By American Academy of Dermatology
People experience many changes as they age, and that includes changes in their skin. The body’s largest organ evolves over time, so it’s important for one’s skin care routine to evolve with it.
Although dermatologists’ skin care recommendations for each patient will depend on that patient’s age, there are a few core steps dermatologists advise virtually every woman to take:
1. Select products tailored to your skin type. For example, special formulations for sensitive skin, moisturizing products for dry skin, and oil-free or noncomedogenic options for oily skin.
2. Protect your skin from exposure to ultraviolet radiation from the sun and indoor tanning beds, which can lead to skin cancer and early skin aging. The American Academy of Dermatology recommends that you shield yourself from the sun’s harmful UV rays by seeking shade, wearing protective clothing and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.
3. Use a retinoid, unless it dries out or irritates your skin. Retinoids increase cell turnover to exfoliate clogged pores and reduce the appearance of fine lines, which means they can effectively treat both acne and wrinkles.
While these steps form the foundation of most skin care regimens, each individual’s skin care routine should be based on her age and her skin’s specific needs. To kick off National Healthy Skin Month, three board-certified dermatologists discuss the top skin care concerns of women in their 20s, 30s and 40s, and provide skin care tips for each age group.
Women in Their 20s: Getting a Head Start on Healthy Skin
Daily skin care
“It’s never too early to start taking care of your skin,” says board-certified dermatologist Nada Elbuluk, MD, MSc, FAAD, an assistant professor of dermatology in the Ronald O. Perelman Department of Dermatology at the NYU School of Medicine in New York. “Many of my patients in their 20s are asking me what they can do now to maintain healthy skin throughout their lives, and some women are starting to seek cosmetic treatments at an earlier age.”
According to Dr. Elbuluk, women in this age group are looking for a simple skin care regimen that they can easily incorporate into their daily lives. “If a routine is too complicated or time-consuming, they won’t stick with it,” she says.
Dr. Elbuluk recommends that women in their 20s wash their face twice a day with a gentle cleanser and use a moisturizer with SPF 30 every morning. She also suggests using an anti-aging treatment, such as a topical retinoid or a product containing antioxidants, as long as it doesn’t cause any irritation.
Dr. Elbuluk advises women in their 20s to be vigilant about sun protection every day, all year-round, no matter the weather. “Sun damage is cumulative, so UV exposure in your 20s could lead to wrinkles and skin cancer in your 40s and 50s,” Dr. Elbuluk says. “Women in this age group may have seen this firsthand if their parents have developed skin cancer.”
Dr. Elbuluk also warns women in this age group not to get complacent about sun protection just because they’re applying an SPF product in the morning. “If you’re using a moisturizer or foundation with SPF, make sure it’s at least SPF 30, and remember that SPF is not additive, so using two products that each have SPF 15 is not the same as using an SPF 30 product,” she says. “And don’t forget, applying sun protection in the morning won’t cover you for the whole day. During the work week, remember to reapply if you’re going outside for lunch and before your commute home; if you’re spending the day outside, you should reapply every two hours.”
“There’s no rule that says acne stops after your teens, so many women are still dealing with acne in their 20s,” Dr. Elbuluk says. “In addition to the type of acne they had when they were younger, women in this age group also may experience hormonal acne on their chin and jawline.” She says women in their 20s may be embarrassed by their acne, thinking it’s something they should have outgrown, and the skin condition may affect their self-esteem.
Fortunately for patients, there are many treatment options for adult acne, Dr. Elbuluk says, and a dermatologist can determine the best treatment plan for each patient based on the type and severity of their condition. Mild cases can typically be controlled with topical medications, she says, while moderate cases may warrant a combination of topical and oral medications. For patients with severe acne that is resistant to other treatments, oral isotretinoin may be the best option.
In addition to a prescription regimen, in-office procedures also may be helpful in treating adult acne, Dr. Elbuluk says. Chemical peels can supplement and accelerate the results of other treatments, she says, and laser procedures also may be an option for patients who don’t respond to traditional therapies.
Women in Their 30s: At the Crossroads of Prevention and Treatment
When women in their 30s come into her Augusta, Ga., private practice to seek treatment for dark spots, board-certified dermatologist Lauren Eckert Ploch, MD, MEd, FAAD, always provides them with tips for prevention. “If you have dark spots at this point in your life, you’re at risk for getting more as you grow older,” she says.
