“Early” aesthetic cosmetology techniques to combat aging facial skin

What are the reasons

In addition to general biological factors - the natural processes of aging of the body, external causes also have an influence:

• ultraviolet irradiation for intense tanning;
• prolonged smoking;
• pathologies of internal organs;
• insufficient skin care.

The harmful effects of smoking are especially noticeable in women

4.Treatment of skin problems

Treatment of skin problems depends primarily on what caused them: diseases of internal organs, allergies or other natural physiological processes. The desired result is also important. For example, flat moles are harmless to human health, but depending on the location, they can cause psychological discomfort and be a kind of cosmetic defect. In this case, they can be removed surgically, with a laser or using nitrogen.

A completely different matter is bleeding growths and other neoplasms on the skin, which increase in size over time and bother a person. If they are detected, it is very important to immediately consult a doctor - a dermatologist or oncologist. Specialists will examine your skin and prescribe the necessary procedures, including removal of lesions. A skin analysis is needed to determine the likelihood of developing oncology, including skin cancer.

The main signs of age-related skin changes

With age, the skin experiences a lack of moisture - this is where all the problems arise. Its strength and elasticity decrease, it loses density and elasticity, and the sweat and sebaceous glands work worse.

Outwardly, this manifests itself in different ways, but there are similar signs:

• the color changes to pale gray or yellowish due to thinning of the epidermis and narrowing of the lumen of blood vessels;
• folds and wrinkles appear on the skin as a result of dryness;
• the skin peels for no apparent reason;
• Defects and neoplasms appear more often, as the skin becomes less durable;
• noticeable pigmentation - spots, chloasma, angiomas, rosacea;
• the volume of hair growth increases - hirsutism and hypertrichosis;
• in open areas, tortuous and dilated capillaries are visible - telangiectasia;
• Seborrheic warts and papillomas appear.

With age, more and more benign neoplasms appear on the skin

Muscular

The muscular or muscular type is uncommon. Sometimes it seems that time has no power over such women - they do not change for decades. However, then the years take their toll, and representatives of this morphotype age sharply. In this case, deep, pronounced wrinkles become the main sign of age. With age, the face becomes rougher, less feminine and pretty.

Distinctive features are pigmentation, drooping corners of the lips, pronounced nasolabial folds. There is no deformation, the tissues do not droop, fine wrinkles are usually absent, but there are deep, clear creases in the skin. In general, the face seems tough, hard, it resembles a man’s - and this is not surprising, because the muscular morphotype is characteristic of the stronger sex. Such signs of age even decorate them - their faces become more expressive and courageous. Ladies are not at all happy with this effect.

Most often, representatives of the Mongoloid race of normal and fragile physique age this way. This type is characterized by developed facial muscles, thick skin and a very thin layer of subcutaneous fat.

Examples of famous women with muscular aging: Demi Moore, Cindy Crawford, Brooke Shields, Sandra Bullock, Lucy Liu, Yoko Ono.

What procedures are recommended? In this case, signs of age are often difficult to correct. A careful approach is needed, since the reaction to many procedures, such as peels or laser resurfacing, can be unpredictable. To combat pigmentation, biorevitalization is recommended. Peels are used with caution, after a sensitivity test. Mesotherapy and plasma lifting provide a certain effect, and hardware procedures, such as photorejuvenation and laser, are allowed if indicated. To eliminate facial wrinkles, muscle relaxants are recommended. Under the influence of botulinum toxin, muscles relax, skin wrinkles straighten out, and the face looks softer and more feminine. It is advisable to make injections when the first facial wrinkles appear, without waiting for deep folds to appear.

What procedures are useless or even harmful in this case? The muscular type is characterized by pronounced nasolabial folds. It is not recommended to fill them with fillers to even out the relief - in this case, the face will become flat and expressionless. Filling the nasolacrimal trough is also not recommended - this will make the face puffy. In general, contour plastic surgery is not recommended.

Thread reinforcement is used only when indicated and very carefully.

How to care for your skin? Since one of the main problems faced by representatives of this morphotype is pigmentation, it is important to protect your face from the sun and regularly use whitening creams and serums that even out skin tone. Creams with retinol and vitamin C have proven themselves well. Almost all Korean and Japanese brands specialize in producing cosmetics for women with muscular aging, so it’s worth paying attention to the products of well-known Asian brands.

Women with a muscular morphotype often rely on good genetics and delay visiting a cosmetologist. This is wrong, because it is easier to prevent the appearance of wrinkles on the skin than to get rid of those that have already appeared.

What causes age-related changes in the skin on the face in women?

The beautiful half of humanity suffers over the years for the following reasons:

• During perimenopause, the amount of collagen decreases. Because of this, the fat layer decreases - the skin loses its elasticity and “deflates”.
• Due to collagen deficiency and hormonal changes, skin elasticity decreases. It sags in the neck, chin and cheeks, and lines and wrinkles appear in the forehead and above the lip.
• Expression wrinkles become more pronounced - the corners of the lips droop, the face takes on a tired expression.
• The same hormonal disorders lead to age-related pigmentation on the face, arms and chest.

finely wrinkled

They say about such women that they age gracefully and gracefully. Detractors may compare the face to a baked apple. From a distance (or after processing in a photo editor), the face looks young, but if you get closer, the illusion disappears. This morphotype is characterized by dry skin and an abundance of fine wrinkles. At the same time, facial features are practically not transformed; changes affect only the skin, but not the subcutaneous fat layer or muscles.

Examples of this morphotype are Maya Plisetskaya, Jane Fonda, Helen Mirren, Jane Seymour, Sharon Stone.

