The information in this book has been compiled by way of general guidance in relation to the specific subjects addressed. It is not a substitute and not to be relied on for medical, healthcare, pharmaceutical or other professional advice on specific circumstances and in specific locations. Please consult your GP before changing, stopping or starting any medical or health-related treatment. So far as the author is aware, the information given is correct and up to date as at May 2013. Practice, laws and regulations all change, and the reader should obtain up-to-date professional advice on any such issues. The author and publishers disclaim, as far as the law allows, any liability arising directly or indirectly from the use, or misuse, of the information contained in this book.
It’s the secret that everyone wants to know – how not to get old!
Are you unhappy with the way a particular part of your body is ageing? Do you wish you could have a firmer bust, fewer wrinkles or plumper skin? Then look no further than this book! How Not to Get Old tells you everything you need to know in order to slow the telltale signs of ageing on both your face and your body.
This stunning book is packed with facts about all the surgical and nonsurgical anti-ageing treatments on the market and which of them are worth trying, as well as pointers to help you slow the signs of ageing naturally through diet, exercise and lifestyle.
How Not to Get Old is a must-have for anyone wanting to make an informed choice about how to make the most of their appearance, whatever their age!
TRANSWORLD PUBLISHERS
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Group Company
www.transworldbooks.co.uk
HOW NOT TO GET OLD
Version 1.0 Epub ISBN 9781448171231
ISBN 978 0 593072 66 0
First published in Great Britain
in 2013 by Bantam Press
an imprint of Transworld Publishers
Copyright © Twenty Twenty 2013
Design and art direction: Smith & Gilmour
Photography: Karl Grant
Hair and make-up: Dina Catepole
Stills photography: Fiona Hanson and Anthony Upton
Additional photography: Andrew Lambton (here),
Paul Farrell (here), Wilde Fry (here)
Illustration: Johanna Fernihough
Editor: Clare Sayer
Karen Dolby has asserted her right under the Copyright, Designs and Patents Act 1988 to be identified as the author of this work.
Every effort has been made to obtain the necessary permissions with reference to copyright material, both illustrative and quoted. We apologize for any omissions in this respect and will be pleased to make the appropriate acknowledgements in any future edition.
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CONTENTS
COVER
ABOUT THE BOOK
TITLE PAGE
NOTE ON THE TEXT
FOREWORD by Dr Rozina Ali
THE FACE
AGEING NATURALLY by Louise Redknapp
TREATMENTS FOR THE FACE
TEETH
HAIR
SURGICAL TOP TEN
MORE THAN SKIN DEEP by Dr Max Pemberton
THE BODY
NIPS AND TUCKS FROM AROUND THE WORLD
EXERCISE AND WELLBEING
ANTI-AGEING FOOD
A GUIDE TO THE DECADES
DIRECTORY
ACKNOWLEDGEMENTS
INDEX
ABOUT THE AUTHOR
COPYRIGHT
Ageing: we’re all doing it. It’s inevitable and it’s gradual. The best any of us can hope for is that it will be as long and slow as possible. But I want more for you.
I think it’s perfectly possible to look better as we age: we can mature into our best selves and achieve the face we deserve, not just the one we’ve earned. My approach to ageing is to embrace the process and aim to age well – that is, to be healthy, fit and attractive for as long as you care to be. It takes effort and it takes time. Ageing well is its own process and How Not to Get Old is your instruction manual to managing this beautiful change.
Beauty, ageing, appearance – they are all so much more than skin deep. In fact, they go all the way down to the bone. Osteoporotic or thinned bones show more wrinkles; poor diet manifests itself in brittle, pasty skin, thin hair, weak bones and bad teeth; life’s worries are etched into frowning faces. But take heart, the converse is also true! Decent diet, regular exercise, healthy lifestyle, sleep, sun protection, skin care and laughter really do work. Essentially, we’re performing an intricate dance between extrinsic ageing (the factors we can control) and intrinsic ageing (free radical damage that affects all the body’s cells including the skin).
