Looking for anti-aging skincare tips by a dermatologist? The science behind anti-aging actually shows that well-aging is a more accurate term. Do aesthetic treatments truly lead to anti-aging? Singapore dermatologist Dr. Teo Wan Lin, published a key opinion piece in the International journal of Dermatology, “On Thoughts Emotions Facial Expressions and Aging”, with her research on the brain skin connection.
The journey of aging is a whole body experience and not isolated to external organs like the skin. Phenomena like inflammaging, cell senescence are key to understanding what happens in aging body cells. Way before we see physical changes in the skin for example, cell damage has been occurring for years. Is there a way for skin anti-aging by targeting these processes?
The following is an excerpt from Edible Beauty: Dermatologist Guide to An Anti-Aging Diet by dermatologist Dr. Teo Wan Lin. It delves into key scientific research that helps us understand the relevance of anti-aging skincare tips from the inside out – well aging.
What Is The Skin Exposome Concept in Anti-Aging?
How Lifestyle Factors affect Skin Anti-Aging
I’m sure you would have heard of how photodamage affects the aging processes of skin. What about other lifestyle factors? Being in a modern society that is fast-paced, leading a hectic lifestyle is something that all of us accept – we take it for granted that it is the way it should be. Nevertheless, being busy does not always correlate with being stressed. That, at the end of the day, is what we are concerned about when we talk about the skin aging exposome.
Lifestyle factors such as stress and lack of sleep, which leads to disruption of the circadian rhythm, can cause your body cells to enter into cell senescence much quicker than what it would have been without these factors. Environmental pollution has also been proven in studies to change the skin microbiome signature. This means that there is a difference in the type of bacteria and microorganism that lives on your skin, depending on what sort of pollutants you’re exposed to in your urban environment.
Dermatologist Anti-aging Skincare Tip #1: Get enough sleep and also sleep at the right time! This means following sundown and sunrise patterns, which is how our bodies are coded to release hormones.
The Circadian Rhythm
One may say that having 8 hours of sleep is a luxury, but from a medical point of view, it is a necessity. Our body is designed to go through periods of activity and rest, and all that is pulsed according to the secretion of our endocrine hormones, and regulated by the hypothalamic-pituitary axis (HPA). Disruptions in the HPA axis have been shown to directly impact the process of inflammaging. The concept of inflammaging is first examined in our research of other organ cells, and it is described as a chronic or baseline degenerative state which promotes inflammation.
Inflammaging & Cell Immunosenescence
Application of botanical-based cosmeceuticals helps in the rejuvenation of the skin as its antioxidant effects can counteract free radical formation. Free radical formation is the result of environmental assaults in addition to our inability to repair damaged DNA as we grow older.
It is important to understand that nutraceuticals are based on sound science that addresses the heart of anti-aging – immunosenescence. The concept of senescence is best understood as a gradual falling asleep of your cells. Our body is able to maintain optimal functions with regard to the skin, which is often a marker of what is happening inside the body.
For example, it can be the function of the immune cells which are declining as you grow older. That is the reason for developing pigmentation, reduced skin immunity, and subsequently, the development of skin cancers which is directly proportional to advancing age. Nevertheless, beyond that, it is important that we also appreciate the cumulative systemic decline of our body functions and organs due to inflammaging, which will undoubtedly affect the health and consequently, the appearance of our skin.
Dermatologist Anti-aging Skincare Tip #2 : Aging truly occurs from the inside out. The brain skin connection is a clear example of how stress and your mood directly affects your physical appearance. Beyond that, lifestyle factors such as diet and exercise affect a process known as inflammaging.
Let’s Define Aging According to Science
What is cellular senescence?
It is a complex stress response that leaves cells incapable of cell division. Senescent cells increase with age in the skin, and can alter tissue homeostasis and promote age-related diseases. The inability of senescent cells to regenerate can lead to impaired wound healing, causing prolonged or permanent tissue damage with age.
Is cellular senescence beneficial or detrimental for our skin?
