Slow Facial Aging

In my medical practice, one of the most common questions I am asked is how to look younger and reverse the signs of aging. To answer that question, let’s take a step back and examine what actually makes us look older. As it happens, it’s mostly skin deep. Changes occur in our skin and underlying fat layer that show the sum of years on our face. Skin changes that we equate with aging include wrinkling (the breakdown of the scaffolding of the skin, collagen and elastin), pigmentation or brown spots, larger pore size and open or broken blood vessels. We also gradually lose the underlying plump, youthful facial fat that pads the skin and fills in all the hollows and shadows.


A number of factors drive the changes; some are inevitable (age), and some are the result of the genetic hand we are dealt (ethnicity and skin type), but some are within our control. Sun exposure easily tops that list of factors in our control, and the ultraviolet (UV) radiation that kisses our skin in summer also secretly steals away our youth. Other lifestyle behaviors like diet, sleep and exercise routines also matter.

It seems everyone wants to look younger, and a billion-dollar cosmetic and beauty industry has blossomed to supply that desire. The magician’s box of techniques and tricks to rejuvenate the face includes lifestyle changes, creams, injectables like Botox and fillers, laser- and light energy-based techniques, as well as the scalpel and surgery. Let’s take a peek at what we can do.

    The adage that prevention is always better than cure is especially true when it comes to sun protection and the skin. Research shows that up to 90 percent of the changes we interpret as aged skin can be caused by chronic sun exposure, while genetics makes a smaller contribution.Wearing sunscreen daily (ideally 50+ broad spectrum) prevents the energy in UVB and longer spectrum UVA rays from creating uneven pigmentation and damaging collagen and blood vessels. You also get protection from skin cancers and melanoma.
    What we eat is very important to keep us looking our best, since our appearance reflects general health and well-being. A balanced diet should include plenty of fresh fruit and vegetables (the more colors the better), packed full of antioxidants, vitamins, trace elements and beneficial compounds like lycopene, anthocyanins, carotene and bioflavonoids. Fish, nuts and legumes offer the good oils omega-3 and omega-6, which are anti-inflammatory and “mop up” damaging free radicals in our body. Limiting alcohol and drinking plenty of water keeps the skin well-hydrated.Maintaining a healthy body weight controls hormone levels. Estrogen is stored in fat and benefits collagen synthesis and production of hyaluronic acid, a natural skin moisturizer. Excessive weight loss reduces our fat stores and estrogen levels, which may make us look older.
    A good night’s sleep makes us look fresher, but did you know that skin renewal is faster at night, peaking between 11 p.m. and 4 a.m.? Quality sleep encourages cell repair and collagen regeneration, along with a long list of health benefits, so be sure to get your eight hours.
    We know exercise is great for the heart, lungs and mental outlook, but it is also a key to healthy and vibrant skin. Exercise improves circulation, increasing blood flow, carrying oxygen and nutrients to the skin, while flushing away free radicals and waste from around skin cells. Sebaceous glands are activated, producing natural moisturizing skin oils. It will come as no surprise that stress ages us. Stress leads to increased cortisol levels and impairs the immune system, also generating internal inflammation. While meditation and relaxation are great at reducing stress levels, regular aerobic exercise is shown to be an excellent way to shake off all that tension. Natural endorphins promote feelings of well-being.
    It’s not news that smoking is bad for you. While heart disease and lung cancer is lurking on the inside, the effects on skin show up early and clearly. Research shows that every 10 years of smoking adds about 2-3 years to visible age. Here’s why. Nicotine reduces blood flow, oxygen supply and nutrients to the living skin, affecting cell renewal. There are more than 4,000 chemicals in tobacco smoke, and this nasty cocktail includes tars, cyanide (yes, you read it right), formalin (also used for embalming) and carbon monoxide, among many others. These chemicals attack collagen and elastin, causing sagging and wrinkles. Think crow’s feet, puckered and lined lips and hollow cheeks. Add dry, flaky, sallow and dull-looking skin and you’ll be able to picture any long-term smoker. Turned you off smoking yet?If you smoke, there is good reason to give it up. Within six weeks of stopping, the skin will benefit from increased oxygen and antioxidants, and looks visibly better.
    Environmental pollutants, smog and dirt absorbed into our skin create free radicals that damage cells. Cleanse your face at the end of the day with gentle products suited to your skin type. We’ve mentioned free radicals a few times. These are damaging and unstable molecules that attack cells and cross-link collagen, making it — and your skin — stiff, inflexible and leathery. They can be generated by sun exposure, toxins and pollutants. There is some evidence that using creams containing antioxidants may protect the skin from these aging free radicals. Typically, products with vitamins A, C, E and B3 (niacinamide) are recommended, along with beta-carotene and green tea extract.Using a moisturizer improves the appearance of skin, especially as we age and oil production and skin hydration fall. For younger or oilier skin types, oil-free moisturizers may be better. Daytime moisturizers should contain sunscreens.
    There are a dazzling variety of creams that promise eternal youth, but the best evidence exists for retinoids (retinoic acid). They’re clinically proven to reduce fine lines, pigmentation and improve skin appearance by several actions, including stimulating collagen production. However, they can also cause sun sensitivity and mild irritation.Older skin sheds dead cells and keratin more slowly, so gentle exfoliation with alpha or beta hydroxy acids (glycolic or salicylic acid) in the form of chemical peels can temporarily improve skin appearance.
    Lines, folds and dynamic wrinkles (those smile and frown lines created by facial muscles) are best treated with a combination of Botox (botulinum toxin) and fillers. Injecting Botox into facial muscles relaxes them and smoothes out the wrinkles they create. Fillers can correct deeper lines and the facial volume loss that accompanies age. Lips also thin with age and can be filled. Intense Pulsed Light (IPL) and lasers target pigmentation, redness and prominent blood vessels. Fractionated laser resurfacing generates collagen and can improve wrinkling and pigmentation.

Aging is natural, and written proudly on our faces is the story of our lives. The ghost of Ponce de Leon might still be searching for the fountain of youth, but the reality is that we can’t turn the clock back. However, with a little effort and some simple lifestyle changes, we might just be able to slow it down.

Dr. Ann-Maree Kurzydlo is a Consultant Dermatologist and a Fellow of the Australasian College of Dermatologists. She has a degree in Nuclear Medicine and studied medicine at Newcastle University, graduating with Honors. Dr. Kurzydlo specializes in general, pediatric, surgical and cosmetic dermatology. She is an expert in all things health and beauty, and advocates a holistic approach to health care.