As life expectancy changes, patient expectations have changed. In the past, plastic surgeons have focused primarily on surgery to address facial aging.
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 to ensure 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 understand the mechanisms of aging better, we also realize that we need different treatment modalities to treat each.
A significant scientific decision was to differentiate between intrinsic (chronological) and extrinsic (premature) aging and the underlying causes and mechanisms. Intrinsic skin aging is determined by genetic factors, hormones, and everyone’s biological clock. In contrast, extrinsic aging is caused by various environmental factors, such as chronic sun exposure and smoking.
A fascinating 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, 52 years old.
The twins spent the first 20 years of their lives together, living in the same household. After that, 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 show twins 3 (left) and 4 (right).
Both are 58 years old; twin 3 has a 6-year smoking history, 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 10 hours per day more in the sun than twin 5.