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Last updated April 13, 2020. 6 minute read

Anti-aging and aging skin: things you can do today

Tretinoin (brand name Retin-A) is a topical medication that is effective at improving the appearance of aging skin; it belongs to a class of drugs called retinoids because they are made from vitamin A (retinol). Tretinoin can improve the fine wrinkles, skin looseness, and brown spots seen in aging skin.

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

The “fountain of youth” has been the subject of stories and legends since the time of ancient civilizations. Over time, the desire to look young has not diminished—the signs of aging can begin as early as your 30s and 40s. Unfortunately, scientists have yet to discover the “cure” for aging. However, there are options for delaying the visible signs of aging. Over $230 billion dollars are spent worldwide on products to help you “look younger” (McCullough, 2006).

Vitals

  • Signs of aging skin can begin as early as your 30s and 40s.
  • Some common signs of aging are fine lines, wrinkles, decreased skin elasticity, and dark spots.
  • The biggest modifiable causes of aging skin are sun damage and exposure to cigarette smoke.
  • Treatments include topical medications (like tretinoin) and procedures (like botulinum toxin or filler injections, lasers, chemical peels, and cosmetic surgery).
  • The best treatment for skin aging is prevention: Apply sunscreen of at least 30 SPF daily.

What are the signs of skin aging

To some degree, skin aging changes can vary among individuals based on their genetics, ethnicity, how well they took care of their skin when they were younger, etc. However, some features of skin aging are relatively common: 

  • Decreased skin elasticity: Think of a rubber band used over and over. With time, that rubber band does not snap back the way it used to and stays stretched out—this is a loss of elasticity and is similar to what happens to our skin over time. Your skin may feel loose or sag and no longer have that firm, tight look you had when you were younger. 
  • Fine lines
  • Wrinkles and deep creases: Dynamic wrinkles are ones that you only see with facial expressions, like the fine lines around your eyes when you smile. Over time, wrinkles become permanent and are present regardless of facial movement.
  • Dark spots
  • Coarse skin texture
  • Visible thin blood vessels
  • Skin becomes thinner and more fragile
  • Loss of fat and muscle under the skin, giving a hollow look.

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What causes the skin to age

As we age, we experience both intrinsic and extrinsic causes of aging. Intrinsic factors are ones that are beyond our control. One example is the loss of soft tissue (muscle, fat) from under the skin that usually occurs with aging (Ko, 2017). This loss leads to a “deflated” appearance (rather than a plump, youthful look) and causes the skin to sag, creating deeper and more numerous wrinkles. Loss of skin elasticity in the skin also occurs with age and contributes to skin sagging and the appearance of wrinkles (Ko, 2017). The constant effect of gravity on the skin also leads to sagging (Khazanchi, 2007). Skin metabolism and turnover changes as we age; the skin becomes thinner, breaks down collagen instead of creating it, and increases the number of pigmented cells (melanocytes) (Baumann, 2007). These changes cause the facial skin to be thin and dry with blotchy or mottled coloration (Ko, 2017). Genetics certainly plays a role in aging and is another intrinsic factor to take into consideration. 

Extrinsic causes of aging are ones that you can modify if you start early; it is easier to prevent extrinsic aging than it is to reverse it. The most common culprit of extrinsic aging is sun damage (also known as photoaging or premature aging). When you expose your skin to the sun, it receives ultraviolet A (UVA) and ultraviolet B (UVB) rays—both of these types of UV rays cause damage to the skin. This sun damage causes you to look older than you naturally would. Up to 80% of aging skin changes may be due to sun damage and not just getting older (Amaro-Ortiz, 2014). Too much sun exposure (either outdoors or indoor tanning beds) not only makes you look older than your age but also increases your risk of skin cancers.

Cigarette smoking is another common cause of extrinsic aging, independent of sun damage, or other factors (Farage, 2008). The chemicals in cigarette smoke can speed up the aging process by damaging the blood vessels in the skin and by decreasing skin elasticity (Ko, 2017). It also makes your skin rougher and increases the risk of wrinkles. One study showed that smokers have almost three times higher risk of moderate to severe wrinkles when compared to nonsmokers (Castelo-Branco, 1998).

How to stop or reverse signs of aging

The best things you can do to keep your skin looking young are to quit smoking and prevent sun damage by using sun protection. You should apply sunscreen whenever you are going outside, even if it is a cloudy day. Be sure to use a broad-spectrum (protects against UVA & UVB) sunscreen with a rating of at least 30 SPF. Wearing protective clothing, like a wide-brimmed hat and sunglasses, can also protect you against premature aging. Lastly, any kind of tanning is unhealthy for your skin. Contrary to popular belief, getting a tan does not protect you from sunburns or sun damage. Regardless of your age, you should protect your skin from further damage with the appropriate skincare and sun protection.

Retinoids:

Tretinoin (brand name Retin-A) is a topical medication that is effective at improving the appearance of aging skin; it belongs to a class of drugs called retinoids because they are made from vitamin A (retinol). Tretinoin can improve the fine wrinkles, skin looseness, and brown spots seen in aging skin (Mukherjee, 2006). Tazarotene and adapalene are less commonly used retinoids (Chien, 2020). Retinoids are not a quick fix—it can take several months for improvements in aging skin to show. Tretinoin can increase your skin’s sensitivity to the sun and make you more likely to sunburn; it can also cause dryness and skin irritation. If you are using retinoids, it is especially important that you apply sunscreen daily. Women who are pregnant or breastfeeding should not use tretinoin.

Other compounds:


Other compounds may also help improve the appearance of aging skin, but the scientific data on how these compounds affect aging skin is limited (Chien, 2020):

  • Antioxidants (e.g., niacinamide and coenzyme Q10)
  • Vitamins (e.g., vitamin C and vitamin E)
  • Hydroxy acids (e.g., alpha-hydroxy acids and beta-hydroxy acids)
  • Plant extracts (e.g., green tea, Ginkgo biloba, ginseng, and grape seeds)

Procedures:

  • Botulinum toxin (brand name Botox) weakens specific facial muscles (forehead, around eyes and mouth) to decrease the appearance of dynamic wrinkles (wrinkles that come from repeated facial movement).
  • Injectable fillers (e.g. Juvederm, Restylane, Radiesse) can be used to fill deep wrinkles. 
  • Injectable volumizers (e.g. Sculptra, Voluma) are sometimes used to create more volume (in cheeks, lips, jawline, etc.), making your face look fuller and more youthful. 
  • Laser treatments may be an option to improve the signs of premature aging, depending on your skin tone, amount of sun damage, and other factors. There are different types of lasers (ablative, non-ablative, etc.), each with varying degrees of effectiveness, required downtime, and associated risks.
  • Chemical peels use harsh chemicals to remove the outer layer of the skin, promoting skin regrowth to even out skin tone and tighten loose skin (Chien, 2020).
  • Cosmetic surgery is the most effective at improving wrinkles and skin laxity, especially in older people, but has the highest potential risks and most prolonged downtime (McCullough, 2006)

Conclusion

As technology advances, scientists are learning more about the process of aging and how to slow it down—but a great deal is still not understood. The best way to slow the signs of aging is to protect your skin from sun damage and exposure to cigarette smoke. Also, protecting your skin while you are young can help you keep your youthful appearance for longer. Don’t wait to see wrinkles before you start wearing daily sunscreen. Consult with your dermatologist to determine if anti-aging treatments are right for you.