Excerpt from Women, We're Only Old Once (Cooper): What's Really Happening to Our Face and Skin

 

The following is an excerpt from Women, We're Only Old Once: Keep What You Can, Let Go of What You Can't, Enjoy What You Have Left.

What’s Really Happening to Our Face and Skin? 

“Everything is just breaking down … it just is,” Dr. Haycox told me matter-of-factly in her captivating English accent.(personal interview 11/04/10).

Skin is the largest organ of our body and the first to show the signs of aging. Just like our vital internal organs, skin is regenerating at a slower pace; unlike our internal organs, we can see it. Of course, a life without skin is unimaginable, but it is lost on most of us that the skin is a complex organ without which we would not have protection, body temperature control, pain or pleasure sensations, hair, and padding. We also wouldn’t have the body contours and structure that shape our faces, our expressions, and bodies. 

Skin is flexible and accommodating of thin figures and obese figures, although once skin is stretched over an obese build for a long period, skin never can return to hug a thin build. 

Understanding the anatomy of the skin helps us understand what happens in aging. Skin has three primary layers, the epidermis, the dermis, and the hypodermis, more commonly known as subcutaneous tissue. Each layer has layers or cells within it, all with specialized functions. We have most familiarity with the epidermis, in which skin cells are developed and pushed to the top only to slough off as dead cells. Our skin completely sheds about every two weeks. 

The epidermis is thinnest on the eyelids and thickest on the palms of hands and soles of the feet. The dermis also varies in thickness; again, the thinnest dermis is on our eyelids and the thickest is on our back. The dermis has collagen, elastic tissue, and reticular fibers (a type of connective tissue) which holds together hair follicles, oil glands, and sweat glands. Blood vessels and nerves running through the dermis are responsible for transmitting sensations of pain, itch, and temperature. Specialized nerve cells transmit the sensation of touch and pressure. 

Finally, subcutaneous tissue is a layer of fat and connective tissue and is important to the regulation of temperature of the skin and body. The layer also houses blood vessels and nerves. Subcutaneous fat is important to padding our bodies to give us soft landings, contouring our bodies to give us plump cheeks and insulating us to keep us warm. 

Elastic Bands Wearing Out 

Dr. Haycox explains that elastin, a substance in the dermis or second layer of skin, starts to break down as we age, and our skin no longer has the recoil of our younger years. “Snap the back of your hand, and it doesn’t immediately snap back,” she directed. So, I did, and it didn’t. Instead the pinched fold stayed intact for at least a second and then began to slowly return to cover my hand. “Pinch the back of a baby’s or child’s hand and the skin snaps back like a rubber band.” 

I envisioned miles upon miles of elastic bands covering our bodies that are simply wearing out like the waistbands of underwear. These are the bands that keep us firm and hold up our features. These are the bands that tuck our chin under our jaw, point our breasts out instead of down, and keep our eyelids from falling over our eyes. Unfortunately, we can’t replace the elastin of our dermis like we can replace the elastic in our underwear.

Losing Fat Cells Not a Good Thing 

The breakdown of elastin is but one accomplice in our falling features and figures. Surprisingly, loss of fat cells is another, surprising because most of us think of loss of fat cells as a good thing. 

“Loss of volume,” Dr. Haycox continued in her professional matter-of-fact way, “is another problem. The skin starts to lose the fat within its layers, and everything caves in and droops down. Not only are fat cells decreased, those that replenish are smaller and provide little or no lift to the heavier layers of skin.” 

“Now, wait a minute,” I protested, “most women have been fighting with fat cells all their lives and would love to have fewer and smaller fat cells.” 

Dr. Haycox asked me to think of people who have lost a great deal of weight and explained that their skin doesn’t bounce back, especially as they get older, and the fat, whether too much or not enough, no longer holds their skin in place.

As we age, we no longer have the resilience of elastin or sturdy natural fat. Gravity begins to rule, and our skin begins to droop. Gravity pulls our chins, breasts, and butts down. The structure of our contours tumbles for lack of girders, and substance falls away for lack of walls. 

