While factors like genetics and lifestyle (including sun exposure) play significant roles in skin ageing, the role of the lymphatic system in skin ageing is an  overlooked however interesting strategy to improve skin's youthful functional (health) and physical attributes (beauty).

The lymphatic system, a vital part of the immune system, is responsible for draining excess fluid, toxins, and waste products from tissues. In the skin, lymphatic vessels collect waste and transport it to lymph nodes for filtration. The lymphatic vessels work with tiny, reflexive muscular contractions constantly pumping cleansing (toxins and debris) lymph fluid through their channels. Interestingly it explains why injections with the muscle relaxant botulinum toxin can cause oedema. 

The function of the lymphatic system

1. Collecting excess fluid from your tissues and returning it to your bloodstream, thus less puffiness and more sculpted.
2. It filters out waste products and abnormal cells from this fluid, thus reducing damage on healthy skin cells and skin components.
3. Protect against invaders like viruses, bacteria, and fungi, hence reducing inflammation.

If you combine all these functions, it's pretty much protecting against accelerated skin ageing.

As we age the lymphatic function and density is decreasing 1:

• Decrease in initial lymphatic vessel density and lymphatic endothelial cell numbers 1.2
• Decrease in collecting lymphatic vessel density and collecting LEC numbers and alters their phenotype
• Decrease in dendritic cell migration and lymphatic pumping and increased leakiness in lymphatic vessels 
• Decrease LEC VEGFR3 signaling and increased senescence and apoptosis 
• Increased immune cell infiltration and nitrosative stress surrounding lymphatics 
• Decreased chemokine and altered junctional protein expression by LECs 
• Downregulation of lymphatic-specific genes like PROX1 (master gene lymphatic system)
• Downregulation of VEGF-C (mediator of lymphangiogenesis and reduction inflammation)

This in turn will contribute to accelerated skin ageing.

Effects of lymphatic system decline on skin:

1. Fluid accumulation: Reduced lymphatic function results in fluid buildup, causing puffiness, especially around the eyes and cheeks.
2. Toxin buildup: Accumulation of toxins in the skin due to poor lymphatic drainage can contribute to inflammation and skin conditions.
3. Decreased nutrient delivery: Impaired lymphatic circulation hinders the supply of essential nutrients to skin cells.
4. Slower healing: A compromised lymphatic system slows down the skin's ability to repair itself, making it more prone to damage and wrinkles.

To sum it up, the ageing lymphatic system can lead to skin dullness, dryness, decreases regeneration, more wrinkles, unevenness and puffiness especially around the eyes. Therewith rejuvenation and activation of the lymphatic system can lead to overall improvement of skin health and beauty.

Rejuvenating the lymphatic system for youthful sculpted skin:

1. Healthy Diet: Consume a diet rich in fruits, vegetables, and antioxidants supports lymphatic function and reduce inflammation.
2. Hydration: Stay adequately hydrated helps maintain the fluid balance in the body and supports lymphatic circulation.
3. Exercise: Regular physical activity, especially movements that promote lymph flow like (facial) yoga or rebounding, can improve lymphatic drainage.
4. Massage: Gentle lymphatic drainage massage, Gua Sha or pressure, tapping techniques can stimulate lymphatic vessels, improving fluid circulation and detoxification.
5. Skin Care: As photo (sun) damage is a primary cause of accelerated skin ageing (80% up to 90%) including lymphatic vessels(2), start with prevention by using sunscreen on a daily base. Moreover, some active ingredients incorporated in skincare, like Mulberry White Bark extract, fermented Ginseng and others (3.4) have proven to rejuvenate or reactivate the skin's lymphatic system.

Wrongful injected fillers in the tear trough or malar (eye socket - cheek area) septum can lead to worsening of malar oedema (fluid retention) or malar bags. Always consult a qualified healthcare professional or dermatologist to determine the most suitable approach for your particular skin condition and rejuvenation goals. 

Take care!
​Anne-Marie

References:
1. Structural and Functional Changes in Aged Skin Lymphatic Vessels R. Kataru et al. Front. Aging, 2022 
2. Reduction of lymphatic vessels in photodamaged human skin Kentaro Kajiya, Rainer Kunstfeld, Michael Detmar, Jin Ho Chung J Dermatol Sci. 2007 
3. Patent Cosmetic preparations comprising natural activators
4. Patent Cosmetic preparations comprising daphne extracts

It is widely known that skin´s own hyaluron is a precious molecule keeping our skin hydrated as it is a powerful humectant (attracting and binding water), hence giving the skin a natural plumpness and bounce. What many don´t know is that skin´s own hyaluronic acid content needs to be replenished continuously, as it´s half-life is only several hours up to one day 1. It´s degradation is fastened by 2 different pathways: an external influence via free radical activity or physical degradation and an internal pathway via enzymatic or biological degradation by a family of enzymes called hyaluronidase or abbreviated HYAL.

