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Natural vs Premature Aging of the Skin | What does "anti-aging" mean to you?

The conversation on the aging of the skin needs a little direction so that your roadmap for finding solutions will actually make a difference. Otherwise, you are wasting money and time on hope and not results that also bear the risk of scarring or disfigurement. The reason for the confusion is that there are two types of aging processes for the skin. There is natural aging that we cannot avoid entirely, and then there is premature aging. This is where we have options. Read more...



anti premature aging skin

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What is the difference between premature aging and natural aging?

Natural aging of the skin is referred to as intrinsic aging. The changes that occur in the skin naturally are a by-product of aging, genetic influences, and hormonal changes and are not directly related to environmental factors. Over time there is a gradual reduction in the collagen content of our skin as well as decreased elasticity. Less collagen makes our skin appear thinner while the loss of elasticity creates a crepey or tissue paper-like wrinkling of the skin. This loss of collagen and elastic fibers does not occur at the same rate as when the environment contributes to these changes. Gradual hair thinning and loss on the scalp occur while increased facial hair can appear for women.

Premature aging of the skin is referred to as extrinsic aging of the skin. Most age-related changes that we see are actually a result of these factors. Extrinsic factors that impact the skin include excess UV exposure, nutrition, medications, and other environmental factors such as pollution have on our skin. Extrinsic changes to the skin also include an accelerated loss of collagen and elasticity. This results in fine lines, wrinkles, and sagging of the skin. These factors also contribute to pigmentation changes such as lentigines and hyperpigmentation as well as persistent redness that can appear as broken blood vessels on the skin from excess thinning of the skin as well.

Distinguishing between these two types of aging can help guide our choices when it comes to interventions that may actually help to reduce the rapid onset of these changes such as the use of sun protection.

What causes skin and hair to age prematurely?

Aging of the skin and hair is accelerated by factors such as the environment, nutrition, medications, lifestyle choices, and pollution. Accelerated changes to the skin and hair are referred to as premature aging.


The environment contributes to premature aging of the skin primarily through solar radiation of the skin and increasingly we are finding that blue light from visible light sources such as energy-efficient lightbulbs and electronic devices may also contribute.

Environmental pollution, smoking, and other exposures that trigger free radical production can inflame the skin and accelerate the aging of the skin. Although sunscreens may not protect against these factors, taking the time to allow the skin’s repair mechanisms to work overnight by providing the skin with adequate hydration can help.


Nutrition can play a key role in the premature aging of the skin. Adequate hydration with water helps maintain a delicate balance of turgor and helps the skin maintain its function. Protein intake supplies the body with the building blocks needed to produce key structural components of the skin. Elements such as copper, zinc, selenium, and iron as well as vitamins are essential for their role in helping enzymes in the skin work for their antioxidant abilities.


Certain medications can play a role in accelerating the aging process. Prescription medications such as steroids can thin the skin, reduce collagen and elasticity, and make the skin appear to advance in age. There are blood pressure medications and certain antibiotics that can trigger photosensitivity and make our skin more susceptible to photodamage. And, drugs such as amphetamines are also known to accelerate the aging of the skin.


Certain lifestyle choices that place our skin in the position of excess light exposure such as outdoor activities, skiing, tanning bed use, and even spending hours in front of a computer screen can accelerate the aging of the skin if adequate measures on not taken to protect the skin.

What causes the natural aging of hair and skin?

Natural aging of the skin and hair is the result of factors that are influenced by genetics and a complex interplay of the skin as the body’s largest organ with other organ systems in the body, most notably the endocrine system. Hormonal changes in the body ultimately impact the thickness and quality of hair and skin. Hair tends to thin and become finer in texture on the scalp while coarse hairs tend to grow along the chin and upper lip. Skin thins, sags, and has less turgor and more dryness.

Genetic influences on the aging of the skin may be dictated by the natural photoprotection provided by melanin content. Other factors that genetics can affect include the synthesis of key structural elements of the skin including collagen, elastin, the proteins and lipids in the skin, as well as the antioxidant mechanisms in cells.

How does premature aging affect a person's self-esteem and mental health?