Facial ageing is that infernal trinity of deflation, droopiness and sun-damage. Volume depletion is due to loss of that most-underrated of all tissues – fat. Fat really is the elixir of youth. We don’t appreciate it when we have it, we hate it in the wrong places but goodness, do we miss it when it’s gone! There are some amazing new research projects under investigation such as autologous fat transfer, whereby your own unwanted fat deposits are harvested and concentrated to replace volume loss in areas such as the face, breasts, or bottom. To me, the future is all about fat.
Sagging is caused by loss of skin elasticity and structure. Eyes, cheeks, corner of the mouth, jawline, breasts, butt, belly – you name it, all things gradually head downwards. Gravity reigns supreme!
As for environmental damage, look no further than your own personal skin ecosystem of make-up, harsh lotions, sun damage, smoking… you don’t need me to tell you that that’s never going to end well!
In this book, we show you how to address – and improve – specific ageing issues. We use our own trinity of moderation, common truths and new sciences and technologies to delay, derail or even reverse the unnecessary ravages of time. We share with you the judicious use of skin care, modern technologies, non-surgical rejuvenation and surgical methods of combatting ageing.
In my view, well-planned surgery can give you back what you had or better it. Of course, there is no such thing as risk-free surgery. It’s a big step that has real risks to go with the rewards. A well-informed patient with realistic expectations is much more likely to achieve an outcome they are happy with and my hope is that How Not to Get Old will give you the full, unvarnished truth that will help to inform your decisions. It offers a pragmatic look at all the approaches out there including state-of-the-art science and cutting-edge surgery. Everything that you see has been demonstrated with real, non-airbrushed results on ordinary, honest people.
My interest in this project stems from my knowledge as a scientist and surgeon, as well as my desire to share valuable information. So trust me, I am a doctor and I do know that there really are pills, potions and procedures that work. You just have to know what your problem is, what the treatment does, and how much it can help YOU.
Take your pick of the rich offerings here – and whatever you decide, at least you’ll be better informed. And that, dear reader, is the wisdom that also comes with age!
We live in a society where youth is prized. Never before have so many anti-ageing products and procedures been available – open any magazine and you are bombarded with articles and advertisements for the latest youth-enhancing product or treatment. With this comes an increased pressure on everyone to look younger to the point where it can seem no longer acceptable to look your age, let alone old. It’s not surprising then that more people than ever are prepared to take drastic measures in an attempt to defy their years. But with so much on offer, it can be hard to know where to start and what really works to enable you to look the best you can, whatever your age.
Nothing gives away your real age quite so obviously as your face. There are other telltale signs, such as your posture, or the inevitable downward pull of gravity on your body, but when deciding someone’s age, most people look at the face.
As with most things, prevention is always better than cure and it’s never too late to start taking care of your self.
THE FIRST WRINKLES usually appear around the mouth and eyes. Heredity obviously plays a part but just how well our skin ages is largely down to lifestyle.
THE WORST CULPRIT IS SUN DAMAGE. UVA and UVB rays penetrate the deepest layers of the skin, breaking down the collagen and elastin that are the skin’s support structures.
COLLAGEN makes up 70 per cent of skin and is the main structural protein, giving skin strength and maintaining elasticity; without it, skin creases and wrinkles more easily. It’s also a vital component of tendons and bones. Elastin is the other main fibrous protein giving skin its bounce. Collagen and elastin are in turn produced by fibroblasts, the most common type of cell in connective tissue. The number and activity of fibroblasts drop as we age.
AS COLLAGEN IS BROKEN DOWN and damaged, the ageing process accelerates. The less collagen we have, the more other factors start to have an impact. Habitual facial expressions etch themselves into lines as the skin loses its ability to bounce back. Frowning may or may not use more muscles than smiling, but furrowed brows lead to deep-set ‘elevens’ above the bridge of your nose.
NATURAL COLLAGEN AND ELASTIN PRODUCTION also declines with age but there are certain lifestyle factors that can speed up the process.