Our bodies no longer have the rapid replacement capacity necessary to keep up with the rate of losing elasticity and supportive fat cells. Slowing replacement and renewal is the fact of aging skin just as it is for all organs of the body. 

Loss of volume from fewer and smaller fat cells also means the loss of the insulation or padding of our hands, feet, arms, and legs that helps keep us warm. Our fat may collect in certain and most unwanted places, but it isn’t enough to ward off chills and explains why I bought an “old lady’s sweater” several years ago.

Natural and Unnatural Images of Aging Women 

Before jumping into the care of aging skin and remedies for common conditions, as well as what we can do to keep our expressions livelier and more animated, it’s worth pausing here to look at what we think an aging woman’s face and skin should look like and why. As noted in the introductory chapter, the advertised face of older women is young, usually women with attractive white hair and relatively unlined faces. You need only check your recent AARP Magazine or Town and Country for examples. 

Television and big screen images, usually unforgiving in close-ups, show women who’ve grown old with us over the years without the wrinkles we have. Exceptions can be found in movies about older folks finding their groove, e.g., The Best Exotic Marigold Hotel. In contrast to few roles for older American women, British actors like Judi Dench, Maggie Smith, and Vanessa Redgrave are sought after for roles in which they play characters their age. Few have had the extensive cosmetic work that freezes the faces of some in the aging Hollywood set and, as a result, their faces are more mobile, fuller of expression, and readily express the range of human emotion. 

Working actors over 50 tend to gravitate to the theater where there are more varied parts for older women and age isn’t an impediment. (Cicely Tyson, age 95, won a Tony in 2013 for her role in A Trip to Bountiful at age 89.) 

Still, in America, we have solid examples of strong and interesting women’s faces on the national stage. They belong to successful women in all walks of life: Hillary Clinton (72), Senators Diane Feinstein (87), and Barbara Milkulski (84), Gloria Steinem (86), and Supreme Court Justice Ruth Bader Ginsberg (87) to name a few. 

These elected national leaders are joined by hundreds of state and locally elected women officials, artists, writers, and activists. When we see photographs of all these women, we see intelligence, wisdom, humor, and resolve in addition to their wrinkles and sagging jowls. 

My guess is that all these women use one if not several skin care products, and some may well have had cosmetic surgery, but few are in service of the beauty industry or dependent on their looks for their success and recognition. This is worth remembering as we explore the twin aspects of caring for our faces: paying attention to both skin and expression. 

Care and Remedies for Aging Skin 

Since most of us get our scientific skin information from beauty aids and cosmetics counters, I thought it necessary to go to the practitioners of skin medicine, those who diagnose and treat, dermatologists, and those who comfort, moisturize, and touch, aestheticians, to learn the care and remedies for aging skin. 

Earlier, I noted the pressures on women to stay young and beautiful along with our own desire to stay visible and relevant. Remembering that aging is a natural process and one that cannot be prevented, each of us need to carefully think about what is important to us in the care of our skin and what is feasible in time and money. We have it within our power to make the decision that is best for our well-being and not to be influenced by expectations and attitudes of others. 

To some of us, it is important to maintain as youthful an appearance as possible. This could be due to careers that require a certain look. It could be due to our own desire to forestall the slippage into old age. It could be that we want an appearance that matches the vibrancy we continue to feel as we age. How often we hear our voice or the voice of other women saying, “I don’t feel old in my head.” Today, we aging women have options that women before us never had or even dreamed. 

There is no true antidote for aging skin. However, there are measures we can take to prevent premature damage, repair damage, and simply look better because we do proper skin care and hygiene. Many remedies are covered in more detail in the chapters on energy and weight (exercise, nutrition and hydration). Overall good health and health practices means healthier skin. 

The first, foremost, and most critical action is to stop smoking immediately or never start. Smoking constricts blood vessels. Therefore, circulation and the amount of restorative blood that can reach the skin. I am happy to report that I stopped smoking 30 years ago. One of the first things one of my friends said was that my skin was beginning to look pinker. That would be the blood reaching all the cells of my skin. 

