Aging Skin

by Christiane Northrup, M.D.


One of the more distressing aspects of midlife for many women is watching our skin change, beginning with wrinkles. Wrinkles are formed when collagen fibers and elastin in the deeper layers of the skin start to break down. Because collagen and elastin keep the skin supple and resilient, allowing it to stretch and contract, when collagen gets broken down, skin tends to sag and wrinkle. (Wrinkles may also depend on your lineage, as the tendency to wrinkle is inherited.)

While wrinkles and most other skin changes associated with aging are natural and harmless, they are, nonetheless, cosmetically unattractive to most of us. Fortunately, you can do a great deal to preserve the health of your midlife skin and even heal some of the damage that has been done. Understanding the anatomy of the skin is the first step in understanding what you can do to keep it looking its best.

The skin has three layers: the epidermis, the dermis, and the innermost fat layer. The epidermis is where new skin cells are produced. This layer also contains the cells known as melanocytes that produce melanin—the pigment that determines the color of the skin. The dermis lies underneath the epidermis and makes up about 90 percent of the thickness of the skin. This is the area that contains the nerves which sense pressure, temperature, and pain, and also sweat glands, hair follicles, sebaceous glands which produce oil, and also blood vessels. The sweat and sebaceous glands secrete a thin layer of perspiration and oil that forms a protective acid mantle on the skin. The dermis also contains the skin’s collagen layer, a dense meshwork of fibers that give the skin elasticity and strength. Beneath the dermis and epidermis lies the fat layer, which serves to insulate and protect our inner organs and acts as a sort of cushion that helps keep our skin plump.

Together these three layers form what constitutes the boundary between ourselves as individuals and the remainder of our world. We can therefore see how important it is to care for this very special “barrier” organ—with not just topical efforts and applications, but from the inside out, by eating healthy foods and drinking clean water, getting adequate exercise and rest, and by cultivating the light of our inner spirit.

Listen to Your Body

Some women notice that their skin gets drier, begins to sag and appear crepey. Some women notice more wrinkles and spots. Growths may also appear. And in addition, following an injury our skin may heal more slowly than it did in our youth.

What Causes This

A number of factors contribute to skin aging, including poor diet, ingestion of toxins, and declining “anti-aging” hormones. But scientists now think that free-radical damage may be one of the primary causes of aging, including premature wrinkling of the skin and age-related diseases such as heart disease, Alzheimer’s disease, and arthritis. In short, free radicals are oxygen molecules that have lost an electron through interaction with other molecules. The resulting oxygen molecules are very unstable and reactive. In order to restore their missing electron, they steal them from other “healthy” molecules, thus creating more free radicals and in the process, damaging cells. The result in the body is like rust on steel.

The collagen layer of our skin is especially susceptible to free radical damage that arises from sun and pollution exposure, resulting in a process known as cross-linking. Cross-linking of the naturally supple collagen molecules makes them become stiff and inflexible, eventually resulting in skin that looks and feels “old and leathery.” Free radicals that are produced when the sun hits the skin activate molecules known as transcription factors, which signal cellular DNA to produce proteins that are pro-inflammatory and harmful to the cell. This same process also produces collagen-digesting enzymes that can leave tiny defects in the skin which give rise over time to wrinkles.

The American Academy of Dermatology now attributes 90–95 percent of skin aging to sun exposure—specifically damage done by ultraviolet rays to the collagen fibers in the dermis. If you do not believe this, just examine the skin on your buttocks and lower back. You will notice something very important: It is very smooth and wrinkle-free! The reason for this is because this skin is generally protected from ultraviolet rays from the sun for most of your life.

Skin that is chronically overexposed to the sun is in a constant state of inflammation. While this mild inflammation of a suntan plumps up the skin temporarily and gives it a youthful appearance, once the tan goes away, wrinkles appear. And any tissue inflammation begins the metabolic cascade that eventually causes degenerative changes.

Cigarette smoking also produces free radicals and is another of the skin’s worst enemies. The ill effects of smoking become very obvious at mid-life. Past studies have shown that the skin of smokers ages twice as fast after the age of 30 as the skin of non-smokers.

Women who smoke often have a paler skin tone, darker circles under their eyes, more crepeyness and premature wrinkling, especially around their eyes and mouth, than non-smokers. Some of this is due to the decrease in circulation to the skin caused by nicotine. When circulation decreases, fewer nutrients can get to the skin and the skin is less able to release toxins produced by cell metabolism. This results in slow skin growth and rejuvenation. Smoking also dehydrates the skin and depletes it of vitamins A, E, C and B–complex, and the minerals calcium, potassium and zinc. In addition, smoking directly poisons the ovaries. This leads to decreased levels of estrogen, which is necessary to help maintain elastin and collagen fibers.

