35 The Future of Rejuvenation Techniques for Aging Facial Skin

Abstract

In the absence of my trusty but rusty crystal ball, where will the future of skin rejuvenation take us? Just a few short years ago skin rejuvenation seemed limited to lay chemical peels, dermabrasion, "fruit acid" baths, and trauma. Today's landscape is much different.Let's begin with a review of the physiological changes associated with aging and the multitude of genetic and environmental factors that play key roles in the health and appearance of skin. We focus on the ability of skin to manufacture epidermis, collagen, and elastin; its ability to protect itself from sun and other environmental insults; how well its internal antioxidation processes ("rust") work; the degree of ongoing inflammation in the body; and how well our body processes glycogen (sugars). With aging, the outer skin layer (epidermis) thins, even though the number of cell layers remains unchanged. The number of melanocytes decreases, but the remaining melanocytes increase in size. Aging skin thus appears thinner, more pale, and translucent. Lentigines appear in sun-exposed areas. Connective tissue weakens (elastosis), reducing the skin's strength and elasticity and skin that has received an overdose of irradiation is easily identified. Dermal blood vessels become more fragile, leading to bruising and purpura. Sebaceous glands and sweat glands fail, resulting in increased dryness and itchiness. 1 At a cellular level, cell physiology takes complex pathways. Regeneration and senescence have in common with each other a set of signaling mediators called "cytokines," which include proteins, peptides, and glycoproteins. Cytokines can behave in both positive and negative ways. Bone-marrow-derived mesenchymal stem cells decline with advancing age. Research continues on ways to extract positive cytokines from stem cells and hopefully use them in aging therapy. 2 Inflammation continues to play a role in cellular, histological, and organ system aging and the role of anti-inflammatory strategies is a growing topic not only in dermatology but in other medical specialties. 3,4 Therefore, common-sense strategies are directed specifically to preventing, slowing down, and hopefully improving this inevitable process. Young and healthy-looking skin is a feature that is universally admired and considered attractive among humans. People seem obsessed with a youthful and healthy appearance. 5