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How skin ages: collagen, elastin, volume, and sun

| Written By R.Ve Aesthetics | Medically Reviewed By Osborne Williams, MD
an older woman looking out away out a window with sunlight on her face to demonstrate how skin ages

Skin ages in every layer at once. The outer layer thins, the collagen and elastin that give the deeper layer its support and its spring are lost over time, the fat under the skin shrinks, and the bones of the face slowly change shape. Sun exposure speeds all of this up more than any other single factor, which is why the face, neck, and hands age faster than skin that stays covered.

This page explains what each of those changes is, what you see in the mirror because of it, and which changes a treatment can address and which it cannot. It is written for the person who has started noticing something and wants to understand it before deciding whether to do anything about it.

Key facts about how skin ages

What changes What it does
The outer layer (epidermis) Thins with age, and the cells that make pigment become fewer. Skin looks thinner, paler, and more translucent, and brown spots appear where the sun reaches.
Collagen The fiber in the middle layer that gives skin its support. There is less of it over time, so skin becomes more fragile and lines settle in.
Elastin The fiber that lets skin stretch and return. With age, and much faster with sun, it loses strength and elasticity. The medical name for that change is elastosis.
Fat under the skin Thins and shifts, so the face loses its full, smooth surface and the eyes can look sunken.
Bone The facial skeleton loses bone in predictable places: around the eye sockets, in the upper jaw beside the nose, and in front of the jowls. Folds deepen partly because the support beneath them has receded.
Sun The greatest single factor in skin aging. Ultraviolet damage adds up over years and shows as wrinkles, brown spots, loose skin, and a blotchy complexion.

 

Skin ages in all three layers

Skin has three main layers, and each one changes with age. The outer layer, the epidermis, holds skin cells, pigment, and proteins. The middle layer, the dermis, holds blood vessels, nerves, hair follicles, and oil glands, and it feeds the layer above it. Under both sits a layer of fat. Every layer is held together by connective tissue: collagen fibers for support and elastin fibers for flexibility and strength.

With age the epidermis thins, even though the number of cell layers stays the same. The pigment making cells become fewer, and the ones that remain grow larger, which is part of why older skin looks paler and clearer in some places and spotted in others. The small blood vessels in the dermis become more fragile, so bruises come more easily. The oil glands produce less, and in women that drop begins after menopause, which is why dryness becomes a new complaint for many women around menopause. The fat layer thins, which takes away padding.

Together these changes explain most of what people mean when they say their skin looks older: thinner, drier, less even, and slower to bounce back. The next three sections take collagen, elastin, and volume one at a time.

Collagen holds skin up, and there is less of it over time

Collagen is the protein fiber that gives the dermis its structure. When there is plenty of it, skin is firm, lines made by expression smooth out when the expression ends, and a small injury heals quickly. With age the loss of collagen and elastic fibers makes skin look older, develop wrinkles, and become more fragile, and the skin repairs itself more slowly. Wound healing in older skin can take up to four times longer than in young skin.

You notice collagen loss first in the lines that stop disappearing. A line that forms when you frown, squint, or raise your brows is a dynamic line: it is made by a muscle folding the skin above it. For years the skin recovers each time. As collagen thins, the fold begins to stay when your face is at rest, and it becomes a static line. The two look alike but they are different problems, and in a consultation we treat them as different problems. Lines that only show with movement are a muscle question. Lines and folds that stay at rest are a skin and support question, and sometimes a volume question, which is the subject of the section after next.

Elastin lets skin snap back, and sun wears it out

Elastin is the fiber that lets skin stretch and return to where it was. With age the connective tissue loses strength and elasticity, a change called elastosis, and it is far more noticeable in sun exposed skin, where it is called solar elastosis. This is the leathery, weather beaten look that outdoor workers, sailors, and lifelong sun seekers develop long before their age would predict it.

In the mirror, elastin loss reads as skin that has gone slack: crepey texture on the cheeks and neck, a jawline that has softened into jowls, and loose skin under the chin. Sagging of the lower face and thin, wrinkled skin on the neck are two of the most visible signs of age. Some of what people call loose skin is skin; some of it is fat that has shifted, and some is the vertical muscle bands of the neck stretching out of shape as the muscles weaken. Which one is behind yours changes what, if anything, is worth doing about it.

