Understanding skin ageing: Taking care of your skin

Cosmetic surgery isn’t necessarily the answer to stopping your skin ageing; understanding what lifestyle factors may be affecting the age of your skin could change everything

There’s no shortage of women wanting cosmetic surgery. In 2022/23, 26,000 women underwent cosmetic surgery procedures, a 101% increase from the previous year.

However, cosmetic surgery isn’t necessarily the answer to ageing skin. Scarring, wound infections, blood loss, blood clots, and nerve damage are just some of the possible complications. A facelift can cost anywhere from £10,000 £30,000! So it makes perfect sense to fully explore other ways for women to rejuvenate their skin without opting for the knife.

How does skin age?

As the body gets older, the skin ages too. But to understand why your skin ages, it helps to know all the things your skin does for you.

The skin has several vital functions:

• To keep foreign organisms out of the body,
• To help regulate body temperature,
• To prevent water loss to ensure we stay well-hydrated, and
• To shield the body from UV radiation.

As it ages, the skin does all these things less efficiently.

Ageing causes the skin to get thinner and bruise more easily. Less collagen and elastin are produced and there is a loss of subdermal fat, making the skin wrinkle and sag. The skin becomes less effective at retaining water, making it feel dry, itchy, sensitive and loses its natural plumpness.

However, 90% of skin damage is photoaging caused by UV radiation. In one study of 61-year-old identical twins, one twin had approximately 10 hours a day more sun exposure than the other, and skin specialists estimated that her skin looked 11.25 years older than the other twin’s. Sun exposure is the most important factor in controlling and slowing skin ageing.

Other factors that affect the appearance of the skin include nutrition, smoking, alcohol, obesity, and the effects of gravity. For good skin, these factors need to be addressed.

Factors that affect skin ageing

Sun exposure—Photo-ageing occurs from excess exposure to UVB and UVA radiation. This could be from natural sunlight, sunbeds, or sun lamps. Photo-ageing prematurely ages the skin and damages the DNA in skin cells, which increases the risk of skin cancer—both melanoma and other skin cancers.

To protect your skin from photo-ageing:

• Apply sunscreen with SPF of at least 30 (and at least 4 out of 5 stars for anti-UVA protection) to all sun-exposed skin. Reapply every 2 hours or more after swimming.
• Avoid the midday sun between 11 am and 3 pm.
• Wear a broad-brimmed hat and sit in the shade when possible.
• Avoid tanning.
• Never use a sun bed – use a fake tan if you want to look tanned.

For more information – British Association of Dermatologists – The Sun Protection Fact Sheet. Note – You should apply sunscreen even in the winter.

If you are worried about sun-damaged skin, ask the advice of a Dermatologist. It’s never too late to start protecting your skin.

Nutrition

Beautiful skin comes from within. The quality of our skin is largely genetic, but one thing we can do to keep the skin in tip-top condition is to eat a healthy balanced diet.

• Macronutrients – Protein is needed for healthy youthful skin as it contains amino acids which are the building blocks of collagen – the connective tissue or ‘scaffolding’ that holds the skin cells together.
  • In terms of the human diet, both high-fat and high-sugar diets have been shown to be harmful to the skin. A high-fat diet speeds oxidative stress and speeds skin inflammation. A high-sugar diet results in larger numbers of advanced glycation end products (AGEs)  which have been shown to accelerate skin ageing. Processed and ultra-processed foods tend to be high-fat, high-sugar foods which should be avoided as they have multiple harmful effects on our health.

