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About Face

How Skin Ages

Chapter Two Aging Skin Factors That Age the Skin How Skin Ages Hollowing Sagging Wrinkling Vitamin A Acid Cream Nonsurgical Face-lifts Injection Treatments Peels

It helps to know a bit about how skin is constructed to understand how it ages. When I work with skin on the operating table, it reminds me of handling pie pastry, because of its texture and the way you have to lift and maneuver it. But my metaphor wouldn’t produce a particularly good pie because skin is astoundingly tough. People think of skin as a thin, delicate sheath, but that is true of only a few places, like the upper and lower eyelids. Also, skin is slightly stretchable in some other places, like the cheeks and jowls. Young interns are always surprised at how vigorously we are able to work underneath the skin during a Liposuction without fear of tearing.

Skin is composed of a fine upper layer called the epidermis, and a thicker layer underneath called the dermis. (On tope of the epidermis is a layer of dead cells called the stratum corneum, or keratin.) The thickness of the dermis varies with each individual, and also varies according to its location on the body. For example, eyelid dermis is much thinner than dermis elsewhere. The dermis, together with a subcutaneous layer of tissue below, houses essential features like sebaceous tissue, including glands that secrete oil for lubricating hair and skin, hair follicles, sweat glands, fatty tissue and proteins like elastic and collagen. Collagen gives strength to the skin.

Skin, combined with its subcutaneous layer, is the protective slip between our internal organs....and the big, wide world. Fred Allen, the American editor and historian, once said about skin, the body’s largest and often least-appreciated organ: “To a newspaperman, a human being is an item with the skin wrapped around it.” He wasn’t far wrong.

When young, the skin is smooth, moist-looking and shiny, with a kind of brilliant sheen. The “glow” , or sheen, is due to another kind of protein which is smooth and regular, called keratin, atop the epidermis. As it ages, this layer of keratin becomes irregular, and, depending on the factors such as heredity and exposure to sun that I’ve outlined above, the skin will appear dry, less shiny and even scaly.

The aging process also thins the dermas layer of skin more than the epidermis, beginning at about age thirty-five in women and age forty-five in men. (The thinner the skin, the earlier it wrinkles, which is why wrinkling often begins with the eyelids.) Postmenopausally in women, and at about age fifty-five in men, the sebaceous, oil-producing glands in the dermis and subcutaneous layers begin to atrophy, or waste away. And finally, the dermis begins to lose structural support as proteins like collagen and elastin begin to change form and atrophy.

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