Cellular senescence can be both beneficial and detrimental during skin aging and wound healing, and contrasting cell autonomous and non-cell autonomous effects of senescent cells can depend on the physiological context. On the one hand, senescent cells can accelerate aging phenotypes through the loss of tissue homeostasis by promoting chronic inflammation, persistent degradation of the extracellular matrix, and stem cell exhaustion. On the other hand, senescent cells can also have essential roles during wound healing by limiting excessive proliferation and fibrosis and promoting the formation of granulation tissue.
What is the current evidence behind interventions for cellular senescence?
Injectables such as botox and fillers do not prevent cellular senescence. Toxins work via temporarily paralyzing or relaxing the facial musclesso that lines associated with facial expressions can be smoothed out with “disuse”. Fillers restore facial volume loss due to age-related subcutaneous fat atrophy. Most fillers are hyaluronic acid-based formulas that are completely reabsorbed into tissues after 6 months, necessitating a “refill”.
Lifestyle interventions described in this book such as the incorporation of a nutraceutical diet are evidence-based in targeting the cellular senescence pathway in the aging process. Not only does this improve the health of the skin, but of the entire body’s functions and leads to greater psychosocial wellness as well.
Dermatologist Anti-aging Skincare Tip #3: Aesthetic treatments may be marketed as the holy grail of looking good. However the science of aging tells us otherwise. Aesthetic treatments can accompany a whole well aging lifestyle. Also understand how aesthetic treatments work so you can choose wisely.
The Conundrum of Aesthetic Treatments in Anti-Aging
No, aesthetic treatments do not truly bring about ‘anti-aging’
In cosmetic dermatology, so much focus has been on aesthetic interventions like fillers, toxins, lasers and peels, all of which I also offer in my practice. But beyond that, I think it is very important to address the fact that to the trained eye, and to somebody who is in the medical field, there are two important aspects to consider when we are performing a cosmetic dermatology treatment.
The first is that you are correcting what has already happened. For example, in the case of reversing wrinkles, you are injecting a toxin to relax the muscles, hence, you are not able to use the muscles for some time. Muscles will atrophy in the same way disuse of your body muscles will lead to it shrinking, which consequently, will translate out to smoothing out of forehead wrinkles. However, this does not address the root of the wrinkle formation itself – muscle overactivity that comes with advancing age, and the inability of the dermis to produce sufficient collagen and elastin to minimize the surface wrinkles.
We are always able to animate our faces from the time we are a child until we are old. The difference is, when we are children, we do not have wrinkles on our faces because we have a plump dermis. The structure of the skin helps to retain a certain smoothness and contour to hide the muscle activity. However, with age, you get thinning of the dermis and epidermis, and that is when you start to see superficial and deeper wrinkles.
The second aspect of cosmetic dermatology interventions is that it is possible to see the effects of these external interventions. For example, it is not difficult for a trained eye to pick up if somebody has had fillers. Is it possible that fillers or toxins are injected in an almost imperceptible way? Yes, but a lot of what is being performed, especially in the field of aesthetic treatments, are performed by non-dermatologists. These treatments are typically interventions around the nose and lip area, and are meant to create a dramatic improvement or change the appearance of one’s skin.
Further considerations in a post-COVID world
When the Moderna COVID-19 vaccine was rolled out in December 2020, it was reported to have caused swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine stated this very specific side effect which has involved several trial participants who have had cosmetic facial fillers.
Aesthetic treatments like dermal fillers fall under the category of injectables and are used primarily for facial augmentation. Filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications.
The ideal facial filler should have the following properties. First of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, will not degrade with time. The commonest type of facial filler used in most cosmetic practices is hyaluronic acid-based. These fillers are fully reabsorbed into the tissues after 6 months and the cosmetic effects are lost.
Fillers and vaccines
Some of the known side effects from using these facial fillers as injectables would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected. Now, what is happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, is best thought of as an allergic reaction, or an immunological reaction.
The process of injecting a vaccine essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler is not a part of the body tissues, and the body starts to mount an immunological reaction against it.
Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids and antihistamines, in which it was observed that their reaction resolved.
Typically it is considered a medical event due to an immune system response to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is that facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances were injected, and are actually not part of your body tissues.
