Facetime: Facing The Facts About Facial Aging

Medical Editor: Gilly Munavalli, MD is medical director and founder of Dermatology, Laser & Vein Specialists of the Carolinas. He is also an Assistant Professor at the Wake Forest University School of Medicine, Department of Dermatology and serves as a Cosmetic Dermatologic Surgery Fellowship Director for the American Society for Dermatologic Surgery.

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Your face ages in many different and specific ways. Some changes come from the outside—namely the sun's damaging ultraviolet (UV) rays and environmental exposures—and others come from the inside, such as your genes and age.

Together, these external and internal forces control how quickly and radically your face ages.

Makeup can cover up some signs of facial aging, including uneven skin tone and tired-looking, puffy eyes, and good skin care can also counteract some of the signs of aging, but they can do only so much.

This is why so many of you are concerned about the signs of facial aging. Topping your collective list of worries is skin discoloration, followed by lines and wrinkles around the eyes, skin texture issues, and overall sagging facial skin in the mid- and lower face, according to the latest survey from the American Society for Dermatologic Surgery (ASDS).

You can't stop facial aging, but you can control how well you age by putting the brakes on some of its more vexing and visible signs. Prevention—first and foremost, the judicious use of sunscreen—can help keep skin wrinkle-free longer. Luckily, a growing array of minimally invasive technologies including energy-based devices, such as lasers and micro-needling, can help erase and smooth some of the other visible signs of aging on the face.

What Is Skin Aging?

Facial aging begins the day you are born, and proceeds at different rates throughout your life. The face ages in five key ways:

Discoloration Skin changes occur, such as brown spots and sallow (yellowish or brownish) color.

Wrinkle Formation Wrinkles form from overactive muscles and dehydration, as well as due to loss of a key skin building block called collagen.

Volume Loss Volume depletes, causing hollow cheeks and temples due to fat loss and the age-related breakdown of the underlying facial structure.

Loss of Elasticity Skin no longer “bounces back” quickly if you press on it because of the loss of collagen and a related component called elastin.

Pull of Gravity As physicist and mathematician Isaac Newton remarked when he described the effects of gravity, “What goes up, most go down.” This is also true for facial tissues and structures.

How Do Wrinkles Form?

When muscles contract repeatedly, collagen and elastin break down under the surface. Superficial or fine lines are caused by skin dehydration and the loss of hyaluronic acid (HA). Deeper folds are the result of declining collagen and elastin.

There are two main types of wrinkles—dynamic and static. Dynamic wrinkles develop over time when you use your muscles to form facial expressions such as smiles and frowns. Static wrinkles, by contrast, are there all the time because of the decrease in collagen, elastin, and hyaluronic acid. Dynamic wrinkles morph into static wrinkles when your skin loses its spring. Wrinkles are treated on a continuum based on their severity and depth.

What is collagen? why is it important?

Collagen is found in the skin, bones, connective tissue, and blood vessels. Your natural supply dwindles with advancing age and after exposure to the sun's damaging ultraviolet (UV) rays, smoking, and/or other environmental factors.

Collagen is also a building block of what's called the extracellular matrix, an intricate network of proteins that support the skin. When collagen declines, skin becomes less elastic and the skin's underlying framework takes a hit.

What is elastin? why is it important?

Elastin is a protein that contributes to flexible and strong skin. Loss of elastin contributes to skin sagging. Like your collagen stores, elastin decreases with age, and the skin becomes less stretchy and resilient as a result.

What is hyaluronic acid? why is it important?

Hyaluronic acid is found naturally in almost every tissue in the body. It pulls moisture into tissues. As you age, your rate of HA production decreases and skin dries out. This is why hyaluronic acid is an important ingredient in many skin care products.

Can collagen, elastin, and hA be replaced?

