Skin Care FAQs



Q. Define skin aging and the main factors responsible for this process:



Dr. Sommerville: Aging in the skin is divided into two biologically independent processes, intrinsic aging and extrinsic, externally-determined aging. Intrinsic aging is a natural process that occurs from slow but progressive and irreversible tissue degeneration. It is based on unique genetic and hormonal factors, and it affects everyone at different rates. Intrinsic aging results in decreased collagen synthesis, destruction of elastic fibers, and loss of hydration leading to fine wrinkling of the skin, loss of skin tone, skin laxity, and loss of underlying fat.

Extrinsic aging is caused by exposure to external factors such as the sun, cigarette smoking, and other environmental factors such as cold, heat, dust, smog, and air pollution. Lifestyle choices including diet, exercise, sleep habits, stress, and diseases also impact aging.

Extrinsic aging results in coarse wrinkling and furrowing, excessive and uneven pigmentation, dark spots, superficial blood vessels, precancerous conditions, and skin cancers. Of all extrinsic (external) causes, ultraviolet (UV) radiation from sunlight has the most negative effects on the skin.


Q. Since we do not have control over our genes, what percentage of aging-related changes is related to external factors? What has the most harmful effect on the skin?



Dr. Sommerville: This is an excellent question. Up to 40% of aging-related changes in the skin are estimated to be the result of extrinsic aging. It is the sun damage (ultraviolet radiation) that plays the most important role in this process. This is why extrinsic aging is often referred to as photoaging.


Q. How do hormones affect skin aging?



Dr. Sommerville: Collagen is a major component of the human skin, constituting about 90% of total dermal volume. A glaring example of hormonal effect on the skin is the fact that 30% of collagen is lost in the first five years post-menopause, resulting in significant decrease in skin thickness and wrinkle formation. Estrogen supplementation in postmenopausal women leads to the increase of skin thickness and collagen content which results in diminished wrinkling, increased elasticity, and increased hydration.


Q. What is new in the area of antiaging skin care?



Dr. Sommerville: All natural botanical ingredients are definitely in vogue. Most of them provide antioxidant benefits. Others such as kojic acid, licorice, and bearberry extract (arbutin), soy, or shiitake mushroom extract lighten the dark spots associated with sun-damaged skin. There is an emphasis on prevention of aging of the skin especially in younger women. This goes along with many patients in their late twenties or early thirties inquiring about procedures that may prevent wrinkle development. Botox® Cosmetic, for instance, may prevent formation of dynamic (expression-related) wrinkles such as frown lines, crow’s feet, or forehead lines. Most of my clients routinely use sunscreen on the face.


Q. How do antioxidants protect us from aging?



Dr. Sommerville: The benefits of antioxidants range from anti-aging, anti-inflammatory properties to conferring a degree of sun protection and possibly anti-cancer effects. The challenge with topical antioxidants such as vitamin C or green tea extract is that they easily break down when exposed to light and air. They must be stored in low-heat environment in airtight containers and they have short shelf life.


Q. What antioxidants should we look for in our skincare product?



Dr. Sommerville: One of the most extensively studied antioxidants is green tea. It offers benefits with either oral or topical administration. Although green tea is incorporated into numerous skin care products, it is not certain that its concentration is sufficient to achieve meaningful clinical efficacy. Other antioxidants include lipoic acid, vitamin E, and ferulic acid. Exposure to sunlight in even small amounts depletes vitamin C from the skin. Vitamin C is necessary for collagen production. Even high doses of oral supplements do not increase the skin concentration of vitamin C.

Many skincare products incorporate vitamin C, but some of these products quickly break down and oxidize, turning brown when exposed to light and air. To overcome this problem, researchers have stabilized vitamin C and vitamin E preparations with ferulic acid which itself is a potent antioxidant present in the cell walls of grains, fruits and vegetables. Some other major antioxidants include coffee fruit extract, idebenone, and reservatrol.

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