Volume: the fat and bone under your skin change shape

The face loses volume with age, and the loss comes from two places. The first is the fat under the skin, which shrinks and shifts so the face no longer has the plump, smooth surface it had. Fat around the eyes settles into the eye sockets, which can make the eyes look sunken, and the lower lids can slacken so that bags form beneath them. The second is bone. It was long assumed that the facial skeleton only grows with age, but the facial bones lose volume in specific, predictable places: the inner upper and outer lower edges of the eye sockets, the upper jaw beside the nose, and the part of the lower jaw just in front of where jowls form. Loss of bone mass in the jaw makes the lower face smaller and the forehead, nose, and mouth more pronounced.

This matters because it changes the diagnosis. The fold that runs from the nose to the corner of the mouth was long blamed only on skin sliding downward; part of it is the bone beneath receding and taking the fold with it. Flat or hollow cheeks, hollows under the eyes, a chin that looks smaller, and a jawline that has lost its line are often volume changes wearing the costume of sagging skin. Lifting or tightening the skin alone does not replace what has been lost underneath, a point the surgical literature makes directly, and this is one of the places where honest advice matters most. In a consultation at R.Ve we look at your anatomy, not only your skin, and we tell you which of these changes is behind what you see before we suggest anything.

The sun is the largest single cause

Sun exposure is the greatest single factor in skin aging, ahead of genetics, nutrition, and everything else. You can see it on your own body by comparing the skin on the back of your hand or your face with skin that has stayed covered. When ultraviolet light reaches the skin it damages healthy cells, and without protection that damage builds up for decades before it shows as freckles, brown spots, deep lines, loose skin, and a blotchy or ruddy complexion. The medical term for these changes is photoaging. The same damage is what leads to precancerous growths and to skin cancer in some people.

Tanning beds concentrate the process. People who use them often see the changes within a few years, and some within a year. Natural pigment offers some protection, so fair skinned people show more sun related aging than people with darker skin, but no skin tone is immune, and skin cancer can affect anyone of any skin color. The practical point is simple: of everything on this page, sun is the one factor you can do the most about, starting today, whatever your age.

What else speeds skin aging

Several other things move the process along. Cigarette smoking makes wrinkles develop more quickly, and the specialty societies list it with sun exposure among the things that make wrinkled skin worse. Hormonal changes, including the ones that come with menopause, make skin thinner and drier. Genetics, nutrition, climate, and the environment you live and work in each play a part. Stress, poor sleep, heavy alcohol use, and harsh soaps and hot showers are on the dermatologic surgeons’ list of things that make aging skin look worse, even where they are not the root cause.

None of these is something a treatment fixes. They are the reasons two people of the same age can have skin that looks a decade apart, and they are also the reasons a good consultation asks about your habits and your health history before it asks what you would like to change.

Which change is behind what you see

Most concerns people bring to us trace back to one or two of the changes above. The table below pairs the common ones with what usually sits behind them and with the page on our site that explains the treatments that address the appearance of each. The American Academy of Dermatology lists more than one type of treatment for sun damaged skin, and the categories below follow its list. Every page linked here states what its treatment is approved for, what to expect, and what can go wrong, and none of them is a substitute for a consultation.

What you notice What is usually behind it Where to read more
Lines that show when you frown, squint, or raise your brows Muscle movement folding skin that has less collagen and elastin to recover with Botox in Huntington, NY
Lines and folds that stay when your face is at rest, including the folds from nose to mouth A thinner dermis, plus fat and bone changes beneath the fold Dermal fillers in Huntington, NY
Flat or hollow cheeks, hollows under the eyes, a softer jawline or chin Fat that has shrunk or shifted and bone that has receded Dermal fillers and biostimulators at R.Ve
Rough texture, fine lines across the cheeks, dull or uneven skin A thinner outer layer and years of sun Skin rejuvenation in Huntington, NY and laser and energy treatments at R.Ve
Brown spots on the face, chest, and hands Pigment changes from long term sun exposure Dark spot removal. A spot that is new, changing, or irregular needs a skin exam before anyone treats it cosmetically.
Loose skin on the neck and jowls Elastin loss, shifted fat, and the neck muscles stretching with age Our consultation first policy. This is a concern where the honest answer is sometimes to wait or to expect a modest change.

 

What no treatment can do

No treatment undoes years of sun damage, and much of that damage is permanent. Treatment can even out skin tone, soften wrinkles, and add volume where it has been lost, and it can do those things well. It cannot stop the process this page describes, and it cannot make skin that has aged behave as if it had not.