Because UV exposure causes dark spots, Dr. Ploch reminds her patients in their 30s about the importance of sun protection. When applying their SPF 30 sunscreen each morning, she says, it’s vital for women in this age group to make sure they cover their neck and chest in addition to their face, especially if they commute. “Because UVA rays can travel through window glass, you need to make sure you’re protected if you’re spending a lot of time in the car or on a train,” she says.
Women who received unprotected UV exposure when they were younger may start to see dark spots on their temples and cheeks when they reach their 30s, Dr. Ploch says, and these spots may be mistaken for melasma, a condition that causes brown patches to appear on the face. While lightening agents like hydroquinone are a good option for melasma, she says, they usually aren’t effective in treating dark spots.
Instead, Dr. Ploch recommends that patients with dark spots follow a multipronged treatment plan. In addition to sun protection, she says, topical vitamin C and retinoids may be used for both treatment and prevention. Laser surgery and cryosurgery are also options for reducing the appearance of dark spots, she says, but these procedures should only be performed by a dermatologist or another experienced medical professional.
Dr. Ploch estimates that about half of her patients in their 30s are dealing with both wrinkles and acne. As a result, she says, many patients in this age group may not be able tolerate wrinkle treatments designed for more mature skin because these heavier formulas can aggravate acne or cause milia, small cysts that occur when dead skin cells become trapped at the surface of the skin.
Dr. Ploch recommends women in their 30s use a retinoid to address both wrinkles and acne. “Retinoids are my go-to wrinkle treatment for women in this age group,” she says. “In addition to improving your skin’s current appearance, they also help build collagen, which can lead to more voluminous skin in your 40s and 50s.”
Dr. Ploch also suggests that women in their 30s use a light antioxidant serum to protect their skin from the elements and improve signs of early skin aging, and she says those who are concerned about wrinkles also may want to consider botulinum toxin and hyaluronic acid fillers. A low dose of botulinum toxin can minimize muscle movements that lead to future wrinkles, she says, and hyaluronic acid fillers can restore volume loss, reducing the appearance of lines around the mouth.
While spider veins are one of the most common problems for women in their 30s, Dr. Ploch says, they’re also one of the least-addressed problems in this age group. Many women believe that treatment would be too invasive or expensive, she says, so they leave the condition unaddressed, allowing it to get worse as they get older.
According to Dr. Ploch, however, laser surgery and sclerotherapy are two accessible and noninvasive treatment options that women in their 30s may want to consider if they have spider veins. She also suggests that women in this age group take preventive measures against the emergence and progression of this condition.
Pregnancy and frequent standing are two risk factors for spider veins, Dr. Ploch says, and the condition takes several years to develop, which is why it often appears in women when they reach their 30s. To help relieve the pressure that causes spider veins, she recommends that women wear compression socks, elevate their legs when possible and exercise, especially if they work in a field that requires prolonged standing, like health care or education.
Women in Their 40s: Improvement Through Noninvasive Interventions
As people age, their skin begins to lose collagen and elastin, making it thinner and looser, without the resilient, springy quality of youthful skin, says board-certified dermatologist Anne M. Chapas, MD, FAAD, a clinical instructor of dermatology at Mount Sinai Medical Center in New York. Skin laxity is most prevalent on the face and neck, she says, but it can occur anywhere on the body, including the arms, abdomen and thighs.
Everyone will experience some amount of skin laxity as they get older, Dr. Chapas says, but the degree of laxity depends on many factors, including sun damage, exposure to pollution, diet, weight fluctuations and lifestyle factors such as smoking. “Women likely will start to notice skin laxity in their 40s, but they may not want to undergo an invasive procedure to correct it,” she says. “Fortunately, there are noninvasive options ideally suited for women in this situation.”
According to Dr. Chapas, energy-based treatments such as microfocused ultrasound and radiofrequency microneedling can help improve skin laxity by promoting the production of collagen and elastin to create firmer skin. “Imagine wrapping your loose skin in shrink wrap to pull everything tighter — that’s the kind of effect these energy devices can have,” she says.
Dr. Chapas says filler injections also can improve skin laxity by replacing lost collagen and elastin. “If you picture your skin as a tablecloth, then you can think of fillers as a sturdier table for it to rest on,” she says.
