Ageing Skin


What is ageing skin?

Ageing of the skin is a gradual process that is associated with changes to the appearance, characteristics and function of the skin.  

There are two types of ageing processes, including:

  • Intrinsic ageing, also known as the natural ageing process, is a continuous process that affects the skin of the entire body; and
  • Extrinsic ageing or ageing caused by external factors, such as excessive exposure to ultraviolet (UV) radiation can act individually or together on the normal ageing process to age skin prematurely.

Who gets ageing skin?

Intrinsic ageing affects everyone and normally begins in mid-20s. Extrinsic ageing affects people who have had excessive exposure to ultraviolet (UV) radiation.

Ageing prematurely can also affect smokers and those who have had significant exposure to other environmental pollutants.

What causes ageing skin?

Intrinsic ageing

As an individual ages, collagen production begins to slow, and elastin has a bit less spring. The production of oils and natural moisturizing factors reduces leading to dryness. Dead skin cells do not shed as quickly, and the turnover of new skin cells decreases; the skin becomes thinner and provides less support to its blood vessels. These changes usually begin in a person’s mid-20s, but the signs of intrinsic ageing are often not visible for some time.

Environmental factors can also contribute to intrinsic ageing.

Extrinsic ageing

Extrinsic ageing may be caused by several factors that age the skin prematurely.  These may include:

  • Ultraviolet radiation: UV exposure from the sun is the main cause of skin ageing and is common on exposed areas such as the face, chest, arms, hands and legs. UV damages the elastin and collagen fibres in the skin, causing the skin to sag, wrinkle, stretch and become blotchy. Sun damage may not show in younger years, but it will later in life. Common signs of excessive UV exposure include freckles and age spots, facial spider veins, rough and leathery skin, thinning of the skin, wrinkles, loose skin, blotchy complexion, yellowing of the skin with thickened bumps (solar elastosis) , actinic keratosis and skin cancer.
  • Smoking: Smoking accelerates ageing of the skin, as smokers are more likely to develop deeply wrinkled, leathery skin and an unhealthy yellowish sallow-hued complexion. Smoking may also increase the risk of skin cancers of the skin and lips and can accelerate the damage caused by sun exposure. Puckering the lips while smoking also increases the wrinkles around the mouth.
  • Facial expressions: Repetitive facial movements can lead to fine lines and wrinkles. Each time a facial muscle is used, a groove forms beneath the surface of the skin, which results in the formation of lines. As skin ages and loses its elasticity, the skin stops springing back to its line-free state and these grooves become permanently etched on the face as fine lines and wrinkles.
  • Gravity: Gravity constantly pulls on our bodies and changes to our body become more pronounced with age and our skin’s elasticity declines. Gravity causes the tip of the nose to droop, the ears to elongate, the eyelids to fall, jowls to form and the upper lip to disappear while the lower lip becomes more pronounced.
  • Sleeping positions: Sleeping in the same position every night may lead to wrinkles on the face, where the head rests on the pillow.
  • Diet: Nutrition is known to contribute to skin ageing. Higher fat, carbohydrate and sugar intake can contribute to ageing of the skin. Excessive alcohol consumption can also cause skin ageing.

 There are also several skin conditions that may occur more frequently in older age, but not directly related to aging. These may include:

  • Pruritus
  • Xerosis and asteatotic eczema
  • Eczema (atopic dermatitis), such as, discoid dermatitis, gravitational dermatitis
  • Seborrheic dermatitis
  • Bullous disorders, such as bullous pemphigoid
  • Psoriasis
  • Leg ulcers
  • Shingles and post-herpetic neuralgia
  • Benign skin tumours, such as skin tags, seborrheic keratoses, solar lentigines, cherry haemangiomas, sebaceous glands overgrowths.

What does ageing skin look like?

Intrinsic ageing

Intrinsically aged skin may include:

  • Fine lines and wrinkles due to gravitational forces.
  • Skin sagging or laxity due to lack of elasticity.
  • Skin thinning.
  • Widening of existing blood vessels, called telangiectasia.
  • Benign neoplasms, such as sebaceous hyperplasia and cherry angiomas.

Figure 1. Intrinsic ageing on side of face. Image reproduced with permission of Adj. A/Prof Gregory Siller.

Figure 2. Intrinsic ageing on forehead. Image reproduced with permission of Adj. A/Prof Gregory Siller.

Extrinsic ageing

Extrinsic ageing is related to environmental factors, and may include: 

  • Ageing to exposed areas of the body, such as face, neck and arms.
  • Deep wrinkling.
  • Dyspigmentation.
  • Telangiectasia.
  • Both benign and malignant skin lesions.
  • Hyperpigmented lesions, such as diffuse mottling, freckles, lentigines, and flat seborrheic keratoses. 

Figure 3. Photoaging on back of neck. Image reproduced with permission of Adj. A/Prof Gregory Siller.

Figure 4. Photoaging on side of neck. Image reproduced with permission of Adj. A/Prof Gregory Siller.

How is ageing skin diagnosed?

Ageing skin is diagnosed clinically.  A skin sample (biopsy) may be necessary for people that present with lesions that may be suspected skin cancer.

How is ageing skin treated?

Treatment options will vary depending on the individual and their needs, and may include:

  • Retinoid creams, with or without vitamin C and E, alpha-hydroxyl acids, nicotinamide.
  • Botox (Botulinum toxin) injections
  • Fillers, such as those made of hyaluronic acid, calcium hydroxyapatite and poly-l-lactic acid.
  • Chemical peels
  • Vascular laser treatment
  • Sclerotherapy
  • Resurfacing procedures, such as dermabrasion, deep peels, fractional laser, laser resurfacing
  • Cosmetic surgery

Other general measures that can prevent the skin from becoming more damaged, include:

  • Applying sunscreen with a sun protection factor (SPF) of 50+, 15 to 30 minutes before sun exposure and every 2 hours thereafter.
  • Wearing appropriate sun protective clothing
  • Wearing a broad-brimmed hat and sunglasses.
  • Avoiding direct sun exposure as much as possible during peak UV index.
  • Avoiding outdoor activities during the middle of the day.
  • Stopping smoking.
  • Eating a health diet, with plenty of fruit and vegetables.
  • Drinking plenty of water.
  • Reducing the frequency of bathing. Avoid hot showers.
  • Using soap-free, fragrance-free liquid cleansers or bath oil.
  • Using moisturiser.

It is also important that individuals regularly perform self-examinations of their whole body, including scalp, hands and feet so that they are familiar with their skin, and look for changes in new and existing moles and spots.

What is the likely outcome of ageing skin?

Ageing is a complex process involving intrinsic and extrinsic factors. It is a normal process that happens to everyone.

Minimising or avoiding UV exposure by using sun protection measures can reduce extrinsic ageing. Sun protection measures include the wearing of sun protective clothing, correct use of a broad-spectrum sunscreen, wearing of a broad-brimmed hat and sunglasses.

Adj. A/Prof Gregory SillerDecember 2023
Dr Antoinette CiconteApril 2017


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