Chapter 1: The Aging Man
Despite what you might think, no two men age at the same rate.
As we age, we go through gradual states of change. With each passing year our skin loses its ruddiness, structure, and youthful resiliency. Aging is genetically programmed through biochemical changes in collagen and elastin, the connective tissues that give the skin its firmness and elasticity. Because every man's genetic program is individual, the loss of skin firmness and elasticity occur at different rates and times. As early as age thirty five the skin begins a slow, gradual descent. By age sixty, the skin visibly sags. Sagging is especially noticeable on the face because it endures more environmental and UV damage. As the skin loses its structure and elasticity, it can no longer fight the effects of gravity. A lifetime of repeated pulling by the muscles under the skin, coupled with damage from smoking, alcohol and environmental exposure, play a role in the formation of wrinkles.
Genetically programmed aging occurs alongside the process of photoaging - the effects of chronic and excessive sun exposure on the skin. Photoaging is responsible for as much as 90 percent of age-associated changes in the skin's appearance, such as mottled pigmentation, surface roughness, fine wrinkles that disappear when stretched, brown spots on the hands, and dilated blood vessels. Sun damage is cumulative. To reduce the effects of chronological and photoaging, sun exposure and tanning must be effectively eliminated, and a comprehensive program combining state-of-the-art skincare with clinical treatment solutions should be implemented. There is no magic bullet.
MALE VS FEMALE AGING
The aging process differs significantly between male and female skin. In men, each year the skin gradually thins at the rate of approximately 1 percent per year. In women, however, the thickness of the skin remains surprisingly constant until menopause, after which there is a significant and sometimes dramatic thinning with age. This difference in skin thickness is attributed to the relationship between skin thickness and collagen content. While collagen content in both sexes decreases with age, it does so at different rates. As women age, they may look older than men of the same age and similar amounts of sun exposure because their skin initially has a lower collagen content. Varying collagen contents may also be related to the difference in hormone production between men and women. Because estrogen and androgen output from the ovaries and adrenal glands decreases after menopause, collagen synthesis and repair in women go down as well. The decline of estrogen production coupled with photoaging can dramatically increase the apparent age of a menopausal woman. Men, on the other hand, do not experience significant declines in estrogen, so they do not appear to age as rapidly as women.
Although skin elasticity decreases with age in everyone, the effect more pronounced in women than in men. As skin loses its elasticity, it appears fragile because it lacks deep, solidly connected cells that are protected by natural oils, which also decline with age. The decline of these natural oils, however, is more rapid in women than men.
HOW MEN AGE
| AGE | APPEARANCE | FUNCTION |
| <18 | Nearly perfect skin Smooth texture, small pores |
Excellent repair capabilities Low productivity of oil Good skin hydration |
| 18-25 | Acne key factor in surface texture Fine lines start to appear, pore size increases |
High productivity of oil Drop in dermal repair, immune system, and collagen synthesis Strong cohesion between skin layers and rapid cell turn over Small drop in skin hydration, noticed particularly in winter |
| 25-45 | More fine lines and appearance of first wrinkles Early signs of sagging near the eye Some loss of elasticity Adult acne |
Moderate decrease in dermal repair, less collagen, increase in damaged connective tissue Noticeable drop in skin hydration |
| 45-55 | More wrinkles, rough texture Sallow yellow color Pores and age spots enlarge Sagging near eyes and cheeks |
Significant decrease in dermal repair and immune system Continued dermal degradation Cohesion between skin layers continues to decline Thinning of skin and deep tissues Skin tends to be dry |
| 55+ | Wrinkles and fine lines in abundance Uneven color, pigmentation. Sagging worsens Dark circles under the eye |
Comprised dermal repair, abundance of damaged connective tissue Low product ion of collagen and oil Increased local over-production of melanin |
WRINKLE REDUCTION
Fine lines are due to the breakdown of collagen and elastin fibers over time. This is exacerbated by the sun damage that men accumulate over the years. Deep wrinkles are typically associated with the constant action of musculature below the skin's surface. Over time, facial expression muscles will thicken the muscle, just like building up your biceps. Deep wrinkle lines may be present on a persistent basis (static wrinkles seen with the face at rest), or may be seen only when those muscles are used (dynamic wrinkles). For example, some men's crow's feet are only obvious when they smile because their cheeks come up, or their frown lines may be evident only when they frown.
