Problem: Elastosis

Skin elasticity is what determines the skin’s ability to stretch and then return to its normal state. A loss of elasticity (tone and firmness) in the skin, known as elastosis, is a natural part of the aging process for most people. This sagging skin is defined significantly by the condition of the underlying muscles.
The connective tissues in the skin that provide flexibility and firmness are collagen and elastin. Collagen is a fibrous protein that is responsible for the firmness in skin, while elastin is a protein that gives skin elasticity. Elastin helps skin to return to its natural position after being pulled or pinched. Collagen does have elastic properties, however it is elastin that provides the skin with what it needs to stretch and be flexible.

Elastosis is most commonly seen on skin that has been exposed to ultraviolet rays over many years; however, this problem can also arise for other reasons, such as substantial weight loss in a short period of time. Vitamin deficiencies can also contribute to destroying elasticity of the skin. However, not everyone experiences sagging skin, which supports the theory that environmental issues play a large factor in elastosis. Nevertheless, the body naturally stops producing these proteins as it ages.
The skin goes through substantial variations, especially during menopause. This happens as a result of the hormonal fluxuations in the body. With the loss of elasticity in the skin, it loses firmness and becomes thinner. During menopause, wrinkles will also become more apparent, as well as the feeling of dry skin. Bruising and discolorations are more commonly seen, having much to do with the loss of thickness in the skin. The age of most menopausal women is 51, but may vary depending on the client’s ethnicity. It is during this stage of life that the previous effects of injury may begin to surface, such as sun damage or smoking. Collagen and elastin production also begin to slow, showing possible sagging of the skin. The facial muscles under the skin also begin to lose firmness, which does not help maintain the tautness in the skin.

Case Study:

A client comes to your spa one afternoon with a very specific challenge: sagging skin. The apparent lack of firmness is troubling to the woman. While she understands that taut skin eventually becomes lax as people age, she inquires about possible skin treatments to battle the situation. At 55 years of age, this female client is of Asian heritage and is post-menopausal. She is currently employed as a high school teacher. She indicates that others in her family do not suffer from lax skin, therefore it is not likely hereditary. Her client history form lists that she does not smoke, drinks a minimum of eight glasses of water each day, but also consumes alcohol regularly. She indicates that she cleanses and moisturizes daily, while exfoliation is sporadic. She complains that her skin still feels dry after application of a moisturizer. Upon examination of her skin, the sagging skin is most present on her jawline, as well as on both cheeks. She does not have an abundance of wrinkles, but you notice a small cluster of age spots on her temple.

As a skin care professional, what solution do you propose to treat this case study?

Solutions:

Sonia Boghosian, president of Bio Jouvance Inc.

“Elastosis is a common problem among mature clients. One should start the treatment with a skin analysis to determine skin elasticity, following up with products specifically formulated for this skin condition. Application of microneedling with water-based, natural serums and ampoules, formulated with specific skin whitening ingredients, such as kojic acid and anti-aging ingredients collagen and elastin, can improve clients’ sagging jaw and cheeks issues. The use of microneedling enhances absorption of active ingredients up to 400 percent without removing the dermis or damaging the epidermis, especially in the case of skin elastosis that cannot endure any more damage. Treatment must be followed with a serum based on hyaluronic acid, DNA/RNA, and masks rich in ingredients compounded with azulene and CoQ10 enzyme. Application of a moisturizer with sunscreen after treatment is a must. Having a client consultation, in addition to providing home care products, is a key to successful treatment.”

Joan Tomeu, R.N., international education at PCA SKIN®

“Once patients begin to age, protective and collagen-building ingredients must be added to their regimen. Loss of elasticity is often triggered by unprotected UV exposure. UVB rays have been proven to increase MMP production and destroy collagen and elastin. Daily, year-round use of a broad spectrum sunscreen product was not mentioned in this patient’s case study, so this is a critical first step in her treatment. Products containing antioxidants, next generation peptides and MMPi are integral additions. Professional treatments should include monthly blended TCA peels alternated with microneedling treatments. These microneedling treatments are an opportunity to push the important collagen and elastin-building ingredients into the skin for more dramatic results. Educating the patient is also critical. She must understand the important role she plays in the health of her own skin. Making appropriate lifestyle decisions, practicing sun avoidance and compliance with her home use products will lead to positive, visible results.”

Gina Charles, D.O., family medicine physician, owner of Makeup By Dr. G

“Elastosis is a condition that increases with age and is most commonly associated with fair-skinned women who have had sunburn on a regular basis. The key to treating elastosis is consistency. Before any professional treatment, the patient must adhere to preventive measures against sun damage: limiting sun exposure (maximum total of two hours per day), wearing protective clothing, and using broad spectrum sunscreen (SPF 30 or higher).
I recommend purchasing sunscreens containing key in-gredients such as benzophenone, oxybenzone, avobenzone, titanium dioxide and zinc oxide and remind her that the use of sunscreen should be carried out year-round to receive optimal protective benefit. I would examine the patient’s skin closely for any lesions or moles, and possibly biopsy a section to assess for precancerous cells. As with any aging skin condition, the patient should moisturize her face daily. Lastly, I would prescribe a topical retinoid to collectively prevent, restore, and heal effects of elastosis.”

Dasha Saian, vice president of SAIAN, LLC

“As women age and go through menopause, they often find that the skin of the face has lost tone and has become flaccid. This is because of the loss of hyaluronic acid and natural breakdown of collagen and elastin in the extrinsically-aged skin. Among the many factors that contribute to this are hormonal changes, dehydration, and exposure to sunlight and ultraviolet radiation (which we can observe from the age spots on the patient’s face). In fact, elastosis is the primary consequence of photoaged skin. When the patient pulls on the skin, it is unlikely to bounce back to its original place, and this shows the decreased elasticity. Daily regimen has very much to do with the patient’s current condition. By overexfoliating the skin regularly but not moisturizing enough, she is pulling moisture out of the skin that is already dehydrated. The patient needs to include hyaluronic acid and peptide based serums and creams into her regimen, as well as avoid the sun, and remember to apply sunscreen every two to
three hours.”