The Sun. In our personal experience we have seen women from the southern hemisphere as young as 20 with crow’s feet (around the eyes) deeper than most people double their age. This is mostly due to constant squinting for hours (same thing you so when you smile - but not for 5 second or 10 sends for you very happy people). However, besides the sun just causing you to squint other harmful effects also do occur. Without protection from the sun’s rays, just a few minutes of exposure each day over the years can cause noticeable changes to the skin. Freckles, age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, a blotchy complexion, actinic keratoses (thick wart-like, rough, reddish patches of skin), and skin cancer can all be traced to sun exposure.
“Photoaging” is the term dermatologists use to describe this type of aging caused by exposure to the sun’s rays. The amount of photoaging that develops depends on: 1) a person’s skin color and 2) their history of long-term or intense sun exposure. People with fair skin who have a history of sun exposure develop more signs of photoaging than those with dark skin. In the darkest skin, the signs of photoaging are usually limited to fine wrinkles and a mottled complexion.

Cutis rhomboidalis nuchae refers to the manifestation of long-term, prolonged sun exposure and resultant damage to the skin occurring on the back of the neck. Long-term, chronic sun exposure causes thickening of the most superficial layer of the skin (the epidermis) and abnormalities in the composition of the middle layer of the skin (the dermis).
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. Scientific studies have shown that repeated ultraviolet (UV) exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks our elastin. Sun-weakened skin ceases to spring back much earlier than skin protected from UV rays. Skin also becomes loose, wrinkled, and leathery much earlier with unprotected exposure to sunlight.
HTML clipboardeople who live in sun-intense areas, such as Florida or Arizona, can show signs of photoaging in their 20s. In fact, some people who live in sun-intense areas develop actinic keratoses (AKs) and skin cancer in their 20s.
While it may seem that the signs of photoaging appear overnight, they actually lie invisible beneath the surface of the skin for years. UV photography enables us to see the damage accumulating beneath the surface of the skin years before the signs of photoaging appear. Most people are surprised by the amount of photoaging that the UV camera shows. To see actual patient photographs that show: 1) what is visible to the naked eye and 2) what damage lies beneath the surface, visit:
UV Photography Reveals Sun Damage
Facial Expressions. If you perform facial exercises to maintain a youthful-looking appearance, it is time to stop. Repetitive facial movements actually lead to fine lines and wrinkles. Each time we use a facial muscle, a groove forms beneath the surface of the skin, which is why we see lines form with each facial expression. 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. Once again - sunglasses help to reduce the expressions around the eyes.
Gravity. Gravity constantly pulls on our bodies. Changes related to gravity become more pronounced as we age. In our 50s, when the skin’s elasticity declines dramatically, the effects of gravity become evident. 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.

The side you sleep on usually has deeper lines and more asymmetry. For example, the most obvious are your nasolabial folds that run from the corner of your nose to the out lip. Once side may be deeper than the other.
Sleeping Positions. Resting your face on the pillow in the same way every night for years on end also leads to wrinkles. Called sleep lines, these wrinkles eventually become etched on the surface of the skin and no longer disappear when the head is not resting on the pillow. Women, who tend to sleep on their sides, are most likely to see these lines appear on their chin and cheeks usually on that side. Men tend to notice these lines on the forehead since they usually sleep with the face pressed face down on the pillow. People who sleep on their backs do not develop these wrinkles since their skin does not lie crumpled against the pillow.
Smoking. Cigarette smoking causes biochemical changes in our bodies that accelerate aging. Research shows that a person who smokes 10 or more cigarettes a day for a minimum of 10 years is statistically more likely to develop deeply wrinkled, leathery skin than a nonsmoker. It also has been shown that people who smoke for a number of years tend to develop an unhealthy yellowish hue to their complexion. Additionally, a study conducted in 2002 showed that facial wrinkling, while not yet visible, can be seen under a microscope in smokers as young as 20.
These signs can be greatly diminished, and in some cases avoided, by stopping smoking. Even people who have smoked for many years, or smoked heavily at a younger age, show less facial wrinkling and improved skin tone when they quit smoking.
For Healthier, Younger-Looking Skin
Prevention. While you cannot stop or even slow down the intrinsic aging process, you can prevent signs of premature aging by protecting your skin from the sun, quitting smoking, and eliminating facial exercises.
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CosMedocs recommend comprehensive sun protection to prevent premature aging caused by the sun. Comprehensive sun protection includes:
- Avoiding deliberate tanning, including use of indoor tanning devices.
- Staying out of the sun between 10:00 a.m. and 4:00 p.m., when the sun’s rays are the strongest.
- Wearing protective clothing, such as a wide-brimmed hat and long sleeves, when outdoors during the day as well as SUNGLASSES
- Applying sunscreen year round. Sunscreen should be broad spectrum (offers UVA and UVB protection) and have a Sun Protection Factor (SPF) of 15 or higher. Sunscreen should be applied 20 minutes before going outdoors to all skin that will be exposed. It should be reapplied after sweating or being in water.
If you are bothered by visible signs of aging, a number of treatments are available. Injectable fillers and botulinum toxin are suitable for people with busy lifestyles who do not want the inconvenience of a long recovery. Radiofrequency is a procedure that offers an alternative to the traditional facelift. Dermabrasion, laser resurfacing, chemical peeling, microdermabrasion, and some topical treatments can restore skin, giving it a smoother and refreshed appearance.
Scientific research in the field of anti-aging continues to give rise to new and promising treatment options. A dermatologist can help you sort through the numerous options, including the myriad of over-the-counter products. During a consultation, the dermatologist will examine your skin, discuss your expectations, and recommend suitable treatment options.
References:
American Academy of Dermatology. “Turning Back the Hands of Time.” February 21, 2005.
Available at: www.aad.org/media/background/news/cosmetic_2005_02_21_turning.html. Accessed June 20, 2005.
Demierre MF et al. “Public knowledge, awareness, and perceptions of the association between skin aging and smoking.” Journal of the American Academy of Dermatology, 1999 Jul;41(1):27-30.
Fisher GJ. “The Pathophysiology of Photoaging of the Skin.” Cutis, 2005 Feb;75(2S):5-9.
Koh JS et al. “Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas.” International Journal of Dermatology, 2002 Jan;41(1)21-27.
Moschella S and Hurley H. (1992) “Aging and Its Effects on the Skin.” Dermatology: Third Edition. Philadelphia: W.B. Saunders Company.
Oikarinen A. “Aging of the skin connective tissue: how to measure the biochemical and mechanical properties of aging dermis.” Photodermatology, Photoimmunology and Photomedicine, 1994 Apr;10(2):47-52.