As cosmetic surgeons, much of what we deal with on a daily basis appears to be due to photoaging from UV light. Yet the total picture is much broader. Solar, environmental scars Consider wrinkles, for example.A wrinkle has it origins in a cellular injury that is imperfectly repaired by the body. The cumulative impact of many of these small injuries is a scar, which eventually appears clinically as a visible wrinkle. So, one way to view a wrinkle is as a "solar scar." Smoking or air pollution and many other environmental agents may produce the same cellular injury. And smoker's wrinkles look like photoaging wrinkles. Therefore, in a more global view, wrinkles are really "environmental scars," resulting from various environmental exposures and not just sunlight alone. Battles of the skin At the heart of premature aging is the body's encounter with free radical ROS (reactive oxygen species) or "oxidative stress." While our bodies produce some free radicals (which play a role in cell signaling) as part of normal cellular function, excessive oxidative stress is a "battle" fought on the cellular level, often producing inflammation and injury. Some battles are of great magnitude, some are chronic, some are acute, or periodically recurring such as tanning bed use, smoking, commuting in heavily polluted air, etc. Each "battle" leaves its mark unless the skin and body's natural defense mechanisms (or externally-added defenses such as cosmeceuticals) extinguish the free radicals before they do damage. Lifestyle choices While part of the outcome of the battle with oxidative stress is controlled by genetics, much is determined by our lifestyle choices. How we interact with environmental oxidative stress and protect our bodies from unavoidable oxidative stress has a profound effect on how each of us age. An analogy I use when talking with patients is to envision what might happen to an automobile years after delivery to different parts of the country. One car shipped to the north in snow and salt may be badly rusted, whereas one that went to the sunny dry southwest is not rusted but has faded paint, and one that was waxed and garage-kept looks much less "weathered" with newer paint and no rust. The cars "age" very differently due to varying degrees of oxidative stress from the different climates. So what is the "radical" thought here? Aging is not totally predetermined by our genes, but rather, free radicals from our daily encounters with environmental oxidative stress produce much aging that is both premature and preventable. Therefore, our daily routine should consist of some degree of avoidance with healthy lifestyle choices, but also a daily program for protecting all the skin that is exposed to unavoidable oxidative stressors. Typical patient Let's consider our typical patient. We focus on photoaging, photoprotection and SPF, but that is only part of the entire story. The SPF is quite important, but our traditional thinking even about sunscreens is incorrect. Many traditional sunscreens contain "holes" and are not totally protective. We need a more global approach to protection: SPF as well as IPF (immune protection factor) and EPF (environmental protection factor). The best protection should include an effective SPF as well as high UVA1 protection (e.g., the newly FDA cleared mexoryl) as well as a super potent antioxidant with high EPF (e.g., idebenone). For those with strong sun exposure, the new DNA repair enzymes (e.g., photosomes and ultrasomes) should also be included. |
