aging skin

Kailua Dermatology & Wellness Center helps lessen the appearance of aging skin by recommending a combination medical and cosmetic plan based on the patient’s needs.

Research shows that there are two distinct types of aging: aging caused by the genes we inherit, or intrinsic/internal aging, and that implemented by environmental factors, or extrinsic (external) aging.

Intrinsic Aging

Also known as the natural aging process, intrinsic aging normally begins in our mid-20s. Collagen production slows within the skin and elastin, the substance enabling skin to snap into place, has less spring. During intristic aging, dead skin cells shed slower and turnover of new skin cells decreases slightly. While these changes usually begin in our 20s, signs of intrinsic aging are typically not visible for decades. These signs are:

  • Fine wrinkles

  • Thin and transparent skin

  • Loss of underlying fat, causing hollowed cheeks and eye sockets and noticeable loss of firmness on the hands and neck

  • Bones shrink away from the skin, causing sagging

  • Dry, possibly itchy skin

  • Inability to sweat sufficiently to cool the skin

  • Graying hair that eventually turns white

  • Hair loss

  • Unwanted hair

  • Thinning nail plates, causing half moons to disappear and development of ridges

Genes control how quickly the normal aging process unfolds. People with Werner’s syndrome, a rare inherited condition that rapidly accelerates the normal aging process, usually appear elderly in their 30s. This condition can cause graying and thinning hair during the teen years and cataracts in the 20s. The average life expectancy for people with Werner’s syndrome is 46 years of age.

Extrinsic Aging

A number of extrinsic, or 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 explained below.

The Sun

Without protection from the sun’s rays, a few minutes of exposure per day over multiple years can cause noticeable changes to the skin. Sun exposure can cause 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.

“Photoaging” is the term dermatologists use to describe aging by sun exposure. The amount of photoaging that develops depends on a person’s skin color and 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. Photoaging in very dark skin is usually limited to fine wrinkles and a mottled complexion.

Photoaging occurs over many years. With repeated exposure to the sun, the skin loses its ability to repair itself, and 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. Unprotected exposure to sunlight causes skin to becomes loose, wrinkled, and leathery much earlier.

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 lines form with each facial expression. As skin ages and loses its elasticity, the skin stops springing back to its line-free state. Grooves then become permanently etched onto the face as fine lines and wrinkles.

Gravity and loss of facial structure

Gravity constantly pulls on our bodies, particularly as our facial bones, fat pads and muscles 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.

Sleeping Positions

Resting your face on the pillow in the same way every night for years also leads to wrinkles. These wrinkles, called sleep lines, 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 sleep lines appear on their chin and cheeks. Men tend to notice sleep lines on the forehead if they sleep face down on the pillow. People who sleep on their backs do not develop these wrinkles.


Cigarette smoking causes biochemical changes in our bodies that accelerate aging. Research shows that a person who smokes 10+ cigarettes a day for a minimum of 10 years is more likely to develop deeply wrinkled, leathery skin than a nonsmoker. It also has been shown that people who smoke for many 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.

Dermatologists recommend comprehensive sun protection to prevent premature aging caused by the sun including:

  • 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.

  • Applying sunscreen year round. Sunscreen should be broad spectrum (offers UVA and UVB protection) and have a Sun Protection Factor (SPF) of 30 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.

Treatment- If you are bothered by visible signs of aging, many treatments are available. In addition to sun protection, using topical products helps to rejuvenate and repair some damage, regardless of how aggressive your treatment plan is.

Injectable fillers and botulinum toxin are minimally invasive, highly effective facial rejuvenation techniques which rival effects of traditional cosmetic surgery. Fillers and Botox have far and away become the most popular cosmetic procedures in the world. Fillers, especially the biostimulatory type, are regularly used to recontour the face and fill in facial volume deficits due to loss of facial bone, muscle, and fat. Botulinum toxin can be used for relaxing wrinkles caused by excessive facial muscle movement. Both procedures are well tolerated, can be done as an office procedure, and are suitable for people with busy lifestyles who do not want the inconvenience of a long recovery.

Several lasers and laser-like devices that are available to heat-stimulate the production of collagen can also be used to tighten skin. Laser resurfacing, chemical peeling and microdermabrasion can be used to remove the surface of unhealthy skin, allowing newer skin to replace and offer a smoother, refreshed appearance.

Scientific research in the field of anti-aging continues to give rise to new and promising treatment options. Your KDC provider will help you sort through the numerous options, including the myriad of cosmeceuticals and over-the-counter products. During a consultation, the dermatologist will examine your skin, discuss your expectations, and recommend suitable treatment options.