What is Facial Aging?

There are two distinct types of aging:

Intrinsic (internal) aging, caused by the genes we inherit.

Extrinsic (external) aging, caused by environmental factors, such as exposure to the visible and sunlight.

Intrinsic Aging

Also known as the natural aging process, Intrinsic aging is genetically wired, and quite variable person to person. Intrinsic aging is a continuous process, generally beginning in the 20s, and occurs throughout our skin, irrespective of sun or other environmental exposures.

Intrinsic aging is caused by a slowing in the production of collagen, a lessening of the “spring” of our elastic tissues, and less effective glandular- and skin-immune systems. Cell turnover may be slowed, and there may be less shedding of dead skin at the surface. Concurrently, our skin barrier may become less effective, with a relative increase in dehydration of skin.

Tissues beneath the skin, such as muscle, fat, and bone, also diminish as we age, leading to sagging of the overlying skin. All of the structures of the skin are involved in the aging process as well, including the hair follicles, which may produce gray hairs rather than colored, and miniaturized hairs instead of long terminal hairs (such as on our head), or thick coarse facial hairs where there was “peachfuzz” before.

These are some of the features attributed to intrinsic aging:

  • Fine wrinkles
  • Thin and transparent skin
  • Loss of underlying fat, leading to hollowed cheeks and eye sockets as well as noticeable loss of firmness on the hands and neck
  • Bone loss, causing sagging skin
  • Dehydrated dry skin from depleted skin barrier
  • Graying hair
  • Thinning hair
  • Hair in unwanted locations

Extrinsic Aging

A number of external factors often act together with the normal aging process to prematurely age our skin. Most premature aging is caused by sun exposure. Other external factors that prematurely age our skin are smoking, pollution, other oxidative stressors, gravity, and repetitive motions or sleeping positions.

Photoaging occurs over a period of years. With repeated exposure to the sun, the skin loses the ability to repair itself, and the damage accumulates. Studies have shown that repeated ultraviolet (UV) exposure breaks down collagen and impairs the synthesis of new collagen and elastin. Sun-weakened skin loses its “spring” and becomes loose, wrinkled, and leathery much earlier than sun-protected skin.

Gravity constantly pulls on our bodies, particularly so as our facial structure (bones, fat pads, and muscle) start to diminish over time. Much like a tent with the poles shortened, or a beach ball with some of the air released, gravity causes the cheeks to drop, the temples to hollow, the tip of the nose to droop, the ears to elongate, the eye sockets to hollow and eyelids to fall, jowls to form, the chin to shrink, and the upper lip to disappear while the lower lip becomes more pronounced.

The hallmarks of “photoaging,” the term dermatologists use to describe aging caused by sun exposure, are:

  • Freckles
  • Seborrheic keratoses
  • Melasma and generally irregular pigmentation
  • Loss of dermis, subcutaneous fat, bone, and muscle, causing deep hollows and sagging skin
  • Leathery, dull skin
  • Bumpy or cobblestoned skin that is somewhat yellowed and sallow
  • Scaly pink and brown pre-cancerous patches or bumps
  • Spider veins on face
  • Excessive bruisability
  • Giant blackheads
  • Excessive wrinkling, both deep and fine
  • Flared or poorly-controlled rosacea
  • Poor skin tone and quality with intermixed dull, dry, and oily areas
  • Enlarged pores
  • Skin cancers- basal cell carcinoma, squamous cell carcinoma, melanoma

Facts About Aging Skin

As we approach and travel beyond middle age, most people experience a wistfulness for the loss of a youthful appearance. Yet we are tending to both live and work longer, and the desire to reclaim that ethereal “beauty” of the past is here to stay and is part of our being human.

Fortunately, there are many ways beauty can be maintained and restored readily, naturally and safely. And there will be many more ways to come for sure.

The Cheek Study

In order for Dr. Kenner to impress upon patients the importance of using sun protection, she decided to conduct a little study which she called the “Cheek Study”.

Dr. Kenner asked 5 different women from 5 different decades (ages 25, 35, 45, 55, and 65), if she could take pictures of their face cheeks, and pictures of their buttock cheeks. She then shuffled up the 5 face cheek pictures and did the same for the buttock pictures, and asked the next 50 patients coming into the clinic if they would order the pictures by decade.

The Results

Everyone could properly order the cheeks of the face by decade, but almost no one was able to do this for the buttocks!