Most often, this type of aging occurs in thin, narrow-boned women with dry, thin skin and an oval or elongated face shape. The facial features are medium-sized, the cheekbones are usually pronounced, and the lips are thin. The morphotype is typical for natives of Western and Northern Europe. In their youth, they look very attractive, but after 25 years, “crow’s feet” and purse-string wrinkles around the lips appear, and over time, the skin on the face, neck and body begins to look like crumpled parchment.

What procedures are recommended for prevention and rejuvenation? In youth, mesotherapy is effective as prevention. In the future, biorevitalization is indicated - a course of procedures literally transforms representatives of this type. Over-dried skin responds exceptionally well to injections of hyaluronic acid, is saturated with moisture, and smoothes out. A noticeable effect appears immediately and increases from one biorevitalization session to another. Plasmolifting also works well - intradermal injections of one’s own blood plasma.

According to indications, mesothreads can be used to stimulate collagen production. Botulinum toxin injections will help in the fight against expression wrinkles. If necessary, contour plastic surgery is allowed.

What procedures will be useless or even harmful for owners of wrinkled skin? You should avoid any influences with a drying effect - they will only aggravate the existing problems. Laser resurfacing is not suitable for sensitive, thin skin. Peels need to be selected very carefully: only the most delicate ones are suitable - based on lactic acid or with a biorevitalization effect. Harsher peelings that cause peeling of the skin will only cause harm.

How to take care of your skin yourself? It is very important to protect your face from the sun so that photodamage to the skin is not added to the signs of chronoaging. Since the skin is highly sensitive, you should also use products with antioxidants and protect your face from temperature changes.

You need to constantly moisturize your skin. It is advisable to choose cosmetics with ceramides, antioxidants, sodium hyaluronate and oils. And, of course, you need to give up smoking: this habit further worsens the condition of the skin and is especially harmful for representatives of this morphotype.

When caring for your face, don’t forget about your neck and décolleté: in women with fine-wrinkled aging, these areas often reveal their true age.

What is senile skin pigmentation?

Pigmentation, caused by a restructuring of the hormonal system in the body, usually does not look aesthetically pleasing and does not decorate a woman at all. The amount of melamine in the skin changes due to age-related changes, lack of vitamins and amino acids, and endocrine diseases. Most often, older people suffer from the following formations:

• Chloasma

Spots from yellow-brown to dark brown shades are localized on the forehead, temples, cheeks, and surfaces of the eyelids. Small formations merge into large ones, forming a clearly visible cosmetic defect.

• Lentigo

Specks of different colors from yellow to black are called “liver spots.” They appear in areas most exposed to ultraviolet radiation - on the hands, face, décolleté, and upper back.

• Vitiligo

These white, flat formations are called “reverse pigmentation.” They stand out sharply against dark skin.

Chloasma - an unpleasant companion of old age

Stages of skin photoaging

Age-related changes in the skin of the face are enhanced by photoaging - fading under the influence of regular contact with the sun's rays. Photoaging should not be confused with natural aging caused by hormonal changes. Its symptoms can also appear at a young age.

There are four stages:

1. No wrinkles. At this stage, people aged 20-35 years have noticeable light pigmentation, there are no deep wrinkles or keratosis.
2. Medium type photoaging – facial wrinkles. They appear in people aged 35-50 years.
3. Pronounced photoaging. There are many wrinkles on the face, they are noticeable even at rest, there are spider veins, dyschromia, and other types of defects. Such signs are typical for people over 50 years of age.
4. Extreme degree of photoaging. At the age of 60-75, the skin acquires a yellow-gray tint, wrinkles are very pronounced and localized over the entire surface, and sometimes precancerous changes begin to appear.

Women are most susceptible to photoaging during the period of hormonal changes - during menopause.

Deformation

Such faces look young for a long time, the skin remains smooth until a very old age. Previously, it was even believed that at the age of 30, every girl faces a choice: a young face or a slender figure. Now, thanks to the achievements of cosmetology, you can get both at once, but there is some truth in the old saying: plump women usually do not develop wrinkles for a long time.

Unfortunately, the absence of wrinkles does not mean youth. The deformation morphotype is characterized by blurring of the oval of the face, “flowing down” of tissues due to weakening of the ligamentous apparatus. Jowls, a double chin, pronounced nasolabial folds, and bags under the eyes appear. The features become blurred, and the face looks middle-aged despite the smoothness of the skin. There is usually no pigmentation, but spider veins and spider veins often appear.

Examples of famous women with deformational type of aging: Alla Pugacheva, Catherine Deneuve, Goldie Hawn, Catherine Zeta-Jones, Isabelle Adjani.

The gravitational type of aging is often found among Slavs, chubby girls with large features and a tendency to be overweight and/or edema, pasty. They usually have plump lips and cheeks, well-developed subcutaneous fat, and the skin is dense, thick, often oily and porous. Heavy tissues, under the influence of gravity, inevitably slide down over the years, and the smaller the chin, the more noticeable the signs of aging.

Procedures for prevention and rejuvenation

The deformation (gravitational) type of aging is the case when only “heavy artillery” will be effective. This does not mean that ladies with this morphotype are doomed to surgical interventions - cosmetologists also have suitable types of influence in their arsenal. First of all, these are all kinds of hardware procedures, for example, photo and laser skin rejuvenation. This type is characterized by spider veins and spider veins, and photorejuvenation will help even out the skin color and give the face freshness.

Fraxel will help tighten the skin and subcutaneous structures. Laser resurfacing will give the skin additional elasticity. Thick skin tolerates even aggressive procedures such as medium peels.

Fat bags can be reduced with intralipotherapy. This technique is well suited for slender girls with heavy, full faces. Massages that relieve swelling and improve lymph flow work well.

