The Secret to Sexy Skin

The most commonly asked question that I encounter at parties or in the office is, "what is the secret to having wonderful skin?"

To answer that question, one must under the skin as an actual organ, and differentiate between the natural aging process and unhealthy aging; yes, aging is natural!

The skin, the largest organ in the body, is responsible for many aspects of our health including immune function, heat and electrolyte balance, barrier function and of course, our "good looks!" The skin is made up of three basic layers: epidermis, dermis and subcutaneous fat. The epidermis, the most superficial layer of the skin, is made up mostly of skin cells called keratinocytes; this layer of the skin is the part of we often scrape off during shaving or light abrasions from falling off the bicycle. Damage to this layer does not cause scarring. The dermis, the middle section, is made up of collagen, elastin and a complex matrix that together provide support, elasticity and volume to our skin. Damage to this layer of the skin can result in permanent scarring. The deepest layer, called the subcutaneous fat or hypodermis, is responsible for not just volume, but our fat metabolism (obviously!), and heat control.

So what happens when we age? Well, we all age and that is just a fact of life! During natural aging, the skin begins to get thinner and we have a slower turn-around in generating new skin. We begin to lose volume in the face; i.e. we lose actual bone mass, get thinner dermis, and even subcutaneous fat (unfortunately in the areas we least like to lose fat!). If you were to look a young face, you will see that besides lacking rhytids (wrinkles) the younger face is round and voluminous; the nasolabial folds are full, the chin is prominent, the cheek bones are well delineated and the lips are full and everted. With aging, we get loss of mass in these areas and look "sunken"- in addition to getting wrinkles.

One can also accelerate the aging process even further without proper care for the skin. Main reasons why skin can age too quickly are sun damage, inadequate hydration, smoking and hormonal changes.

This brings us to the second question I encounter daily: "what can I do to look better?" This is a harder question because it depends on the individual's bone structure, the level of skin damage present, any underlying medical problems, as well as desired effect to be achieved. In general however, there are many options available to address the multiple manifestations of aging. Brown spots, oily skin, and uneven skin pigmentation (usually an epidermal) can be addressed with bleaching creams, light cryotherapy, chemical peels as well as laser treatments. Red spots (telangiectasia) can also be addressed by electrosurgery as well as certain laser treatments.

However, wrinkles are a deeper and more complex problem and need a different approach. There are two forms of wrinkles: dynamic and at rest. Dynamic wrinkles are the result of movement and best respond to Botox. Wrinkles at rest can benefit from either deep chemical peels, certain, or certain laser treatments. Volume loss can also affect various areas of the face and can be corrected by fillers. Examples of fillers include Restylane, Jevederm, Radiesse and various formulations of collagen. It is important to use the correct filler product in the appropriate anatomical subunit of the face, using precise injection technique for that area. Please note that we have not mentioned surgery once! That is because the idea of pulling skin tighter and tighter is an outdated approach. While surgery is still the treatment of choice for certain aging scenarios, the new thinking in facial rejuvenation focuses on using a combination of various procedures named above to address the multiple manifestation, and underlying reasons for aging.

In short, the secret to sexy skin is simple: love your skin! It is up to you to protect and maintain its needs, so it can take care of you. Always, keep an eye on all the moles and have all new growths examined carefully by your dermatologist, avoid agents that accelerate aging, and use your sunscreens daily. Finally, consult your dermatologist when in doubt - put our lifetime of schooling to use!

Yours,

Tanya Kormeili, MD