Meera - Whilst ageing is both a physical and psychological process, when many of us think about getting older we think of wrinkly sagging skin. So this week, I'm in Brentford in Essex in the home of Dr Patrick Bowler, fellow of the British Association of Cosmetic Doctors, to find out what happens to our skin as we age and if, as all the cosmetic companies promise, it's possible to reverse the effects of ageing.
Patrick - The skin is the largest organ in our body. We have a base layer, called the dermis, in which there are blood vessels and fat and nerves. Then there is a very important layer above that - the epidermis - which produces new skin cells constantly. These cells make their way to the surface and shed off in a 28 day cycle, or something like that.
Meera - So what happens to our skin as we age?
Patrick - There are many factors that cause our skin to age. There is a genetic factor, then there are environmental factors which are probably the most important. There are a number of changes that go on in the skin. The skin becomes thinner so if you took the extreme of a lady in her eighties or nineties and looked at the back of her hand the skin is almost translucent and you can see the blood vessels. We get pigment changes, age spots and the elastic tissue, a bit like the cement between bricks, and the foundation of the skin starts to reduce in strength. That is part of the problem in developing sagging skin and wrinkles. So the supporting structure of the skin starts to become less elastic.
Meera - I can imagine that a loss of elasticity can cause sagging, as the skin is less taught. What about the wrinkles, why do they happen?
Patrick - There are different types of wrinkles. If you look at the forehead for example or around the eyes where there is a lot of muscular movement. The muscular movement plus damaged, aged skin produces wrinkles. As we go further down the face to for example the cheeks and down into the jaw line and the neck, that is more due to loss of volume in the skin so you lose fat and elastic tissue and we therefore get sagging. In that sagging you get wrinkles. It's a bit like letting a balloon down quickly; you're left with that crinkly appearance
Meera - In our society today there is a wide range of products out there that people are resorting to in order to try and reverse these effects. What are these ingredients that are being used in the creams that are purely targeting people that are wanting to reverse their ageing?
Patrick - We had about 25 years ago a big breakthrough in skin treatments, where a form of vitamin A called a retinoid was actually shown to reverse some of the signs of ageing. That's pretty miraculous for that to be proven scientifically. It was in a very strong form of vitamin A which was quite irritating. At that time the cosmetic companies jumped up and down and thought that this was fantastic and that they would use this. They developed ingredients derived from vitamin A which are basically different types. Most of them are weak because if they increased the concentration then they would become irritating. Unfortunately you have to increase the concentration for them to be effective and a true anti-ageing effect. All the vitamins you see in over the counter products, like vitamin A, C and E (which are the common ones that we see) are going to have a positive effect, but are not going to be true anti ageing effects.
Meera - So, is the true way to have an anti-ageing effect then, to irritate the skin and then cause the skin to regenerate?
Patrick - With vitamin A, that is the case. The concept of irritating the skin on the surface makes the cells underneath react and produce newer fresher looking skin cells. In a single skin cell, and this always amazes me, there are something like 10,000 receptor for vitamin A. When vitamin A locks onto these receptors, certain things trigger off in the skin which affects cell division and other complex chemical cycles that go on. The vitamin A, retinoids in particular, have also been shown to stimulate collagen production in the dermis. This is very important because one of the effects of ageing skin is that we lose collagen and volume. So if we replace that in some way that is going to have a true anti-ageing effect. In summary it is not just the irritation: there are some more profound things going on deeper in the skin and in the cells that we don't really understand just yet.
Meera - What if people were to just increase vitamin A in their diet rather than applying it to their skin?
Patrick - Vitamin A, in particular if you take it orally can be toxic if you over do it. It can have quite serious effects on the liver. So I would usually advise my patients in this instance that it is good to treat the skin inside and out. So apply creams containing vitamins superficially and also ensure you have an adequate diet. If you don't think you do have an adequate diet then take a vitamin tablet as a fail-safe.
Meera - What should people be doing in order to help their skin in the long-term and just try to not maybe resort to cream?
Patrick - For most things moderation is the key. However looking after your skin there is one thing that is really important. You have to be very careful with the amount of sun exposure you have. To have in your moisturiser a sunscreen is probably the best tip that I can give you to keep your skin looking good.