According to indications, a thread lift can be done. In this case, strong threads with notches are used, which are firmly fixed in the tissues and allow them to be lifted and tightened.

What procedures will be useless or harmful? Most procedures aimed at improving skin quality will be useless: with a deformed morphotype, the problem lies deeper, in overdeveloped fatty tissue. For this reason, the effect of biorevitalization, for example, will be practically unnoticeable. Injections of hyaluronic acid are recommended only as a complement to other, more effective interventions. For example, you can take a course to prepare for skin resurfacing.

There is also no point in using fillers: they will not be able to hold heavy tissue and will only add puffiness to the face, aggravating existing problems.

Home care

We recommend cosmetics with an anti-rosacea effect, as well as products that increase skin elasticity. You must be aware that it will not be possible to overcome tissue drooping solely with the help of cosmetics, even the best ones. Not a single cream with a lifting effect can resist the law of gravity, so cosmetics are used only to maintain the good quality of the skin.

In addition, competent home care will help consolidate and preserve for a long time the results of professional influence in the clinic.

With the deformation type of aging, it is very important to monitor your weight, avoiding its increase if possible. Equally important is the fight against swelling. You should not get carried away with salty, sweet, spicy foods and alcohol - a reasonable diet is useful for both swelling and telangiectasias.

How are age-related skin changes treated?

Cosmeceuticals – medicinal cosmetics – help many women fight age-related changes in their facial skin. It contains peptides that restore the barrier function of the skin, stimulate the synthesis of important components, and reduce the contraction of facial muscles. Priority is given to drugs with antioxidants, especially complex ones, as they create a cascade effect and have a prolonged therapeutic effect. Unfortunately, this method is not suitable for everyone due to the inaccessibility of high-quality cosmeceuticals and their high cost.

It is much more effective to combat age-related skin changes with the help of hardware cosmetology.

• Laser resurfacing

A laser pulse in the form of many microbeams heats the skin in a targeted manner. Micropores are formed on it, surrounded by undamaged areas. They promote immediate skin contraction - eliminating enlarged pores, hyperkeratosis and wrinkles. The result is noticeable after the first procedure.

• Laser peeling

The laser beam is divided into thousands of microbeams, penetrates deep into the skin and removes old cells in it. It also triggers the synthesis of young collagen. This procedure evens out the complexion and improves skin tone. After a course of several sessions, fine wrinkles and pronounced enlarged pores disappear, and a pleasant natural shine returns. Laser peeling is indicated for dull complexion and moderate pigmentation.

• Photorejuvenation

Melanin and oxyhemoglobin in unaesthetic skin tissues absorb light flashes, they heat up and are destroyed. The modification of collagen fibers begins - the restoration process with a rejuvenating effect begins. Intense pulsating light affects pigment spots, vascular “mesh”, gradually reduces their severity, and also promotes skin lifting. The color is evened out, the skin becomes elastic, the tissues are tightened.

• Laser biorevitalization

The device generates waves of a certain type, which open transport channels in the skin for the passage of hyaluronic acid. The substance penetrates deep, is evenly distributed there and saturates the cells with moisture and nutrients. Cellular respiration and microcirculation increase - fine wrinkles are smoothed out, skin tone improves.

Laser rejuvenation is trending today

A modern view of the problem of skin aging

Aging is a complex biological process of metabolic, structural and functional changes in the body, affecting both internal organs and systems and tissues that make up the external appearance [1, 2]. The problem of preserving and restoring a person’s aesthetic health is currently becoming increasingly relevant [3]. The aging process of humanity today is steadily gaining momentum, especially in European countries and Russia. In most cases, in many regions the age group over 60 years old makes up more than 25% of the general population, and in Russia over 65 is about 14%. But at the same time, this age category leads an active social lifestyle - this is reflected in the accumulated professional and life experience, as well as the desire to realize it [4]. The structure of requests for cosmetological care is dominated by women of socially active age from 35 to 64 years: from 19 to 34 years - 24.5%, from 35 to 49 years - 48% and from 50 to 64 years - 22.1% of cases [2 , 5]. Skin aging is part of irreversible biological processes occurring in the body and caused by genetic disorders, telomere shortening, resistance of cellular structures to oxidative damage (free radicals), as well as aggressive environmental influences. The properties and functions of the skin and its appendages deteriorate with age, and the causes of these disorders are associated with many different factors: excessive sun exposure, smoking, dietary habits and hormonal disorders [2, 3, 6].

Genetic and epigenetic mechanisms are deeply involved in the aging process, which is characterized by wide individual variability associated with the diversity of pleiotropic genes. Antagonistic pleiotropy is expressed in the fact that the same gene can have a beneficial effect in a young person and a negative effect in an elderly person [6]. Individual “biological clocks” are genetically programmed, although they are often influenced by external factors. The main role in their work is given to the p53 protein, called the “guardian of the genome,” and the CIP1 protein, which allows damage to structural, signaling and metabolic genes, disruption of hormonal regulation and telomere shortening. Telomeres are nucleotide structures located on the distal arm of eukaryotic chromosomes. Telomeres shorten with each cell division, and when they become too short, the cell stops dividing and enters a period of aging. Measuring the length of telomeres in a cell allows us to determine the age of each person. Short chromosomes are a signal for proliferative cell aging or apoptosis, that is, telomeres are a kind of biological clock that determines the proliferative life of the cell. Depending on the degree of damage by external factors, “cellular age” may be ahead of the real one. The work of a number of foreign authors has shown that chronic stress, smoking and obesity shorten telomere length through mechanisms associated with inflammation and increased oxidative stress [6–9].