Healing Alternatives

Some scientists now believe that topical treatment with vitamin A creams, such as Retin-A and Renova, can have some effect on the rebuilding of collagen. However, these products can be very irritating to some skin types and can result in excessive flakiness on the cheeks and jaw line. Women who use Retin-A or Renova on the fine lines around the eyes have reported some improvement. However, many note that the improvement generally disappears when they stop using the cream. It could be that the slight irritation of the Retin–A or Renova causes the lines to appear less visible. When the inflammation subsides after discontinuing the product, they are left with little improvement over where they started. It is always best to avoid skin irritation whenever possible.

Spiritual and Holistic Options

In addition to such things as getting enough sleep, drinking lots of water, reducing stress, and avoiding alcohol, cigarettes, and other drugs, there are several specific steps you can take to minimize the effects of aging on your skin. Here are some suggestions:

  1. Follow an insulin-balancing diet and supplement program. Eat a low glycemic index, insulin-lowering diet rich in vegetables, fruits, lean meats, and omega–3 fats such as those found in salmon and swordfish. Eliminate high glycemic index foods that increase insulin levels, such as foods made from or including white flour and white sugar. Soy has been shown in recent studies to be very helpful for skin, hair, and nails. Take antioxidant vitamins (especially vitamins C and E) and essential omega–3 fats, either as flaxseed, fish oil, or DHA. Increased intake of omega–3 fats, even with no other changes made in diet, has been shown to help all kinds of skin problems.
  2. Protect your skin from the sun by wearing sunscreen daily. Use sunscreen with an SPF #15 or higher on your face, neck, and hands every morning, except during the regular, brief, early morning or late afternoon “sun baths” that I advocate for optimal vitamin D levels. Golnick1
  3. Moisturize. If your sunscreen, AHA, or antioxidant formula is not in a moisturizing base, then finish off your daily skin care regimen with a light moisturizer for day and a richer formula for the evening. This helps keep much needed moisture in your skin cells and will keep them plumped up during the day and night.
  4. Use skin care products that contain alpha– or beta–hydroxy acid or glycolic acid. The hydroxy acids help dissolve the “glue” that holds dead skin cells together, thus resulting in easier removal, so new plumper cells can rise to the surface. They also increase the hydration of the skin and they encourage the repair of elastin and collagen in the skin and may even help thicken it a bit.

    AHAs are naturally-occurring acids derived from substances such as milk (lactic acid), sugar cane (glycolic acid) and apples (malic acid). Commercial products usually contain 5–10% fruit acids, concentrations that are low enough and safe enough for all skin types and tones. It’s always best, however, to test any new skin care product first, either on the inner part of your elbow or just under your jawline, to make sure you’re not sensitive to it. Glycolic acid has a structure and function similar to that of vitamin C and, like the other fruit acids, has been shown to help reduce fine lines and wrinkles, fade age spots, and moisturize the skin with regular use. Gycolicacid2

    Products ranging from 5 to 12% concentration are widely available and have been shown to help the exfoliation and skin rejuvenation process in all skin types. They help normalize your skin whether it’s dry or oily. If it’s oily, they remove the top dead layer of cells, thus allowing oil to flow out of the follicle more easily, so that it can be removed without stripping away essential moisture. If your skin is dry, fruit acids remove the dry dead layer and stimulate cell renewal. If your skin is sensitive, start with a 5% product, test it on an inconspicuous patch of facial skin (under your jaw) first. Then gradually work upward to 10–12%, if tolerated. You may experience a slight stinging with some products until you get used to them.

    Many fruit acid-containing lotions and creams are also available for the legs, arms, etc. It usually takes about two weeks before you’ll notice a difference in your skin with regular use of an AHA. Start with an AHA at night only, and then after a week or more, apply it twice per day for maximum effect. In addition to the exfoliant properties of alpha, beta hydroxy and glycolic acids mentioned above, they also have antioxidant properties, and therefore work well in combination with other antioxidants.

  5. Use topical antioxidants. Research has shown that applying antioxidant vitamins and herbs to the skin can help repair or prevent free radical skin damage. Look for a product that contains at least two of the following:

    – Vitamin C in a fat-soluble form
    – Green tea extract
    – DMAE
    – Vitamin E
    – Vitamin A
    – Coenzyme Q-10
    – Boron nitrite
    – Tocotrienols
    – Pentapeptides
    – Essential plant oils (e.g., Calendula, lotus, ginseng, orange peel)
    – Oligomeric proanthocyanidins (OPCs)
    – Alpha lipoic acid

Learn More — Additional Resources

  • Your Diet, Your Health videotape and audiotape
  • The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 7, “The Menopause Food Plan” and Chapter 11, “From Rosebud to Rose Hip: Cultivating Midlife Beauty”
  • Women’s Bodies, Women’s Wisdom,by Christiane Northrup, M.D.,Chapter 17, “Nourishing Ourselves with Food”


  1. Gollnick, H., et al. (1996). Systemic beta–carotene plus topical UV sunscreen are an optimal protection against harmful effects of natural UV sunlight. Eur. J. Dermatol., 6, 200–205; Perricone, N. (1997). Aging: Prevention and Intervention. Part I: Antioxidants. J. Geriatric Dermatol. 5 (1), 1–2.
  2. Perricone, N., & DiNardo, J. (1996). Photoprotective and anti-inflammatory effects of topical glycolic acid. Dermatologic Surgery, 22 (5), 435–437.
Last Updated: October 5, 2006

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Stephanie Monserrate
    6 years ago

    Hello, Dr Northrup! Thank you for your beautiful work and dedication.

