Treating the Young Aesthetic Patient: Evidence-Based Recommendations
June 2017 | Volume 16 | Issue 6 | Supplement | s81 | Copyright © 2017
Lauren Meshkov Bonati MDa and Sabrina Guillen Fabi MDb
aIcahn School of Medicine at Mount Sinai, New York, NY bCosmetic Laser Dermatology, San Diego, CA
BACKGROUND: There is growing demand for cosmetic treatments in the younger population, yet counseling and treating this age group can be difficult to justify.
OBJECTIVE: Chronologic changes that cause noticeable signs of aging are discussed within each age group. Age-appropriate cosmetic preventions and interventions are therefore recommended.
METHODS: A PubMed search was performed for high quality trials and evidence based reviews on the basic science of aging, as well as on cosmetic modalities and their histological, biochemical, and clinical effects.
RESULTS AND CONCLUSIONS: Specific age-related changes occur with each decade of life. A complete understanding of when these physiologic changes occur helps determine age-appropriate cosmetic counseling, preventions, and interventions.
J Drugs Dermatol. 2017;16(6 Suppl):s81-83.
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Recent speculation has indicated that it is rarely too early to begin aesthetic treatments.1 The growing demand for anti-aging in younger populations requires thoughtful and age-appropriate counseling for delivering preventions and interventions. The physiologic, age-related changes that occur with each decade of life may serve as a blueprint for when to start cosmetic treatments.
Photoprotection Photodamage begins with childhood exposure to Ultraviolet radiation (UVR). Between the 1st and 9th decade of life, staining for type I and type III collagen has been shown to reduce from 82.5% and 80.4% to 53.2% and 44.1%, respectively, in sun-exposed skin when compared to photoprotected skin (P=0.0004 and P=0.0008).2 Daily UV filters that contain zinc oxide and titanium dioxide are less irritating and recommended for anyone over 6 months old. Alpha-Hydroxy Acids Alpha-hydroxy acid (AHA) cleansers reduce photodamage, wrinkling, roughness, dyschromia, and additionally improve acne that may affect this age group. After months of daily use, histologic benefits include a thickened epidermis, increased papillary mucopolysaccharides, improved elastic ber quality, and increased collagen density.3 Retinoids Topical retinoids are a mainstay of anti-aging and a first-line treatment for those with acne. Multiple studies have demonstrated the beneficial effects of tretinoin on overall appearance, surface roughness, ne and coarse wrinkling, mottled pigmentation, uneven skin tone, and sallowness. Histologically, tretinoin has been shown to increase anchoring brils and collagen in the papillary dermis, and to normalize overall structure.4
During the 20s
Daily exposure to UVR, smoking, and pollution causes cumulative damage that results in dyschromia, loss of collagen, reduced elastic recoil, and premature aging. Collagen decline beginning in the 20s reduces from 70% to 50% by age seventy.5 A similar decline in bony volume starts in the mid to late 20s, resulting in poor resting tone of the mimetic musculature that originates on bone, and results in static rhytides.6 A stepwise increase in rhytides has been reported by age 33,7 warranting preventative treatment in younger patients with noticeable fine lines and wrinkles.
Antioxidants Topical antioxidants compensate for the declining endogenous response to oxidative photodamage that begins in the 20s.8 A double-blinded, split-face study of 10 patients who used a daily antioxidant blend found increased Grenz zone collagen and type I collagen mRNA when compared to vehicle control (P=0.01).9 Growth Factors Topical growth factors may help reduce photodamage and wrinkles. Twelve subjects who used twice daily human growth factors for 6 months reported 33% and 25% average improvement in periorbital and perioral wrinkles, respectively.10 Histological