Here’s something I find myself telling patients almost daily: Your skin is not just a wrapping. It’s a window. A window into how well you’ve been sleeping, whether you’ve been drinking enough water, how much stress you’re carrying, and yes—how your body is aging on the inside. Of all the organs we have, the skin is the most accessible, the most visible, and often the most honest.
By 2050, one in five people globally will be over 65. That’s not a distant statistic—it’s your titas, your parents, maybe even you reading this over your morning coffee. And with this shift comes a growing field we call geriatric dermatology, which sounds clinical but really just means: how do we care for aging skin with the nuance it deserves?
Intrinsic vs. extrinsic: The two faces of skin aging
When we talk about skin aging, we’re really talking about two separate processes happening simultaneously. The first is intrinsic aging—the biological clock ticking inside every cell. This happens to everyone, regardless of lifestyle. It’s genetic, inevitable, and honestly? Beautifully human. The second is extrinsic aging—and this is where your choices come in. Sun exposure, pollution, smoking, late nights, and that third glass of wine at Friday dinner? They all leave fingerprints on your skin. UV light alone accounts for so much of what we call “photo aging.” Think the leathery texture, the deep creases, and the uneven pigmentation we associate with getting older. The fascinating thing is that while we can’t stop intrinsic aging, we have tremendous control over the extrinsic factors. This is why two people of the same age can look decades apart.
What’s changing under the surface
Let me paint you a picture of what happens as skin matures. In the epidermis—that outermost layer—cells become larger but less efficient. Melanin production becomes erratic, which is why you might notice dark spots appearing seemingly out of nowhere. The skin barrier weakens, leading to that persistent dryness, even any moisturizer is not enough. Go deeper into the dermis, and collagen is declining steadily—about one percent per year after your 20s. Elastin fibers fragment. Sweat glands become less active, which affects your skin’s ability to regulate temperature. Wound healing slows. That small cut that used to disappear in days? Now it lingers for weeks. And in the hypodermis, the fatty layer that gives youthful faces their plumpness? It thins out, contributing to that hollowed look under the eyes or the loss of volume in the cheeks.
Here’s what you need to remember
Age is a crude measure of life expectancy—and an even cruder measure of skin health. I’ve seen 60-year-olds with resilient, glowing skin and 35-year-olds whose skin tells a story of neglect. The central question isn’t how do we stop aging—because we can’t, and frankly, we shouldn’t want to erase the evidence of a life fully lived. The better question is: how do we age with intention? How do we support our skin so it remains healthy, functional, and yes, beautiful in ways that honor where we are in life? It starts with the basics that everyone knows, but few consistently practice: Daily sun protection (non-negotiable), adequate hydration, quality sleep, and managing stress. Beyond that, there are now remarkable treatments—from regenerative therapies to targeted actives—that can support cellular function and slow extrinsic damage.
The Fountain of Youth was never a place
The ancient Greeks searched for it. The Fountain of Youth has captured human imagination for millennia. But, here’s what modern science is teaching us: The fountain was never a destination. It’s a practice. It’s in how you care for yourself daily, the boundaries you set, the small rituals that compound over years. Your skin will age. Mine will too. Though there’s something powerful in understanding how it ages—because knowledge transforms anxiety into agency. And that, I think, is the real secret to aging well.