FREE RADICALS are unstable oxygen molecules that damage cells and slow the production of collagen. They are thought to be a key factor in the ageing process. Sunlight, smoking and air pollution all add to the production of free radicals.
SMOKING can reduce collagen by up to 40 per cent and as it also restricts blood flow to the skin, robbing it of nutrients and oxygen. Wrinkles can start appearing on the faces of smokers as young as twenty. Lines tend to be deeper, skin has a coarser texture and less healthy colour so that by the age of forty, smokers often have as many wrinkles as non-smokers twenty years older than them.
HORMONES also play a part. Reduced levels of oestrogen as we age may decrease collagen levels by 2 per cent a year.
HYALURONIC ACID is a naturally occurring component of skin which helps hydration and elasticity. It also removes toxins, supplies nutrients and supports collagen and elastin. It effectively moisturizes skin from the inside, guarding against wrinkles, but levels fall over time as a result of ageing and the effects of sunlight and pollution.
STRESS, POLLUTION, ALLERGENS, SUNLIGHT AND POOR DIET all cause inflammation which shows itself in the body in stiff, aching joints, irritable bowel syndrome and illnesses such as sinusitis. On the skin, inflammation results in wrinkles and other signs of premature ageing.
Far from being depressing, the message is that what we do makes a real difference and we can all have some control over how well our faces age by following some basic guidelines.
PREVENTION IS ALWAYS BEST What you do in your twenties really affects how well you age in your forties and fifties. Make sure any habits you develop are good ones. But it’s never too late to start looking after your skin with a sensible moisturizing, nurturing skincare regime.
WEAR SUNGLASSES with UV protective lenses to avoid developing crow’s feet from squinting in the sun. They will also guard against long-term damage to your eyes.
AVOID OVEREXPOSURE TO THE SUN and always wear a sunscreen rated SPF 15 or higher that protects against UVA and UVB. Remember that much of the harm happens by chance whenever we’re outside and that tanning is a sign of sun damage. Don’t forget your neck, décolletage and the backs of your hands. Nothing ages you faster than sun damage, except smoking…
GIVE UP SMOKING! It’s not always easy but this is the one choice you can make that will really affect how old you look. It’s estimated that an average smoker ages fourteen years for every ten years of smoking. Do it for your skin, to say nothing of your general health.
SLEEP ON YOUR BACK (this is not a joke). If you always sleep on the same side, the pillow puts pressure on your face leading to lines over the years; lying on your back encourages blood flow and reduces puffiness. Silk pillowcases can also help.
AVOID YO-YO DIETING Constantly losing and gaining weight damages skin. If you need to diet, aim for gradual, sustainable weight loss.
IMPROVE YOUR DIET Balanced nutrition including plenty of fruit and vegetables is essential for healthy skin. B Vitamins biotin and niacinamide (B3) are particularly good for skin, while Vitamins C and E are antioxidant, helping to fight free radicals and protect from sun damage. Vitamin C is also essential for collagen production while Vitamin A helps to repair and maintain skin tissue.
DRINK PLENTY OF WATER to keep skin hydrated and plump out fine lines. This is such a simple tip, but it really makes a visible difference to your skin.
EXERCISE It goes without saying that exercise, fresh air and a good night’s sleep all work wonders for your looks.
LONG-SPECTRUM UVA rays penetrate cloud and mist.
THE SUN’S RAYS are at their strongest between May and October, and between 10am and 3pm. Reflection from water, snow, sand and even concrete magnifies their effect.
AT HIGH ALTITUDES the atmosphere is thinner, allowing more harmful ultraviolet radiation (UVR) to reach us. UVR levels rise by 4–5 per cent for every 1,000 feet of altitude.
UVA RAYS PENETRATE more deeply into the skin than UVB ones, reaching the dermis, the living layer of skin.
FAR FROM PROTECTING your skin, a tan is the skin’s response to cellular DNA damage.