At R.Ve we say this plainly because it is the basis of a good plan. Sometimes the best advice is to wait, and we will tell you that too. A spot that is changing is a medical question before it is a cosmetic one, and it needs a skin exam first. A line that bothers you in photographs but not in the mirror may not be worth treating. And a change that comes from bone and fat is not improved by a treatment aimed at the skin’s surface, however good that treatment is at what it does. We would rather show you than tell you, and a consultation is where we do that.

How to slow skin aging down

Because most skin aging comes from the sun, protecting your skin is a lifelong habit rather than a treatment, and it is the single most useful thing on this page. The American Academy of Dermatology recommends a sunscreen with an SPF of 30 or higher that is water resistant and says broad spectrum on the package, applied about fifteen minutes before you go outside and reapplied every two hours and right after swimming or sweating. Most adults need about an ounce to cover the skin that clothing does not, and at least a teaspoon for the face. Sun reaches your skin on cloudy days and in winter, so the habit does not stop in October. A wide brimmed hat, sunglasses, and clothing that covers your arms and legs do the rest, and tanning beds and sunlamps are off the list entirely.

Beyond the sun: do not smoke. Keep skin moisturized, use a mild soap and warm rather than hot water, and treat dry, itchy patches early. Eat well and drink enough water, since dehydration makes skin more fragile. Check your skin once a month and see a doctor about any growth that is new, any sore that does not heal, or any mole that is asymmetric, has an irregular border, changes color, is larger than a pencil eraser, or is changing in any way. None of this is glamorous, and all of it does more over twenty years than any single procedure.

What a consultation about aging skin looks like at R.Ve

Every treatment at R.Ve begins with a consultation. It is an unhurried conversation about what you have noticed, what you would like, your anatomy, and your medical history, and it ends with a written plan you take home, with the treatment, the dose, and the price in it. There is no pressure to book, and you can book when you are ready, or not at all. If what you are seeing is a change that treatment does not address well, or a change we think you should wait on, we will say so.

R.Ve Aesthetics is a physician led practice. Osborne Williams, MD, our co-founder and medical director, writes the practice’s protocols and reviews its treatment plans, and treatments are performed by our licensed providers under his direction. A two week review is included with injectable treatments, so the result is something we look at together rather than something you are left to judge alone. You can read how the visit works on our consultation first policy page, and what a med spa is, and is not, in our article on what a med spa is.

Questions people ask about skin aging

At what age does skin start to age?

There is no single age. The changes on this page are gradual, and sun damage starts adding up from the first unprotected exposures in childhood, long before anything shows. Some changes arrive earlier than people expect: the lower outer edge of the eye socket, for example, begins to recede by middle age. What people notice first, and when, depends more on sun history, smoking, and genetics than on the number itself.

Can lost collagen come back?

Skin keeps repairing itself throughout life, more slowly with age. Some treatments are designed to work with that repair response, and others add volume or soften lines directly. What each treatment is approved for, how long its effect lasts, and what it does not do are stated on its own page, and no treatment restores skin to the state it was in before. A consultation is where we match the change you see to the treatment that addresses it.

Can sun damage be undone?

Not in full. Years of sun damage cannot be undone, and much of it is permanent. Treatment can even out skin tone, smooth some wrinkles, and improve the appearance of brown spots, and daily sun protection stops new damage from being added to the old. Without protection, treatment results fade faster and the damage continues.

Why do I look tired even when I am rested?

Usually because of the area around the eyes. Fat from the eyelids settles into the eye sockets, which makes the eyes look sunken; the lower lids slacken and bags can form beneath them; and the bone at the edges of the eye socket recedes with age, which lengthens the area between the lower lid and the cheek. Each of these looks like tiredness, and each has a different answer, so a provider needs to see which is behind yours.

Does darker skin age differently?

Natural pigment gives some protection against sun induced damage, so people with darker skin tend to show fewer sun related changes, and later, than people with fair skin. The changes from collagen loss, fat and bone change, and habits such as smoking happen in every skin tone, and skin cancer can affect anyone of any skin color. Sun protection is for everyone.

Do anti aging creams work?

Be skeptical of products that claim to be anti aging or to reduce wrinkles. Most are cosmetics rather than drugs, so they are not required to be tested in people or approved before they are sold, and over the counter creams only address the mildest changes in the skin’s uppermost layer. A daily sunscreen and a moisturizer are worth using. Anything stronger is a conversation with a clinician, not a purchase.

Keep reading

Sources

Book a consultation when you are ready

Ready when you are. Start with a consultation: it begins with a conversation about what you have noticed and ends with a written plan and honest answers, including the answer that nothing needs doing yet. Book a consultation online, or contact the practice with a question first.

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