I look older than I really am. I'm wondering what is causing the problem, and how it can be remedied. (Photo)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Thank you for your question about skin rejuvenation.You may want to look into the Forever Young BBL.  The research behind it is sound.To be sure, see two or more licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have these treatments.I hope this helps.

There are many different things that can contribute to
looking older than your years, including lifestyle habits (smoking, not getting
enough sleep) and environmental factors (sun exposure). To preserve a youthful
look for as long as possible, it’s important to protect the health of your skin
with a high-quality skincare regimen that includes a daily SPF sunscreen. You
may also consider looking into nonsurgical med spa treatments like chemical
peels or laser skin resurfacing to help keep signs of aging at bay for longer
and reverse existing damage, while dermal fillers or BOTOX® can reduce the
appearance of wrinkles that have already developed.

Be sure you are using a medical grade sunscreen.  I would suggest a skin care routine at home that includes a medical grade Vitamin C product and Retin A.  Start with a low dose and work up to a higher dosage.  Try using it every night.  You may be a candidate for a medium to deep grade chemical peel.  I hope this helps.

Genetics play a role but environmental factors are also a huge contributor.  Smoking and sun exposure are the biggest culprits in making people appear older than their stated age.  Appropriate skin care is a great start -- make sure that what ever regimen you start incorporates tretinoin and daily sunblock.  Additionally, minimally invasive non-surgical procedures such as Botox, Xeomin, Dysport, or fillers can help to smooth things out and open your eyes a bit more when in repose.  Be sure you seek out the consultation of a facial plastic surgeon, plastic surgeon, or dermatologist to discuss this.  I wish you well, and thanks for your service!

You are right that our genetics play a large role in how we age. I highly advise starting a daily SPF! It is the most preventive anti-aging thing you can do for yourself. Men tend to really like the light weight, non greasy feel of Revision Skincare's Multi-Protection SPF50. Apply all over the face each morning. It also has peptides and anti-aging properties to work against the aging process as we go about our day. Also, doing a vitamin-A product at night like Retin-A will help your cells turn over quicker causing a smoother, brighter and tighter appearance.Which leads to a more youthful look! A Vitamin-A product like NeoCutis Nouvelle is creamy and tends not to drying like Retin-A if you're a first time vitamin-A user.Thanks!

90% of prematue aging is caused by sun damage so I hope that you are wearing a great mineral/ physical sunscreen daily and reapplying often. That said, genes, diet, sleep, stress and supplements (or lack thereof) can make a major impact on your skin and general appearance. You will likely benefit from a vampire facial with PRFM, an advanced form of PRP (platelet-rich plasma) with microneedling with an FDA approved device. It uses your own growth factor to stimulate your own stem cells for a younger you! The microneedling stimulates collagen production as well.
Too many medspas are doing this incorrectly and with substandard equipment so please do your research. A great medical grade HydraFacial will also help brighten your skin and address your unique needs. And high quality medical grade skincare will transform your skin. I am passionate about antiaging at my Boca Raton practice Bawa Medical, and so I hope that my answer helped!

I agree that is most important that you control environmental factors to help your skin looking younger.  Avoiding tobacco, too much sun exposure, is very important.  A good topical skin care program in combination with microdermabrasion can also be helpful.  For more information please read the following link: