Chapter 142
Keeping Skin Young
Skin is the fastest-growing and largest organ in the human body—about 1.85 square meters in size, it makes up around 10 percent of our body weight. The aging process shows most conspicuously on it. With age, skin becomes thinner and more vulnerable, loses volume and elasticity, can sag, and form wrinkles.
It consists mainly of three components: collagen, hyaluronic acid, and elastin. Collagen, which makes up about 75 percent of skin, makes it firm and taut; hyaluronic acid holds water in the skin and thus provides moisture; and stretchy, elastic fibers that contain elastin make up about one to two percent and pull the skin back into place.
With increasing age, the production of collagen and elastin decreases by about one percent per year, as does skin thickness. As we age, skin renews itself significantly more slowly—rather than every 28 days in youth, only every 40 to 60 days. The skin microbiome also changes, which is why a bacterial swab from the skin can be used to estimate a person’s age to within four years. However, we still do not know enough about these microbes to be able to assess their role in skin aging, which likely is primarily related to oxidative stress. This stress is responsible for age spots, accumulations of oxidized fat and proteins, the so-called age pigments, or lipofuscin (from the Latin lipo and fuscus, “dark fat”).
Nothing New Under the Sun
Only 3 percent of skin aging is based on genetic factors, so-called intrinsic aging, and the rest—extrinsic aging—is determined by our lifestyle, that is, by what we do to our skin. The difference becomes clear when you compare the skin aging process in areas that are usually protected with skin that is exposed to the sun—for example, the skin on the buttocks or the inner upper arm compared with the face and hands. Intrinsically aged skin loses elasticity and develops fine little wrinkles, but otherwise tends to be smooth and flawless and only minimally pigmented. Extrinsically aged skin, by contrast, can become leathery, uneven, blotchy, and full of deep wrinkles and furrows.
80 to 90 percent of facial skin aging in light-skinned people is due to sun exposure. People with darker skin are also affected, but thanks to their built-in melatonin sun protection they are relatively safe. Therefore, dermatologists today agree that protecting the skin from the sun is the most important measure for slowing the signs of skin aging. To illustrate this, the New England Journal of Medicine published the striking image of a trucker whose left side of the face had received more sun for decades through the driver’s-side window than the right side, so that he looked like a Batman villain. You can view that at see.nf/trucker and on many other websites. Through factors such as sun exposure and smoking, people can look eleven years older than they are. On the other hand, thanks to cosmetic surgery, people can look up to eight years younger. Living healthfully could preserve a youthful appearance even better.
You should take care of sun protection for your skin for your entire life. This includes sunscreen, protective clothing, hats, and sunglasses, and not going out into the sun during the peak period between 10 a.m. and 4 p.m., instead seeking shady and covered places. Sunbathing is now frowned upon, even with sunscreens such as zinc oxide or titanium dioxide that provide broad-spectrum protection against UV-A and UV-B rays. It is known that other wavelengths such as near-infrared, which are not covered by sunscreens, also age the skin. Men and women who lie in tanning beds appear significantly older than others, and sun worshippers look years older than they are, similar to smokers.
Something Is in the Air
In addition to sun rays, oxygen in the air, cigarette smoke, car exhaust, and other environmental pollutants also have an oxidizing effect. Smokers develop a distinctive wrinkle pattern on the face, the so-called smoker’s face. This is so striking that pictures of these aging changes can prompt teenagers to quit smoking. Whereas in a control group only one out of 80 teenagers quit smoking, in the other group—whose faces were digitally aged as smokers and as nonsmokers using software—11 out of 80 did. A similar study, in which the harmful effects of UV rays on the face were shown, produced lasting changes in the behavior of sun worshippers.
A link has even been recognized between air pollution and skin aging. There is a significant connection between poor air quality and age spots, wrinkles, and sagging skin. Polycyclic aromatic hydrocarbons (PAHs) are considered the reason for this. These byproducts of combustion adhere to diesel exhaust particles and are also produced when coal is burned, tobacco is smoked, or meat is grilled.
About half of smokers’ PAH exposure comes from cigarettes; the other half they take in through food. In nonsmokers, almost 99 percent of PAH exposure could come from what they eat. Most of these chemicals are found in meat—apparently more in pork than in beef—but even dark-green leafy vegetables can be contaminated through the air. So don’t pick your dandelion right next to the highway, and wash your vegetables under running water.
Because PAHs are fat-soluble, you absorb less of them if you eat a low-fat diet. At least they apparently do not accumulate in the human body. In contrast to environmental toxins such as PCBs, which take 50 to 75 years to disappear from the body if, for example, you have regularly eaten Atlantic farmed salmon, PAHs usually pass through us in a day. After a portion of grilled chicken, these chemicals reach a high spike in the eater’s body—an increase of up to 100-fold. Even so, the body can detoxify from these PAHs within 24 hours. But wouldn’t it be better not to poison yourself in the first place? A recently published dermatology review ended with the summary: “In conclusion, the research findings support the recommendation of a whole-food plant-based diet when patients ask about a diet that will make their skin look younger.”
Medical Skin Treatments
Anti-aging medicine is one of the fastest-growing areas of medicine and is often directed at women who are under pressure to maintain their youthful appearance “by any means available.” 92 percent of all cosmetic procedures are performed on women, usually with Botox, fillers, or laser or chemical peels for skin resurfacing. Every year, millions of people in the United States undergo cosmetic surgery, including hundreds of thousands of facelifts, which in technical language are called rhytidectomies.
Losing Face
At see.nf/faceliftsbotox I describe in detail what is known about facelifts. Basically, no method has been shown to be superior, and all are relatively safe when performed by a board-certified plastic surgeon. In the video I talk about all the complication rates and how important it is not to have expectations that are too high.
Worry Lines
In the same video I also talk about Botox injections, the most common nonsurgical cosmetic treatment. Overall, their side effects are short-lived and go away on their own, but more and more often the injections are being administered by nonmedical personnel, raising concern that there could be more cases of what are actually extremely rare respiratory failure and deaths, in the hours or even weeks after treatment.
Facial Filling
At see.nf/fillers I talk about the second most common cosmetic procedure, injecting soft tissue with fillers, so-called fillers. Undesirable results occur with every 40th treatment, usually bruising, discoloration, swelling, or ugly lumps and bulges. The most serious complication of filler treatment is permanent blindness if the injection needle accidentally injects into an artery. In the video you’ll see more about that and also about similar concerns because more and more filler treatments are being carried out in wellness studios (and not in medical facilities), where illegal, unapproved fillers may be used. There are reports of cases in which all sorts of substances—from rubber cement to tire sealant—have been injected, leading to disfigurement and even death.