Therapy for wrinkles is aimed at correcting many issues. Some are preventative, others are restorative. Sun-damaged skin is characterized by a weakening of supporting collagen and elastin fibers caused by a reduction in collagen production. The key to maintaining your skin is to keep it taught, with good structure and elasticity. Cosmetic surgery, such as a facelift, is most effective for deep wrinkles and sagging skin in the lower face. It is somewhat effective in the middle face, yet not very effective for the upper face.
Classifying Wrinkles
- Crinkle-type wrinkles - Fine wrinkles formed around folded skin; generally seen in the elderly and men with sun damage.
- Glyphic wrinkle - A crisscross pattern that makes a diamond shape; usually found on the cheeks, neck, and hands.
- Deep wrinkles - A major line or deep grooves; usually long and straight.
Fat Migration
As you turn the corner from the thirties to the forties, one of the first signs of aging is the loss of soft, round, cherubic fullness. As you get older, you actually need all the fat you can get in your face, while it becomes harder to keep it off your body. Men tend to gain weight as they grow older. The little fat pad under the chin and pouches along the jaw line start to expand. As the natural fat of your face changes shape, hollows start to show up around the eyelids, the middle of the cheeks, and around the mouth. The fatty layer on the backs of the hands, the neck, and the face becomes noticeably thinner. This leads to more noticeable blood vessels on the hands. Fat pads moving south below the eyes exacerbate the appearance of dark circles, and the overall thinning of the skin allows for increased fragility. The disappearance of facial fatal so exacerbates some of the deeper wrinkling changes along the jaw line and around the mouth.
Muscle Relaxing
Below the skin layer lies the fat and beneath that is muscle. Deep wrinkles are due to the build-up of muscles in areas of over used facial expressions, such as smiling or frowning. The same can be said of the deep lines that form around the mouth, sometimes called smoker's lines. Chronic puckering of the mouth-particularly if there is additional sun damage-may lead to the formation of deep creases and folds which will require different therapy than treatments for finer lines associated with damage within the dermis or deeper tissue.
Non-Surgical Age Management
Today's man has embraced the concept of having multiple non-invasive, non-surgical treatments for lines, creases, and folds.
Skin rejuvenation is not about looking thirty - five when you turn fifty. Rather, it is about choosing a reasonable approach to caring for your skin, maintaining its health, and moisturizing to keep it looking healthy.
Making the most of what science and technology have to offer, the war against wrinkles is being fought with an arsenal of fillers and injectable substances. In my practice, the most popular non-surgical treatments for men are Botox® and dermal fillers such as Radiesse®, Scutptra® and Restylane®. These treatments have the advantage of being safe, effective, affordable, and quick. Many of my male patients schedule a procedure before an early meeting, at the cod of the workday, or during lunch, since there is little or no downtime.
My Philosophy
The key to anti-aging is maintenance. Compare it to working out. You cannot just go to the gym once; you have to keep going to maintain the benefits of a fitness program.
I am a big advocate of doing everything one can to prevent wrinkles, rather than waiting to correct wrinkles once they have appeared. I routinely recommend to my patients-especially the younger ones-to begin with smaller, less-invasive procedures and earlier surgery. Not everyone wants to have a facelift, even if we will all ultimately benefit from surgery to correct skin laxity and sagging. Many of my male patients prefer to concentrate on non-surgical, minimally invasive procedures combined with active skincare to forestall the need for surgery until later.