Researchers from Newcastle University found that the mitochondrial complex II enzyme was less active in the skin cells of older people, likely due to the influence of free radicals [10]. Oxidative stress induces mutations in mitochondrial DNA with a decrease in cell vital energy. The release of free radicals affects all cellular elements: every day, the DNA of a cell is subject to 10,000 free radical attacks [6]. In general, the better organized the DNA repair mechanisms are, the longer the cell life cycle. Moreover, there is an inverse relationship between the lifespan of an organism and the rate of metabolic processes, in particular the cumulative oxidative damage to DNA caused by aerobic metabolism [7].

Hormonal signaling pathways play a causal and important role in the aging process. A decrease in circulating estrogens is associated with a decrease in dermal collagen, a decrease in skin extensibility and elasticity. Skin hydration and sebum production also decrease, which leads to dryness; the number of wrinkles increases. The number of wrinkles increases especially clearly during menopause in women who do not receive hormone replacement therapy. Estrogens and progesterone modulate skin inflammation, increase keratinocyte proliferation and collagen synthesis, reduce the activity of matrix metalloproteinases and increase the synthesis of dermal mucopolysaccharides and hyaluronic acid [7]. According to a number of researchers, keratinocytes express specific insulin receptors with high affinity for insulin-like growth factor, peptides with anabolic and mitogenic activity, which partially realize the effects of growth hormone. Aging keratinocytes and fibroblasts lose the ability to respond to signals from certain growth factors [6, 11, 12]. Insulin is a key metabolic hormone. It ensures the absorption of nutritious energy substrate, but it can also accelerate aging if synthesized in excess, which is observed with insulin resistance. In this case, the goal is to maintain insulin sensitivity and secretion levels. Thyroid hormones play a major role in aging, and a decrease in their levels is often manifested by significant dry skin, diffuse itching, hair loss on the scalp, and decreased density of body and eyebrow hair [6, 13]. Sex steroids influence epidermal growth and are closely involved in maintaining the structure and function of the skin. In the dermis, they enhance the activity of fibroblasts and stimulate the production of macromolecules collagen, elastin and hyaluronic acid. Their numbers decrease during the hormonal decline of perimenopause, which leads to increased signs of aging, including dryness, atrophy, atony and deterioration of skin color. Changes in the balance of androgens, estrogens, and the expression of key steroidogenic enzymes and receptors in the skin contribute to some of the major gender differences in skin aging. Serum concentrations of sex steroids differ between men and women and affect the age of each sex differently. Concentrations of the sex hormone dehydroepiandrosterone (DHEA) and its sulfate form (DHEAS) decline sharply with age in both sexes, although concentrations are consistently lower in women. These age-related changes are especially important for women, since DHEA is the main, if not the only source of androgen and estrogen synthesis after menopause. In men, serum testosterone concentrations gradually decline with age but remain higher in older men than in postmenopausal women. Likewise, levels of the very potent androgen dihydrotestosterone are higher in older men than in women. After menopause, estrone turns into a weaker estrogen, formed from DHEA in peripheral tissues, becoming the only source of estrogen in women, and in men, DHEA does not significantly affect estradiol levels. This profile specificity influences gender differences in skin aging. Although both androgens and estrogens promote collagen deposition, noted estradiol deficiency in postmenopausal women results in thin, dry skin with decreased collagen and decreased elasticity of the skin [14].

Sun exposure, smoking, air pollution and poor nutrition accelerate natural aging. Helioderma includes all variants of skin changes associated with insolation (clinical, histological and functional manifestations of chronic skin irradiation). Solar irradiation, in addition to the obvious risks of developing malignant skin tumors or transforming precancerous conditions, contributes to skin aging due to its negative effect on elastin fibers. “Senile spots” appear, solar elastosis of the skin of the face and neck develops in the areas most susceptible to insolation, and therefore the most damaged areas. With the same duration of irradiation, such changes appear earlier in people with a light phototype. Pigmented and depigmented actinic spots, thickening of the skin, uneven skin tone, telangiectasias, networks of wrinkles, especially on the cheeks, skin laxity, poikiloderma and erythroderma are just some of the many signs of skin damage due to excess sun exposure. Glycosaminoglycan levels increase. The number of dihydroxyphenylalanine-positive melanocytes decreases (from age 30), while the density of melanosomes increases. The dark pigment is poorly distributed and concentrated in the form of clusters (senile lentigo). The balance between melanogenesis in keratinocytes and melanocytes is disrupted. The activity and number of Langerhans cells in photodamaged skin drop sharply, leading to immunodeficiency, accompanied by the induction of T-suppressors and a decrease in the number of natural killer cells [6].

Smoking increases wrinkles, promotes the formation of deep lines in the corners of the lips, eyes, vertical lines on the cheeks and lower part of the face, leads to atrophy, gray skin tone, congestive plethora and redness. It has been established that the harmful effects of tobacco smoke components may include ischemia caused by vasoconstriction under the influence of nicotine or stimulation of the sympathetic nervous system, decreased skin oxygenation, increased tissue carboxyhemoglobin, increased platelet aggregation, decreased prostacyclin formation, and reduced collagen deposition. Smoking reduces hydration and vitamin A levels in the skin; leads to a decrease in the level of estrogen in the skin, which increases its dryness and atrophy. Smokers have poor wound healing and an increased risk of developing skin cancer. In the development of these changes, importance is attached to the direct mutagenic effect of tobacco smoke on the cells of the epidermis and dermis [7]. Due to the antiestrogenic effect in microcirculation disorders, damage to connective tissue macromolecules, and “tobacco” elastosis, menopause occurs earlier. Nornicotine, a psychoactive metabolite of nicotine, promotes protein glycosylation through the Maillard reaction. Oxidative stress results from the formation of large amounts of free radicals; Smoking disrupts the balance between matrix metalloproteinase-1, a key enzyme in connective tissue metabolism, and its tissue inhibitor, leading to the destruction of collagen, elastin and glycosaminoglycans. These effects are additive to those associated with ultraviolet radiation, enhancing the proteolytic activity of matrix metalloproteinase. A number of authors have found that the relative risk of developing wrinkles in smokers is 2.3 for men and 3.1 for women. The earlier a person starts smoking, the greater the dependence of wrinkles on smoking and the deeper the changes in the skin are visualized [6, 8]. Repeated contractions of the orbicularis oris muscle during cigarette smoking accelerate the formation of vertical wrinkles of the upper lip. Smoking worsens the condition of the oral cavity, which becomes a source of infection and gives the teeth a yellow tint. Along with lysis of the alveolar bone, it can change the appearance of the lip area. It should also be noted that smoking is associated with well-known risks of lung cancer, chronic cardiovascular and pulmonary diseases and leads to premature aging of the skin [6].

