12. Understanding and treating photoaging

Pigment blemishes, wrinkles, and flaccid skin are not just the natural consequence of the passage of time, but the result of excessive time in the sun. Photodamage also develops into actinic keratoses and skin cancer, and because we live in an era of ‘ozone holes’, we can expect the incidence of photoaging and skin cancer to increase dramatically. People are simultaneously living longer than ever before, and more people will want facial rejuvenation, but a facelift carried out with photodamaged skin merely produces a ‘neater’ older person. When we do facelifts on people with healthy, young-looking skin, we actually rejuvenate the face. Therefore, all plastic and cosmetic surgeons should advise their patients on how to achieve healthy skin. In order to devise a scientifically based strategy for preventing or treating photodamage, we need to understand what sunlight does to the skin. Of course, we all have to go out into the sun because we also need sunlight to be healthy so we have to use science to protect young skin while getting healthy sunlight, yet minimize photoaging. A tan is the first step in photoaging and since most of our sun exposure occurs before the age of 20, young people already show signs of photoaging. ETIOLOGY OF PHOTOAGED SKIN