Dermatologist Anti-aging Skincare Tip #4: Fillers are not for everyone. Aging is not a one-faceted process of loss of volume. Also consider that what your physician thinks you should improve on is not necessarily what you may think as well. You could very well have a different opinion a few months or few years later. The trend of dissolving fillers last year was an example of how an aesthetic treatment designed to deliver a certain “look” went out of trend. Do you want your face to be a victim of trends?
Dermatologist Anti-aging Skincare Tip #5: There are alternatives to well aging that can also be delivered via topical modalities. These can be complementary to a well aging routine.
Alternatives to injectables to correct aged skin
The human facial structure is a composite of skin that is composed of: the epidermis, dermis subcutaneous fat, the SMAS layer and the muscle. Aging affects all these structures dynamically. Fillers only address one part of the aging equation – the restoration of volume. In order to restore facial structure and facial sagging, consider other technologies such as radiofrequency and high intensity focused ultrasound (HIFU) which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.
Other alternatives to injectables include advances in our understanding of textile cosmeceuticals in the form of polysaccharides, polymers and nanoparticle materials. These cosmeceuticals can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.
Dermatologist Anti-aging Skincare Tip #6 : Never trust another person’s version of how you should and can look better. Focus on skin health and research how a holistic lifestyle intervention can help reduce the impact of cell damage in aging.
The Ethical Conundrum
Fundamentally, I think we do need to approach the ethical basis of such treatments. Not to say that it is wrong, but as dermatologists, we are first of all medical specialists in skin health. I feel that the public is ready to hear what we have to say about aging and skin health advocacy, and it is important for us to communicate the right kind of information about aging as well. In a post-COVID era, the fundamental concern should really shift to holistic interventions (proactively recommended by the physician) in anti-aging, beyond simply anti-aging skincare, that will also improve one’s overall health.
I do have many patients in fact, who are on these treatments regularly. What I want to emphasize in this book is what I always tell my patients as well – you can perform all these interventions, but if you are not healthy, if you are not changing your lifestyle, none of these will be sustainable – and it is going to show.
There is a visible outcome difference between an individual who does all these external treatments without lifestyle modifications, expecting a head to toe makeover with ‘zero effort’ vs an individual who is committed to leading a disciplined lifestyle.
Dermatologist Anti-aging Skincare Tip #7: Beauty is not a commodity. However, choosing your health over all is a good way to distinguish between what works and what doesn’t in well aging. Start your well aging journey with what matters most. Your lifestyle.
The Truth about Anti-Aging Skincare
The age-old adage of a healthy lifestyle is understated, likely because there are no marketing dollars attached to it, but the science today bears it out.
It’s been widely spoken about for a long time that we should all eat healthily and exercise. The public needs to understand that it is not just about looking trim and not being obese, but it’s really important for the health of our organs. Let’s not forget about our innate vanity – all of us want to look good, and we want to age gracefully. The key to understanding the aging process and what we can do from the perspective of skin aging, is to pay attention to where new anti-aging interventions in dermatology and healthcare will take us.
Why your anti-aging diet is so much more relevant than supplements
@drteowanlin Your Beauty Lifestyle Guide: Inside the Edible Beauty Kitchen with Dr.TWL #healthydiet #antiaging #dermatologist ♬ original sound – Dr. Teo Wan Lin
While it is rare for individuals living in developed countries to have overt nutritional deficiencies, it is equally relevant for us to base our recommendations on current evidence from animal and clinical models in inflammaging.
What the science tells us about anti-aging
Specific cell studies show that molecular pathways such as telomerase pathways and insulin growth factor signalling processes are involved in the inflammaging process.
Free radical generation is a result of environmental assaults, which can be in the form of UV radiation, environmental pollution, lack of sleep, psychological stress. All these will affect our body’s ability to repair DNA. In early stages, that will translate into signs of skin aging – increased pigmentation, wrinkles, loss of elasticity, radiance. In late stages, a condition known as chronic actinic dermatitis is diagnosed – an advanced form of photoaging which predisposes one to a higher risk of skin cancer.
In this next chapter, I will go on to a specific, evidence-based nutraceutical diet for anti-aging holistically (beyond simply anti-aging skincare), the science behind the bioactive ingredients in the plant and fungi kingdom, and why I advocate dietary modification as opposed to taking oral supplements.Tags: ~All Topics, Anti-Ageing, Dermatology, Skincare