What Happens When Skin Ages & How to Counter It

By Joyce Park, MD

Anti-aging is a million dollar industry, and women and men alike spend countless amounts of money trying to prevent themselves from looking older. What exactly changes in our skin as we age? By knowing what occurs on a molecular level, we can figure out where to target with anti-aging therapies.

Aging of the skin occurs both with time and with increased cumulative sun exposure. Our skin becomes thinner as we lose collagen and sags more as we lose elasticity, and the effects of gravity and repetitive movements of facial expressions start showing in the form of wrinkles.

Glycosaminoglycans (like hyaluronic acid!) in our skin responsible for binding and keeping moisture decrease and don’t function as well, resulting in dry wrinkled skin. Aging skin also has longer turnover time, resulting in buildup of dull skin that sticks around longer.

Sun exposure causes a particular type of aging called “photoaging,” presenting as brown and white spots, visible blood vessels (telangiectasias), wrinkles, and a rough leathery texture of the skin. We’ve all seen photos of coarse tanned skin on people who spent too many summers on the beach; that appearance is a result of sun damage.

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The first step to anti-aging is prevention through sun protection. By using a broad spectrum sunscreen with at least SPF 30 daily, rain or shine, you will cut down exposure to harmful UV radiation that damages and ages your skin. For more information on choosing the right type of sunscreen for your skin type, read my blogpost here. Beyond prevention though, since it is impossible to live like a vampire your whole life, there is an entire arsenal of therapies we can use to try to reverse the effects of time and sun.

Tretinoin

Retinoids are on every dermatologists’ bathroom counter, a secret weapon against aging of sorts! Retinoids are a vitamin A derivative that can decrease fine lines and lighten dark spots over time by helping to speed up skin cell turnover. Studies have shown that topical application of retinoids result in new collagen formation and increased epidermal thickness, as well as clinical improvement in wrinkling, dark spots, rough skin, and skin texture.

Prescription strength retinoids can be obtained by seeing your dermatologist, and they will choose a type of retinoid and vehicle (gel vs. foam vs. cream) depending on your skin type. Retinoids can initially irritate your skin and make you more sensitive to the sun; other than that, remember that pregnant women cannot use topical retinoids because theoretically it can damage the developing fetus.

When you start out, apply a pea sized amount every other night and slowly build up to nightly as tolerated. If your skin gets too dry and irritated, which is the most common side effect, mix the retinoid with lotion or use some over the counter steroid cream to calm down the redness.

If you want to try retinoids but don’t want to go the prescription strength route, you can buy over the counter products with retinol, a slightly different formulation of vitamin A, which take a bit longer to work, but may be more gentle with less side effects for those starting out.

Alpha-Hydroxy and Beta-Hydroxy Acids

The ability of the skin cells to turnover and renew slows over time, so exfoliating, or the shedding of dead skin that builds up, becomes more and more important as we age. AHA (lactic acid and glycolic acid) and BHA (salicyclic acid) are two examples of exfoliants that we use commonly in chemical peels. They help to effectively loosen and get rid of dead skin, helping you achieve a brighter and more even complexion.

Antioxidants

UV radiation causes oxidative stress and damage to the skin, which translates to photoaging. Certain vitamins can help prevent and even reverse some of this damage! Fat soluble Vitamin E (also known as tocopherol) helps reduce inflammation in the skin and accelerates repair from sun damage. Vitamin C (ascorbic acid) is an all-star in anti-aging, proven to even out skin tone, help with DNA repair from photodamage, and assist with collagen production.

The two vitamins together have added effects, and both appear to be stronger when applied topically rather than ingested orally. Look for sunscreens or serums with Vitamin C or E (or both!) to help protect against sunburns and help with skin repair from the sun’s damaging rays.

Hyaluronic Acid

Hyaluronic acid is a naturally occurring compound in your skin that is your most POWERFUL humectant, meaning it retains an immense amount of water to keep your skin looking dewy, youthful, and moisturized!  One gram of HA can hold up to 6 LITERS of water – that is mind blowing.

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As we age, we lose the amount of hyaluronic acid in our skin, meaning our skin has a harder time holding on to moisture and we all know that dry skin wrinkles more easily. Some people choose to get more hyaluronic acid through injections of filler like Juvederm or Restylane; dermatologists can inject filler into sunken areas of the face to temporarily fill them up for 3-6 months depending on the material. However, this method is more invasive, painful, and can be very pricey!

I typically recommend turning to filler as an option if you are older; patient in their 20s and 30s can start by using topical preparations like serums and ampoules that contain HA. By supplementing our skincare regimen with hyaluronic acid, we can try to replenish our natural (and dwindling!) supply.

Resveratrol

Resveratrol, a compound derived from the skin of grapes, berries, and peanuts, has become a new hot topic in anti-aging because of its DUAL-antioxidant properties. That means that not only does it function as an antioxidant itself, neutralizing free radicals that damage the skin, but it also helps the body produce more antioxidants on its own. Recent early research from Harvard Medical School has also found that it actually helps stimulate your body to make more hyaluronic acid, which I mentioned above is a powerful humectant.

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About the author:

Joyce Park, MD is a dermatology resident in New York City and a skincare and beauty blogger at TeawithMD. Originally from the Bay Area, Dr. Park moved to New York City last year after completing college and medical school at Stanford. During medical school she spent a year doing a medical journalism fellowship, working at the World Health Organization and then on NBC’s medical team helping to make news stories for The Today Show and Nightly News. When Dr. Park is not at the hospital, she can be found blogging at cute cafes, trying out new Korean beauty products, and eating her way through NYC.

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