The damage factor

As we jet off on holiday or catch the odd ray of sunshine at home, our skin is at an increased risk of being damaged. However, much of it won't be visible for up to ten years and could even lead to skin cancer later in life.

We asked Dr Rachel Morris-Jones, a dermatologist at St Thomas's Hospital in London, to analyse the skin of three women. Using a special camera that shows skin magnified by 30 times she was able to look deep into the dermis. What she found was shocking.

Diane Cole

A 55-year-old sales executive from Wandsworth, South London, she is divorced with three grown-up daughters. Diane has sunbathed all her life and had a facelift to remove sun damage. She says:

Last February, I finally took the plunge and had a facelift because I just couldn't bear to look at myself in the mirror. My cheeks looked jowly, I was covered in wrinkles and instead of looking my age I felt I looked 15 years older.

The worst thing was that the reason my skin had aged so badly was because of my own stupidity. Until I was 23 I lived in California and spent my life on the beach.

Back then, you just had to have a golden glow if you lived there and I spent hours cultivating a deep mahogany tan.

Looking back, it seems like complete madness, but in the Sixties and Seventies we didn't have the same level of awareness.

When I moved to the UK with my former husband, I continued to sunbathe at every opportunity and would use a sun bed once a week to keep me looking 'healthy'.

When I was 45, I developed breast cancer. I was one of the lucky ones who got better quickly after my lump was removed but I became far more conscious about my health.

The first thing I did was stop my search for the perfect tan. But unfortunately, the damage was done, so in my eyes a facelift was the only way to get my looks and my confidence back. It was the best thing I ever did and people now comment on how lovely my skin is for my age.

I've also had a chemical peel which has reduced my wrinkles, and Botox on my forehead. I feel like my old self again but I wish I hadn't had to pay nearly £6,000 to get that feeling.

If I could turn back the clock I wouldn't sunbathe at all. Having a tan in your 20s just means misery in your 40s.

I still love looking brown, but now I only every use fake tan. In the old days I never used a sun screen, but now I don't leave the house without factor 20 all over my face. I tell my daughters to do the same.

I am fascinated to see what this machine will show up. I am hoping the surgery will have made a difference to my skin and that there aren't a lot more wrinkles under the surface that are going to appear in a few years time.

If they did then I would go under the knife again to get rid of them. Now I look this good, there is no way I am going back to the way I was.

The expert says: Diane looks good for her age but that can be explained by her facelift. However, we can still see clearly from the magnified picture that there are deep wrinkles around the eye area which will become more prominent.

When the camera shows such indentations there is little that can be done to prevent them coming to the surface eventually.

The chemical peel will have helped to reduce fine lines around the eyes but at Diane's age it is inevitable that wrinkles will appear in that area. Around her mouth the magnifying camera shows she has dilated capillaries, or broken veins, that will surface in five to ten years

While the Botox has helped to smooth out any wrinkles or expression lines on her forehead, I can clearly see sun damage and pigmentation. I imagine that the whole picture would have been much worse if Diane hadn't had surgery.

She is typical of many women in her age group who sunbathed in their youth and live to regret it. Your 40s and 50s are also the time when skin cancers tend to appear.

Recommendations: She should avoid going out in the sun whenever possible because skin thins with age and is therefore more at risk of damage. She needs to wear factor 60 suncream every day and a specific eye cream to reduce the appearance of fine lines.

Karen Holmes

Aged 33 and single, she works as a secretary in London. She loves to sunbathe and until recently was a heavy smoker. Karen says:

I am addicted to sunbathing so I know my skin isn't in as good condition as it could be. I always have a deep, dark tan and can't imagine what I would look like without it.

I go on three or four foreign holidays a year and in the past I have been on a lot of sunbeds to maintain my tan in the winter. I use fake tans occasionally, but they just don't look as good as the real thing.

Until recently I was a heavy smoker. I started when I was 16 and smoked 30 cigarettes a day. Three months ago I managed to give up.

