Introduction
Wrinkles, crows feet, age spots…call them what you like, but if you are bothered by their presence, they are considered unwanted signs of aging. Everyone’s skin is genetically programmed to change as part of the natural aging process. Sun exposure and smoking can intensify and accelerate the process. Fortunately, with advancements in skin care products, lasers, and surgeries, you have options to correct these signs of aging skin achieving younger and healthier looking skin.

Anatomy
Your skin is the largest organ of your body and covers your body to protect it from the harsh environment. Your skin is composed of three layers, the epidermis, dermis, and subcutaneous tissue. The epidermis is the outermost layer of your skin that protects your inner layers of skin. The epidermis is made up of protein containing cells called keratinocytes. The keratinocytes form at the bottom layer of the epidermis and move upward to the outer layer of the skin. They eventually wear off and are replaced by the next layer of cells. This layer contains dying or dead skin cells. As your skin ages, the superficial layer becomes thicker with dead cells yielding a more leathery appearance to the skin.

The dermis is your second layer of skin. It is made up of connective tissue and provides structure. It is composed of collagen and various elements that give your skin strength and elasticity. The dermis contains hair cells, sweat glands, and sebaceous glands that secrete oils to hydrate the skin.

Subcutaneous tissue composes your inner most layer of skin. Subcutaneous tissue contains fat cells. The fat cells insulate your body and make your skin appear plump or full. Below the subcutaneous tissue are fat tissues that cover your muscles and bones.

Causes
Your skin, like the rest of your body, naturally ages over time. The rate and degree of skin aging depends on both intrinsic and extrinsic factors. Intrinsic factors are controlled by hormone levels, nutrients, as well as, the genes that you inherited which control the natural aging process. For example, as you grow older, the skin begins to lose supportive collagen, fat, and elasticity, all which contribute to fine lines and wrinkles. With age, new skin cells are created at a slower rate, and dead cells do not shed as quickly, leading to rough, dry skin.

Extrinsic factors are contributing conditions outside of your genetics that intensify the aging process. The greatest extrinsic factor is sun exposure. Other extrinsic factors include smoking, facial expressions, and the position of your face on your pillow while you sleep.

Symptoms
Wrinkles can range from fine lines to deep grooves. Skin may sag or droop causing jowls and heavy eyelids. Hair loss or unwanted hair may develop over time. Your skin’s texture may change. Your skin may become dry and rough. You may have “age spots,” transparent skin, red capillaries, and skin lesions.

You should receive yearly mole and skin checks for skin cancer as a precaution as you age.

Diagnosis
Your doctor can evaluate your skin integrity by reviewing your medical history and carefully examining your skin. UV photography may be used to show the amount of aging below the skin’s surface.

Treatment
There are a variety of treatments to help improve the appearance of aging skin. Prescription lotions and creams may help fade skin spots, build up collagen or stimulate its production to help smooth out wrinkles, and correct or reverse the sun damaged skin. Facial lines and wrinkles can be plumped up with injectable fillers made out of collagen or fat. BOTOX® is an injectable medication that is used to relax the muscle movements that contribute to wrinkles. There are a variety of cosmetic laser treatments for skin rejuvenation, vanishing spots and veins, and hair removal. Liposuction can remove unwanted fat from localized areas such as the chin or other areas on the body. There are many surgeries to “lift” the appearance of sagging skin on the face, such as facelifts or eyelifts. Further, you may combine procedures to enhance your results for younger more youthful looking skin.

Am I at Risk
The following may contribute to the appearance of aging skin:

• Increasing age
• Sun (even on a cloudy day) or artificial tanning light exposure
• Cigarette smoking
• Vitamin or nutritional deficiency
• Exaggerated facial expressions
• Gravity