In practice, patients tend to find comfort in natural changes that occur to their skin and hair over time that are shared amongst their peers of the same age. When these changes occur earlier than expected, they can impact self-image and self-esteem as well as their psycho-social outlook. Interestingly, the concerns that arise are not always about vanity. It has far more to do with a mirror image that does not reflect how we feel about ourselves. Most of my patients that seek cosmetic procedures rarely seek to change or alter their appearance to look like someone else. They most often feel as though the changes they seek in their skin as a result of premature aging make them appear tired or even upset and possibly have lines or wrinkles that make them appear angry when this is not how they feel overall.

Why are people being encouraged more to embrace natural aging?

Embracing natural age-related changes in our skin and hair can feel empowering once these changes are viewed as earned as a result of experience, wisdom, and time that is reflected in these changes. I rarely find patients bothered by the natural changes we see in skin. The extrinsic or premature age-related changes in the skin can, on the other hand, feel frustrating as these are factors that are somewhat preventable.

Hair loss is an exception to this. Thinning or losing hair is a very personal experience and one that has significant psychological and emotional complications, especially for women.

What are ways you can embrace the natural aging process?

Natural aging of the skin occurs very gradually over time. Taking the time to manage the skin on a daily basis by creating a skincare routine to reduce the tendency for extrinsic factors to accelerate these changes can help embrace these changes.

The most important steps to a daily skincare routine are to cleanse, treat/repair, and protect the skin.

Cleansing involves helping remove excess dirt, sebum, and oil, and buildup on the skin. Generally, a simple cleanser is sufficient however some may find it helpful to add an exfoliant in at this step.

Treat/repair involves understanding if there are any challenges that your skin faces- acne, dry skin, wrinkles, etc. These challenges can be addressed by the addition of products designed to address these factors.

Protecting the skin involves understanding the importance of keeping the skin’s barrier intact. Moisturizing and hydrating the skin effectively is important here as is applying sunblock to protect the skin from harmful UV rays.

What is the best way to support and embrace our hair or skin that is experiencing premature aging?

If you define ‘anti-aging’ as halting or slowing the process of developing age-related changes to the skin then protecting our skin on a daily basis, year-round, indoors and outdoors is best achieved with sunblock.

Your first line of defense to age-related skin changes:

  • Use products that contain zinc and/or titanium or other sunscreen ingredients on a daily basis every morning.

  • Use products that moisturize or hydrate the skin overnight to allow the skin to repair and restore itself from the environmental exposures it faced during the day.

  • Avoiding smoking or secondhand smoke as these contribute to the free radicals that can accelerate age-related changes to the skin.

Is surgery ever recommended for someone if they are not comfortable with the aging process? If so, why?

Over the past 2 decades, I have evaluated thousands of patients for cosmetic procedures. Although trends in interest for cosmetic procedures vary based on regions of the country and individual preferences, the vast majority of patients that I see are trying to just look like themselves. They see lines or wrinkles that create an appearance that does not reflect how they feel about themselves.

From a cosmetic perspective, I break down cosmetic procedures as Restorative, Enhancing, or Transformative.

  • Restorative cosmetics focus on “restoring” a change we see in our skin. These are patients that come in and say “Where did this line come from” or “I look tired all the time”. Most of my patients fall under this category where they are not asking to look like someone else - they truly just want to look like they did when they felt the most confident. These patients do not tend to have unrealistic expectations and are wonderful to work with because they define beauty as confidence. They define beauty as feeling good in their skin and wanting to look like their best self.

  • Enhancing cosmetic procedures are ones where we define or augment a feature. Common examples are lips, cheeks, and chin. For example, we lose lip volume over time. This leads to fine lines and furrows around the mouth. These lines cause lipstick to bleed into them. They also lead to recurrent cases of perleche- cracked inflamed corners of the mouth. Facial bones in the cheeks and jaw change over time and these procedures can play a role to help restore these contours.

  • Transformative cosmetic procedures are focused on changing a feature such as accentuating cheekbones before cheekbone loss occurs or creating fuller lips before volume loss occurs.

The question as to whether or not I would specifically recommend a surgical intervention to address the anti-aging process, the answer is it depends. If there are minimally invasive procedures such as fillers, botox, and lasers that can simply address concerns then given the nature of these procedures they are a reasonable starting point. However, if I do evaluate a patient and find that the concerns that they have cannot be adequately addressed through minimally invasive interventions I do review the option of consideration to a surgical option if they are seeking a more timely and effective option. The true goal in practice is prevention. Taking the steps to protect your skin early in life can reduce the need for cosmetic interventions later.