Dr. Kenner published her findings in a peer reviewed medical journal, and we’ve had a copy of the article (which serves as a very effective teaching tool!) in our waiting area for years now.

The Big Difference

The point is, the skin throughout your whole body is influenced by your genetics, stress, diet, and pollution, but only your unclothed skin is bombarded by light every day. The difference between sun-exposed and sun-protected skin is like night and day. Your REAL skin age (chronological skin age) is the skin that is sun protected. Your prematurely-aged skin (photodamaged skin) is what the world sees on your face, neck, chest, arms, and hands.

If you want your skin to stay healthy and youthful over the years (and you don’t want to wear underwear on your face), use sunscreen every day, regardless of the weather outside!

Book Your Appointment

Aging Skin: Treatment Basics

Aging is a complex set of biological conditions, and well crafted skin care programs, will stimulate the stem cells within skin to regrow, encourage repair and renewal, and display a beautiful healthy surface. The basic approach to treating aging skin is two pronged:

  • Prevention against further damage
  • Repair of past and ongoing damage

In addition to sun protection, using topical products to help rejuvenate the skin and repair it on an ongoing basis is appropriate, no matter how aggressive a plan you decide to embark upon.

How To Preserve Your Skin

Avoid deliberate tanning, including use of indoor tanning devices

Stay out of the sun intentionally

Wear protective clothing, such as a wide-brimmed hat and long sleeves, when outdoors during the day

Apply sunscreen year-round. Sunscreen should be broad spectrum (UVA, UVB and visible light protection) and have a Sun Protection Factor (SPF) of 30 or higher.*

Lipid soluble forms of Vitamin C and B3*

Alpha hydroxy acids*

Certain peptides (there are many peptides, and certain forms can be used to encourage collagen growth)*

Botanical antioxidants*

Growth factors*

*Visit the SkinHappy Pyramid for more information on these products

Prescription Treatments For Aging

In the category of pharmaceutical treatments, one must be cautioned when using prescription-strength products on fragile, aging skin. Many of the products can be irritating for people with sun-thinned skin. Here are common prescription medications for aging skin:

Tretinoin or other prescription grade retinoids - Well-formulated products (like the ones we have at SkinHappy) will be gentle yet effective, avoiding the "retinoid reaction" that causes people to stop using the product. Intermittent use of retinoids does not allow the skin to benefit from these molecules, so a product must be tolerated for daily use.

Hydroquinone - This product can help lighten skin if pigmentation is a symptom of aging. Some forms of prescription-strength hydroquinone are irritating and, other than lightening, hydroquinone has no rejuvenating skin benefit. In rare cases, hydroquinone can cause a side effect that - ironically - discolors the skin.

Clinical Treatments For Aging

In addition to a medical diagnosis and treatment plan, the following clinical services can help aging skin:

Medical Grade Facials (Hydrafacials)

The Hydrafacial MD is a professional level facial treatment using vortex extraction of surface dead skin, blackhead plugs, and dirt/pollution buildup, followed by infusion of therapeutic and rejuvenating serums.

Rapidly effective, this treatment combines rejuvenating, calming, and hydrating infusions with exfoliation to give the skin a buffed glow that produces an “immediate” beautification treatment.


Touted as the "non-surgical facelift," filler treatments are rapidly replacing or delaying the need for face or neck lifts! Filler treatments use natural ingredients to re-volumize and restore the aesthetics or youthful shape of your face. But fillers go beyond just the face! These amazing treatments can be applied to the hands, chest, earlobes, jawline, and neck as well!

Medical MicroNeedling

This unique combination of techniques painlessly and effectively rejuvenates the skin at all levels: stratum corneum, epidermis, and upper dermis. Microneedling creates precisely designed microscopic “punctures” into this protective barrier. This allows our specially formulated solutions of collagen-stimulating and brightening molecules to penetrate the skin and dramatically enhance skin rejuvenation, scar repair, and enhanced skin health.

Electric microneedling is particularly effective for wrinkles, sun damage, poor skin tone, lax skin, and pigmentation. This powerful skin treatment is suitable for the face, and many other surface areas, including neck, chest, hands, arms, bellies, scalp, etc.

Neurotoxin: Xeomin, Dysport and Botox

Injection with neurotoxin has rightfully earned recognition as the most common cosmetic procedure in the world. Nearly painless, and highly effective, this treatment relaxes muscles causing wrinkles (and more) and can erase years within a few short days!

Skin Aging: Before and After