The emotions evoked by the tickle of a feather, the heat of a hot summer’s day, the biting cold of snow and sleet in winter, or the warm heartbeat of a loving hand – these would not be possible without the skin.

The emotions evoked by the tickle of a feather, the heat of a hot summer’s day, the biting cold of snow and sleet in winter, or the warm heartbeat of a loving hand – these would not be possible without the skin. Skin is also the only organ of the body which shows the signs of aging visibly. It is the largest organ of the human body, and extremely important for non-verbal communication.

As life expectancy changes, patient expectations have changed. In the past, plastic surgeons have focused primarily on surgery to address facial aging, but today we have a more holistic approach: we target the entire face, we include additional aesthetic areas, like the neck, décolleté, arms and hands; we combine different treatment modalities, and we ensure that better, more natural appearing aesthetic results are achieved.

As science is confronted with an aging population, research into the mechanisms of skin aging has increased. As we begin to understand the mechanisms of ageing better, we have also realized that we need different treatment modalities to treat each mechanism.

A very important scientific decision was to differentiate between intrinsic (chronological) aging, and extrinsic (premature) aging, and the underlying causes and mechanisms thereof. Intrinsic skin aging is determined by genetic factors, hormones and everyone’s biological clock, while extrinsic aging is caused by various environmental factors, such as chronic sun exposure and smoking.

A very interesting study was done on identical twins to demonstrate the effect of external factors on skin aging. As identical twins are genetic equals, they will age the same – except for the external factors they are exposed to.

In the photographs below, meet Twin 1 and Twin 2, both 52 years old. The twins spent the first 20 years of their lives together, living in the same household. Thereafter they followed similar career paths in the same city, doing the same activities – hence most other external factors they were exposed to, were the same. The big difference in aging: twin 1 started smoking in her twenties, while twin 2 has never smoked.

The photographs below, is of twin 3 (left) and 4 (right) – both 58 years old, where twin 3 has a 6-year history of smoking, while twin four has never smoked.

And if you thought the claim that sun exposure ages you significantly is a myth, this might change your mind:

Twin 5 (on the left) and twin 6 (on the right) are 61 years old. Twin 6 has spent an average of about 10 hours per day more in the sun than twin 5.

Many other factors play a role, including stress, ill health, the use of certain medications, and diet.