SUNBURN AND SKIN CANCER were believed by experts to be caused by UVB, while UVA was responsible for photoaging. The reality is more complex and both contribute to ageing and the risk of skin cancer.
CHEMICAL SUNSCREENS should be applied around twenty minutes before sun exposure so that your skin has time to absorb them.
MINERAL SUNSCREENS work immediately because they form a physical barrier on the skin surface.
AS A GENERAL GUIDE, if your skin normally burns after twenty minutes in the sun, an SPF 15 sunscreen will protect you for fifteen times longer. But damage can be invisible, so dermatologists recommend reapplying cream after two hours.
OLDER SKIN benefits from the addition of liposomes or essential fatty acids to rehydrate skin and enable the sunscreen to retain its effectiveness for longer.
A WORD OF WARNING
Always check with a doctor or dermatologist, especially if you notice any changes in pigmentation or moles.
THIS WORKS
Ellagic acid is an antioxidant that boosts your skin’s natural defences against the sun. It is found in the pulp and seeds of red berries such as raspberries, strawberries, cranberries and blackberries, as well as pomegranates.
Sadly for women there’s some truth in the notion that men age better. Certainly they start off with some natural advantages. Because men produce more of the sex hormone androgen, the middle and lower levels of their skin, or dermis, are thicker, making them more resilient and less prone to wrinkling. Testosterone levels also mean that male skin is more oily, again guarding against fine lines and wrinkles. When testosterone production falls from the mid-thirties onwards, men begin to show more signs of ageing.
It’s estimated that for every minute you spend smoking, you lose a minute of your life. Smoking ages the skin, heart, lungs and can trigger early menopause, cancer and osteoporosis, cutting life expectancy by around ten years.
SMOKING AGES SKIN by triggering the production of an enzyme that breaks down collagen, attacking skin’s elasticity. Smokers who sunbathe age even faster as UV rays accelerate this reaction.
TOBACCO SMOKE RESTRICTS BLOOD FLOW to the skin and deprives it of nutrients.
IT PARTICULARLY ROBS THE SKIN of vitamin C’s antioxidant protection and vitamin A’s moisturizing defence.
SKIN IS LEFT DRYER, GREYER and with a noticeably more coarse texture. Stress lines develop around the mouth and eyes.
SMOKERS OFTEN DEVELOP HOLLOW CHEEKS from the action of drawing on a cigarette as well as the telltale puckering around the lips.
However...just two weeks after giving up you should notice a marked improvement in the way your skin looks as circulation improves and nicotine and carbon monoxide levels fall.
The starting point for anyone wanting to look younger for longer has to be a good skincare regime. This is for the long term – not a quick fix but a sound investment for your future and has to be followed rigorously every day. Don’t worry – it doesn’t have to be elaborate or take hours. Just a few simple steps make all the difference.
IT’S IMPORTANT TO ALWAYS cleanse your face. In the morning this freshens and prepares your skin for any other products you use. You’re aiming to clean skin without sapping the moisture, so look for hydrating cleansers rather than soap. Cleansers such as E45 or aqueous cream are cheap but effective.
ALWAYS FOLLOW CLEANSING with a moisturizer, preferably one with anti-ageing ingredients. Moisturizer reinforces the skin’s naturally protective, oily surface layer, the stratum corneum, which can quickly become dehydrated, dry, flaky and wrinkly.
DON’T FORGET SUN PROTECTION You may prefer to combine this with your moisturizer or other face cream but if you are on holiday somewhere sunny or during the summer months when rays are at their strongest, it is often more effective to use a separate sunscreen with SPF 15 or higher.
MOISTURIZER not only locks in hydration and moisture, it also protects skin from the environment and the harmful effects of free radicals. It soothes and calms any irritation and forms a good base for other cosmetics and make-up, helping them last longer and look better.
AT NIGHT THE ROUTINE should be repeated to remove any dirt that’s accumulated during the day, and to allow your skin to breathe and repair itself – vital for youthful-looking skin. You may prefer to use a different moisturizer at night, particularly targeted at anti-ageing, with extra antioxidants.
