None of us can completely avoid the appearance of facial aging. However, research is helping us understand why these changes occur.

The “volume” of our faces is comprised of bone, fat, muscle and skin. After the age of 40, we lose about 1 tsp of this volume per year. Our bones actually resorb and change shape, the fat shifts and diminishes as do muscles. Lastly, skin becomes thinner. We lose about 6% of the mass of our dermis (the second layer of the skin where collagen is formed) per decade.

Volume loss is being treated very successfully these days with a variety of fillers. Likewise, there are effective remedies for treatment of the skin itself. I have always told my patients that it is important to keep collagen stimulated throughout the years because once the fibroblasts in our skin cease to produce collagen, they cannot be re-stimulated.

The ongoing KEEPS trial ( is studying the effects, including skin effects, of estrogen replacement therapy in the post-menopausal period. Type 3 collagen decreases by up to 50% within a few years of menopause. We know that estrogen is good for skin. It protects against oxidative damage and stimulates fibroblast production. The question of whether to use estrogen replacement therapy in women is a decision that should be made in consultation with a gynecologist. These findings were discussed recently by Dr. Diane Madfes at the American Academy of Dermatology meeting.

What can we do to keep producing collagen? Use it or lose it!

By that I mean that we should continue to stimulate our fibroblasts. Ways to do this include laser resurfacing, microneedling and chemical peels. Dermatologists have the tools. Use them!