Christine Sowle, PA-C, is a physician assistant in Dermatology at the University of Vermont Medical Center.

Aging skin. It’s something we will all deal with as we get older. I frequently tell my patients “the more birthdays we acquire, the more bumpy, wrinkled, scaly, saggy, and spotty we become.”

There are different types of skin aging we go through. They are due to extrinsic and intrinsic factors. Extrinsic factors are based on what we’ve “done” to our skin. Smoking, tanning (whether in the salon or outdoors), and excessive outdoor activities, sports, or work are examples of extrinsic factors. These are all things we CAN change through avoidance.

Intrinsic factors are based on what we have inherited and expected age-related changes of our facial structure over time.  These we CANNOT change.

Aging Skin: Photoaging

Photoaging is the result of ultraviolet radiation — in other words, sun exposure. It may present as fine wrinkles, discoloration (light spots, dark spots), and the appearance of tiny blood vessels called telangiectasia (we get more and more of these over time).

Photoaging may be prevented by wearing sunscreen and sunblock anytime you are exposed to the sun. Reminder: sun exposure happens when you are outside and even when NOT wearing a bathing suit or at the beach. Crazy concept, I know.

Here’s how to protect yourself:

  • Sunblocks or sunscreens are the most important tool in your skin health arsenal. It should be broad spectrum UVA/UVB > 30 SPF. Apply it 20-30 minutes prior to sun exposure and reapply it every two hours, or sooner after getting wet. It should be less than two years old. I tell my patients to wear a 50 SPF and use a self tanner.
  • Topical retinoids (Retin A/Tretinoin) may help decrease some of the collagen destruction from ultraviolet radiation. That can help with fine wrinkles. It also helps with discoloration due to mild sun damage; however, it can be quite irritating, and will cause increased scaling and increased sun sensitivity (you will burn more easily). Topical retinoids are given by prescription. 

Aging Skin: Volume Loss

Volume loss is due to loss of fat pads throughout the face and bone resorption of the jaw. Over time, the fat pads in our cheeks, forehead, temples, and chin eventually disappear and our previous youthful skin becomes more hollowed-out in appearance. Compare a toddler’s facial structure to that of a twenty-year-old to a forty-year-old and to an eighty-year-old. The shape of the face changes and loses volume, most notably in the temples and cheeks. The eyes appear more sunken and the cheeks sag.

Facial wrinkles are due to a combination of both extrinsic and intrinsic factors. As the facial muscles are used in various facial expressions, they tend to start making “creases” in the skin, like ironed napkins/clothing wrinkles. Some of these facial expressions can be smoothed out by using Botox to paralyze the muscles that cause the resulting creases. This can get expensive and you will continue to need injections every few months to prevent recurrence.

How to Prevent Skin Damage

There is absolutely no cream that reverses the changes associated with fat and bone loss! In addition to regularly wearing sunscreen, you may also prevent skin damage by following these tips:

  • Moisturize to help maintain the integrity of the skin barrier and prevent further water loss. We stop producing oil in the skin like we did in our 20s!  
  • Avoid washing the whole body with soap and water. It strips oil from the skin and changes the Ph balance of your skin.  
  • Stop smoking! Smoking causes degradation of collagen, it delays wound healing, increases risk of infection, and significantly accelerates the skin aging process.

There are no oral or “all natural” supplements that will transform your skin into “younger and healthier looking skin.” Please remember, just because something is “all natural” does not mean it is healthy and not harmful. Poison ivy is all natural. It’s not something I would recommend ingesting or slathering all over the skin. 

Think of your skin as like the body of a car.  First remember, how old is your car? You notice over the years the paint fades, the windshield gets foggy, rust starts to develop… It’s all about maintenance, folks.

Christine Sowle, PA-C, is a physician assistant in Dermatology at the University of Vermont Medical Center.

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