SKIN AROUND THE EYES is more delicate and should be treated differently. Use a specific eye make-up remover (although some people swear by Johnson’s Baby Oil or Vaseline). Follow with an eye cream that reduces puffiness and works on fine lines.
FROM TIME TO TIME it is worth adding extra, targeted products to keep your skin healthy. Seasonal changes such as dryness in winter or uneven pigmentation at the end of summer, periods of stress and changes in your hormone levels can all wreak havoc with your complexion.
TRY TO EXFOLIATE once a week to remove dead skin. This helps to keep your complexion glowing and youthful. There are many good exfoliating creams, washes, masks and peels to choose from, or you can achieve the same result with a clean, warm flannel. Squeeze out excess water and gently massage your face using a circular motion. Take care not to pull the skin and finish by lightly pressing the warm cloth against your face. Moisturizing masks work particularly well after exfoliation. Face scrubs, particularly those containing high levels of fruit acids, proteolytic enzymes and glycolic acid, help strip away the dull, lifeless surface layers of the skin. It is vital that you moisturize and protect the soft, new skin that emerges.
THIS WORKS
Aqueous cream, which costs less than £4 for a sizeable pot, is a non-greasy cleanser and moisturizer that leaves a layer of oil on the skin surface that prevents moisture evaporating.
The way you apply products also makes a difference. Always be gentle, using light circular movements to cleanse or moisturize. It can be helpful to warm creams in the palm of your hand before application.
FOR EYE CREAM less is definitely more. Take a tiny amount, roughly the size of a grain of rice, and warm between your two little fingers. Pat it lightly into the skin below your eyes and across the brow and socket line until it is absorbed.
EXPERT TIP
Eye cream also works effectively on the lips. Any eye cream left on your fingers can be patted into the skin around your lips and your nasolabial lines running from your nose to your mouth.
While scientists may not have found the age-defying miracle cure just yet, research has revealed a number of key ingredients that slow down and may even reverse some of the signs of ageing. It is worth looking out for these when choosing an effective skin cream.
VITAMIN A comes in a few forms including retinoids, tretinoin and retinol, which vary in their degree of intensity. Tretinoin can only be prescribed by a doctor and was originally used to treat acne but it was noticed that a side effect was that patients looked younger. It boosts collagen production, thereby plumping skin and reducing the appearance of fine lines, sun damage and discolouration. This is quite a harsh ingredient and the skin has to build up tolerance to it. Typically, products contain no more than 0.3 per cent and should be applied at night only as it is unstable in sunlight. For anti-ageing, dermatologists would usually recommend its use just twice a week as it is very drying, so skin should also be well moisturized. Pure retinoids are also only available only through prescription, while retinol, a milder form of vitamin A, can be used in cosmetics.
A WORD OF WARNING
Prescription-strength Vitamin A should not be used when pregnant, when trying to get pregnant or when breastfeeding.
VITAMIN C is an antioxidant that helps to protect skin from free radical damage. It is also vital for the production of collagen and it seems that it is important not just to eat it but also to include it in our skin cream. However, you need a high concentration for it to make any impact and as Vitamin C can become oxidized if exposed to the sun, there are only a few stable forms which have been developed for topical use. Most are water-soluble and therefore unable to penetrate the skin’s epidermis, but tetrahexyldecyl ascorbate is more lipid-soluble which means it is more effective.
VITAMIN B3 OR NIACINAMIDE improves the skin’s moisture barrier which helps the natural production of collagen. It also strengthens the surface layer of the epidermis, the stratum corneum. It can even help to reverse the signs of past damage by encouraging skin renewal and improving the appearance of uneven pigmentation and enlarged pores.
HYALURONIC ACID is a naturally occurring component of connective tissue in the body, giving flexibility to blood vessels and cartilage as well as the skin. It also boosts the skin’s moisture and hydration levels, giving it a youthful, healthy appearance. Unfortunately, hyaluronic acid levels decline with age adding to the development of fine lines and wrinkles. Cosmetic-grade hyaluronic acid can help reverse the decline and stimulate the skin’s own production.
