Meet Dr. Ferial Fanian, a dermatologist with a PhD in Skin Biology, specializing in chronic wound healing and aesthetic dermatology. With over 25 years of experience in the field, Dr. Fanian shared her passion for skin quality and health with the IMCAS team.

Could you share a bit about your background and expertise?

Dr. FF: From the start, I’ve been fascinated by skin aging, diving deep into understanding every layer of the skin. When I speak to my patients, I always emphasize that while beauty is in their hands, I’m here to ensure their skin cells are healthy. Healthy cells lead to better results for their appearance, and this is the foundation of my approach—caring for every layer of skin to ensure long-term health and beauty.

For doctors just starting to explore regenerative anti-aging, could you explain the concept of biological age and its importance in aesthetic treatments?

Dr. FF: Biological age, in the context of skin aging, refers to the balance between DNA damage and DNA repair over time. From birth, our bodies are highly efficient at repairing DNA damage, but as we age, the repair processes slow down while the damage accumulates. Skin aging, and even the risk of skin cancers, begins when this balance shifts. This shift is influenced by both intrinsic factors—such as genetics and hormonal changes—and extrinsic factors like UV radiation, pollution, smoking, and poor sleep. The result is visible signs of aging, such as wrinkles, pigmentation changes, and an increased risk of skin cancers. It’s important to address these signs not just for beauty, but for overall skin health.

How does the process of skin aging manifest, and what are the early signs you advise your patients to watch for?

Dr. FF: Skin aging starts as early as the day of birth. When we’re born, our skin is resilient, and DNA repair mechanisms are in full force. However, as we age, DNA damage begins to outpace the repair processes. Around the age of 25, many people begin to notice the first signs of aging, like fine lines, loss of elasticity, and the breakdown of collagen and elastin. These changes are linked to oxidative stress, inflammation, and cellular degeneration. This is also when the skin becomes more vulnerable to UV radiation and other environmental stressors, leading to visible damage and an increased risk of skin cancers.

You mentioned that skin aging is not just about beauty but also about the health of the skin. Could you elaborate on how the scientific understanding of skin aging informs your approach to treatments?

Dr. FF: Absolutely. For me, the scientific understanding of skin aging is crucial in shaping my approach to treatments. Skin aging is a complex process that involves the breakdown of collagen, elastin, and other structural components. When treating patients, I emphasize the importance of maintaining skin health first. For example, we’ve conducted studies where we biopsied skin from both wrinkle-prone and healthy areas on the same patient. With advanced tools, we observed that fibroblasts in the wrinkled areas had significantly reduced contractile force compared to the healthy areas. This shows that aging skin isn’t just a cosmetic issue—it’s a sign that the skin cells are under stress. This is why treating skin aging with a focus on improving the health of the skin cells is so important.

How do you use accurate profiling to assist in diagnosis and treatment success?

Dr. FF: Profiling is key to understanding the rate of skin aging in different patients, as not all 60-year-olds have the same skin condition. Chronological age does not always correlate with biological age, so we need tools to measure skin aging objectively. There are devices that use photographic technology to score conditions like wrinkles or pigmentation. For deeper analysis, we can measure hydration levels, elasticity, pH, and even skin thickness with ultrasound. I strongly recommend practitioners use devices that provide reproducible results, as consistency is crucial for tracking the skin’s progress over time. For example, skin hydration is vital—without it, treatments like lasers or energy-based devices, such as radiofrequency, won’t be effective. Ensuring that the skin is well-hydrated beforehand significantly improves treatment outcomes.

Can you elaborate on the role of collagen and how aging affects its production?

Dr. FF: Collagen is the backbone of the skin’s structure, and as we age, collagen production decreases. Certain areas of the face are more prone to aging signs due to their structure. For instance, the skin around the eyes is thinner and lacks significant support from the hypodermis, so it shows signs of aging sooner. The cheeks, on the other hand, may show signs of aging later, especially in people with more facial fat. Collagen breakdown is influenced by both intrinsic factors, like genetics, and extrinsic factors, such as UV exposure. People with lighter skin types (like those of European descent) tend to develop wrinkles earlier than those with darker skin, but darker skin types may have more concerns with pigmentation changes.

How do you prepare older patients’ skin for treatments?

Dr. FF: Older patients typically face challenges like skin thinning, loss of elasticity, and volume loss. The key to treating them effectively is to focus on improving skin quality first. If the skin quality is poor, injecting fillers or using energy-based devices will not give the best results. I always advise starting with treatments that improve hydration and overall skin health. After a few months, when the skin has improved, we can move on to other treatments. For patients with significant volume loss or sagging, surgical intervention may be necessary, especially if fillers aren’t enough to restore the lost volume.

You’ve discussed the benefits of biostimulators like calcium hydroxyapatite and poly-L-lactic acid. Could you explain how these work in treating skin aging?

Dr. FF: Biostimulators are a category of injectables that help stimulate collagen production by targeting the fibroblasts in the skin. The fibroblasts are responsible for producing collagen, but as we age, they become less effective. Biostimulators like calcium hydroxyapatite (CAHA), poly-L-lactic acid (PLA), and polycaprolactone (PCL) work by stretching these fibroblasts, which triggers them to produce new collagen. However, these stimulators alone cannot create long, healthy collagen fibers without micronutrients. To optimize the results, we need to support the fibroblasts with the right micronutrients, as aging skin often has reduced microcirculation, making it difficult for the cells to absorb these nutrients. This is why micronutrient injections are so effective.

What’s your perspective on using exosomes in aesthetic medicine?

Dr. FF: Exosomes are promising, but I believe we need more evidence before fully integrating them into practice. I prefer to focus on proven methods, like polyrevitalizing products packed with micronutrients and non-crosslinked hyaluronic acid. These treatments nourish the skin, making it more receptive to other procedures like injectables or energy-based devices.

How does lifestyle or climate impact your treatment recommendations?

Dr. FF: Lifestyle and seasonal changes significantly affect skin health. For example, after summer vacations, skin often shows signs of damage from sun exposure, requiring immediate care. Similarly, winter can dehydrate the skin, especially in colder climates. I recommend seasonal treatments, like micronutrient and hyaluronic acid injections, to help the skin recover and maintain its health. These simple yet effective interventions prepare the skin for harsher conditions, ensuring long-term resilience.

Any final advice for younger doctors entering this field?

Dr. FF: Focus on understanding the science behind skin health and aging. Invest in essential diagnostic tools, build a comprehensive treatment approach, and emphasize patient education. Remember, it’s not just about appearance—it’s about promoting skin health for life.