• Micronutrients – Vitamins A, B2, B3, B6, C, D, E, zinc and selenium are especially important for good skin health.
  • Unfortunately, vitamin and mineral deficiencies are increasingly common in the UK. This has been linked to poor diets, including a heavy intake of processed and ultra-processed foods. For example, in 2024, 57% of UK adults were found to be deficient in vitamin D. The NHS recommends all UK adults take 10 mcg (400 IU) of vitamin D a day in the winter months October to March, but some experts recommend this all year round. There are specific recommendations for children.
  • We need to eat a wide range of different foods – restrictive diets are not good for the skin. Antioxidants obtained from the diet are vital to delay skin ageing.  Oxidation takes place in every cell of the body continuously to produce energy for cellular processes. As a byproduct of oxidation, negatively charged particles called reactive oxygen species (ROS) are produced. These ROS are dangerous as they can damage DNA and accelerate lipid oxidation both of which fuel the ageing process which includes skin ageing. Antioxidants are obtained from the diet – the body cannot make them. Fruit and veg contain the highest amounts of antioxidants. To slow/delay ageing and prevent many chronic diseases, it’s imperative to eat 5-a day (some now say day 10 a day) of fruit and veg. Unfortunately taking antioxidant supplements has not been shown to help. They have to come from fresh food.
  • Omega-3 fats are also important for skin health. If you don’t like oily fish, consider omega-2 supplements.

Good hydration

This is vital, you need to drink at least 2 litres of water a day, more in hot weather.

Smoking

Smoking induces enzymes that break down collagen, reducing the elasticity of the skin and causing wrinkling. Smokers often have a typical appearance with deep crow’s feet around the eyes and prominent mouth lines from sucking on cigarettes. The single best thing a smoker can do to help their skin is stop smoking.

Alcohol

This affects the skin in several ways. Alcohol is a diuretic so tends to dry out the skin. Many heavy drinkers have poor nutrition especially vitamin A needed for skin health.Alcohol also reduces collagen production so accelerates wrinkles. For best results, cut down your alcohol intake or stop drinking alcohol altogether.

Caffeine

Caffeine also acts as a diuretic to dry out the skin and reduces collagen production. Excess caffeine is associated with lower levels of vitamins B and C – both essential for healthy skin. Caffeine also causes constriction of the tiny capillaries at the skin surface which causes a dull complexion and contributes to wrinkles. Drinking coffee in the afternoon or evening can cause insomnia which is detrimental to the skin. For best results limit your caffeine intake, only drink caffeinated coffee in the mornings and preferably only drink decaffeinated coffee.

Obesity

In obesity, people have thicker skin folds and tend to sweat more. This encourages skin infections such as folliculitis, boils and intertrigo. Obesity is associated with acanthosis nigrans – patches of hyperpigmented skin often in the groins and armpits. Skin tags are more common. Chafing can occur leading to soreness, redness and skin irritation. Obesity is associated with cracked heels and facial hirsutism in women. Losing weight and ensuring your BMI is in the normal range of 21 – 25, is a very positive way to improve your skin health.

Exercise

Taking regular exercise promotes blood flow to the skin and the removal of waste products. This ensures the skin cells are well-oxygenated to carry out their particular tasks. Exercise is linked to improved sleep which also improves skin health.

Sleep

Collagen production increases during sleep. So chronic sleep deprivation leads to dark shadowed eyes, fine lines and a pale complexion. Sleep deprivation also increases trans epidermal water loss from the skin causing dry skin. Acne, eczema and psoriasis are all worsened by loss of sleep. Lack of sleep leads to raised cortisol levels which can exacerbate skin inflammation.

For the best results, ensure you get at least 7 hours of good quality sleep every night.

Stress

Chronic stress of any cause can lead to premature ageing of the skin. Stress causes raised cortisol levels, increasing skin inflammation and accelerating water loss from the skin. The skin also becomes oilier so pimples and spots are more common. Hyperpigmentation can occur with uneven skin pigmentation and age spots.

Take a holistic approach to lowering stress. This means getting fresh air and exercise, switching off with relaxation methods such as mindfulness, yoga or meditation. There are numerous ways to de-stress. Find a pastime you enjoy and make time for it during your daily/weekly routine.

Menopause

Falling estrogen levels in the perimenopause can aggravate ageing skin. Post-menopause, your skin can feel dry and tight, and you may notice wrinkles, lines and age spots. Women may develop facial hair and notice their scalp hair is thinning. For the best results, manage any menopausal symptoms optimally. Protect your skin from sun damage with care. Moisturise your skin often.