PEPTIDES are short chains of amino acids (tiny fragments of protein molecules) that occur naturally in the skin. They are the building blocks for the natural production of the proteins collagen and elastin. Hailed as a Botox effect in a cream, peptides are a growing trend in anti-ageing skincare and can improve hydration in the stratum corneum (the surface layer of the epidermis) by boosting collagen levels which decline with age, thereby plumping the skin and giving it elasticity. Oligopeptide-34 is one type of peptide which has been clinically proven to reduce wrinkles and fine lines. When tested, it also proved to be the most effective skin whitener not derived from hydroquinone, which is restricted in many countries. Various other peptide ingredients have been developed such as Matrixyl, RonaCare Cyclopeptide-5 and Pal-KT and laboratories are working to produce longer-chain peptides and better results.
ALPHA HYDROXY ACID (AHA) was one of the first products found to have anti-ageing properties. AHAs are derived from foods, for example: glycolic acid from cane sugar, lactic acid from sour milk, malic acid from apples, citric acid from citrus fruits and tartaric acid from wine grapes.
AHAS EXFOLIATE by helping skin shed the unhealthy dead outer layers which can build up, allowing other moisturizers and treatments to penetrate the skin and work more effectively. They are particularly useful for treating sun-damaged skin which has thickened and become rough and uneven in tone, and for smoothing surface lines. Both skin tone and texture improve after exfoliation.
FOR ANY TOPICAL TREATMENT to be effective, it must penetrate the outer layer or epidermis to reach the living dermis. Glycolic acid has the smallest molecular size of all the alpha hydroxy acids and so has the best chance of being absorbed. Glycolic and lactic acids are also the most researched forms of AHAs.
BETA HYDROXY ACID (BHA) is similar to AHA but is only available as salicylic acid. It is used in lower concentrations than AHAs but, for both, the pH of the product should be between three and four in order to effectively exfoliate skin. If the pH is lower than three it will be too irritating for most skin types.
EPIDERMAL GROWTH FACTORS (EGF) are the newest buzzwords in the cosmetics industry. They are a group of cells with a number of specialized functions, most importantly, the activation of cellular proliferation and differentiation. Basically, they turn essential cellular activities on and off, playing a role in increasing cell production and division, as well as the production of blood vessels, collagen and elastin.
EGFs are present in the platelet-rich plasma (PRP) treatment used in Dr Sister’s so-called ‘Dracula Therapy’ (see here). There is some controversy around the use of EGFs at the moment, as many dermatologists believe the molecules are too big to penetrate the epidermis. Cosmeceutical brands such as Medik8 advise their use with a dermaroller to ensure the product penetrates through to the dermis.
LIGHTENING AGENTS are used to treat hyperpigmentation as a result of sun damage. A number of agents are known to be effective including hydroquinone, kojic acid, arbutin and azelaic acid, all of which work by inhibiting melanin production. In Europe, hydroquinone can only be prescribed by a doctor as it can be harmful.
No guide to anti-ageing creams would be complete without mention of sunscreens, which are the best defence against early ageing. Most skincare experts would recommend regular use as their number one anti-ageing tip.
AVOBENZONE is a chemical screen that offers good protection against UVA but not UVB rays.
OCTOCRYLENE AND OXYBENZONE are chemical screens that are effective against UVB rays.
TITANIUM DIOXIDE OR ZINC OXIDE are physical, mineral sunscreens that are effective across the UVA and UVB spectrum – micronized versions mean they no longer leave that unattractive white residue on the skin.
MEXORYL SX is one of a new generation of organic filters that is UVA protecting.
ANTHELIOSSX combines MEXORYL SX with avobenzone and octocrylene to give effective broad-spectrum sun protection.
RESEARCH SUGGESTSVitamins C and E