Skin ageing is a complex biological process influenced by a combination of internal (intrinsic) and external (extrinsic) factors. Natural ageing is inevitable, however, premature ageing – which is usually caused by extrinsic factors – is not. While ageing signs of internal organs cannot be seen, the skin’s outward expression provides the first obvious marks of the passing of time: if life is about change, skin is proof of that change. The fact remains that good, healthy-looking skin, and beauty, is
still considered one of the principle factors representing overall perception of well-being in people. Therefore, in order to best treat, reverse and prevent further premature ageing, a therapist must be fully aware of the multi-faceted processes that occur in skin as we age. 

In this article we highlight some lesser known yet vitally important changes that therapists should be aware of, and the best in-clinic and home-care approaches for the safe and effective treatment of ageing skin. 

Increase in pH 
The healthy pH of the skin is somewhere between 4.1 and 4.8 – much lower than once thought. Indeed, the average pH is approximately 4.7, with men’s skin being more acidic. 

The acid mantle plays a crucial role in: 

  • Skin integrity and cohesion – working with skin’s own natural building blocks such ceramides, cholesterol, enzymes and sweat etc., to enable epidermal barrier homeostasis.
  • Immune function – normal, healthy skin is able to resist acidic/alkaline aggression to some extent (buffering capacity). Furthermore, an acidic pH restricts colonisation of pathogenic flora while promoting growth of healthy flora, and thus preventing dermal infections and disease. 

As the skin ages however, its pH increases, resulting in an impaired barrier, poor skin cohesion, defective lipid processing, reduced resistance to pathogens, increased sensitivity to treatments and products, increased likelihood of inflammation and disease, and reduced response and repair to injury. These pH changes occur between 50 and 80 years of age. 

Solution 

• Ensure that your client is using pH balanced cleansers and skincare products. 

• Ensure your client is not repeatedly disrupting their skin’s pH by use of highly alkaline or highly acidic products that progressively damage skin. 

• Use of acids in treatments – (if indicated) we recommend monthly facials with the addition of an acidic exfoliator and low pH products. 

• Home care – (if indicated) weekly at-home acid peel and regular use of a low pH product such as an acidic based serum/ cream. This can be used two to three times per week. 

• Look also for ingredients that support the acid mantle’s healthy flora such as probiotic lactobacillus. 

TIP: We recommend glycolic acid (GA) as it is the most multifunctional acid and also the safest across the Fitzpatrick scale. Glycolic acid also has a brightening effect on pigmentation. Pigmentation changes are common in aged skin and presents as photo-damage, sun/age spots, melasma, and post-inflammatory hyperpigmentation. GA also boosts elastin and collagen biosynthesis for skin regeneration and repair. Therefore it is effective on fine lines, wrinkles and scarring. Last but not least, GA increases dermal and epidermal hyaluronic acid and therefore acts to increase moisture content; as skin ages there are also changes to water content. 

Changes in water content 
People are not plants, therefore drinking more water does not hydrate skin. Trans epidermal water loss (TEWL) occurs for many reasons, and which need to be established in order to best treat dehydrated skin. Contrary to belief, the total hyaluronic acid (HA) level in the dermis of ageing skin remains stable. However, epidermal HA diminishes markedly. 

The major age-related change is the increasing lack of bonding of HA to water: in young skin most of the water is bound to HA and other proteins (‘bound water’). In older
skin however, most of the water is bound to itself, known as tetrahedron or ‘bulk water’. As a result, collagen and elastin become harder and stiffer, and together they can obstruct the passage of nutrients and waste between cells. Therefore, this lack of interaction between water and surrounding molecules may explain that although water content in older skin remains stable, it is often dry, withered and of poor quality. 

Solution
Identify the difference between dehydrated and lipid deficient skin. Identify any extrinsic reasons for TEWL/dehydration, such as products, treatments, lifestyle, work/home environment, climate etc. By identifying the cause you can help prevent further TEWL.

Look for advanced water-binding ingredients that help build and preserve tissue
hydration such as intelligent high weight/low weight HA, minerals (magnesium, calcium, potassium etc), Venuceane, chondrus, crispus, Pentavitin, Aquaderm, amino acids etc.

Look for polypeptides that help the skin build its own water reserves and promote barrier repair and cell adhesion for prevention of TEWL/dehydration such as: Collaxyl (Hexapeptide-9), Fibronectin Biomimetic Peptide, Oligopeptide 24, etc.

Hormonal dryness
Many of the symptoms we see in the ageing of skin and body are directly attributed to a decrease in hormones. The main hormonal deficit in women is menopause, which causes a decrease in oestrogen and androgen products. Although women produce only one tenth the amount of androgen that men do, testosterone and related androgen metabolites are as important to women throughout their lifespan, as is oestrogen. Reduction in oestrogen and androgen production results in;

• a decrease in sebum production
• a decrease in the skin’s ability to retain moisture
thus leaving the skin prone to lipid dryness, dehydration/TEWL and itchiness.

Solution
Use of an occlusive lipid-rich product nightly as the last product over serums and moisturisers. The fatty/occlusive product will lock in moisture while allowing the skin to repair itself overnight.

Look for ingredients that have hormone like effects (HRT) to ease the symptoms of hormonal reduction, such as DHEA, melatonin, black cohosh, soya, etc.

Look for ingredients that target epidermal lipid synthesis, optimise lipid homeostasis, and correct dryness and itchiness such as: lipigenine (flaxseed extract), essential fatty acids (EFAs), seabuckthorn (highly recommended due to its EFA makeup – Omega 3, 6, 9 & 7 ), ceramides, squalene, shea butter, etc.

A-grade tip
For all clients over 40, use of well-formulated and stable vitamin A (retinol, retinaldehyde, etc.) cream (if indicated) is a necessary, three nights per week. Vitamin A is still a gold-standard in anti-ageing because it acts as a highly effective cell- communicator and thus theoretically tells skin cells how to look, act and behave like younger and healthier skin cells would.

Conclusions
The motivation of any skin anti-ageing therapy is to achieve a healthy, smooth, blemish-free, and resilient skin. That is why it is so important to understand all factors that cause skin ageing. We are well aware that approximately 75 per cent of premature ageing is due to UV damage and other environmental causes. However, when we are dealing with ageing and menopausal skin, we need to also look at intrinsic factors such as pH and hormonal changes that cause external structural changes.
While natural ageing is genetically determined, extrinsic ageing can be prevented. Aesthetic treatments and home care should contribute to ‘healthy skin ageing,’ not only by trying to erase time vestiges in skin, but by also playing a significant part in prevention, regeneration, and delaying of skin ageing.
Last but not least, the desired therapeutic anti-ageing effect of the skin is a continuous, step-by step process that must also explore inner health as well as skin health in order to achieve long-lasting and positive changes.

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