Saving face

To be fair it was nothing life-threatening, not that a leaking eyeball as a complication of glaucoma surgery is anyone’s idea of fun. But it meant my mother required specialised treatment that wasn’t available to her in central Queensland, necessitating her being flown to the Royal Brisbane and Women’s Hospital ophthalmology unit.

The day she was admitted we drove from the Gold Coast to visit her. While we were there a nurse came in and bathed my mother’s eye. She put drops into it. When visiting hours were nearly over we stood up to leave. I gave my mother a hug and stepped back and immediately felt ashamed of myself for realising that, instead of her eyepatch, I was looking at her wrinkles.

Maybe it was the fact she was in pain. Or maybe it was the fact the tyranny of distance meant that I hadn’t seen her for nearly six months. Or maybe, it was because she hadn’t put on any foundation or blush. Either way I couldn’t help but notice the deep spiderweb of lines spreading from the corner of her eyepatch, or the furrows of flesh crossing her brows, or the creases on her cheeks, or the sagging skin beneath her jawline.

As we drove home that night I was silent, worrying about my mother’s upcoming surgery, and feeling ashamed that I was also worrying that I had looked into a mirror. At my own face. In 27 years’ time.

Skin, which is composed of the epidermis, dermis and hypodermis layers, is the largest organ of the human body. It is also an organ where women are at a distinct disadvantage compared to men when it comes to ageing. At all ages, male skin is thicker than female skin with increased amounts of collagen fibres in the dermal layer[1] due to the stimulatory effect of testosterone[2]. This thicker dermal layer may offer better protection against UV radiation, irritants and allergens[3].

Females have more subcutaneous fat and undergo more pronounced muscle atrophy as they age. These physiological differences are known to predispose to peri-orbital wrinkles and a sagging chin[4]. Given that these physical attributes are a prime feature used by others in estimating a woman’s age[5], and given that collagen loss begins in our twenties[6], it is perhaps not surprising that the worldwide skin care market was estimated to be worth approximately $175 billion in 2016[7].

At menopause a further rapid deterioration in the health of a woman’s skin occurs with lower oestrogen levels leaving skin drier, thinner and more prone to sagging[8].

“In the first five years of menopause you can lose up to 50 per cent of your collagen and supporting soft tissue,” says Melbourne-based dermatologist Adam Sheridan. “As the oestrogen falls, the relative dominance of testosterone rises, resulting in thicker facial hair, increased sebum production with a greasier T-zone and adult acne. There is also a reduced blood supply to the epidermis leaving you more prone to rosacea and broken blood vessels.”

There are a number of factors that contribute to ageing skin, including smoking, diets high in refined carbohydrates and low in fresh fruit and vegetables, excessive alcohol consumption, sedentary lifestyle, stress and exposure to pollutants and harsh chemicals. Sun damage, however, is by far the biggest culprit.

“A certain amount of sunlight is required,” says Sheridan. “But if you think about it, the sun is many billions of nuclear bombs going off per second, so it is nuclear radiation hitting your skin. At the very least you want 50-plus sunscreen on your face and on the backs of your hands every day, even when it’s cloudy.”

Fair skin is prone to developing wrinkles, rough spots, skin discolorations and pre-cancerous lesions, all of which can be reduced by good skin care regimes. “The net effect is to make the skin healthier, more evenly coloured and looking smoother and younger”, says plastic surgeon Terrence Scamp. “Skin care needs to start early. It’s estimated that half the lifetime UV exposure occurs by age 15. Parents who protect their children’s skin when young give them a huge head start in preventing skin cancer.”

Caring for your skin should always be an integral part of caring for your whole body, says Dr Scamp. “Not smoking, maintaining a healthy body weight and exercising are all activities designed to maintain good health,” he says. “After all, your face is your window to the world. Women with healthier skin can wear less makeup and look better.”

To the millions of women out there who look at their credit card balance and then into the mirror and wonder if all that money spent on skin care regimes has been worthwhile, there is some consolation with numerous trials[9] showing at least mild and temporary improvements in skin appearance after application of topical creams and ointments containing retinols, poly-peptides, growth factors and anti-oxidants[10].

But there are limits to what a healthy lifestyle, preventative measures, and expensive cosmeceuticals can achieve, which is why many Australian women are also turning to cosmetic surgery. According to the Australasian College of Cosmetic Surgery more than a billion dollars is spent annually in Australia on invasive skin procedures such as anti-wrinkle injections, fillers and laser therapy.

Perth-based cosmetic physician Ehsan Jadoon was inspired to pursue cosmetic medicine after working in Alice Springs and seeing first-hand the effects sun damage can have on a woman’s confidence and self-esteem.

“More people are separating in their 40s and 50s and are finding themselves on the dating scene again,” he says. “They want to have the self-confidence to go and meet someone. Likewise, more people are choosing to stay in the workforce for longer and they want to look their best. People who grew up without the awareness of sun-damage are now seeing premature ageing, and from the inside, they don’t feel old but from the outside, people are treating them as older people.”

Perhaps if we lived in a utopian world our appearance wouldn’t matter. For most of us, however, the way we present ourselves to others is important.  

“There are many factors that contribute to our sense of self and appearance is just one of them,” says Royal Australian and New Zealand College of Psychiatrists president, Kym Jenkins. She believes there is nothing wrong with wanting to present ourselves as well as possible as long as we keep things in perspective.

“Our real sense of self comes from knowing who we are deep inside. It’s all those things such as: Who am I? Am I loved? Do I matter? Am I doing something worthwhile? Even if appearance is really important to you, your sense of self comes from a lot more than what you look like,” she says.

Jenkins says that it’s important to have age-appropriate standards. “We don’t have enough realistic role models of women as they age. For example, a sixty-year-old woman can look sixty and still be beautiful,” she says.

Wrinkles can often force us to face uncomfortable truths, such as the ageing process, and our own mortality. “It’s like when you look in the mirror and you realise that you look like your mother, it can be a shock,” Jenkins says.

Recently, my mother, whose eye had healed, came to visit and we took my four-year-old daughter to a nearby park. It dawned on me the reason my mother had looked so different when I saw her in hospital was not due to her wrinkles but because she was unwell.  

All the vibrancy and the animation in her features that had been lacking on that day were back. She was happy playing with my daughter in the park. And when I looked at her in this light, I realised that my mother was indeed beautiful.

For more details go to Suvi’s YouTube Channel at:

https://m.youtube.com/channel/UC0z6wSZIsYe5wU-PpgzUhZA

[1] https://www.ncbi.nlm.nih.gov/pubmed/19574028

[2] https://www.ncbi.nlm.nih.gov/pubmed/18215723

[3] https://mdmflow.com/skin-series-part-two-how-does-the-skin-differ-between-sex-and-race/

[4] https://www.ncbi.nlm.nih.gov/pubmed/19574028

[5] https://www.ncbi.nlm.nih.gov/pubmed/26113073

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606623/

[7] https://www.prnewswire.com/news-releases/global-skin-care-products-market-expected-to-reach-194961-million-by-2024—allied-market-research-674704383.html

[8] https://www.aad.org/public/skin-hair-nails/skin-care/skin-care-during-menopause

[9] https://www.ncbi.nlm.nih.gov/pubmed/29601620

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583892/pdf/de-4-308.pdf