Article Summary

What is aging?
What causes us to age
How the face changes
Prevention and treatment
Emerging research on aging

Laugh lines, sun spots, gray hairs. We all know the visible signs of aging and it’s an inevitable process that we will all face. And while everyone has different feelings on getting older, aging can be difficult to navigate when there’s so much pressure on women especially to “age gracefully.” Here’s what happens as we age - and what you can do about it, if you wish to.

What is Aging?

We’re all getting older with each passing second and have been since conception. But around age 30, we start to see aging-related changes in organ systems that mark the shift to aging rather than simply getting older. Aging is a result of the deterioration of physiological processes in the body over time. Think of the body as a factory - as we age, it becomes harder to repair old parts and keep things running as smoothly as when the machinery was shiny and new.

You’ve probably been told that aging is natural… but that’s only partially true. The aging process is influenced by both internal and external factors. Our skin is unique because unlike our other tissues, its aging is primarily due to external causes. Just like how a coat of paint on the exterior of a house becomes old and weathered over time with exposure to the elements, our skin is mainly aged by our environment. This means that most skin aging is actually preventable.

When we examine aging, we’re looking at how the aging process is impacting our body. In the skin specifically, we start to see changes in not just how the skin functions but its actual structure. For example, damage to skin cells and their DNA can prevent them from replicating while loss of collagen means the skin is thinner with less support. But it isn’t just how the skin ages but why. Understanding what can accelerate the aging process means we can prevent premature aging.

Contributing Factors

There are a number of potential causes when it comes to aging and we can organize them into two general categories: internal and external causes.

Extrinsic skin aging is also called photoaging because the primary contributor is sun exposure. Along with UV radiation, other environmental aggressors as well as lifestyle habits can disrupt the structure of our skin and its ability to function normally over time. Photoaging is usually present on sun exposed areas and the skin will look thickened with coarse wrinkles and pigmentation.

Intrinsic skin aging is what we call chronological aging. In women, it can be partially caused by estrogen deficiency after menopause. Emerging research on intrinsic aging has been looking at the role of cell senescence and glycation which we will touch on later. This type of aging will be present on skin that isn’t exposed to the skin and thinning skin as well as fine lines are common indicators.

It’s important to distinguish between the two categories of aging because one is almost fully preventable while the other is not. When it comes to skincare, we aren’t trying to stop the natural aging process - we’re trying to prevent premature aging as well as help repair damage that has already occured.

Within these two categories of aging, there’s a number of contributing factors that research has linked to aging. While we’re still learning more about their role and to what extent they contribute to aging, here’s the main ones to be aware of:

Sun exposure. The number one cause of extrinsic skin aging, UV radiation damages both our cellular DNA and the structure of the skin.

Other environmental aggressors. Pollution, smoking, and blue light exposure from the sun can all generate oxidative stress and cause damage to our skin.

Lifestyle. Diet, exercise, and stress are all examples of lifestyle related factors that can contribute not just to aging but our overall health.

Hormones. Estrogen deficiency in the skin after menopause causes a number of skin changes in women and accelerated aging. Increased collagen loss, less protection against oxidative stress, and reduced production of hyaluronic acid and skin lipids are most common.

Cell senescence* Senescent cells enter an irreversible cell-cycle arrest, meaning they remain alive but cannot divide or grow. While this prevents damaged cells from dividing, it also prevents them from contributing to the healthy functioning of our bodies and they can secrete factors that cause inflammation and other issues.

*There are many more contributors to aging like DNA damage, mitochondrial dysfunction, glycation, telomere shortening, and inflammation. But as they’re all thought to contribute to cell senescence, I’m including them under this category.

The Aging Face

It’s helpful to understand not just why we age but what is actually happening in our face as we age. This can help prepare you on what to expect as well as guide any potential skincare purchases and in-office treatments. While skincare targets skin, aging impacts all of our tissues.

Facial Changes As We Age:

skin becomes thinner and firmness and elasticity is decreased
the fat pads shift lose volume and support, causing them to shift
facial muscles exert more tension on the skin as a result of decreased skin resistance and repetitive muscle contractions result in dynamic wrinkles
facial bones remodel and recede, causing shifting of the fat pads and muscles on top

You might be surprised to learn that some of the most common concerns that people report are not related to the skin at all, but instead result from changes to deeper structures like the facial fat compartments and bones. This means that skincare will not be effective for these issues as skincare targets our skin only. Examples: nasolabial folds, hollow under eyes, jowling, and marionette lines are primarily due to fat loss.

Aging impacts our skin by preventing the skin from functioning optimally and also by affecting the structural integrity of our skin. That means that the skin can look more textured as skin cells lose their normal uniform shape, impaired barrier function can cause dry skin, and we start to see more wrinkles and laxity as collagen and elastin is not only damaged but not enough is produced to replace what is lost.

Addressing Skin Aging

There’s two ways to go about tackling skin aging: prevention and prevention.

Okay, that isn’t the only option and we will go into how to target signs of aging once they do pop up after this. But prevention is always going to be the easiest route and should be your first course of action.

