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Dr Nedic writes about Ethnic skin ageing in A2 magazine

Dr Nedic writes about Ethnic skin ageing in A2 magazine

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Aging is a complex unavoidable process that happens in all humans. This includes aging of the skin that we notice first, and we intend to take some action to improve it.

Women who possess a youthful appearance are consistently rated as more attractive than older-appearing women according to studies. Furthermore, skin texture studies have shown that the effects of skin pigmentations can contribute that the perceived age might be even 20 years more than actual age. Younger, flawless and skin with an even tone, is not just more attractive but considered as healthier. Irrespectively of skin color majority of women (and most man) like to look younger, more attractive and healthy.

 Characteristics of skin aging in Ethnic skin

When we talk about Ethnic skin types we refer to a broad range of skin complexions that characterize persons with darker skin such as one off African, Asian, and Latino descent, and what we usually in medical literature call  Fitzpatrick V-VI.

Aging skin can be described clinically as a presence of wrinkles, sun damage, pigmentations, uneven skin texture and sagging skin. These skin changes are induced by intrinsic (inside) and extrinsic (outside) factors and can vary in deferent skin types and ethnicities.

One of the most prominent extrinsic factors for aging is a sun damage (photoaging). In darker skin types the amount of melanin is higher, and degradation of melanosomes is slower making the ethnic skin more protected from UV radiation and photodamage signs usually seen in lighter skin types ( including skin cancers) are fewer. In fact, the study demonstrated that ethnic skin, on average, provides an SPF of 13,5. However ethnic skin reacts to harmful UV with pigmentations that are considered as a sign of photoaging. There are multiple defined pigmentation genes, which also contribute to ethnic differences in pigmentation problems.

Other extrinsic factors such a smoking, alcohol, nutritional depletion due to too much junk food consumption, environmental toxicity, stress, high sugar intake are all involved in premature skin aging, predominantly loss of firmness and elasticity. Usually darker skin types exhibit these changes much later in life, but nowadays due to an inadequate lifestyle that increases oxidative stress, younger ethnic women have signs of premature aging. Optimistically, they also start seeking treatments at the younger age to prevent premature aging.

Intrinsic aging is genetically determined and hugely depends on hormonal depletion. With chronological aging people display thin skin, fine wrinkles, fat atrophy, sagging, and bone remodeling. Ethnic skin show less severe intrinsic facial aging with signs appearing even 10 years later than lighter skin types.

Skin aging is also associated with advanced waste and structural changes of the dermis (deeper skin layer) causing folds and wrinkles, and darker skin has thicker and more compact dermis than lighter skin.This possibly adds to the lower incidence of wrinkles in the ethnic skin. Also, darker skin types have greater lipid content compared to lighter skin that increases skin barrier properties and skin retain more hydration.In darker skin collagen fibrils are compact and have more parallel orientation, allowing skin to maintain its youthful appearance longer than lighter skin types. However, cell structures increase possibilities for keloid scars. Furthermore, it is the thickness and weight of ethnic skin that contribute to sagging jowls that is never as prominent as in lighter skin.

In conclusion, darker skin type characteristics are:

o    Signs of skin aging appear very late (unless premature aging)

o    Less wrinkling

o    Pigmentation are very frequent

o    Increased skin barrier properties

o    Better hydration

o    Keloids scars possibility

o    Skin cancers very rare

o    Genetically, this skin type is less susceptible to damage from UV radiation, although the skin can still get burned.

o    Sagging face and neck are due to premature aging and more thickness

Skin procedures suitable for ethnic skin aging

As a general rule any aesthetic procedure that keeps ethnic skin integrity undamaged is suitable and safe, and contrary if skin continuum is broken there is a high risk of pigmentations ( PIH-postinflammatory hyperpigmentation)and even hypopigmentation.

-Dermal fillers and neuromodulators (Botulinum toxin A) are suitable for darker skin types, and they are used for treating static and dynamic lines and wrinkles,3D face recontouring, Liquid facelift, nonsurgical nose correction, jaw line correction, nonsurgical neck lift, etc.

-Radio-Frequency treatments (Thermage, Tripollar, Vela shape 3) are all suitable and safe in darker skin types and can be used to address sagging skin, on the face neck, eyelids and jowls and can remove unwanted fat such as double chin. Additionally, ultrasound therapy and tailored infrared light ( like Titan ) that also address sagging skin can also be used safely.

-Microneedling (Dermaroller, Dermapen) for improving skin texture, mild pigmentation, and mild acne scarring and can be used to deliver active ingredients that have anti-aging properties like growth factors, platelet rich plasma, hyaluronic acid, etc. Overall this procedure is suitable for darker skin types providing that patients use pre-and post-treatment and care that decrease possibilities of pigmentations ( PIH)

-Laser treatments are very potent tools in aesthetic, but some of them can be very dangerous for darker skin tones (dyspigmentations and burning). Suitable and safe for African and Asian skin is a laser that uses 1064nm wavelength like ClearLift laser. It stimulates collagen, reduces fine line and wrinkles, brakes up melanin diminishing hyperpigmentation, and melasma minimizes large pores. Similarly, can be used for tattoo removal new wavelength 1064nm Nd: YAG is suitable for hair removal on a dark skin type. Other fractional laser treatments might be used, but each case should be individually assessed, exclusively by a medical doctor who has experience in laser procedures. Under no circumstances, the person with a darker skin type will allow being assessed and treated with a laser by a person other than a medical doctor or at least under the doctor’s supervision. IPL that emits a broad spectrum of light is also less safe and needs doctors supervision.

-Light chemical peels are another excellent treatment for darker skin types. Chemical peels improve the appearance of fine lines and wrinkles, sun damage, skin pigmentation and melasma, mild acne scars, and some forms of acne. Superficial and medium peels can be used in the darker skin but deep peels like TCA with extreme caution and previous spot test. Light chemical peels can be used in conjunction with cryotherapy, mesotherapy ( cryo-meso –peel) or  LED therapy to enhance anti-aging properties, improve melasma, acne, and acne scarring treatments, etc. They all are safe and suitable for ethnic skin.

In general ethnic skin, aesthetic procedures need to be done under doctor’s supervision in practice dedicated to treat ethnic skin problems.


Some references used:

  1. Halder R, Richards G. Photoaging in patients of skin color. In: Rigel D, Weiss R, Lim H, Dover J, editors. Photoaging. New York: Marcel Dekker; 2004. pp. 55–63.
  2. de Rigal J, Des Mazis I, Diridollou S, et al. The effect of age on skin color and color heterogeneity in four ethnic groups. Skin Res Technol. 2010;16(2):168–178. [PubMed]
  3. Jones D, Brace C, Jankowiak W, et al. Sexual selection, physical attractiveness, and facial neoteny: Cross-cultural evidence and implications [and comments and reply] Gurr Anthropol. 1995;36(5):723–748.
  4. Rawlings AV. Ethnic skin types: are there differences in skin structure and function?Int J Cosmet Sci. 2006;28(2):79–93. [PubMed]
  5. Kaidbey KH, Agin PP, Sayre RM, Kligman AM. Photoprotection by melanin—a comparison of black and Caucasian skin.J Am Acad Dermatol. 1979;1(3):249–260. [PubMed]
  6. Brissett AE, Naylor MC. The aging African-American face. Facial Plast Surg. 2010;26(2):154–163.[PubMed]