Ageing skin

Skin is the body's largest organ, made up of three main layers - the epidermis on the surface, the dermis beneath it, and the subcutis below that. Like the rest of the body, it changes with age: it thins, heals more slowly, loses elasticity, and produces less collagen, elastin and oil.

Ageing cannot be stopped. What can be influenced is how much of it is avoidable - and in Australia, a large share of what people call ageing skin is sun damage, which is a different thing with a different remedy.

Two kinds of ageing

Intrinsic ageing

The internal, genetically programmed process. Produces gradual thinning, dryness, dullness, loss of elasticity and fine lines. It happens on skin that has never seen the sun - compare the skin on your inner upper arm with the back of your hand, and the difference between the two is mostly the second kind.

Extrinsic ageing

Damage from outside - overwhelmingly ultraviolet light, plus smoking, pollution and poor nutrition. Produces deep wrinkles, coarse texture, mottled pigmentation, broken capillaries, leathery thickening and yellowing (solar elastosis).

This is the important distinction on this page. Intrinsic ageing you can slow only modestly. Extrinsic ageing is largely preventable - and prevention does more than any treatment will later recover.

Other contributors: hormonal change, particularly the fall in oestrogen at menopause, which reduces collagen, skin thickness and barrier function; and chronic illness, which diverts the body's resources from skin maintenance.

The signs, and what actually causes each

Sign	Main driver	What helps
Age spots and mottled pigment	Sun	Laser, IPL, peels, pigment inhibitors
Lines and wrinkles	Muscle movement plus collagen loss	Injectables for dynamic lines; resurfacing for static
Dryness	Reduced oil and lipid production	Barrier-repairing skincare
Dull, uneven tone	Slowed cell turnover	Exfoliation, retinoids, peels
Sagging, jowls, volume loss	Collagen and elastin loss, fat pad descent	Fillers, thread lift, or surgery
Easy bruising	Thinner skin and more fragile vessel walls	Largely unavoidable; sun protection helps
Visible capillaries	Sun damage to vessel support	Vascular laser, IPL

Ageing skin and skin cancer

Sun-damaged skin does not just look older - it carries a higher risk of solar keratoses and skin cancers, including basal cell carcinoma, squamous cell carcinoma (which arises from keratinocytes in the epidermis) and melanoma.

Any new, changing, scaly or non-healing spot should be assessed rather than treated cosmetically. A lesion that could be a cancer is examined and, if removed, removed whole and sent to pathology - never lasered off, which destroys the evidence.

Treatments

Cosmeceutical skincare - retinoids, vitamin C and other antioxidants, and daily sunscreen. The unglamorous foundation, and the part with the strongest evidence.
Laser resurfacing - for texture, pigment and lines
Skin needling - collagen stimulation
Chemical peels and microdermabrasion
Dermal fillers - to replace lost volume; from $590 including GST as at September 2024
Muscle-relaxing injectables for dynamic lines - prescription-only medicines requiring a doctor's consultation, which is why they cannot be named in advertising
Thread lift - from $4,600
Surgery - facelift, blepharoplasty, brow lift - where laxity is the dominant problem

Prevention, which is where the leverage is

Sun protection. Daily broad-spectrum SPF 30 or higher, hat, sunglasses, shade, no solariums. Nothing else on this list comes close.
Don't smoke. Smoking degrades elastic fibres and accelerates every aspect of skin ageing.
Diet. Fresh fruit and vegetables with antioxidants and vitamin C; less sugar and refined carbohydrate.
Hydration and adequate sleep.
Moderate alcohol.
A consistent skincare routine - gentle cleanser, moisturiser, sunscreen, and a retinoid if your skin tolerates it.

Vitamin D matters, but it is obtained safely with incidental exposure rather than deliberate sun-seeking - and in Australia most people get enough without trying.

What results are realistic

Skin treatments improve the visible signs of ageing - tone, texture, pigment, fine lines, firmness. They do not stop or reverse ageing, and no product or device does, whatever the packaging says.

Improvement takes months, because collagen remodelling is slow, and needs maintenance. Individual results vary with age, skin type, the extent of sun damage and consistency.

Risks

Redness, swelling, peeling and crusting after resurfacing
Changes in pigmentation, which can persist, particularly in darker skin types
Blistering, burns and scarring with deeper treatments
Infection, including cold sore reactivation
Irritation from topical actives
Bruising, asymmetry, lumps or vascular complications after injectables
Incomplete improvement and the need for repeat treatment
Surgical risks where surgery is chosen, including bleeding, infection, permanent scarring, nerve injury and anaesthetic complications

See risks and complications of cosmetic surgery.

Cost

As at September 2024 and including GST: skin assessment $50, Cosmetic Doctor consultation $150, Specialist Plastic Surgeon consultation $350. Dermal skin treatments from $130; volumising from $590; thread lift from $4,600. Surgical prices are on the individual procedure pages. Not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.