How to Prevent Premature Aging

Sun protection. Remember, almost all skin aging is extrinsic aging and almost all extrinsic aging is due to sun exposure. Safe sun habits include not just applying a high protection sunscreen liberally and often but also sun protective clothing and sun avoidance during peak hours when possible.
Antioxidants. No sunscreen works 100% and there are other environmental aggressors that can age our skin. Antioxidants help mop up free radicals that result from any exposure we can’t avoid.

Barrier Therapy. In addition to sunscreen and antioxidants to protect our skin, it’s also about the overall health of the skin. A gentle cleanser and a moisturizer with barrier replenishing ingredients make sure the skin barrier is functioning optimally and the skin can protect itself too.

Diet and Exercise. While the literature is sparse in terms of linking diet to improvement of specific skin concerns, we do know that healthy eating and regular exercise is important for overall health and can help prevent aging contributors like glycation and inflammaging.

Okay, so maybe you started your skincare routine late in life or you’re starting to see signs of skin aging despite your best efforts - what now? Don’t beat yourself up, it’s never too late to start a skincare routine and see improvement and we’re all just doing the best we can with the knowledge we have at the time. While prevention is the easier route, there are some evidence backed ways to address aging skin.

Targeting Signs of Aging

Retinoids. This is the star of the show and one of the most researched and effective ingredients for aging skin. As we’ve discussed here, retinoids can help repair damage as well as increase collagen expression.

Ascorbic Acid. Vitamin C levels are often depleted in more mature skin and this ingredient not only protects our skin but really helps retinoids when it comes to repair and new collagen formation.

Glycolic Acid. In addition to helping with new collagen production as well, glycolic acid is fantastic as helping to resurface the skin and can help target age spots.

Niacinamide. Found in Stratia’s Rewind Serum where it’s paired with other ingredients to further improve its efficacy, niacinamide can tackle a number of aging related changes from dullness, dark spots, fine lines, and more.

Remodeling. When there is significant damage to the skin from the sun or other environmental factors that can cause premature aging, skincare alone may not be enough. Treatment like laser, chemical peels, and microneedling are able to not only increase collagen production in the skin significantly but can actually replace damaged collagen and elastin.

Injectables. Whether you go in-office and seek additional interventions is a personal choice and not one we can tell anyone to do or not do. It is helpful to know though that neuromodulators (Botox, Dysport) and fillers are some of the few options available for addressing dynamic wrinkles and volume loss.

Ultimately, you’re the only one who gets a say in how you decide to approach aging. There is no right or wrong, just what is right for you. Some of us just want to stick to skincare, others want to take every measure we can to target signs of aging. It’s all about what helps you feel beautiful and confident.

Emerging Research

The science of aging has been the focus of a lot of new research as of late. There’s been a lot of buzz around new terms like cell senescence, inflammaging, and glycation as a result - likely because they’re potential explanations for intrinsic aging. It’s only natural that there would be a lot of interest in not just preventing premature aging but actually slowing chronological aging.

We’ll wrap up this article by diving into some of the latest science on aging for our science nerd community. But don’t forget, sunscreen and retinoids remain the most researched and effective when it comes to skin aging - and have the benefit of decades of use.

It all comes back to cell senescence.

With the discovery of these cells that are just hanging around without dying or creating new cells, the question then became why. The main theory is that it’s likely to prevent damaged cells from replicating - mutation and uncontrolled cell division can cause cancer. But this doesn’t fully contain the damage and these senescent cells secrete inflammatory factors that change the environment of the skin.

“Inflammaging” is the term for the low grade, chronic inflammation found in the body as we age. It’s a risk factor for a number of age related diseases, including cardiovascular disease. Within our skin, it’s suspected to be involved in the breakdown of the skin’s extracellular matrix and in the decline of skin’s immune response. Inflammaging is directly linked to the number of senescent cells in the skin.

But what causes this accumulation of senescent cells in the first place? There's a number of causes but glycation is key. Glycation is a term used to describe a chemical reaction in the body where sugars are interacting with our lipids and proteins, creating what we call “advanced glycation end products” (AGEs). Their presence in the body is linked to diabetes and kidney disease while within our skin, they’ve been shown to accelerate aging by damaging our skin and causing cell senescence.

It’s a vicious cycle where oxidative stress increases the formation of AGEs while at the same time, AGEs also cause more oxidative stress which damages cells and their DNA. Cell senescence, inflammaging, and advanced glycation end products all work off each other to age the skin and our bodies.

So what can we do?

Advanced glycation end products (AGEs) can be created within our body as well as consumed through foods. Healthy eating and weekly exercise have been shown to help prevent both glycation from occurring and can reduce inflammation as well. Research will likely continue to look at senolytic drugs like rapamycin to target senescent cells as well as medications like metformin that have the potential to reduce the damaging effects of AGEs.

Being a guinea pig is never a good idea so I’ll be holding off on medications like metformin and rapamycin until there’s more research done and my medical provider recommends it to me - and I suggest the same to anyone reading. But having a healthcare team you trust is an invaluable asset as you get older and they can guide you in terms of diet, exercise, and other interventions that are safe and well studied.

Skincare is important. And when it come to sunscreen, this is a product that isn’t just self care - sunscreen is healthcare. But at the end of the day, it’s about feeling good as we get older and being able to enjoy what is important to us as long as possible.

References

The Intriguing Science of Growing Older