What options for surgery are recommended for those that want to slow the process of premature aging?

Interventions to slow the process of premature aging are focused on addressing the specific changes that we know occur in the skin over time. Although a good skincare routine can help, some changes are hard to avoid. To really understand why we get wrinkles, it is important to break down what I refer to as the “anatomy of a wrinkle”. The anatomy of a wrinkle is broken down into three key features:

  • Loss of volume/fat

  • Thinning of skin

  • Muscle contraction

As we get older we naturally redistribute fat and lose volume in certain areas of our face while perhaps gaining in others. The volume loss is both made up of fat and a reduction of the bony structure underlying our skin such as the cheekbone and mandible that retracts backward.

In terms of minimally invasive options, neurotoxins for facial muscle relaxation can reduce the tendency to form a forehead wrinkle in the first place. This addresses the muscle contraction that contributes to wrinkles developing.

Thinning of the skin can be addressed by skincare products as well as various procedures such as radiofrequency skin tightening, laser, and chemical peel options.

Loss of volume can, in the early stages, be addressed with hyaluronic acid fillers. As it progresses, when skin laxity and redundancy contribute to this loss further, surgical interventions can be considered.

What are at least 10 ways in which you can prevent premature aging? Please explain how each works.

The best way to prevent premature aging of the skin is to consider interventions during each decade of life.

Intervention #1: UV protection to the face with sunscreen products

The age that most people will start to see the effects of aging is usually by our mid to late 20s. Although the effects of aging are noticeable at this age, the reality is that the foundation for premature aging of the skin is laid early in childhood. UV exposure accelerates this process by damage to the DNA of our cells. Sunburns and chronic sun exposure in childhood and teenage years are not always immediately accompanied by the signs of aging. More often there is a delay in seeing the impact on our skin by about 10-20 years after those initial intense and/or prolonged UV exposures.

The main concerns that my patients in their 20s have noted with regard to aging of the skin are most often related to pigment changes and early fine lines around the dynamic portions of the face such as the mouth and eyes. This age group is often eager to take steps to prevent or slow down the process of aging as well!

The absolute most important way to combat their concerns is sunblock. Getting into the habit of wearing sunscreen every single day of the year - regardless of the chances for sun exposure is important. We are learning more about other sources of potential UV exposure indoors through some energy-efficient light fixtures as well as potentially from screen use from computers and smartphones. Choose a sunscreen that has zinc and/or titanium as the ingredient and not chemical sunscreens. The jury is still out on chemical sunscreens. The concern about chemical sunscreens being absorbed into the bloodstream and serving as potential “endocrine disruptors” is most concerning to me for children, teens, and premenopausal women. If you are not a fan of the whitish hue of many of these sunscreens, choose a tinted one so it’s less noticeable but still effective.

Wearing sunscreen on a routine basis every morning is important to prevent and reduce the discoloration that can occur. Sunscreen use can also slow down and prevent further UV damage to our cells.

Intervention #2: UV protection to the body with sun-protective clothing

Including the body in your skincare routine is essential. The crepe-like or tissue paper-like wrinkling that can occur in the skin can often affect the body as well. Wearing sunscreen on the entire body routinely can be challenging on a daily basis. Sun-protective clothing can play an important role in reducing the tendency towards premature aging of the skin on the body.

Intervention #3: Retinol

Starting in our 20s is a great time to include Retinol in the evening routine. Retinol is the long game- its effects and benefits are reaped over time. Ideally, we start young with retinol - in our 20s to 30s to ward off the signs of aging. If you are looking to get rid of some wrinkles by next month or by the time an event rolls around- see your dermatologist for other options.

The best approach to take for consumers and my patients is to not look to the immediate results of these products. The overall trend is to focus on natural and effective. Retinol fits perfectly into this class and if you start early, you will reap the long-term benefits. Retinoids are known to improve fine lines and wrinkles by boosting collagen production in addition to retaining water in the skin. They can help actually reverse the signs of aging that come from sun damage. They can also work to minimize discoloration in the skin and give the skin more of a glow.

