Although minimally invasive injectables are
the gold standard once adipose tissue and bone
mass have been lost, there are many proven
ingredients and product categories that can be
added to a client’s daily regimen to help preserve,
maintain and increase the facial volume of the
skin—and your clients’ youthful appearance.
The physiology of facial volume loss
The primary cause of visible facial aging
of the skin is matrix degradation. The
extracellular matrix (ECM) is a complex
framework of biomolecules that support and
protect dermal cells. The ECM is made up
of structural proteins (collagen and elastin),
adhesive proteins (laminins and fibronectin),
glycosaminoglycans (GAGs) and proteoglycans.
These components are all vitally important
for a full, youthful appearance that is free of
laxity, wrinkling and poor surface texture. The
breakdown of these all-important structures
is a result of both intrinsic aging that happens
due to time and genetics, and extrinsic aging,
which is largely avoidable.
The offending extrinsic factors
Although ECM-breakdown occurs naturally
with the passage of time, it is accelerated
by external factors, primarily UV exposure.
The oxidative stress instigated by UV rays
increases matrix metalloproteinase (MMP)
ECM. These enzymes are increased with as little
as 0.1 minimal erythema dose (MED), which is
one-tenth of the UV exposure it takes for skin to
become red. This demonstrates the critical nature
of the daily, year-round use of broad-spectrum
sun protection; you don’t need to tan to begin
the cascade of facial volume loss. (Editor’s note:
See the article “Sunscreens: What You (and Your
Clients) Must Know” on Page 34 of this issue.)
Free radical formation is also increased with
UV exposure. It is well-documented that UVB
rays specifically instigate a cascade that leads to
the creation of highly reactive radicals that have
unpaired electrons in their outer shell. There are a
variety of types of free radicals, yet reactive oxygen
species (ROS) are widely
studied, due to their proven
damaging effects on the skin.
The aged appearance that
occurs due to the loss of
facial volume is compounded
by the atrophy of both the
epidermis and the dermis.
It has been demonstrated
that the drop in estrogen
levels during perimenopause
and menopause slows
the production of matrix
components. In addition to
the degradation of mature
collagen already mentioned
due to UV exposure, it has
also been demonstrated
that UV rays compound facial volume loss by
inhibiting the expression of the genes responsible
for the formation of new collagen—both type
I and type II procollagen. This dermal atrophy
contributes substantially to visible facial aging.
The loss of facial volume is a key contributor to an aged facial appearance.
Although some of the visible loss of facial volume is due to reduced facial fat and the
resorption of bones, you may be able to help clients potentially avoid resorting to a face lift,
which simply stretches and removes excess tissue, by implementing topical cosmeceuticals
that work to protect existing volume, and replace epidermal and dermal matrix volume that
has already been lost.
UV rays compound
facial volume loss
by inhibiting the
expression of the
for the formation
of new collagen.
BY JENNIFER LINDER, MD