Wrinkles are a visible reminder to yourself and others that you are getting older. Most of us dislike acknowledging this inevitable process. People in the United States spend over 50 billion dollars annually on anti-aging products, medications, and procedures.
Before there were effective treatment options, your only choice was to accept that your skin thins, sags, wrinkles, and accumulates age spots, but today many people are seeking age management treatment options.
Exposure to ultraviolet light (sun exposure) is the biggest external contributing factor to wrinkling, and therefore wrinkles start earlier and are more prominent on skin-exposed surfaces.
Skin aging is a complex process. Genetic predisposition, immune response, exposure to UV light and pollution, diet, and smoking all play a role in the skin aging process. While everyone accumulates wrinkles with age, there are ways you can reduce their appearance and steps you can take to delay their onset.
In This Article
Skin aging results from both intrinsic (genetic predisposition, muscle movements) and extrinsic factors (smoking, UV light). Intrinsic factors cause thinner, drier skin that accumulates fine lines. Exposure to environmental factors results in coarser wrinkles, loss of elasticity, and a rough-textured appearance.1
Skin is the largest organ in the body, and it weathers daily environmental exposure. However, not everyone’s skin responds the same.2
The skin has three layers: the epidermis, dermis, and hypodermis. With aging, all three layers thin and lose cells that provide nutrition and support.
The epidermis is the outer, exposed skin layer. It is made up of cells called keratinocytes. Keratinocytes provide a waterproof barrier that protects the dermis and underlying organs and tissues. These cells are produced by the deepest layer of the epidermis and are pushed upward as new cells are formed. Outer layers are shed once they reach the skin surface and are replaced by newer cells.
With age, the basal layer of the epidermis does not produce cells as quickly. The epidermis thins as fewer keratinocytes are produced. The contact area between the epidermis and the dermis also gets smaller, so the epidermis receives less nutrition from the dermis.1
The dermis is a thick layer of fibrous and elastic tissue made up of collagen and elastin. Collagen provides strength, and elastin provides flexibility. The dermis also contains sweat glands, nerve endings, oil glands, blood vessels, hair follicles, and immune cells.
With aging, there is a decrease in cells, including collagen and elastin, and blood supply in the dermis. The extracellular matrix that holds everything together in the dermis becomes more disorganized and fragmented.3
The hypodermis is the fatty layer below the dermis that insulates the body, protects from injury, and stores energy as fat. The hypodermis can vary in thickness.
The hypodermis also thins with aging. Attachments between the hypodermis and the underlying muscles weaken, which results in skin sagging.3 The effect of gravity makes this more noticeable as the neck, upper arms, and breast tissue sag.
Under the skin surface is the muscular layer. Fine lines develop as facial muscles contract and repeatedly move the skin in the same way. As the skin thins, these lines deepen. Facial expressions allow us to communicate as humans, and wrinkles provide a record of expressing emotions over a lifetime. Medical treatments can remove these wrinkles and provide a more “neutral” facial expression.4
Both intrinsic and extrinsic factors affect skin aging. Genetic predisposition is the primary intrinsic factor affecting the aging process, and UV radiation and smoking are the primary extrinsic factors.
Researchers are investigating genes that are linked to skin aging.5 Genetic differences contribute to the thickness of the dermis, skin elasticity, and wrinkles.2
Ultraviolet radiation (UVR) comprises UVA and UVB radiation. UVA rays penetrate the skin to the dermal level. UVB has more energy than UVA rays but can only penetrate the superficial skin layers.
Long-term sun exposure causes photoaging (changes in the skin due to long-term UVR exposure), which is due to damage and fragmentation of elastin and collagen at the epidermal-dermal border.6
Solar elastosis occurs in sun-exposed areas. It presents as thickened skin with a yellowish color. It occurs due to changes in elastin fibers.
UV exposure also decreases collagen in the dermis, which increases skin wrinkling and sagging, 7 damages DNA, increases inflammation and causes oxidative cell damage.8
Cigarette smoking results in premature facial wrinkling and damage to elastin.
Typical skin changes associated with smoking include:9
Cigarette smoking causes oxidative damage to cells, changes in blood vessels, skin dryness and irritation, decreased blood flow to the skin, and damage to collagen and elastin. All of these changes contribute to skin aging and wrinkling. 9
While it is difficult to erase skin wrinkles completely, there are many ways you can reduce the effects of skin aging. Supplements can nourish your skin from the inside out, and skin care products can improve your skin’s look and feel.
Read More: Tips for Better Skin as You Age
Topical medications are used to moisturize the skin and reverse the signs of aging.
Retinoids are derivatives of vitamin A that bind to receptors on DNA and increase protein production, thus increasing fibroblast growth and stimulating collagen production. Retinoids also inhibit metalloproteinases, which are enzymes that degrade the matrices that hold cells together.