The next important action is the diligent application of sunscreen. Exposure to too much sun damages our skin. Sunscreen is particularly important for fair-skinned women who are more susceptible to sunburns. All you need to do is look at areas of your body exposed to the sun and areas not. You will see that unexposed skin continues to be softer even though it, too, is going through the aging process. 

Sun isn’t the only environmental concern. We face pollution, wind, dust, and cold. Exposed skin loses the natural protective moisture sooner and results in dryness, making the skin more prone to flakiness and, in worse cases, open areas, such as cracks, splits, chafing, and flakiness, and infection. Those of us who live in colder climates and stay indoors more during the winter have the additional problem of heated air drying out our skin. We are not as aware of the drying when we are young, but as we age, we feel the dryness because our body is losing its natural ability to restore moisture to our skin. The good news is that we can replace moisture by putting a pot of water on the wood stove, using a humidifier to replace moisture in the air, and applying moisturizer as part of our skin care hygiene. 

The dry skin problem is not lost on the makers of cosmetics who know that the best remedy for skin that loses its protective moisture is to replace it. The manufacturers vie for our attention in marketing their products, a remarkable number of them within a wide price range. Replacing moisture is what counts and should be a part of every woman’s regime starting in their 30s if not sooner. 

I have a beloved female relative in her early 50s who enjoys all things outdoors. She has a natural zest and desire for challenging her body. She runs, she climbs, she bikes, she swims, she competes, and she gets down in the mud. She is attractive and healthy except now in her late 50s her face is showing what I think are serious signs of damage. I pointed out to her that the skin on her face had as many if not more wrinkles and dryness than mine which is well into the aging process. 

Hers is not natural; mine is. Hers is damage. She listened patiently as I explained that her skin only would get worse and is losing the ability to restore itself. She even agreed to use sunscreen and moisturizer. I sent her a starter kit—along with a stern warning about skin cancer—which she promised to use. We live far enough apart that I won’t know what she will do. I will not make it an ongoing part of our relationship. I love her too much for that. I think she may be like many women who see skin care as either vanity or a waste of time rather than seeing it as protective and caring for the largest organ of their body. 

For the rest of us, many if not most manufacturers of skin care products tie moisturizing to “anti-aging” remedies like reducing fine lines. I really don’t know what “reducing fine lines” means and don’t know of any meaningful studies. What I think it means it that the product can’t reduce big lines. 

Another product claim is that the product when applied will improve elasticity or result in a minor skin lift. I do think there are products that tighten skin temporarily. Eventually, our skin will droop again as Dr. Haycox tells us. We only are helped by our genetics and our physical fitness; that is, unless we turn to special remedies which include surgical intervention. 

Facials as a Remedy 

Aestheticians are trained practitioners of skin care and typically provide services around the care and keeping of the skin of our face. Most are credentialed through training and in some states are licensed for their expertise. In my opinion, a woman should have at least one facial during her life. Not only is she treated to an hour of total attention to caring for her face in an environment of comfort and relaxation, she learns from her aesthetician how to care for her own skin. Aestheticians will advise a woman on the condition of her skin especially as it relates to dryness and hydration. No doubt she also will be introduced to products sold by the aesthetician, but there is no obligation to buy. 

A good aesthetician will interview her client before she starts the service to determine what her client is looking for and if there are any medical issues that might influence treatment. Rosacea, a skin condition often present in older women, is characterized by varying degrees of sensitivity to heat. Clients with rosacea or other types of heat sensitivity are not candidates for steamy towels on their faces but can enjoy other aspects of having a facial. 

Aestheticians generally exfoliate which means a treatment that removes dry skin from the face, then deep cleans the skin, sometimes picking out those tiny whiteheads encased in membrane, and finally moisturizes with wonderful facial massage. Many will include massages of hands and feet, too. The experience is truly beneficial to the skin, and most women leave relaxed and slightly red, a condition that soon disappears. There are products a woman can purchase inexpensively or expensively that will exfoliate and moisturize their skin, face, and body. Products are available for exfoliation that do not use microbeads which are known water pollutants and harmful to sea life. 

The cost for facials varies depending on area and the salon. The most reasonable are around $75-$100 an hour. Of course, they are only reasonable if a woman can afford the service. A woman seeking the service of an aesthetician will want to get references from those she trusts. 

