All About Anti-Aging

One of the most popular questions I receive at the Levana Dermatology Clinic is, “What is the best anti-aging regimen?” To answer this question, I start by explaining the aging process.

Can we stop aging?

You CANNOT stop aging — but you can slow down the process (or speed it up).

Skin aging, in particular, is influenced by several factors including genetics, environmental exposures, ultraviolet (UV) radiation, stress, hormonal changes and metabolic processes that generate reactive chemical compounds i.e. “reactive oxygen species” or “ROS” (these are the substances targeted by anti-oxidants), among others.

There are two types of aging: intrinsic (natural aging) and extrinsic (external factors that speed up intrinsic aging). Dermatologists often address the latter, particularly photoaging, the premature aging of skin occurring due to cumulative UV radiation.

What happens to our skin as we age?

Photoaged skin often manifests as coarse, lax skin with wrinkles and irregular hyperpigmentation (dark spots). This is because of structural changes in the skin that lead to 1) a decrease in skin renewal and 2) a decrease in the integrity of dermis  (the inner layer of the skin made up of three crucial components; collagen, elastin, and glycosaminoglycans (GAG’s).

In your 20s, skin takes around 21 – 28 days to renew itself. In your 30s, it can take up to 40 days. When skin renewal is longer, dead skin cells tend to build up on your face, causing your skin tone to appear dull and patchy.

The damage in the dermis is characterized by the degeneration of collagen (the main structural protein of the skin responsible for firmness and suppleness) and elastin (responsible for elasticity and resilience), and a decrease in glycosoaminoglycans (GAGs), amino sugars (a sugar linked with a protein) that, together with water, create a fluid that fills the space between the collagen in the dermis, giving it turgidity. These factors highly contribute to skin wrinkling and sagging.

On a side note, collagen is a large protein, and as such collagen does not penetrate the skin. It cannot be topically added to skin to boost collagen levels; it can only be synthesized by your own body. There are active ingredients (discussed further below), such as Vitamin A, Vitamin B and Vitamin C derivatives, that boost collagen synthesis by accelerating its production. If you see “hydrolyzed collagen” on an ingredient list, it is meant collagen in its broken down form. It is mainly used a moisturizer (it holds water in the skin), but it cannot increase the amount of collagen in skin.

To reiterate, important factors to address in skin aging include:

  1. Sun exposure
  2. Slowing down of epidermal turnover (skin renewal)
  3. Damage to the structural integrity of the dermis

What can I do to slow down aging?

  1. Protect your skin from the sun. Sun protection must be foundation of every anti-aging skin care regimen. I suggest the use of a sunscreen that offers broad-spectrum protection (both UVA and UVB coverage), SPF 30 to 50, and water resistance. I will post another blog post devoted to sunscreens.
  2. Moisturize. As we age, our skin becomes drier. Moisturizers can hold water in our skin, giving us a more youthful appearance.

    Tips in choosing the right moisturizer:

    Cream, Lotion, or Ointment?

    • Moisturizers are helpful, regardless if you have oily, dry or combination skin
    • Ointment: thickest, good for dry, itchy skin
    • Creams: thinner, good for normal skin
    • Lotions: lightest (water is their main ingredient), good for oily skin

    Suggestions/”buzz words” according to skin type:

    • Oily or acne-prone skin:
      • Non-comedogenic, oil-free; dimethicone, alpha-hydroxy acids or salicylic acid
    • Dry skin:
      • Oatmeal, hyaluronic acid, glycerin, propylene glycol, lanolin, ceramides
    • Sensitive skin:
      • Hypoallergenic and fragrance-free; less than 10 ingredients

    What to avoid when choosing a moisturizer:

    • Colorings and perfumes
    • Antibacterial agents
    • Oily skin: avoid lanolin, mineral oil, petrolatum, shea butter (can clog pores/cause acne)
    • Dry, sensitive skin: too many acids, (alpha-hydroxy acids, salicylic acid)
    • Products with alcohols

  3. Apply medications or cosmeceuticals. There is no one-size-fits-all. Consult a board-certified dermatologist to know which medication/cosmeceutical is right for you.

    What are examples of products with the most clinical evidence for anti-aging?


    • Tretinoin and vitamin A derivatives (e.g. retinol)
      • Mechanism of action:
        • Decrease fine lines and wrinkles
        • Increase collagen synthesis and decrease collagen breakdown
        • Decrease hyperpigmentation
        • Increasing shedding of the skin 🡪 decrease skin roughness and even out texture
      • Tretinoin is the gold standard for anti-aging, but not everyone can tolerate it (cause irritation, redness, burning)
      • Retinol is a milder version of Tretinoin, it causes less fewer side effects but is also less effective as an anti-aging agent

    • Vitamin B derivates (e.g. niacinamide)
      • Mechanism of action:
        • Antioxidant effects
        • Decreases fine lines and wrinkles
        • Increases collagen production
        • Decreases hyperpigmentation
        • Increasing shedding of the skin 🡪 decrease skin roughness and even out texture
      • Can be used with Tretinoin
      • Can be used as an alternative for Tretinoin-sensitive individuals (my personal favorite because I cannot tolerate Tretinoin)
      • Can produce mild, stinging sensation

