DANA POINT, CALIF. – Finding ways to restore elasticity of the skin is a better goal than is developing and refining ways to tighten the skin, according to Dr. R. Rox Anderson.
"The loss of natural skin tension with aging is due to a loss of its elasticity," Dr. Anderson said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "It’s the impressive loss of cutaneous elastic recoil with aging that accounts for the effectiveness of Botox, for example. A simple hypothesis is that restoring skin elasticity is a better goal than tightening the skin."
Dr. R. Rox Anderson
The "players" in cutaneous elastic recoil, he said, are numerous, but it remains unknown which are pivotal. Is it the extracellular matrix content and cross-linking, the fibril microstructure, or the active cytoskeleton?
"When you lose elastic recoil, we don’t know which ones of these are most important," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston. "If we knew that, we could design treatments that actually treat the cause as opposed to [treating] flabby skin."
He said that "powerful, verified" research tools are needed to improve understanding of cutaneous elastic recoil, including "composite, dynamic structural models" to expand understanding of the difference between microscopic and macroscopic skin. "Those exist; we don’t have to invent them," he said. "I’m an adjunct professor at Massachusetts Institute of Technology, [which has] an entire department that does nothing but material science and modeling. They’re really good at composite materials. That’s what we [humans] are: we are complex composite material."
Stress-strain component analysis is another key tool to improve understanding of elastic recoil. "Each of those components has its own structural and dynamic behavior," said Dr. Anderson, who also directs the Wellman Center for Photomedicine. "I think it’s important to recognize that the skin is a dynamic system that responds to stress. So Langer’s lines are due to particular strain receptors and fibroblasts. The genes that are strain inducible have been at least partially noted, but they have not been studied in the context of skin tightening and rejuvenation. I would love to see that: a dose response analysis for strain-mediated gene expression."
Studies involving in vivo microscopy will also be important. "Elastin, for example, is easy as pie to image in vivo in human skin," he said. "We should be able to map mechanical properties of skin."
Dr. Anderson said that he had no relevant financial conflicts to disclose.