Used in concentrations of 0.02% or higher, retinoids are expected to improve mild-to-moderate skin damage from UV light, fine and coarse wrinkles, pigmentation changes, and skin texture.
Many people discontinue the use of retinoids due to their side effects: skin irritation, redness, scaling, and dryness. Using a lower dose, using moisturizers, and slowly increasing retinoid strength can help minimize side effects.8
Alpha hydroxy acids, such as glycolic acid and lactic acid, and similar products such as citric acid and pyruvic acid, are used to remove calcium adhesions in the epidermis. This exfoliates epidermal skin cells, allowing for increased shedding of dead and dry skin. Decreased calcium also helps skin cells grow, improving fine lines and wrinkles.8
Vitamin C, coenzyme Q10, and NAD are all antioxidants that can help neutralize oxidative stress on skin cells.
In addition to acting as an antioxidant, vitamin C also promotes collagen synthesis. Vitamin C, when used with vitamin E and ferulic acid, can help decrease the formation of thymine dimers, which are changes in DNA in response to UVR. Using vitamin C creams regularly can help reduce fine lines, surface roughness, and changes in pigmentation.8
Coenzyme Q, also known as ubiquinone, is a powerful antioxidant that can help neutralize free radicals and prevent oxidative damage to skin cells. It is found in both the dermis and the epidermis of the skin. Coenzyme Q levels in the skin decline with age and UVR exposure, which may contribute to skin aging. Coenzyme Q is commonly added to skin creams along with moisturizers, other antioxidants, and alpha hydroxy acids.10
NAD+ is a coenzyme, antioxidant, and signalling molecule that is involved in over 500 chemical reactions in the body. Unfortunately, NAD+ levels decline with age.
NAD+ face cream has the following potential benefits for your skin:11,12
Laser skin resurfacing can remove damaged skin and reduce the appearance of lines and wrinkles, even out pigmentation, reduce skin sagging and remove skin lesions. Depending on the type of laser, laser skin resurfacing can also stimulate collagen growth and remodeling.
There are two main types of lasers used for cosmetic purposes: ablative and nonablative. Ablative lasers vaporize the upper layers of skin, while non-ablative lasers can penetrate deeper into the skin.13
Dermabrasion and microdermabrasion are skin resurfacing techniques that are used to treat wrinkles, sun damage, pigment changes, and skin lesions. Abrasive crystals are propelled across the skin surface using a vacuum device to remove the top layers of the skin.14 Side effects from dermabrasion include scabbing and swelling.
Wrinkle fillers are products that are injected into the dermis of the skin to fill in hollows that develop when fatty tissue under the skin thins and bone tissue is reabsorbed. Fillers can reduce the appearance of wrinkles and tighten lax skin. Dermal fillers can be temporary, semi-permanent, or permanent.15
Botox injections work best with dynamic wrinkles. These wrinkles are associated with repetitive facial movements like wrinkling your forehead or smiling. Injecting small amounts of botox neurotoxin into overactive muscles can relax the muscles and smooth the overlying skin. It usually takes about two weeks to see results from botox injections, and the effects last three to four months.16
Facelifts are surgical procedures that remove excess skin and pull the skin tighter to reduce lines, wrinkles, and skin sagging. In addition to surgical facelifts, people may choose nonsurgical facelifts that use liquid fillers instead.
A facelift involves only the lower two-thirds of the face. Brow and eyelid surgeries are separate.17
While many treatments are available to reduce the appearance of wrinkles, the best strategy is to try to prevent wrinkles from developing. You can take steps to ensure your skin looks good with age without surgery. It’s never too early to start thinking about anti-aging.
To look healthy, it’s important to be healthy, which means ensuring that you eat a healthy diet, exercise, get plenty of sleep, manage stress, stay hydrated, protect your emotional and mental health, and treat any medical illnesses in a timely and effective manner.
Some sun exposure is important to ensure you get adequate vitamin D. Other than 20 minutes two to three times a week for vitamin D, avoid sun exposure without applying a broad-spectrum sunscreen with an SPF of 15 or higher. Wear a hat to shield your scalp and face from UV radiation, and consider wearing clothing with sun protection, especially if you are outdoors a lot.
Tips to protect your skin from UVR:
Sunburn is an inflammatory reaction to UVR that damages the outer layer of your skin. Sunburn increases your risk of skin cancer. Repeated sunburns increase your risk even more.18
Apply moisturizers to soothe dry skin, reduce cracking and improve skin texture. Moisturizers only penetrate the outer layers of skin, so soothing dry skin and reducing fine lines after applying moisturizers will be temporary.
Skin is the biggest organ in your body and the only one constantly exposed to a slew of environmental toxins.19 A diet rich in antioxidants such as carotenoids, tocopherols, and flavonoids, as well as vitamins (A, C, D, and E), essential omega-3-fatty acids, lean proteins, and lactobacilli can provide your skin with the nutrition it needs.