Intervention #4: Vitamin C

By our 30s, more discoloration, freckles, and pigmentation starts to develop. This is when my patients will say “I swear I’m wearing sunscreen every day- why am I getting these spots?!” I believe them when they say they are wearing sunscreen daily. The reality is that it’s those sunburns from our childhood, those times they went to a tanning salon to get ready for prom, those summers as a lifeguard - all catching up with them!

This is a great time to add in Vitamin C. Topical vitamin C does several things: it’s a potent antioxidant to prevent damaging our cells from UV and the environment, it inhibits an enzyme called tyrosinase in the skin to prevent hyperpigmentation, it is an anti-inflammatory to help with redness in the skin, and it can boost collagen production. It has been shown to improve the texture and appearance of skin overall. One note- even though vitamin C can improve pigmentation in the skin, I find the best results are from pigment as a result of sun damage. Its mechanism of improving pigment is by blocking a specific enzyme that triggers hyperpigmentation. Although this can be a similar issue with acne scars, not all pigment is the same and I do not always find that acne scars respond consistently as well to vitamin C compared to other options.

Intervention #5: Hyaluronic Acid

By our 40s, we are starting to see the impact of aging in terms of more persistent pigment changes and deeper lines or wrinkles that stay at rest. I tend to describe this as ‘I stopped smiling 5 minutes ago- why are my smile lines still there?!”

Our skin is getting thinner over time and less able to hold onto hydration. This is a great time to look at adding topical formulations of hyaluronic acid (HA). These are seen in anti-wrinkle creams and any product targeting skin hydration. (It is important to note that when applied topically, it does not penetrate deep into the skin to give the effect of an injectable filler.)

The goal of HA topically is to increase and improve skin hydration, and elasticity and decrease wrinkle depth. HA can strongly attract and retain moisture in the skin. When applied topically it is not reversing the signs of aging long-term or treat sun damage the way other anti-aging preps work.

Technically its topical effect is based on drawing moisture to the skin when applied to improve the overall appearance of the skin while it is used. It improves the turgor of the skin. This is a good thing- many people cannot tolerate anti-aging topicals that contain alpha hydroxy acids and retinol. They can be too irritating or dry for the skin. It’s a welcome option to have a product that works by really hydrating the skin.

Intervention #6 & 7 : Fillers & Toxins

Our 40s is also when many start to seek other options. For deeper lines and wrinkles present at rest, toxins and fillers tend to be the next step to intervene. I do spend more time helping my patients understand their options and helping them navigate their choices by keeping things in perspective.

Intervention #8: Peptides

There is this frustrating tissue paper-like wrinkling or ‘crepey’ quality to the skin that starts to appear in our 50s. This is just difficult because it is a true change in the quality of skin that takes effect. This is the result of the loss of collagen combined with the loss of elasticity in the skin. In terms of OTC options, peptides in serums are thought to work by stimulating collagen production in the skin. These are small molecules that are believed to stimulate receptors in the skin to result in collagen synthesis. This effect along with the hydrating effects of the numerous oils and antioxidants improves the overall appearance of fine lines and wrinkles quickly with this product. Remember to use a moisturizer on top to make it more effective.

Intervention #9: Radiofrequency skin tightening, lasers, or LED light therapy

Let’s talk about the neck. The neck starts to stand apart and reveal our age even when we are being really good about caring for our faces! This type of loose, excess skin can be difficult to address. I have more patients saying to me “I’m fine with my face, it’s aging gracefully- but my neck!” Aside from surgical intervention, radiofrequency tightening of the skin has been very successful to help in improving the crepey appearance of this skin.

Intervention #10: Moisturizers

The most common issue for this age group beyond the above is quite simply easy bruising on the arms and hands. It is probably the most common new ‘cosmetic’ concern I see at this age. It is frustrating, can be unsightly, and difficult to manage as a result of the easy tearing that can accompany it. It is truly the result of thinned atrophic skin over years of sun damage and aging. It can be worsened by blood thinners commonly taken in this age group but not always caused by them (and not a reason to stop taking them!). I recommend focusing on thicker moisturizers to really create more turgor to the skin to help it withstand shearing forces from friction and minor bumps and hits our skin is exposed to. Wearing long sleeves or athletic sleeves when active can help reduce the impact on the skin by behaving almost like a second skin.

anti premature aging skin


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