Although preventing skin ageing is not an indication for HRT, using HRT has been noted to have some improvements in skin health including reducing and preventing wrinkles.

Gravity

Unfortunately, gravity pulls on the skin causing saggy eyelids, sunken cheeks and generalized lines and wrinkles.

Your skincare regime

It’s important to establish a regular skincare regime. Dead skin cells need to slough off and new skin cells come to the surface. The skin needs to be clean, well moisturised, not too greasy and have all the nutrients it needs for good cellular repair.

Morning skincare

Follow these steps in the correct order –

• Cleanse the skin in the mornings with an alcohol-free cleanser. If you have dry skin, use an oil-based cleanser containing ceramides, glycerin or hyaluronic acid. For oily skin use a cleanser containing benzoyl peroxide, glycolic acid or salicylic acid.
• Wash your face with warm water and pat it dry with a clean towel. Don’t use very hot water as this increases oil production.
• Apply a toner to the T section of your face, putting a cotton wool pad soaked in toner on the skin and allowing it to absorb into the skin for a few minutes. Again look for a toner recommended for dry or oily skin.
• Apply any acne treatments such as benzoyl peroxide or salicylic acid, or for hyperpigmentation apply a specific product containing niacinamide or vitamin C.
• Apply a skin serum – Skin serums have a high antioxidant content – such as vitamin C, E or niacinamide. Smooth the serum gently onto the skin of your face and neck.
• Moisturiser  – This is vital for keeping the skin well hydrated and preventing water loss from the skin. Choose one containing hyaluronic acid, glycerin or urea for dry skin.  For oily skin go for those that contain hyaluronic acid. aloe vera, squalene, or niacinamide.
• Sunscreen – Now apply sunscreen – about a quarter to one third of a teaspoon spread evenly over your face. ‘Dip, dot and smear’ – meaning pour a little sunscreen into the palm of one hand, dip a finger in it and dot the sunscreen around the face. Then, smear this over the face and allow it to dry. Use a little more for the tops of your ears, your temples and your neck.
• Make-up  –  This is the last thing to put on your skin after all the other products.

Evening skincare

Again follow these steps in this order –

• Cleanse – Using a makeup remover. For oily skin use an oil-free cleanser. For dry skin use an oil-based cleanser.
• Toner – Apply toner with a cotton pad all over the face. Use a toner appropriate for your skin type.
• Acne treatments – As above apply these next.
• Serums – Next apply a skin serum.
• Retinol – This can be applied at night to help improve skin turnover and reduce fine lines. Retinol should not be applied to the skin in the morning as it should not be used when the skin is exposed to sunlight.
• Moisturiser – Apply an appropriate moisturizer (see above) generously and rub it gently into the skin. For those with very dry skin, this is the time to apply  face oil if needed.

A couple of extra tips

• Exfoliate twice a week using a cleanser, peel or special toner. This is a way to remove dead skin cells and help the skin to look bright and fresh instead of dull.
• Use a face mask twice a week to moisturize and unclog pores for those with oily skin.

Anti-ageing face masks can improve the skin texture and appearance.

Supplements

• Collagen
  • A recent 2022 review and meta-analysis of 12 studies concluded that collagen whether taken orally or applied to the skin delays skin ageing. Collagen supplements improve skin elasticity, moisturization and hydration. They also reduce skin wrinkling and the roughness of the skin. Some studies have shown the best results with collagen peptides – which have a lower molecular weight and are better absorbed from the gut.  This is a fundamental change in advice that can be given by dermatologists.
• Other supplements
  • In a 2024 review of 238 articles, the authors concluded the following have promising effects on skin, some providing extra photo protection – vitamin A, vitamin C, vitamin D, vitamin E, curcumin, chlorella, Omega-3, biotin, Polypodium leucotomos, Simmondsia chinesis, gamma oryzanol, olive leaf extract, spirulina, and astaxanthin. However, there is no easy substitute for a healthy lifestyle and making the changes listed above. More research is needed.