Whether done by an aesthetician or at home, establishing a skin care routine of hygiene, moisturizing, and hydration becomes more important as we age. Good skin care is as much, if not more, about maintaining the good health of the largest organ of the body as appearance. 

Drooping Lids and Disappearing Lips 

Our eyelids are the thinnest skin area of our bodies so we should not be surprised that eyelids often are the first noticeable casualties of lost volume and elasticity. In youth, our eyelids stay up and away from covering the top of the eye. If we choose, we can apply eye shadow on the lid over the top of the eye and liner at the eyelash line to create a more defined deep-set eye look. For many, this makeup trick brings out sparkle and color of their eyes.

As we age, our eyelids lose their elastic capacity to stay in place, and the eyelid progressively covers more of the eye. Eye makeup gets lost in the folds and is absorbed into the creping skin and may never be seen again until it appears on the makeup remover pad. Our eyes appear smaller as eyelids encroach on eyes. In more advanced cases of eyelid droop, the lids fall over the eye enough to affect vision and may require surgery to lift the eyelid. 

Many women choose the same eyelid surgery called blepharoplasty, the procedure for taking out excess skin from eyelids for cosmetic reasons. If eyelid drooping is significant enough to impair vision, Medicare covers the cost of the surgery for Medicare beneficiaries up to the benefit limit; supplemental insurance will cover deductibles and co-payments depending on the plan. 

Another mark of an aging face is thinning lips which start to disappear as winkles appear. Lips also are losing volume and will appear thin especially when our mouths are closed. Lip plumping is a remedy for thin lips. Certain products such as lip gels and exfoliation promise lip plumping. The most effective temporary remedy for thin lips is through injections of products such as Restylane or Juvéderm administered directly into the lips by a dermatologist. The resulting lip plumpness is reported to last up to six months.

From Peels, Injections, and Lasers to Facelifts 

Several procedures have evolved to help women who are looking for remedies for damaged skin or simply want a younger look. Nearly every procedure mentioned here should be done only by a trained and experienced professional because if done by inexperienced hands, permanent damage can result. The color and tone of your skin is a prominent consideration in whether you are a candidate for any of the treatments because the procedure could result in uneven color on darker tones. 

Most results are temporary, lasting weeks to months and occasionally years. I gave myself the gift of a laser treatment on my face for my 60th birthday. Lasers work through application of pulsating light that penetrates the skin. I was looking for something that would refresh my skin down a few layers and get rid of blue veins that had popped up on my chin. The procedure was performed by a dermatologist in a clinical setting. I was pleased by the result even though she warned me the veins would reappear in the future. I treated myself again for my 65th birthday. This time the procedure was done as effectively by a trained physician assistant who worked under the direction of a dermatologist. 

Dermabrasion, also performed by a dermatologist or plastic surgeon, is much like having your face “sanded” or a more extreme form of the exfoliating scrub you do at home. The upper layer of the skin with some of its imperfections is removed. This may be a procedure suitable for women with more color tone; however, careful consultation with an experienced practitioner is strongly advised. 

Chemical peels are applied and blister, causing the skin to peel off. What results in what seems like a bad sunburn is performed by a physician in a controlled setting and results in smoother less-lined skin. These procedures involve working with and to some extent through the top layers of skin, causing disruption and using the body’s own healing mechanisms with noticeable smoother skin as a result. 

Botox injections temporarily lessen the appearance of wrinkles work by blocking the nerves that contract muscles. Since the injected muscle doesn’t voluntarily or involuntarily move, the injected skin area is smooth and wrinkle-free. The resulting unresponsive skin area explains the common perception that those who have had Botox injections are expressionless. 

The more commonly known of all the procedures is the facelift. Facelifts are surgical procedures with all the potential risks of surgical procedures: anesthesia, infection, and pain. Plastic surgeons go to great lengths to explain the risks and establish reasonable expectations. Like all surgical procedures, a recovery period is necessary for healing. Unlike several of the above procedures, healing doesn’t cause the transformation; rather, surgical shaping of the face takes place during the facelift. 