Air pollution accelerates skin aging by inhibiting its defense systems due to a chronic subinflammatory status. Ozone destroys skin lipids and vitamin E, nitrogen dioxide increases skin acidity (increases the amount of lactic acid), and sulfur dioxide stimulates seborrhea; There is also a decrease in hydration and enzymes that provide desquamation in the stratum corneum. Low air humidity (frequent travel by car or plane, long stay in the surgical department) can lead to dehydration of the skin, and climate changes affect its physiology. Excessive blinking (in bright sunlight, long periods of work at the computer) contributes to the appearance of wrinkles around the eyes [6].

A sedentary and stressful lifestyle, intake of toxic substances from food leading to changes in the intestinal mucosa, cooking food that destroys heat-sensitive vitamins, consumption of fast food and modern demands for fashion and beauty can lead to the development of multiple deficiencies of vitamins, P-carotene, calcium, magnesium and iron. . The skin is an important consumer of antioxidants, but it is constantly attacked by various factors (ultraviolet radiation, cigarette smoking, pollution, etc.), which can reduce the local absorption of vitamins (seven days of ultraviolet irradiation without photoprotection reduces the skin's vitamin A intake by 30%). Vitamin A has been shown to promote healthy cellular turnover. Lack of sleep and psychological stress also have a detrimental effect on the appearance of the skin. Significant loss of body weight, accompanied by sagging skin, contributes to the premature appearance of signs of aging not only of the face, but also of the skin of the entire body (abdomen, thighs, shoulders, buttocks, chest, etc.) [6].

Consequently, the manifestations of aging have large individual differences depending on the prevalence of ptosis, the severity of wrinkles, thinning of the skin and the influence of external factors (insolation, smoking, etc.). Of particular importance is the bone relief of the facial skeleton, especially the malar and mandibular regions. Pronounced cheek bones slow down soft tissue ptosis, and underdevelopment of the lower jaw or “long” face syndrome contribute to earlier sagging of the lower third of the face and neck. A round face, often found with overweight, ages more slowly, but significant weight loss will increase sagging skin. Signs of facial aging can be of a general nature or isolated. Two mechanisms play a major role in aging: tissue changes, including all components, and general drooping of facial tissues. All layers of the tissue framework undergo aging: primarily the skin, as well as adipose tissue, the muscular aponeurotic system and the bone base. In accordance with skin type, morphotype and the influence of certain predisposing factors, various components and elements of the face age unevenly. Impaired skin is the cause of fine lines, wrinkles, folds and sagging. These changes are the result of two processes - a decrease in skin elasticity and repeated contractions of facial muscles. Manifestations of solar elastosis, affecting the dermis and epidermis, become noticeable from about the middle of the second decade of life, especially in the case of a genetic predisposition (light phenotype). Wrinkles begin to appear on a woman’s face approximately from the middle of the third decade of life, i.e., during the period when estrogen levels begin to decrease. Changes begin in the epidermis, in the form of accumulation of dead keratinocytes in the stratum corneum. Towards the end of the fourth decade of life, the rate of keratinocyte turnover decreases. The epidermis becomes thinner, cellular turnover slows down, the number of melanocytes decreases (by 10–20% every 10 years), and fine superficial and deep wrinkles and expression lines appear. With a rapid drop in estrogen levels during menopause, the epidermis becomes heterogeneous, the thinning of the dermis becomes more noticeable, and the layer of subcutaneous fat atrophies. As the skin loses its elasticity and becomes thinner, its ability to renew itself decreases, as does the vascularization of the dermis and hypodermis. The dermoepidermal junction atrophies and gradually smoothes out. The superficial dermis also undergoes atrophy, which is manifested by disruption of the collagen framework, degeneration and progressive disappearance of elastin fibers, and an increase in the volume of mucoid interstitial substance. At the same time, signs of a further degenerative process appear, which is characterized by the accumulation of colloidal masses in the dermis, giving the skin a yellowish tint [6]. Under the double negative influence of degenerative tissue changes and gravity, progressive ptosis is formed involving the skin, fatty structures, and the facial part of the subcutaneous muscle of the neck. This leads to the formation of skin folds and defiguration of the oval of the face. These skin changes are complemented by manifestations of aging of deep structures. Beginning around age 40, basal metabolic rate declines by 5% each decade, promoting fat accumulation in the abdomen, waist and hips and, to a lesser extent, the face, especially under the chin, cheeks and around the eyes. Facial fat is supported by septate fascia, which weakens with age. Fat begins to be localized in deep areas under the fascia, while subcutaneous fat becomes thinner, which is facilitated by thinning and vulnerability of the skin. The progressive decrease in secretory activity after menopause and atrophy of the glandular tissue of the face also contribute to the loss of elasticity and density of the skin. The surface layers of the skin become thinner, dehydrated and gradually lose their elasticity. The volume of subcutaneous fat begins to decrease. Degenerative changes in the skin are aggravated by hypotrophy of adipose tissue and muscle hypotonia [6]. Senile skin atrophy usually develops more often in women aged 60–70 years in places exposed to solar insolation: the face, the side of the neck, the V-region of the neck and chest, and the back. The skin becomes atrophic, elasticity is lost, peeling, wrinkles, and a yellow tint appear - “Milian lemon skin” [7]. The thickness of the skin depends on ethnic characteristics. Dark skin contains more melanin in the deep layers of the epidermis and is better protected from sun exposure. Accordingly, solar elastosis occurs earlier and has a greater phenotypic severity in people with pale skin and red or blond hair. Those with this phenotype should be particularly vigilant regarding the duration of sun exposure, given the increased risk of sunburn and especially basal cell carcinoma, spinocellular carcinoma of the skin and melanoma. As we age, the face and neck undergo significant changes in morphology and appearance. Among the main diagnoses used to describe the clinical picture of aging of the face and skin, according to the clinical criteria and definitions of the International Classification of Diseases, 10th revision (ICD-10) - section “Diseases of the skin and subcutaneous tissue”, two nosologies associated with age-related skin changes are distinguished: chronoaging—“senile atrophy of the skin” (L 57.4) and photoaging—“skin changes caused by chronic exposure to non-ionizing radiation” (L 57).