Probiotics

Probiotics are foods that contain healthy bacteria. The skin flora and gut microbiome have a significant effect on skin health and skin ageing. Taking probiotics has been shown to improve the skin’s pH, boost antioxidant activity and the immune system, lower inflammation and improve insulin resistance (the way the body processes sugar). They also help reduce photo-ageing and improve the skin barrier function. Look for foods containing lactobacilli and bifidobacteria.

Foods that contain probiotics include live yoghurt, sour cream, kefir, pickled foods, sauerkraut, tempeh, kombucha, kimchi, sourdough bread and some cheeses such as cottage cheese, cheddar, mozzarella and Gouda.

Prebiotics

These have also been shown to be important to slow skin ageing. Prebiotics are a type of indigestible fibre which once inside the human gut, provide a substrate for gut bacteria. They have been shown to support eh the correct balance of microflora in the gut microbiome, which also improves skin hydration, and lowers skin inflammation. Foods which are prebiotics are high-fibre foods such as whole grains, oats, leafy green veg, onions, garlic, soybeans, bananas, almonds, flax seeds, peas and beans.

Non-surgical cosmetic procedures

Fillers are collagen-based/ hyaluronic acid injections which are injected into the layers of the skin to help reverse some of the ageing changes. They replenish lost tissue volume as well as stimulate collagen production. However, they only last 6-12 months, and are expensive.

Botox is a botulinum toxin injected under the skin in small quantities to paralyse the facial muscles allowing the skin to relax and sag less, reducing wrinkles. The effects only last 3-6 months and the treatments are expensive.

900,000 Botox injections were carried out last year in the UK, but a large percentage were in women under 30. Unfortunately, the effect of influencers, the pressures of social media and an increase in body dysmorphia means more and more women want Botox and fillers who really don’t need them. It’s now illegal for anyone in the UK under the age of 18 to have them.

What to do to have youthful skin without surgery?

There’s no simple fix to young healthy skin. You need to attend to all the factors listed above.

In summary:

• Nutrition – Eat a healthy balanced diet. Consider supplements such as vitamin D, omega-3 and collagen. Ensure you include probiotics and prebiotics in your diet.Avoid processed and ultra-processed foods. We should all be having 30 g of fibre per day.
• Water – Drink at least 2 litres of water per day. Mineral water contains higher levels of potassium, magnesium and zinc which all have properties that enhance the skin.
• Smoking – Stop smoking. This is one of the best things you can do to improve the health of your skin.
• Alcohol – Reduce your alcohol intake to the NHS recommendation of 14 units per weekor stop drinking altogether.
• Caffeine – Limit your intake of caffeinated coffee, only drink this in the morning and regularly drink decaf. Chocolate, green tea and energy drinks also contain large amounts of caffeine.
• Obesity – Lose weight and maintain your weight within the healthy range 21-25.
• Exercise – Regular exercise improves blood flow and hence oxygen to the skin and ensures the removal of waste products.
• Sleep – Make sleep a priority and ensure you have 7 hours of good quality sleep per night. If you are not sleeping well, see your GP.
• Stress – Actively destress as part of your daily/weekly routine. Take regular exercise, which is a great way to lower stress, but also consider breathing exercises, mindfulness, Yoga or any other relaxing pastimes.
• Establish a regular skincare regime – Use an appropriate cleanser, toner and moisturizer for dry, oily or combination skin. Do this every morning or night without fail. Twice a week, exfoliate and use a face mask.
• If you have concerns about your skin – See your GP or see a Dermatologist. Non–surgical options include Botox and fillers which may be appropriate for older women as they reach middle age and beyond.

Final thoughts on skin ageing and how to protect your skin

Before you decide to opt for expensive and risky cosmetic surgery, there is much you can do yourself to improve the health and vitality of your skin. Spending time and money on your diet and health is a far better way to improve your skin naturally without the physical insult of surgery.

Adopting a healthy lifestyle and making a priority of caring for yourself, and your skin will reap so many benefits. The healthier your skin, the better it can perform its vital functions. Take care of your skin and it will take care of you – well into old age!