is the experience and training of the injector who understand the injection techniques and can give beautiful results.”

Body sculpting is becoming increasingly popular. While many new lasers and energy devices have been introduced, combinations of injections and energy devices offer the most promise in fat reduction.7

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