Correcting the aesthetic consequences of aging is becoming an important part of medicine. Successful facial rejuvenation requires a thorough understanding of age-related changes in facial contour (aging of the underlying soft tissue) and changes in texture (aging of the skin). The face can be divided into three zones: upper, middle and lower. Most often, the first signs of aging appear in the upper third of the face. The upper zone of the face covers the forehead, temples and periorbital region. Aging is manifested by a flattening of the eyebrow line, redundancy of the eyelid skin, the formation of false fatty hernias and the formation of dynamic wrinkles at the lateral corners of the eyes. Horizontal wrinkles on the forehead develop as a result of contractions of the frontalis muscle during unconscious attempts to lift sagging eyebrows. Deformation of the marginal groove between the cheek and eyelid develops as the upper part of the cheek thins. This groove deepens as tears drain. Ptosis of the annular eye muscles can cause swelling in the cheekbone area, which is called the zygomatic semicircle [1]. Wrinkles form in the forehead and between the eyebrows, and thin lines around the temporo-orbital zone - “crow’s feet”. Sagging and thinning of the frontal muscle leads to the formation of horizontal frontal wrinkles, which, unlike ordinary facial wrinkles, can transform into deep furrows or even folds. Hypertrophy of the procerus muscle and the corrugator muscle is the cause of the so-called lion's eyebrow wrinkles, which are often the result of very pronounced facial expressions. The pride muscle forms horizontal wrinkles, and the corrugator muscle forms oblique wrinkles. As in the forehead area, disruption of their activity can manifest itself as ordinary expression lines (expression lines), deep furrows or folds affecting the reticular dermis. Due to the weakening of the orbicularis oculi muscle, the tail of the eyebrow lowers. As a result of the overhang of the forehead tissues and the expansion of the sinus, the glabella area becomes more protruding. The temporal fossa recedes, and the external orbital arch, due to the resorption of superficial fatty tissue and bone growth, protrudes more strongly. There is excess skin in the upper eyelid area, which can be so pronounced that it even interferes with vision. Excess fat is often visualized, usually at the internal level, which leads to the formation of a fatty pseudohernia, especially when the orbital septum is weakened. However, some people may also have a deficiency of fatty tissue [6, 15].

The middle zone of the face includes the cheek bones, which form a smooth transition from the eyelid to the lip. The melolabial fold is a flat, smooth junction between the lower cheek and upper lip. As the face ages, the soft tissues of the zygomatic region shift downwards, which emphasizes the bony edge of the orbit. Ptosis of the fatty tissue in the center of the cheeks causes swelling lateral to the melolabial fold, which is regarded as a deepening of the nasolabial folds [1]. In the lower eyelid area, the increase in adipose tissue can manifest itself in different ways, forming nasal, medial or temporal fat pads, as well as excess skin. The degree of bulging of these fat masses depends not only on the volume of fat, but also on the severity of the weakening of the septum that holds them. The teres oculi muscle relaxes, making the fat pads more visible and causing the suborbicularis oculi fat (SOOF), called the sac, to bulge, while the canthal ligament stretches, causing it to sag. Flabbiness of the thin muscles of the middle third of the face emphasizes the insufficiency of subcutaneous fat, which creates the impression of its accumulation in the lower anterior region and decrease in the lateral upper region. Therefore, the nasolabial fold takes on the appearance of a deep furrow. The zygomatic bone is smoothed and reduced [6]. Fat in the malar, cheek and submalar areas atrophies, which leads to skeletonization of the protruding zygomatic arches and recession of the submalar area, while at the same time “jowls” appear, which progress from the age of 30. The reduction in fat is especially noticeable at the level of Bisha's lumps, which aggravates the skeletonization of the face. Skin and muscle laxity that appears at the level of the cheeks strengthens the nasolabial fold and leads to the appearance of a labiomental groove. The orbicularis oris muscle weakens and atrophies, contributing to thinning and dystrophy of the skin of the upper lip and chronic muscle contraction (especially in smokers), which causes characteristic vertical wrinkles to appear and progress - signs of aging of the upper lip. First, multidirectional fine lines are formed, then converging wrinkles and, finally, real folds and vertical or oblique furrows. The profile of the upper lip and vermillion (the pink outer surface of the lips) becomes smoother. Tooth loss and osteoporosis of the anterior maxilla increase the stretching of the skin of the upper lip. Taking into account the drooping of the corners of the mouth, the interlabial line becomes below the line of closure of the teeth. The nose also undergoes aging, but in isolation from other parts of the face. Skin quality deteriorates due to solar elastosis (high exposure area) and loss of elasticity. Sometimes there is excess skin, and in men there is an increase in the density of the sebaceous glands and thickening of the skin (which can lead to the formation of rhinophyma). The tip of the nose loses its distinct outline and falls below the horizontal line crossing the nasal ridge. With age, there is a decrease in the anterior part of the nasal septum, due to its separation from the upper jaw due to lysis of the alveolar bone and reduction of the nasal ridge. Due to the thinning and separation of fibrocartilage between different structures, the cartilage of the nasal wings decreases, the suspensory ligament weakens, the cartilage becomes thinner, and the skin, on the contrary, thickens [6].

