Face facts

  • Health
  • Sunday, 09 Feb 2003

Dr TING HOON CHIN discusses important facts that can help you maintain a good complexion despite the onslaught of ageing

THE face provides a snapshot of a person’s identity. Our first impression of a person is based largely on our perception of the features of his or her face. The qualities of the skin have a great impact on the perception of youthfulness or senescence of an individual. 

The beauty of a person, as encapsulated in the face, can have far-reaching consequences. These days, we often hear of products launched by the “face” of certain “super brands”. In the distant past, faces could launch things that are even more remarkable. For instance, Helen of Troy had a “face that launched a thousand ships” – a reference to the naval battles fought in the attempt to rescue her. 

Ageing of the skin is a gradual process that results in the appearance and functional differences that we associate with old age. The most obvious signs of ageing skin on the face are thinning, laxity, wrinkling, sagging, dryness, yellowness, pigmentation and other blemishes (age spots). Skin ageing may be: 

In the elderly, the elasticity of the skin is lost, and wrinkles(linear furrows) become a permanent feature of the face.

  • Intrinsic: This is inevitable and is related to genetic programming. 

  • Extrinsic: This is caused by external factors. For instance, it has been stated that on exposed skin, more than 90% of age-associated problems are caused by the ultraviolet spectrum present in natural sunlight. Cigarette smoke is another potent cause of wrinkling. Heavy smokers are five times more likely to be wrinkled than non-smokers of the same age. Substances in cigarette smoke can cause constriction of blood vessels leading to reduced blood supply, decreased oxygenation and reduced collagen deposition. All these factors accelerate the ageing of the skin. 



    The skin becomes increasing thin in the elderly and both the superficial part (epidermis) and deeper part (dermis) are involved. 

    In the epidermis, the cell turnover rate is halved between the third and seventh decade of life. The rate of epidermal repair also declines with age. 

    The dermis consists largely of a supporting matrix, or ground substance, in which polysaccharides and protein coexist. Running through and attached to this matrix are several kinds of protein fibre, the most important of which are collagen, which have great tensile strength, and elastin, which has considerable elasticity.  

    Collagen makes up 75% of the dry weight of the skin. The thinning of the dermis is related mainly to a decrease in collagen. The collagen bundles also become fragmented and disorientated. The elastin fibres disintegrate and are reduced in amount. These changes in the dermis also lead to laxity and sagging of the skin. 




    Wrinkles may be defined as creases or furrows in the skin surface. There are three types of wrinkles: 

  • Crinkles – This is very fine wrinkling that occurs in aged skin even in areas protected from sunlight. They disappear when the skin is slightly stretched. Crinkles are caused by deterioration of elastin, the special supporting structure in the skin discussed earlier. This deterioration occurs especially in the vertical fine elastic fibres that keep the superficial part of the skin (epidermis) bound to the deeper part of the skin (dermis).  

    Even in normal people, the elastic fibres begin to deteriorate from the age of 30 years onwards, regardless of the amount of skin exposure to sunlight, although such exposure definitely increases the damage. 

  • Glyphic wrinkles – These creases are an accentuation of the normal skin marking. They occur in skin that has been prematurely aged by degeneration of elastic fibres caused by sunlight, for example, on the neck. 

  • Linear furrows – These are long, straight or curved grooves usually seen on the face. They include the horizontal frown lines along the forehead, the “crows’ feet” radiating from the sides of the eye and the creases from the nose to the corners of the mouth. 

    The facial skin has a remarkably complex elastic tissue mesh which helps to support the skin. In youth, the linear furrows caused by facial muscle contraction disappear due to elastic recoil, but in older people, the elasticity is lost and the furrows become permanent. 




    A prominent change in fair skin with ageing is irregularity of pigmentation. Yellow or brown flat patches are found on the face in more than 50% of people above 45 years. These patches are due to a localised increased in the number of melanocytes (pigment cells) in the skin and are called senile lentigines.  

    Another common abnormality often seen on the aged facial skin is brownish raised small mole-like growths called seborrhoeic warts. 



    The capacity of the most superficial skin layer (stratum corneum) to restrict water loss does not vary with age. However, the water-binding capacity of the stratum corneum is reduced. This, together with the reduced function of skin glands, contributes to the dryness of aged skin. 

    What can be done about ageing skin?  

    There are various ways to slow down the ageing process in the skin. For a start, we can cut down the factors that lead to extrinsic ageing. Reduction of sun exposure is very important in this respect. The sun is hottest between 10am and 3pm and it is wise to schedule our activities, be it shopping or games (especially golf), outside these hours.  

    Routine use of a sun block with a sun protecting factor (SPF) greater than 15 is important. It is advisable to choose a sun block that protects against both the UVA as well as the UVB part of ultra-violet light. 

    Obviously, we should also avoid smoking to prevent our complexion “going up in smoke”! 

    Topical retinoids have shown good results in improving sun-damaged skin and wrinkles. Chemical skin peels can improve wrinkles and blemishes. Superficial chemical peels such as those with alpha-hydroxy acids are generally safe if done by competent therapists, but deep peels, like those with trichloroacetic acid, may have complications like scarring and uneven pigmentation if done inappropriately. 

    Deep frown lines and crows’ feet respond well to botulinum toxin injection. The injections are given locally in the affected areas and paralyse muscles that cause the grooves through their contraction. However, the effect of the injections is temporary, lasting about six months. 

    Various “fillers” have gained acceptance in the treatment of wrinkles. Bovine collagen can be injected to plump out the skin. The effect lasts for about six months. A test injection is necessary and about 3% of patients react to the substance.  

    Newer fillers like hyaluronan and polylactic acid are easier to use as the risk of an allergic reaction is negligible. The effect of hyaluronan lasts for about six months but polylactic acid can give good correction for about 18 months. 

    More invasive treatment methods for wrinkles include laser resurfacing and surgical dermabrasion. These are effective, but in patients with dark complexions, the possible side effect of uneven pigmentation is a real concern.  

    A surgical face-lift can reduce wrinkles and tighten the skin, but this is a major operation. 

    Pigmentation of the skin can be lightened with topical creams like hydroquinone, retinoid acid, azelaic acid and kojic acid. Various lasers can also remove pigmentation effectively. It is important to use a sun block as well to help reduce skin pigmentation.  


  • References: 

    1. Smith JB, Fenske NA. ‘Cutaneous Manifestations and Consequences Of Smoking’. JAAD 1996;34: 717-732 

    2. Graham-Brown RAC. ‘The Ages Of Man and Their Dermatoses’. In: Rook/Wilkinson/Ebling ‘Textbook of Dermatology’, 6th edition. Blackwell Science, Oxford. 1998. 

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