Maintaining or recovering a youthful appearance is driven by the desire for healthy, great-looking skin—regardless of age. However, in Houston’s sun bathed climate, few of us can avoid the damaging affects of the sun. In my practice it is very rare that I see someone who comes in for skin care by the age of 30, who has firm, plump, youthful skin. The few people that actually have this skin have avoided the sun all their lives.

This is very difficult to do in Houston.

Sun exposure is the primary environmental stressor leading to damaged skin. The damage to skin components caused by both prolonged and incidental sun exposure is called photoaging. Although cigarette smoke, exposure to harsh weather conditions, and pollution are prolific contributors to environmental aging, UV damage from the sun's rays accounts for 90 percent of premature skin aging. Photoaging damages collagen, elastin, melanocytes, and the moisture barrier, resulting in wrinkles, sagging, uneven skin tone, dark spots, and a rough, dry skin texture.

Sun damages is measured in the Glogau Scale of levels I to IV. Let's put it this way, only babies and small children with none to little protected sun exposure are a level I. From adolescence into the early twenties we can consider ourselves a level II if we aren't sun worshippers. This is characterized by fine lines appearing when you squint. Sun worshippers will be a level III by their early 30's and a IV in their early 40's. This is due to the accelerator factor that sun damage causes. A level III has one or two lines at rest shows several deeper lines to form in the crow's feet area when squinting the eyes and it usually takes about a 1/2 second for the skin to snap back when pinched. Level IV has permanent deeper lines at rest and the skin doesn't snap back from the pinch test...it slowly returns in one or two seconds.

As UV rays directly penetrate the epidermis, they damage basal cells, and slow the rate of cell division which slows cellular turnover. Finally, failure to exfoliate the surface of the skin with physical or chemical exfoliates for the purpose of smoothing the skin and stimulating cell renewal contributes to the decline in renewal. The use of retinols can help to repair this damage and increase cellular turnover. It is directly responsible for removing damaged skin cells and helping the body to reestablish healthy layers of skin.

The most common visible signs of aging are fine lines and deep wrinkles in the skin that occurs in photoaged skin. The structural protein called collagen, which is found in the dermis, provides a mesh-like framework of support and strength for the skin. As sun damaged skin is weakened, aging is accelerated as collagen production decreases and collagen fibers degrade at a faster rate than in earlier years. When sun damaged cells are present, this degradation happens at a faster rate. The normal aging process loses 1% of the framework per year after the age of 30. Sun damaged skin loses this framework at 2% per year. This results in an accelerated overall decrease in the amount of collagen in the dermis. Areas with less support begin to cave in and wrinkles begin to form.

To add to the normal aging process, UV exposure accelerates the enzyme collagenase which breaks collagen down. Another factor contributing to decreased collagen levels is free radicals from UV exposure. These can damage collagen strands and stimulate collagenase activity, which leads to the formation of irregular collagen linkages that weaken the skin. In order to avoid UV damage to collagen fibers and fibroblasts, application of a consistent daily broad spectrum sunscreen is necessary.

Resurfacing the skin with chemical peels or laser is the most effective treatment is reversing sun damage skin conditions. It removes the damaged cells and stimulates the body's own repair mechanism to heal the skin. This healing process stimulates the cells to produce new collagen. This healthy collagen will lessen wrinkles and produce a more even skin tone.

The following are factors that decrease collagen levels in the skin:

• UV rays can penetrate the skin and cause damage to collagen-producing fibroblast cells.

• Mechanical stress on the skin caused by repeated wrinkle causing behaviors can also break down collagen.

• With age, the synthesis of glycosaminoglycans (GAGs) (hyaluronic acid) decreases, affecting moisture levels in the dermis; this allows collagen to become brittle and prone to breakage.

• Poor nutrition

Enlarged pores are also a sign of aging skin. To a large degree, pore size is determined by genetics; however, as we age, our pores tend to appear larger. The pore's enlarged appearance is due to a buildup of dead cells around the pore. As more collagen breaks down and production slows, the supportive structures surrounding cells decrease and cells can appear stretched.  This type of condition needs serious therapy.  A face lift won’t make even one change in your skin quality.  Deeper resurfacing treatments such as TCA or laser treatments can cause the skin to lay a new collagen bed to refine pores and lessen wrinkles.  At this level, you may want to start hormone therapy and nutrient supplements to support this treatment to a more desirable outcome.

Age spots are the last evidence of aging on damaged skin.  Normal skin pigmentation helps protect healthy skin from the stress of mild UV exposure. Melanin, the skin's photoprotective pigment, is produced in specialized melanocyte cells in the lowest layer of the epidermis (stratum basale). As we age, melanocyte activity decreases, making the skin more susceptible to UV damage. With age, melanocytes also tend to cluster together. This results in patches of pigmentation called age spots.

Many factors contribute to the production of age spots. First, hormone imbalances that occur with advanced age result in fewer melanocytes and can also trigger excessive melanin production. Second, UV light rays stimulate melanocytes to produce skin pigment. UV light can also penetrate the skin and damage melanocyte DNA, which can stimulate melanocytes to enlarge and cluster together. Third, as the cell renewal cycle decreases, wounds heal more slowly and the skin thins, becoming more susceptible to environmental damage. This can lead to damaged melanocytes and abnormal  pigmentation. This can lead to cancerous cells being formed.

Prevent Premature Skin Aging with Proper Skin Care

The majority of premature, avoidable skin aging is caused by UV radiation; thus, it is absolutely essential to use a daytime moisturizer with sunscreen. Even if you aren't in the sun for extended periods, effects of incidental sun exposure accumulate and show up on the skin.

Fortunately, you can turn back the clock on your skin. Even if you did not properly care for your skin in years past, there are many technologically advanced ingredients and exceptional botanicals that help repair sun damage and reverse some of the effects of both biological and mechanical aging. Because youthful, healthy skin portrays confidence and beauty, we are all concerned with what we assume is inevitable skin aging. The good news is that we have more control than we realize over the rate at which our skin ages. Maintaining youthful skin starts with good skin care. Using products specifically formulated for your skin type is the first step to preventing unnecessary skin damage.