Does our skin age because of what is going on inside our bodies, or what is going on outside? What can we do to slow this ageing?

Skin changes are some of the most visible signs of our ageing. They include wrinkling and sagging, as well as the development of "liver spots".


In this article, we look at how our skin changes as we get older, what some of the major factors are that affect those changes, and what we can do to slow down the skin-ageing process.

  • Seven factors responsible for skin-ageing
  • What is going on inside our bodies that causes our skin to age?
  • Ways of slowing our natural skin ageing
  • What is going on outside our bodies that causes our skin to age?
  • Ways of slowing down skin ageing caused by external factors
  • Conclusions.

Seven factors responsible for skin-ageing

A systematic review and meta-analysis published online in November 2021 identified seven notable risk factors for various skin-ageing phenotypes:


What is going on inside our bodies that causes our skin to age?

Natural skin degeneration

As we grow older the major components of skin (elastin and collagen) naturally degenerate.

  • Elastin allows our skin to resume its shape after stretching or contracting.
  • Collagen normally gives our skin its fullness or plumpness.

The degeneration of these skin components results in wrinkling, loss of elasticity, laxity (the skin loosens and starts to sag), and a rough-textured appearance.

Loss of muscle mass

As we age, we also lose muscle mass, a condition called sarcopenia. This can also affect the appearance of our skin. A typical warning sign is the sagging of the skin over normal areas of muscle such as the legs and arms.

Menopause and oestrogen

The menopause and a reduction in oestrogen production can have a further significant effect on skin wrinkling and ageing, as a 2022 article explains.


According to a 2014 review, stress is another factor that seems to be associated with skin ageing.

The exact mechanism of how stress affects skin ageing is still unclear. However, recent research has provided evidence that UV irradiation is one of the major ‘stressors’ responsible for premature skin ageing.

Ways of slowing our natural skin ageing  

Apart from cosmetic surgery (with all its pros and cons!) two things we can do are:

These two things help combat muscle loss (sarcopenia) as we age.


Muscle loss is one of the major factors that affects natural skin ageing.



What is going on outside our bodies that causes our skin to age?

Why external factors matter  

Skin ageing due to the natural process of ageing tends to be more subtle, generally producing finer wrinkles. Ageing caused by external factors (extrinsic ageing) produces coarser wrinkles and can give the appearance of premature ageing. This process varies between individuals and depends on initial skin pigmentation, with darker skins being more resistant to this kind of ageing.

Sunlight (UV light)

A 2012 study described the sun’s effect on our skin as ‘photoageing.’ While a 2013 study of 298 Caucasian women concluded, ‘UV exposure seems to be responsible for 80% of visible facial ageing signs.’ However, skin which is protected by naturally high levels of pigmentation (melanin) in ethnic groups with dark skin is less susceptible to these effects.


The profoundly damaging effects of smoking on skin wrinkling has been confirmed in many studies. It affects you if you smoke, and even if you spend time with a smoker. A study of 79 pairs of twins, published in 2013, found that smoking particularly affected the middle and lower thirds of the face.

Air pollution

This is also associated with the signs of external skin ageing, with pollutants contributing to skin ageing in a number of different ways.

Interestingly, alcohol doesn’t seem to influence skin ageing and may even have a mild protective effect. That was the conclusion from a small-scale study published in 2009, which compared 65 pairs of twins.


Ways of slowing down skin ageing caused by external factors

This table lists some creams you can apply to your skin, and some habits you can change, that can help slow down skin ageing.

Sun-blocks and sun creams

An Australian study involving 903 adults aged under 55 showed that everyday application of sunscreen slowed the development of wrinkles and a sagging skin. This was supported by a review of the available evidence published in 2021.

However, this may be more relevant for summer than winter in countries like the UK, where modest daily exposure to the sun helps us to top up our Vitamin D levels.

Sun screen can also prevent the two main types of skin cancer, melanoma and squamous cell carcinoma.

Stop Smoking

Tobacco smoke speeds up skin ageing. The skin of heavy smokers at the age of 40 can resemble the skin of non-smoking 70 year olds!


Some studies suggest certain foods can slow skin ageing, for instance:

Skin-hydrating creams

So called ‘trans epidermal water loss’ (TEWL) from the skin accelerates as we age. This has a marked effect on skin appearance. So the daily use of hydrating or ‘aqueous’ creams may be useful here.

Vitamin-based skin creams

Vitamin A derivatives (retinoic acid and the retinols) have been extensively investigated and some positive improvements documented. Retinol exerts its anti-ageing benefits by increasing collagen production and by increasing elastin production.

However, a review of the evidence published in 2022 questioned the effectiveness of the more commonly used retinoids in cosmeceuticals, due to the poor quality of the evidence available. Two other retinoids contained in medicines (tazarotene and adapalene) were found to be more effective.

Two powerful antioxidants, Vitamin C alone or with Vitamin E, have been shown to be of some value when applied in face creams.

Creams containing N-acetyl glucosamine

In a small-scale trial published in 2016, creams containing N-acetyl glucosamine (NAG) were reported to significantly improve firming and smoothing on the neck and décolletage of older trial subjects.



  • Avoid smoking, avoid prolonged exposure to strong sunlight – unless you use a sunscreen – and minimise the time you spend on air-polluted city streets. This should minimise the effect of harmful external factors.
  • Ensure your diet is high in Vitamin C by eating plenty of fruit. Also, try to ensure that you consume foods rich in Vitamin E such as sunflower seeds, almonds, pine nuts, peanuts, olives and spinach. Eat plenty of cruciferous vegetables such as cabbage and sprouts.
  • Use hydrating skin creams to minimise skin water loss and to provide a barrier against chemical pollutants. Vitamin-based creams are also helpful.
  • To minimise muscle loss, take plenty of exercise, particularly resistance exercises, and make sure you eat enough protein.
  • Try to address any problems that are leading to stress or poor sleep quality.

Reviewed and updated by Karen Rollins, January 2023. Next review, December 2026.