Facelifts do exactly what they say: pull, lift, shape, and tighten the skin and tissue of the face and neck. The face and neck are relieved of excess unnecessary skin, and, voila! bone structure is once again seen surrounded by smooth-appearing skin. 

Facelifts will make a woman look five to ten years younger, but, of course, she will continue to age. The woman with a facelift always will have a face that appears five or ten years younger than her actual age. That is, as long as she continues to make healthy choices for her skin like wearing sunscreen, not smoking, using moisturizer, and staying hydrated. 

The average cost of a facelift and neck lift varies according to the region, surgeon, how much is done, and where it is done. The best I can find on what one can expect to pay is anywhere from $10,000 to $12,000. The cost is in part explained by remembering that these are surgical procedures that involve a sterile environment, anesthesia, post-op medicines, and aftercare. 

“I can tell that (she) had a facelift because her face looks young but the back of her hands look old. You can’t fool anyone,” announced my favorite mother-in-law. I decided she was correct; the thinning and creping skin of our hands exposes our aging, often accompanied by age spots. Moisturizers and sunscreens are as important to our hand skin health but won’t correct thinning and creping. 

Creping hands are only a problem if your motive is to hide your age. For many, hiding age is less the point of cosmetic surgery than just wanting to look good and feel good about how we look. It does help to use moisturizer. 

Not everyone is a candidate for elective cosmetic surgery. If you smoke or stopped recently following a long period of smoking, the surgeon may advise you that you will not heal properly. Once again. remember that smoking constricts blood vessels, reducing circulation and the amount of healing blood that can reach the surgical area. 

Our Aging Face May Not Display Our True Feelings 

As we age, faces no longer reflect the automatic expression of what we are feeling, which may explain why we tend to see older folks as unhappy. When the skin tissue and remaining muscles of an older person’s face relaxes as in his or her most contemplative moods, the folds seem to fall into the sad face of the clown with the downturned lips. The elasticity and volume that kept us looking alert no longer holds the tension of our expressions. The same look may occur when we are listening intently, causing the speaker to think we are uninterested or disapproving. 

The single most effective antidote to a sullen aging expression is a simple smile. All those slackened facial muscles lift up, eyes brighten, and noses lose their prominence. Every one of the women I interviewed appeared younger when they were animated with thought and expressing themselves—and never more so than when they were smiling. Smiling for the sake of smiling is not always easy, of course. A forced smile may feel unnatural or too reminiscent of being told to smile to be pretty. As girls and young women, we may have been encouraged to smile because we were much more attractive when we smiled. On the other hand, a genuine smile of appreciation, interest, or friendship is almost always is appreciated. 

Either way, I recommend becoming more aware of what our faces are doing and recognizing that after a certain age the default tends to be a downturned mouth, conveying the opposite of what you are intending. Improving your awareness increases your opportunity to use your face to express what is no longer automatic. Engage your face to reflect your engagement in the moment with another person. 

Observation of others tells me that curious minds are betrayed by complacent faces. We older ladies no longer have the security of a youngish face with enough elasticity to hold our expression in place regardless of our interest. As much as we think that others should honor our age and seek to learn from us, it simply doesn’t happen, especially if we appear uninterested and grumpy. 

Be Aware, Be Interested, Be Engaged 

Part of healthy aging is to understand why people no longer pay attention to you or ascribe characteristics to you based on those slack jowls. It takes hard work and focus to balance acceptance of natural aging with preservation of a healthy and engaged appearance. My solitary walks are often on the same path as others my age and older whom I pass on their walks. People who ignore me are rare, and eye contact with a smile brings an immediate smile and greeting. 

Most of us don’t feel as old and dispirited as we look. Inside, we are still the person we always have been. In fact, we are at a loss to explain the reaction of others who ignore or avoid us. The societal view of aging as a grumpy dumpy time is pretty much caused by our lack of awareness of our own presence. Practice animation so that you convey what you intend to convey. 

Be aware, and be engaged.

For more posts about Bertha Cooper and her books, click HERE.

Read about her contribution to the pandemic series, Old and On Hold.