Ask your doctor about ways to boost your supply of this powerful trio. One way is with radiofrequency (RF) microneedling devices, such as the Profound® treatment. With the Profound treatment, RF energy is paired with tiny microneedles to create dermal wounds to the skin. These wounds trigger the skin's natural wound healing process. As compared to mechanical microneedling devices, the combination of RF energy with microneedling promotes the production of collagen, elastin and hyaluronic acid. In fact, studies show that the Profound treatment creates close to five times the elastin, twice the amount of collagen, as well as more hyaluronic acid in a single treatment.¹ Just one Profound treatment is needed to see results. Expect about a week of downtime.

Do genes affect facial aging?

Yes, but your DNA is just one piece of the puzzle. Sun damage, pollution, alcohol, stress and even habitual facial expressions (smiling, scowling, squinting, and frowning) all cause and worsen the signs of skin aging. Your diet may also affect skin tone and quality.

What is the greatest external cause of aging skin?

Hands down, sun damage is the greatest threat to your skin. Fully 90 percent of skin aging is caused by exposure to the sun, according to the Skin Cancer Foundation. Protect yourself by wearing a broad-spectrum sunscreen with an SPF of 30 or higher every day.

Can I prevent facial aging?

You are not powerless. You can't change your genes or your age…yet. But you can hit pause to slow the rate at which your facial skin ages. Individuals who use sunscreen with an SPF of 15 or higher daily show 24 percent less skin aging than those who didn't, according to the Skin Cancer Society. Don't smoke, and if you do, quit. Smoking causes wrinkles by damaging your collagen and elastin stores.

You can't always avoid stress, but you can change how you cope with it. Find something that helps you de-stress and do it every single day, whether yoga, meditation or deep breathing. If you are concerned about skin tone, wrinkles or the overall quality of your skin, talk to your doctor about what else you can do to slow the facial aging process.

For example, the Profound treatment can help you rebuild your collagen, elastin and hyaluronic stores; replenishing the building blocks of youthful skin from the inside out.⁶ The Picoway® Resolve laser can brighten skin and help smooth milder wrinkles;^7-11 and CO₂RE® has the ability go deep for more significant wrinkles and folds.

It's not just wrinkles. As I age, I feel like my skin is drier and I see other changes. Why?

During menopause, the production of the female sex hormones estrogen and progesterone shuts down. This affects everything from your skin and hair to your bones and heart. Your skin becomes dryer and thinner during and after menopause. You may also lose some fat under your skin, and your skin becomes less elastic. This can result in sagging—especially around the neck.

Why is my skin growing more red with age?

Millions of people live with rosacea, a skin condition marked by flushing or redness on the cheeks, nose, chin, or forehead that may come and go in response to various triggers. With age, however, your skin may grow more red, even if you don't have rosacea. As collagen breaks down due to age and sun damage, your blood vessels become wider and are more visible to the naked eye. Early treatment with a laser designed to target blood vessels, such as Vbeam® Prima laser system, can erase these blood vessels. The earlier you start treatment, the more efficient it will be. Talk to your doctor today.

With the Vbeam Prima laser energy goes directly to blood vessels, where it destroys them below the skin's surface, without damaging nearby skin. A series of three to four treatments at monthy intervals are usually needed to delete redness. Expect some redness, mild swelling, or puffiness that will last 1–3 days. The laser has a one-of-a-kind Dynamic Cooling Device (DCD^TM) that differentiates it from competitors. The DCD protects the skin by keeping it cool as the laser energy is delivered to the blood vessels. Candela's patented DCD is programmed to deliver precise and consistent epidermal protection with each laser pulse.

Why are there blue veins around my eyes?

The skin beneath the eyes is among the thinnest and most delicate on the entire body, making it a prime spot for fine lines, wrinkles, and dark circles to form. Some people develop blue colored veins around the eye.

When skin becomes thinner and less elastic with age, blue veins can be even more prominent. The Vbeam Prima can target and eliminate these veins.

What about redness and visible blood vessels?

If you are bothered by the appearance of blood vessels—often called spider veins—on the face, energy-based devices that target these blood vessels can help.