The lower zone of the face is represented by the well-defined edge of the lower jaw and the cervical-mental angle. With age, ptosis of the subcutaneous muscle of the neck and ptosis of the cheek fat along the lower jaw cause the appearance of sagging cheeks. Atrophy of the soft tissue on the anterior surface of the jaw leads to the formation of a premaxillary groove, which emphasizes the bony structures of the face. Ptosis of the subcutaneous muscle of the neck makes the cervical-mental angle obtuse, causing the formation of platysmal bands - “Turkish neck”. Textural changes of the face include superficial and deep wrinkles, pigmentation disorders, telangiectasia formation, loss of skin elasticity, and actinic keratoses. As a result of aging, there is a significant loss or redistribution of subcutaneous fat, especially in the forehead, temporal fossa, chin, perioral and prezygomatic areas [1]. Aging of the cervical-mental angle becomes especially noticeable with a decrease in subcutaneous fat and its accumulation in the lower parts of the cheeks. The contours of the oval of the face lose clarity with visible sagging of the skin and muscles, forming after 30 years the so-called jowls, which increase due to the displacement of fat downwards and can hang over the edge of the lower jaw. The top of the chin smoothes out and becomes below the mandibular line. Hypotonia and stretching of the orbicularis oris muscle and the depressor anguli oris muscle form vertical wrinkles in the corners of the lower lip and on the chin and deepen the nasolabial fold. Skin atrophy contributes to the appearance of these wrinkles. As the nasolabial fold expands, a labiomental wrinkle is formed. Muscular hypotonia is often exacerbated by gingival retraction and alveolar bone resorption. Aging of the neck is manifested by a decrease in skin tone and weakening of muscles, which can be of particular importance and be accompanied by diastasis of the inner edges of the subcutaneous muscle of the neck. The subcutaneous neck muscle also undergoes wasting, stretching, and sagging, forming a characteristic “turkey neck” appearance with visualization of muscle bands. Weight gain, often observed with aging, is accompanied by varying degrees of fatty infiltration posterior and anterior to the subcutaneous muscle of the neck. Due to the separation of the fibers of this muscle, the fat located behind it becomes visible and increases the volume of the neck. Fine cervical wrinkles, formed as a result of skin atrophy, solar elastosis and reduction of subcutaneous fat, form semicircular folds and smooth out the cervical-mental angle. The contour of the neck becomes convex due to compression and hyperlordosis of the cervical spine. This also leads to shortening of the neck, disappearance of the curvature of the occiput, descent of the hyoid bone below the level of C5 and hypertrophy, protrusion of the trachea, thyroid and cricoid cartilages [6].

As a result of aging, muscle atrophy occurs, which further contributes to the loss of facial volume. In addition, dynamic wrinkles, muscular in origin, often give the face an angry, tired expression or age it. Selective chemical denervation provides a noticeable weakening of these lines. As a result of aging, these structures sag and lose their elasticity [1]. The superficial fascia in the facial area provides a person with facial expressions, which can be described as a superficial muscular aponeurotic layer (superficial musculoaponeurotic system, SMAS), consisting of components of muscular origin, localized in one plane and forming an integral structure. According to foreign authors, this is a set of discrete structures, since the thin muscles of the face, the parotid aponeurosis and the thin muscles of the neck or the subcutaneous muscle of the neck are not located in the same plane. A number of researchers distinguish two types of SMAS: type 1 - a network of connective tissue septa surrounding lobules of adipose tissue, which is found in the back of the face, behind the nasolabial folds, at the level of the forehead, covering the parotid gland, cheekbone, infraorbital region and type 2 - a network of collagen and elastin fibers intertwined with muscle fibers, which is found anterior to the nasolabial fold at the level of the upper and lower lips [11, 12]. Muscle aging is characterized by a decrease in muscle mass, changes in metabolism and excess fat deposition. Particularly noticeable weakening occurs at the level of the orbicularis oculi muscle, as well as around the lips. A decrease in fat volume is observed in the orbital, temporal and submalar areas. In addition, the fat pad in the premalar area progressively descends, “slipping” from the buccal area into the canine fossa and causing an overhang of the nasolabial fold. Excess adipose tissue, the formation of which is facilitated by a decrease in basal metabolism, is especially often formed in the area of ​​the cheeks, chin and under it [6].

According to H. Israel, the facial skeleton is not a static, but a dynamic structure that evolves with age. The upper part of the face expands and deepens, its relief increases by 6%, the frontal sinus - from 9% to 14% and the lower jaw - by 7%. The prominence of the supraorbital arch increases and the bony prominences become more pronounced, emphasizing the frontal tuberosities and increasing the nasofrontal angle in males. Finally, there is a change in the shape and degree of protrusion of the chin due to rotation of the lower jaw, which forms a general retraction of the facial contour. The volume of the facial bones does not decrease, but, on the contrary, increases. Due to the progressive demineralization of bone tissue, which accelerates during menopause, bone structures undergo resorption, which can change the appearance of the face, especially in very old people. The most severe resorption occurs in the jaw bones. Thinning of the alveolar bone can lead to tooth loss, and decreased thickness of the anterior maxilla exacerbates skin laxity and upper lip wrinkles [6].