I feel much healthier now, but worry that I have already done a lot of damage to my skin. It feels less dehydrated and is much brighter, but after all those years of breathing in chemicals I am sure there must be damage below the surface.

I try to look after my skin by cleansing, toning and moisturising, but I'm not sure it will reverse the damage I have done.

The expert says: I can't believe how tanned Karen looks. She might think she has a healthy glow but frying herself in the sun is making her a prime candidate for skin cancer. Her eyes and forehead are badly wrinkled and we can see from the magnified shots that these lie deep in the dermis and will get worse.

There is little Karen can now do to prevent these from appearing, but she can stop any more developing by staying out of the sun.

On her forehead the magnified shot shows broken capillaries and pigmentation that will become visible to the naked eye in roughly five to ten years. This is definitely from sunbathing. With all the great fake tan products on the market there is no reason to expose our skins like this. A fake tan is the only safe tan.

Around the lip area we can see the damage Karen has done by smoking. Not only are there deep expression lines which are natural for her age, but also she has broken veins that will become more prominent with time.

By stopping smoking now she has decreased her chances of getting fine lines around her mouth which are commonly found on smokers as they age. However, it will take her a number of months to rid herself of the toxins that have built up, making her skin dull and dehydrated.

Recommendations: My advice would be to use a good hydrating moisturiser, because although her skin is oily it lacks moisture due to smoking and overexposure to the sun. She should also make sure it has a very high SPF and, of course, no more sunbathing.

Katie Rowen

Aged 33, from North London, she is single and works in marketing. Her job means she is often out socialising and drinking. She also loves to sunbathe and has a year-round tan. Katie says:

I have a real Sex And The City lifestyle and I'm out partying almost every night. I work in marketing for a large film company so I'm constantly invited to celebrity bashes where the champagne is flowing.

I know I drink far too much - three Martinis a night is my average - and that a high level of alcohol is not good for my skin.

Nearly every weekend I jet off to the sun, be it for work or pleasure, so I spend hours sunbathing because I love to have a tan. I think it makes me look healthier, and I use factor 10 suncream so I don't burn.

However, when I was a teenager I burnt really badly because I didn't bother with suncream, but I regret it now. I also wish I hadn't smoked for ten years. I gave up when I was 26 but I'm sure it had a lasting effect on my skin.

I can't see that many wrinkles yet, but it will be interesting to see what is lurking under the surface. I would consider having plastic surgery in future if I aged badly, because my looks are very important to me.

However, prevention is better than cure so whatever advice the dermatologist gives I will definitely take.

The expert says: Even though Katie has quite a dark tan, she actually has very fair skin. The uneven discoloration we can see on her cheeks and the multitude of freckles show us that her skin doesn't want to tan - she is forcing it to. She looks very blotchy.

Having said that, she doesn't have any deep underlying wrinkles around her eyes, just fine lines. However, this will not last if she continues to sunbathe.

It is Katie's forehead that I find particularly shocking. We can see a lot of sebum, or oil, on it, but even that can't hide the obvious, dark pigmentation visible to the naked eye.

When we look at the magnified shot of this area we can see that there are dark spots deep within the dermis that will almost definitely come to the surface in five to ten years.

The skin does heal itself, especially if you stop whatever damage you are doing at a young age. Therefore, the fact that Katie stopped smoking when she was 26 means she shouldn't have any lasting damage or wrinkles caused by smoke, but she does have some broken capillaries around her mouth that can only be seen using the camera.

These are definitely as a result of smoking. Combine that with the sun damage and you have a problem.

The amount of alcohol Katie consumes will not help because a dehydrated skin ages far more quickly.

Recommendations: To help her skin she should use an anti-ageing cream with retinol. This helps to repair the collagen and increase elasticity, making it less prone to wrinkles. There is little she can do about the severe pigmentation but avoid the sun and use factor 60 cream on her face from now on. She should also cut down her drinking.