Wrinkles, Lines, and Sagging Skin: Here’s What You Can and Can’t Control

17 Feb 2015 at 5:00pm


Written by Knoxville plastic surgeon and Change 500 contributor Dr. David Reath

Coco ChanelThere’s a lot of focus on appearance as Hollywood awards season hits its peak, especially for those who are walking the red carpet. It’s particularly during this time — a time of increased media scrutiny — that beautiful actresses of a certain age trot out the old adage: “You get the face you deserve.”

It was actually famous fashion designer Coco Chanel who first uttered this sentiment: “Nature gives you the face you have at 20. Life shapes the face you have at 30. But at 50 you get the face you deserve.” The idea here is that you’ve lived your life in a way that’s affected your appearance. You made your choices, both good and bad, so you deserve the consequences, right? Well, perhaps.

Let’s look at this question a little more closely. Do we really get the face we deserve? The answer is no… and yes.

What You (And Your Face) Don’t “Deserve”

One of the biggest factors in how we look as we grow older is our genetic inheritance. I can’t tell you how many people come to me saying there’s something about their face they want to change and they see it in their relatives as they age. This is genetic inheritance, and I don’t know anyone who got to pick their parents, genetically speaking.

Our genes give us much of our appearance: the shape of the bones of the face, facial asymmetries, skin type — both color and thickness — hair color, hair growth pattern, the list goes on. These are the things we come into the world with, and they’ll always be the basis of our appearance. In the game that we call aging, this is the hand we’re dealt.

But it’s more complex than anatomy. How the muscles move our face will determine where wrinkle lines occur. If you have strong muscles between your eyebrows, and frequently use these muscles during facial expressions, you’ll be more prone to getting lines in this area. If you have strong muscles surrounding your mouth, they’ll tend to pull your lips down at the corners, creating somewhat of a permanent frown.

This is in no way a reflection on how happily or healthily you’ve lived your life. These lines are not there because you “deserve” them, but because of the facial anatomy you inherited from your parents. In other words, your parents should be paying for your Botox. (You can tell them it’s the doctor’s orders!)

Of course, we also can’t forget about gravity. It’s one of the principle drivers of the aging process and none of us deserves gravity. Then again, it would be difficult to imagine life without it. And then there was the movie with Sandra Bullock and George Clooney, but I digress...

Yet There Are Things In Your Control

What Coco Chanel was getting at is that we're responsible for how we care for our appearance — how we play the hand so to speak. What we “deserve” are the effects of the factors we can control.

Sun ExposureLet’s start with the sun. Ultraviolet radiation is one of the main culprits that ages our skin. Exposure to the sun without using sunscreen will give your skin a nice tan… and then turn it into leather. If you’re living in a city at a higher altitude (think Denver, Santa Fe, and Salt Lake City), the atmosphere is thinner and you get even more sun exposure than you would at sea level. The sun also causes us to squint, which can create crow’s feet at the edges of the eyes. The good news here is that we can actively protect our skin from the sun. Wearing sunscreen, sunglasses, and protective hats will pay off big in the long run.

Next up is smoking. I’m sorry to be harsh here, but if you’re a heavy smoker, you do get what you deserve in terms of how your skin ages. The nicotine in cigarettes impairs blood flow to your skin so it doesn’t get as much oxygen and other important nutrients like vitamin A. Tobacco smoke also damages collagen, which is what gives your skin strength and elasticity. As a result, your skin starts to wrinkle and sag. My nurses and I are usually able to tell who the smokers are just by looking at their faces. No lie, cigarettes are major bad juju.

Dramatic changes in your weight also have an effect on your face. If someone loses a significant amount of weight, they’ll lose facial fat as well — and when it comes to a youthful appearance, facial fat is king. Losing this fat makes the face look deflated, saggy, or sunken in. We all lose facial fat as we age (definitely not something we deserve), but this is exacerbated by major weight swings.

The Bottom Line…

I think the Chanel take-home here is that if you take care of your skin by using medical-grade products, you skin will look better. And I have to agree. Antioxidants, exfoliating ingredients, and sun protection can have a huge effect over the course of time, as will in-office procedures like Hydrafacials and chemical peels. If you take care of your face this way, perhaps you do deserve your age-defying looks.

Facial appearance and beauty are complex matters, so many things can affect them. Some of these we can control, some we can’t. What we’re born with may ultimately be the most important thing, as long as we take care of it. So, thanks, Mom and Dad.


Dr. ReathAbout Dr. David Reath
Dr. David Reath is a Board-certified plastic surgeon in Knoxville, Tennessee. Because of his passion for educating the public about plastic surgery, he served as Chairman of the Public Education Committee of the American Society of Plastic Surgeons for several years. In addition to being an active blogger and frequent speaker, he is the author of two award-winning eBooks about plastic surgery, A Girlfriend’s Guide to Breast Augmentation and The Plastic Surgery Planner. Both are free downloads.

Read more from Dr. Reath on his blog




Photo credits: Marion Pike, available in the public domain via Wikimedia Commons; Some rights reserved by Maggie Brauer