In addition to losing collagen and elastin as they age, Dr. Chapas says, women also lose fat in areas like the face and hands, resulting in a loss of skin volume. As a result, she says, women in their 40s may experience sagging skin, as well as prominent bones and veins.
According to Dr. Chapas, noninvasive treatments with dermal fillers and energy devices can help restore lost volume in addition to improving skin laxity. These treatments also may be combined to provide the best possible results, she says.
In addition to seeking treatment for lost collagen, Dr. Chapas also recommends that women in their 40s take steps to preserve the collagen they still have. “It’s important to continue protecting your skin from the sun and the elements as you age,” she says, “and you also should consider incorporating topical growth factors and peptides into your skin care routine.”
Women in their 40s may have unwanted body bulges as the result of a slowing metabolism, pregnancy or other lifestyle changes, Dr. Chapas says. Even if women exercise regularly and are otherwise fit, she says, it may be difficult for them to eliminate fat in areas where the body is designed to store it, including the torso and the legs.
According to Dr. Chapas, women in their 40s who have isolated pockets of fat are ideal candidates for noninvasive body sculpting procedures like focused ultrasound, thermal energy treatment and cryolipolysis, all of which create areas of damaged fat that the body gradually removes. While these treatments can be performed anywhere on the body, the waistline and thighs are the most commonly treated areas, Dr. Chapas says, while the neck and bra spillover area are currently gaining popularity.
Dr. Chapas says interest in these body sculpting treatments has surged in recent years because the procedures are noninvasive, quick and effective, with little downtime for patients. Although liposuction remains the gold standard for fat removal, she says, other body sculpting procedures can provide subtle results for women who want to address problem areas without undergoing an invasive procedure.
No matter your age or skin concern, a board-certified dermatologist can answer your questions about skin health and help you develop a skin care plan that’s right for you.
Dermatologists Share Their Skin Care Secrets
Dr. Nada Elbuluk
“I wash my face twice a day with a mild cleanser and use a morning moisturizer with SPF 30 or higher. If I’m having an acne breakout, I use an acne spot treatment, typically with benzoyl peroxide and clindamycin. I also avoid the urge to pick or squeeze at any acne, as I know this will cause more inflammation and subsequent scarring. In the evening after cleansing, I use an eye cream and facial cream with retinol and antioxidants. During the day, if I know I will be outside for extended periods, I carry sunscreen in my bag so I can reapply. I also keep an eye out for any new growths or changes I see on my skin. Following these guidelines has helped my skin stay healthy, acne free, skin cancer free, youthful and radiant.”
Dr. Lauren Ploch
“Each morning, I apply an antioxidant serum that contains vitamin C. I follow this with a zinc oxide-containing sunscreen. I apply a retinoid product three to four nights per week, which is as often as I can tolerate it without irritation. I attribute my even, acne-free complexion to my retinoid — it’s the one skin care product I could not go without.
“I have treated my dark spots with various lasers and found them to be very effective as long as I protect myself from the sun after treatment. For wrinkles, botulinum toxin has ensured that I don’t have any! I started getting the occasional botulinum toxin injection in my mid 20s but began regularly injecting myself every four to six months in my early 30s. I prefer injecting smaller doses over the span of a few weeks to ensure that I always retain some natural expression. I also had a hyaluronic acid filler treatment last year and plan to follow up with additional treatments as necessary to restore volume lost over the past decade.
“Because I work long hours on my feet, compression socks are a must. I also wear them when traveling long distances, as sitting on a plane can lead to swelling and increased pressure in the legs. I prefer laser therapy to sclerotherapy for my small spider veins, and I elevate my legs at rest whenever possible to prevent their recurrence.”
Dr. Anne Chapas
“I’ve had noninvasive radiofrequency tightening treatments and dermal fillers regularly over the last few years. I also really like laser resurfacing, which removes damaged skin cells and replaces them with new ones. I think that smaller, regular, preventive in-office treatments, in addition to sun protection and topical retinoid use, have helped to maintain my youthful, healthier looking skin.
“Patients always comment on how ‘natural’ I look after I explain the treatments that I’ve personally received. I think it serves as an example that aesthetic treatments should look natural and healthy, not like you’ve had a lot of ‘work done.’ As dermatologists, we are experts in what healthy skin should look like and are the best-trained physicians to help patients to achieve this goal.”