There are 6 different ones identified and HYAL 1 is the most active one. HYAL 1 “cuts” large size hyaluron molecules (the most capable of binding water) into smaller molecules, which are eliminated even faster. One of the strategies to maintain skin´s own hyaluron content is to inhibit the HYAL enzymes, especially HYAL1. Comparing photo-exposed skin to photoprotected skin showed significant increase in the expression of L-HA (low molecular weight HA) which are smaller or broken hyaluronic acid molecules. An increase of degradated hyaluron was associated with a significant expression of HYAL-1 (2)..UV, ROS or free radical activity leads to the activation of hyaluronidase (3,4).

You may now wonder how it is possible that hyaluron filler injections can have a lasting effect of several months or even longer than a year. This is because in those injectable gels the hyaluron molecules are stabilized to protect them from the impact of free radicals and HYAL enzymes. Often this is done with chemical crosslinks (BDDE). Manufacturers of those hyaluron injectable gels use different stabilizing or crosslink technologies and different number of crosslinks, which impacts the gels consistency and longevity. They aren´t completely resistant to hyaluronidase, as it can be used to dissolve injected hyaluron. As hyaluron is anyway depleted and replenished every day, this dissolving procedure hardly affects skin´s own hyaluronic acid content. This is a common misconception.

In skin care however, the use of crosslinked hyaluron (hence lasting for months or longer) does not make a lot of sense as we usually cleanse our skin twice daily and thus wash it away. It is too large to penetrate. There are some benefits for crosslinked hyaluron, but it does not impact the longevity of skin´s own hyaluronic acid content. One ingredient derived from the roots of Chinese Licorice plant called Enoxolone (also known as Glycyrrhetinic acid) however, has proven to decrease the HYAL1 activity by 54% (in vitro) (5.6). This is a novel and safe topical way to protect skin´s own hyaluronic acid content from fast degradation and elimination.
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However, as mentioned before free radicals increase HYAL1 activity and as we age our skin becomes less resilient against accumulated oxidative stress. Therefore, the most optimal approach to inhibit increasing break down of hyaluronic acid is to combine HYAL1 inhibition with powerful anti-oxidants. In the illustration, which I created professionally, it is Saponin. Saponin is next to a powerful anti-oxidant, also a potent bio-stimulator of the fibroblast for hyaluron (+256%), collagen (+49%) (6) and elastin (+19%). Furthermore, Enoxolone stimulates melanin production, supports the skin's own repair mechanism against UV-induced DNA damage and inhibits enzymatic elastin degradation. What a power-couple to have in dermo-cosmetic products to manage the biological degenerative process of ageing skin. 
 
Take care

1. HA: a key molecule in skin aging E. Papakonstantinou
2. Dermatoendocrinol. 2012 Jul 1; 4(3): 253–258. doi: 10.4161/derm.21923 Hyaluronic acid: A key molecule in skin aging Eleni Papakonstantinou, 1 Michael Roth, 2 and George Karakiulakis 1 
3. BMC Complementary and Alternative Medicine December 2013, 13:304| In vitro determination of the anti-aging potential of four southern African medicinal plants Authors Gugulethu NdlovuEmail, Gerda Fouche, Malefa Tselanyane, Werner Cordier, Vanessa Steenkamp
4. Bioorg Chem. 2018 Apr;77:159-167. doi: 10.1016/j.bioorg.2017.12.030. Epub 2018 Jan 4. In-vitro evaluation of antioxidant, anti-elastase, anti-collagenase, anti-hyaluronidase activities of safranal and determination of its sun protection factor in skin photoaging. Madan K1, Nanda S2.
5. EADV Poster 2021 A holistic hyaluron-centric anti-aging concept to improve static and dynamic wrinkles Geloven van A, Harbig S, Stuhr A, Dunckel J, Kuhn A, Dippe R, Warnke K, Beiersdorf AG, Hamburg, Germany 
6. EADV Poster 2021 Multifaceted novel approach to increase skin’s own epidermal & dermal hyaluron content Bussmann T, Warnke K, Krüger A, Möller N, Harbig S, Stuhr A, Dunckel J, Geloven van A, Weise J, Beiersdorf AG, Hamburg, Germany
7. Hong et al. Glycyrrhetinic Acid: A Novel Modulator of Human Skin Pigmentation and DNA-Repair September 2009Journal of Investigative Dermatology Conference: 39th Annual European-Society-for-Dermatological-Research Volume: 129