    • Vitamin C (with or without Vitamin E)
      • Mechanism of action:
        • Anti-oxidant effects
        • Decreases fine lines and wrinkles
        • Increase collagen synthesis and decrease collagen breakdown
        • Decreases hyperpigmentation
        • Photoprotectant effect
      • Not all Vitamin C preparations can penetrate the skin!
      • Can be used with Tretinoin
      • Can be used as an alternative for Tretinoin-sensitive individuals
      • Can produce mild, stinging sensation

    • Alpha hydroxy acids
      • Mechanism of action:
        • Increasing shedding of the skin 🡪 decrease skin roughness and even out texture
        • Decreases hyperpigmentation
        • Most powerful agents in peeling away old skin, but can cause irritation and burning
        • Can prepare the skin to accept other products more completely
        • Examples: glycolic acid (smallest, quickest and deepest, most irritating); lactic acid smaller, less irritating
        • Can be used with Tretinoin but needs caution
        • Can be used as an alternative for Tretinoin-sensitive individuals
        • Not as good as others in producing collagen

    Tips in using anti-aging medications and cosmeceuticals?

    • Consult a board-certified dermatologist. No one understands skin better than a certified skin expert. We KNOW skin from the inside out. We are here to develop an anti-aging regimen with and for you. Just like you, your skin care regimen will be unique – dependent on your skin type, lifestyle, budget, skin care needs and other skin issues.
    • Start with one product. Using several anti-aging products at the same time can irritate your skin. Some patients can tolerate using all four products discussed above. Others (like me), can only tolerate one. I usually start patients on one product then slowly step up the anti-aging ladder as tolerated. This is why skin care regimens must be personalized.
    • Test the product before applying it to your face. Even hypoallergenic products can cause a skin reaction. If you have a history of sensitivity, I usually suggest testing it on the ventral surface of your forearm twice daily for one week. I’d in my practice, the neck is often more sensitive than the face with many anti-aging regimens.
    • Stop using a product that stings, burns, or tingles. If you are using a product prescribed by your dermatologist, ask if this should be happening before you stop using it. As I discussed, there are products that are known to cause some burning upon application, but this may go away in minutes.
    • Follow directions. Some products contain active ingredients that can cause problems if you apply more than directed.
    • Give the product time to work. Patience is a virtue! Most products take at least 6 weeks to work. Sometimes it can take up to 3-6 months. So please, continue using if you want to continue seeing results. Some people stop using a product once they see results (or if they don’t). As anything worth having in life, slowing down aging takes time and effort.

  4. Adjunctive dermatological procedures. Don’t be afraid of dermatological procedures. There are many safe, effective procedures (when conducted by a board-certified dermatologist) that are considered valuable tools in the anti-aging armamentarium. You can choose from multiple non-invasive and invasive procedures. The most popular procedures at the Levana Dermatology Clinic include chemical peels, microdermabrasion, botulinum toxin injections, LED light therapy and radiofrequency. I will not be discussing everything in detail here but I would like to discuss Preventative Botox briefly.

    Wrinkles are most commonly caused by UV radiation and strong facial muscles (the muscles of expression). Because I have a very dynamic face (I use my facial muscles a LOT), I started preventative Botulinum toxin injections since I was 31 years old. When used at the correct dose and placement, neuromodulators like Botox relax the strong muscles of expression to prevent them from constricting and wrinkling overlying skin. Preventative Botox starts that process early on for people who NEED it more. What’s important to understand is wrinkles initially start to show up when you’re making facial expressions, but they go away at rest. However, there may come a time when wrinkles will stay even when you’re not making a particular facial expression. The idea behind Preventative Botox is that when you start to notice the earliest sign of resting wrinkles, this is the best time to start treating them (before they begin to stick around). However, Preventative Botox isn’t for everyone, and for those who aren’t good candidates, there are many other options to slow down aging for you.

A good anti-aging regimen for me is one that addresses both intrinsic and extrinsic aging. For the former, we cannot underemphasize the impact of a healthy lifestyle incorporating diet, exercise, micronutrient/antioxidant supplementation, avoidance of smoking and excessive alcohol, adequate sleep and minimal stress. For the latter and from a dermatologist’s perspective, I often recommend products and procedures that hydrate the skin, trigger skin renewal (i.e. exfoliation) and stimulate collagen production. One of the most important things to remember is that It is the combination of all of these modalities that will work best in retarding skin aging.

In summary, good anti-aging skin regimen (or a slow-down-aging skin regimen) involves:

  1. Adequate sun protection;
  2. A regimen suited to your skin type that ideally has a) active ingredients to induce skin renewal and collagen production and b) provides adequate skin hydration;
  3. Non-invasive procedures that do more of the same (these procedures often go deeper than topical agents do), and
  4. Possible invasive procedures for more advanced cases.

We can’t prevent aging, but we can control how we age.

Skincerely yours,

Dr. Mara Evangelista-Huber

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