In recent years, interest in methods for the prevention and correction of age-related skin changes, which are an important problem in modern dermatology and cosmetology, has increased significantly. Appearance has a significant impact on social well-being, adaptation in society and a person’s quality of life. Basic correction methods do not always lead to a lasting clinical effect, which causes dissatisfaction among patients and leads to the development of new treatment methods. The search for new methods for effective cosmetological correction of involution-changed facial skin is a promising area of ​​modern dermatology and cosmetology [2, 3].

Thus, healthy aging implies a stable psychological and physiological balance, a balanced diet with a hypocaloric regime (facilitating the work of mitochondria), regular, moderate physical activity, effective protection from toxic environmental influences, and the use of preventive and active cosmetology.

Literature

1. Avram M. R., Zao S., Tannous Z., Abraham M. M. Atlas of cosmetic dermatology / Transl. from English edited by N. N. Potekaeva. St. Petersburg: Dialect, M.: Binorm. 2013. 296 p.
2. Yusupova L. A. Volumetric modeling using combined fillers based on hyaluronic acid and dextranomer // Injection methods in cosmetology. 2016. No. 4. pp. 17–19.
3. Ivanova E. V. Pathogenetic rationale for the use of an oxygen-ozone mixture in the correction of age-related skin changes. Author's abstract. diss. ... Ph.D. M., 2007. 23 p.
4. Konovka E. P. The use of combined laser effects in the restorative correction of involutive changes in facial skin. Diss. ... MD M., 2014. P. 10.
5. Gubanova E.I. Involutional changes in the skin of the lower third of the face in women (clinical and functional study). Author's abstract. diss. ... MD M., 2010. 29 p.
6. Injection methods in cosmetology / Ed. B. Asher, trans. from English M.: MEDpress-inform, 2014. 584 p.
7. Rodionov A. N. Skin aging. Dermatocosmetology. Lesions of the facial skin and mucous membranes. Diagnosis, treatment and prevention. St. Petersburg: Science and Technology, 2011. pp. 227–344.
8. Valdes AM, Andrew T., Gardner JP et al. Obesity, smoking, and telomere length in women // Lancet. 2005. 366. R. 662.
9. Epel ES, Blackburn EH, Lin J. et al. Accelerated telomere shortening in response to stress // Proc Natl Acad Sci USA. 2004. 101. R. 17312–17315.
10. Chang AL Expanding our understanding of human aging // J. Invest Dermatol. May 2016 136(5). R. 897–899.
11. Dillin A., Crawford DK, Kenyon C. Timing requirements for insulin/IFG-I signaling in C. elegans // Science. 2002. 298. R. 830–834.
12. Li W., Kennedy S.G., Ruvkun G. Daf-28 encodes a C. elegans insulin superfamily member that is regulated by environmental cues and acts in the DAF-2 signaling pathway // Genes Dev. 2003. 17. R. 844–858.
13. Yusupova L. A., Mingazetdinova N. I. Current state of the problem of dry skin // Attending Physician. 2014. No. 5. P. 41–46.
14. Farage MA, Miller KW, Zouboulis CC, Piérard GE, Maybach HI Gender differences in skin aging and the changing profile of sex hormones with age // J Steroids Horm Scientific. 2012, 3. P. 109.
15. Yusupova L. A. Dermatocosmetological approach to the skin around the eyes. Materials of the IV interdisciplinary scientific and practical conference "Modern methods of diagnosis and treatment of skin diseases and sexually transmitted infections." 2011. pp. 60–66.

L. A. Yusupova, Doctor of Medical Sciences, Professor

GBOU DPO KSMA Ministry of Health of the Russian Federation, Kazan

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Other methods to combat age-related skin changes

Cosmetology clinics also use effective injection techniques:

• Mesotherapy. Cosmetologists know well which components fight age-related skin changes, so they offer optimal formulations for subcutaneous administration. They contain vitamins, amino acids, enzymes, peptides, hyaluronic acid, etc.
• Biorevitalization. Hyaluronic acid is injected subcutaneously or intradermally and moisturizes the deep layers.
• Botulinum therapy. Botulinum toxin temporarily blocks the nerve endings associated with the facial muscles, which helps smooth out facial wrinkles.

Prevention of age-related skin changes

In order for age-related changes to appear as late as possible, a person must lead a healthy lifestyle and avoid active exposure to ultraviolet radiation. The diet should be balanced and low in calories. It is very important to move a lot, think positively, avoid stress, and also use high-quality cosmetics.

Our cosmetology clinic performs effective procedures to prevent skin aging and also knows how to combat signs that have already appeared. We have innovative equipment, so we get good results for patients of different ages with various cosmetic defects.

Diagnostics

To identify jaundice and determine what kind of disease a person has, you need to carry out the following diagnostics:

• CBC, where hemoglobin is determined;
• Blood biochemistry, which shows total bilirubin and its secretions;
• Lipid profile study;
• Test for thyroid hormones;
• Testing for tumor markers;
• Test for roundworms;
• TAM, which determines the level of bilirubin and its secretions;
• Immunological analysis to detect antibodies to viral hepatitis;
• PCR research;
• Antiglobulin test (for newborns);
• Fibrogastroduodenoscopy, which shows inflammation, neoplasia and bile duct stones.

Dyspnea

Diagnostic procedures for each patient are selected individually by the doctor.