"> The Secrets of Skincare | Dr. Dominic Bray | Facelift Plastic Surgeon in Harley Street, London

THE SECRETS OF SKINCARE

(USING A CROQUE MONSIEUR)

Great skin is not rocket science but does need a little understanding and commitment to achieve and maintain. On this page I will explain with simple analogies how skin works, how it becomes damaged and how it can be repaired.

Our skin is structurally like a ham and cheese toasted sandwich. The top slice is the epidermis and the bottom slice is the dermis. The ham between the two is called the basement membrane and the sticky melted cheese attaching the ham to the bottom slice is collagen. Collagen comes from the ancient greek Kolla (glue) and Gennoa (I produce) and for millenia glue has been produced by boiling animal skins tendons and ligaments.

The Secrets of Skincare
Epidermis Renewal Function

Epidermis

The epidermis is the skin you can feel. It has two main functions, the first is to renew itself and the second is as a barrier to the outside elements.

Deeper epidermal skin cells are moist and hydrated like a dough ball, but as they migrate superficially they dry out and flake off our bodies as dust.

In healthy skin, this cycle takes about 30 days by continuous exfoliation so that the visible skin is always new. As we age the skin becomes lazy and 30 days becomes 60 or 90. This skin is exposed for longer and has time to toast in the elements becoming drier, more coarse and pigmented. Ironically moisturisers also slow down the skin cycle so should be used sparingly.

The second function of the epidermis is as a barrier. As the drier skin cells hang around longer than they should, they weaken and crack allowing allergens and irritants to enter our bodies through a normally impervious oily layer – the barrier function weakens. This leads to “sensitive” or “reactive” skin, repairing the barrier function will make skin more tolerant and less sensitive and less reactive.

Epidermis Barrier Function

Dermis

The dermis is the bottom slice of bread. It also has 2 main functions, the superficial half builds collagen and the bottom half provides structure and support and contains hair follicles, sweat glands and small blood vessels.

There is not much more to know about it so let’s move on to the interesting part: The dermal-epidermal junction or basement membrane or rather the ham and cheese between the slices.

Dermis Vitality & Tightness
Peeling Resurfacing

Dermal-Epidermal Junction

This is where most causes of skin damage and ageing occur. Smoking, UV light and free radicals activate enzymes which attack the collagen bonds between the upper dermis and the basement membrane of the epidermis – figuratively they peel the ham off the cheese.

As this happens the top slice or epidermis is no longer supported by a firm foundation and is able to crease and fold creating fine lines and wrinkles which get deeper and deeper as the skin cycle slows further. Most Prescription skin treatments target this area

Pigmentation

The top slice of bread is granary (I might be taking this analogy too far!) the grains are pigment cells called melanocytes which are responsible for our skin colour.

As they reside within the lazy top slice they are exposed to UV light and as we age are responsible for age spots, freckles and moles. These cells are sensitive and can be activated by heat or energy (post inflammatory hyper-pigmentation after LASER) or can become inactive with trauma (which is why some scars go white)

Melanocytes Produce Melanin
Skin Perfection - How?

Healthy Skin

So aged skin is lazy, sensitive, wrinkled, pigmented, and dry. Can it be repaired? The answer is yes and it’s easy. It needs commitment and patience but everyone can have great skin.

The basis of all prescription skincare programs is essentially the same, exfoliate off the old skin (scrape off the toast!), speed up the skin cycle, stabilise the pigment cells, stick the ham back on to the cheese and prevent further damage. However much like the lottery it’s an all or nothing game, the skin will rebel against the game at first, but keep playing and you’ll both be the winner.

Unhealthy Skin

This photo is from a famous article in the New England Journal of Medicine from 2012.

This gentleman shows clearly how a lifetime of sun exposure through his truck cab window has aged his skin on one side. Sun protection is a must if you want to maintain healthy skin!

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