What are “age spots” really?

Age spots—also called liver spots in lay terms and solar lentigines by doctors—are small dark areas on your skin. They tend to appear in places where you get a lot of sun exposure. These are not cancerous but you may be self-conscious about them—especially those on your face. Treatment with the PicoWay picosecond laser using the new Zoom handpiece can erase these telltale signs of aging, largely by breaking up the pigments that cause age spots. Ask your doctor if the PicoWay treatment can help erase your age spots.

How do energy-based devices affect the skin?

The field of energy based devices has grown dramatically over the last two decades, and companies like Candela have been at the forefront, leading innovation. Most energy-based devices use light or other forms of energy that are intended to heat a specific target. That heat induces a thermal injury that sometimes destroys the target (such as the hair bulb for laser hair removal, components of blood when treating blood vessels, or even pigmentation in the skin). In other cases, that injury initiates a process of healing and regeneration that can help the skin replace lost stores of components like collagen and elastin. These are the two main proteins that are responsible for the supple, elastic properties most associated with youth.

Newer devices may rely less heavily on thermal (heat) damage and instead use non-thermal energy to generate changes in the skin. Some interventions, like microneedling, physically puncture the skin, creating tiny wounds that signal the natural healing process.

Sounds like science fiction. Is it safe?

Lasers are the stuff of science fiction. But they have been used in medicine for years. When properly applied and with appropriate safety precautions in place, these treatments are designed to be safe. Your doctor can talk to you about some safety measures that may be required. For example, many energy-based devices require that the doctor and the patient wear protective googles to protect the eyes from intense laser light.

The efficacy of a given device often relies on the development of specific, controlled skin injury.

What will I feel like AFTER?

Immediately following treatment with CO₂RE laser, for example, you may feel like you have a sunburn that will last several hours. You can expect peeling in the treatment area. This may last 7-10 days. Common side effects after treatment with PicoWay picosecond laser may include redness, swelling, and tingling that may last for a few hours to a few days after treatment. With the Vbeam Prima laser system, you may experience redness or mild swelling immediately following treatment, but this usually goes away in a few hours. Occasionally a bruise may occur.

Will treatment with energy-based devices hurt?

You may feel a slight tingling or pinprick sensation with some energy based skin rejuvenation treatments, such as the Vbeam Prima laser system. Other treatments, such as the CO₂RE laser, may involve moderate discomfort, but the anesthetic applied prior to the procedure will minimize any pain.

Should I talk to my doctor about my aging skin?

Absolutely! Your doctor is the expert able to assess your unique needs and make the right recommendations for you. Even if you're not ready for a procedure now, it can be helpful to better understand your own face and your options!

1. Hantash BM, Ubeid AA, Chang H, Kafi R, Renton B. Bipolar fractional radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med. 2009;41(1):1-9.

2. Alexiades-Armenakas M, Newman J, Willey A, et al. Prospective multicenter clinical trial of a minimally invasive temperature-controlled bipolar fractional radiofrequency system for rhytid and laxity treatment. Dermatol Surg. 2013;39(2):263-273.

3. Willey A, Kilmer S, Newman J, et al. Elastometry and clinical results after bipolar radiofrequency treatment of skin. Dermatol Surg. 2010;36(6):877-884.

4. Data on file. Individual results may vary.

5. Berube D. Real-time temperature feedback for clinical reproducibility: the mechanism of action of Profound. 2015. Candela, data on file.

6. Profound 510(k) clearance (K161043), September 2016.

7. PicoWay 510(k) clearance for tattoos (K142372), October 2014.

8. PicoWay 510(k) clearance for benign pigmented lesions (K150326), April 2015.

9. PicoWay 510(k) clearance for tattoos with 785 nm handpiece (K160607), July 2016.

10. PicoWay 510(k) clearance for acne scars (K162454), February 2017.

11. PicoWay 510(k) clearance for wrinkles (K170597), May 2017