There are two factors contributing to the way skin ages:

  1. Intrinsic Aging, which is our genetically based predisposition to aging, and
  2. Extrinsic Aging, which is the acceleration of aging due to free radical and oxidative skin damage caused by environmental exposures.

Intrinsic aging

Intrinsic aging is a continuous process that normally visibly begins in our mid-20s, with gradual progression over time. Here are some of the features attributed to intrinsic aging:

  • Fine wrinkles
  • Thin and transparent skin
  • Loss of underlying fat, leading to hollowed cheeks and eye sockets as well as noticeable loss of firmness on the hands and neck
  • Bone loss, causing sagging skin
  • Dehydrated dry skin from depleted skin barrier
  • Graying hair
  • Thinning hair
  • Hair in unwanted locations

Our genes control how quickly the normal aging process unfolds.

Extrinsic aging

Most signs of skin aging, and especially prematurely aged skin, result from extrinsic aging, most notably excessive sun exposure. The hallmarks of “photo-aging” are:

  • Freckles
  • “Liver spots”
  • Melasma and generally mottled irregular pigmentation
  • Loss of dermis, subcutaneous fat, bone, and muscle causing deep hollows and sagging skin
  • Leathery dull skin
  • Bumpy or “cobblestoned” skin that is somewhat yellowed and sallow
  • Scaly pink and brown precancerous patches or bumps
  • Spider veins of face
  • Excessive bruisability
  • Giant blackheads
  • Excessive wrinkling, both deep and fine
  • Flared or poorly controlled rosacea
  • Poor skin tone and quality with intermixed dull dry and oily areas
  • Enlarged pores
  • Skin cancers

While environmental pollution and cigarette smoke have a role here, the major cause of Extrinsic Aging (and the major cause of skin aging in general) is ultraviolet (UVA/UVB) light. The amount of photo-aging one develops is the sum of 2 forces: the intensity or duration of sun exposure and the fairness or sensitivity of the skin to sun and burning. Although photo-aging is a cumulative process of skin damage occurring over many years, some people experience the sensation of a “tipping point”, whereby certain visible signs of aging (wrinkles, brown spots, etc) seem to have occurred “overnight”. The good news: extrinsic aging can be prevented or modified by your behavior and skin care regimen.

As the loss of collagen, elastin and facial support (bone, muscle, fat) progress, gravity exaggerates the process. Much like a tent with the poles shortened, or a beach ball with some of the air released, the loss of facial structure and support results in drooped cheeks, jowls, chin and nose, hollows in the eye sockets and temples, elongated ears, and shrunken lips.

Treating aging skin

The basic approach to treating aging skin is two pronged: Prevention against further damage, and Repair of past and ongoing damage. In addition to sun protection, using topical products to help rejuvenate the skin and repair some of the damages incurred are appropriate no matter how aggressive a plan you decide to embark upon.