Dietary benefits for healthy skin aging: 19,20
Antioxidants neutralize skin-damaging free radicals. Oxidative stress from pollutants can damage skin and accelerate skin aging. Many skin creams contain antioxidants to protect skin from oxidative damage. Nourish your skin from the inside as well by consuming a diet high in antioxidants and using antioxidant supplements like glutathione if your diet is lacking.
In addition to consuming a healthy diet, drink plenty of water to ensure your skin is well hydrated. Water is essential for every chemical reaction in the body. It helps with digestion, circulation, supporting body tissues, and protection. Drinking plenty of water keeps your skin hydrated, increases blood flow to supply your skin with nutrients, and removes toxins and metabolic waste.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
1. Zhang S, Duan E. Fighting against Skin Aging: The Way from Bench to Bedside. Cell Transplant. May 2018;27(5):729-738. doi:10.1177/0963689717725755
2. Vashi NA, de Castro Maymone MB, Kundu RV. Aging Differences in Ethnic Skin. J Clin Aesthet Dermatol. Jan 2016;9(1):31-8.
3. Boismal F, Serror K, Dobos G, Zuelgaray E, Bensussan A, Michel L. [Skin aging: Pathophysiology and innovative therapies]. Med Sci (Paris). Dec 2020;36(12):1163-1172. Vieillissement cutané – Physiopathologie et thérapies innovantes. doi:10.1051/medsci/2020232
4. Teo WL. On thoughts, emotions, facial expressions, and aging. Int J Dermatol. May 2021;60(5):e200-e202. doi:10.1111/ijd.15443
5. Flood KS, Houston NA, Savage KT, Kimball AB. Genetic basis for skin youthfulness. Clinics in Dermatology. 2019/07/01/ 2019;37(4):312-319. doi:https://doi.org/10.1016/j.clindermatol.2019.04.007
6. Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. Journal of the American Academy of Dermatology. 2017;76(3):S100-S109. doi:10.1016/j.jaad.2016.09.038
7. Flament F, Bazin R, Laquieze S, Rubert V, Simonpietri E, Piot B. Effect of the sun on visible clinical signs of aging in Caucasian skin. Clin Cosmet Investig Dermatol. 2013;6:221-32. doi:10.2147/ccid.S44686
8. Sunder S. Relevant Topical Skin Care Products for Prevention and Treatment of Aging Skin. Facial Plast Surg Clin North Am. Aug 2019;27(3):413-418. doi:10.1016/j.fsc.2019.04.007
9. Aizen E, Gilhar A. Smoking effect on skin wrinkling in the aged population. https://doi.org/10.1046/j.1365-4362.2001.01238.x. International Journal of Dermatology. 2001/07/01 2001;40(7):431-433. doi:https://doi.org/10.1046/j.1365-4362.2001.01238.x
10. Cirilli I, Damiani E, Dludla PV, et al. Role of Coenzyme Q(10) in Health and Disease: An Update on the Last 10 Years (2010-2020). Antioxidants (Basel). Aug 23 2021;10(8)doi:10.3390/antiox10081325
11. Oblong JE. The evolving role of the NAD+/nicotinamide metabolome in skin homeostasis, cellular bioenergetics, and aging. DNA Repair (Amst). Nov 2014;23:59-63. doi:10.1016/j.dnarep.2014.04.005
12. Gehring W. Nicotinic acid/niacinamide and the skin. J Cosmet Dermatol. Apr 2004;3(2):88-93. doi:10.1111/j.1473-2130.2004.00115.x
13. American Board of Cosmetic Surgery. Laser Skin Resurfacing: Top 8 Things You Need to Know. https://www.americanboardcosmeticsurgery.org/skin-resurfacing/the-top-8-things-you-need-to-know-about-laser-skin-resurfacing/
14. Shaw E. Rebuttal: Should family physicians prescribe medication for obesity? NO. Can Fam Physician. Feb 2017;63(2):e83.
15. Liu MH, Beynet DP, Gharavi NM. Overview of Deep Dermal Fillers. Facial Plast Surg. Jun 2019;35(3):224-229. doi:10.1055/s-0039-1688843
16. Small R. Botulinum toxin injection for facial wrinkles. Am Fam Physician. Aug 1 2014;90(3):168-75.
17. American Board of Cosmetic Surgery. Facelift Guide. https://www.americanboardcosmeticsurgery.org/procedure-learning-center/face/facelift-guide/
18. Skin cancer Foundation. Sunburn & Your Skin. https://www.skincancer.org/risk-factors/sunburn/
19. Cao C, Xiao Z, Wu Y, Ge C. Diet and Skin Aging-From the Perspective of Food Nutrition. Nutrients. Mar 24 2020;12(3)doi:10.3390/nu12030870
20. Schagen SK, Zampeli VA, Makrantonaki E, Zouboulis CC. Discovering the link between nutrition and skin aging. Dermatoendocrinol. Jul 1 2012;4(3):298-307. doi:10.4161/derm.22876