    I am 32 years young and I just quit to smoke. I can see the effects of my skin (pores, cheeks muscle and upper lip area, hair) and I would like to know what you can recommend me to revert the effects and tap in to the flourishing process. Is looks like I start the aging process very young. My gray hair start at my 17, I recently was diagnosed with androgenic alopecia and I would like to know which healing path is the best for me. I thought that maybe I could start a bio identical hormone therapy and also do the PRP therapy. I know that there is more to do but I would like to know where I can start. I already have a low glycemic diet and I start to do daily exercises. If you can give me your advice, I would really appreciate. Also, I’m leaving in Miami, if you know any doctor that make an holistic approach I would like to know. (Here or USA)
    Thank you!!! Best regards!!

  2. David Bowie
    6 years ago

    Nice blog you have written and it is having very useful content for so many peoples so keep sharing such kind of articles. Thanks for sharing this most important blog for us.

  3. Sharon
    7 years ago

    My skin is literally deteriorating before my eyes, I have had a few years of constant stress but in the last few months It’s changed so much I get a shock when I look in the mirror. It’s all I think about and I know it’s not helping.

  4. Donna Haney
    8 years ago

    I’ve been suffering bouts of rosacea since 1997. One of the worst bouts was this past April 2016. I have switched all cleansers and moisturizers to Cerave products; key ingredients hyaluronic acid and ceramides. They even have a facial suncreen that is SPF 50. My skin has improved dramatically. Are you familiar with this line?

  5. Jean
    8 years ago

    My problem are my arms, they are very crepe paper thin and wrinkle beyond!! I’ve seen a dermatologist and was told the only thing too correct the problem is to see a Plastic Surgeon have the skin surgically removed??? Not wanting to go that way not sure what else to do??Topical creams haven’t worked,I’m 67, lost a lot of weight and now putting some back on, I’ve lost most of my hair, have some mouth ulcers, and it seems a lack of muscle just hanging skin..I paid $2500. for a procedure to have a liquid injected into my arms to give me some shape however it didn’t take away the crepe shin, if you can help me I would greatly appreciate it!!

    1. Christiane
      8 years ago

      though not all of this can be reversed, I’ve seen some really good results working with fascia. Fascia is connected to all our bones, joints, muscles and skin. And when you hydrate it through fascia stretching, you can often get a rejuvenating effect. Check out for more information. Or — google resistance flexibility on you tube. You will find exercises you can do at home illustrated by Luther Cowden. I wish you well. And I certainly appreciate the problem.

  6. Verna Zwicker
    8 years ago

    I was wandering what you think about botex treatments or filler injections for wrinkles and saggy skin? Thank-you!
    Please reply.

  7. chezron
    8 years ago

    What about biohormone supplementation?

  8. Nia
    8 years ago

    I’ve started using Renova. It is not irritating my skin at all after 5 days straight now. My question is, can I use topical AHA and vitamin C along with the Renova? I am wearing sunscreen and using a mild face wash.

  9. Dan
    8 years ago

    Collagen type 1 we have 29 identified now but it is collagen type one of note ! from the inside out collagen type 1 make up 90% of all our collagens and 30%+ of our bodies weight, – If you want to drop 10 years off you looks start eating 2 whole raw egg’s for breakfast and 2 at dinner Shells and all dinner give your body the nutrients it needs ! induce oral tolerance body wide detox and perfect for systemic detox ( the non oxidized cholesterol does this this!) in 90 days as cells replace them selves your giving them a 100% HBV with everything to make a living creature and in perfect propreportions it just does not get better than the raw eggs

    1. Dan
      8 years ago

      Oh we have 100’s of people on these now many has severe autoimmune conditions and we are adding doctors so if interested in my research Christiane Northrup M.D. would love to have you aboard ( I am talking Life Changing ! oral tolerance works for virtually all autoimmune conditions no matter what stage they are in !) All Arthritis conditions and countless AI conditions from detoxing to rebuilding stronger cells we have all the information – even 4 with MS that was bedridden and wheel chaired for 5+ years up and walking ! and this is no joke !

    2. Lindsey
      8 years ago

      this is so interesting.. I have a hard time getting raw eggs down.. what is the easiest way you would recommend so they are basically hidden.. 😉 It’s the idea of eating them .. argh.. but I’m on board if I can disguise them .. thanks!

  10. karen
    8 years ago

    I have read you various “products ” that should help hydrate skin. I would like to attempt to make my own using as many as I can find from your list. What is your opinion on this?

    I am 72..i have amazing skin..virtually flawless and few very fine wrinkles my neck is tight and chest and body smooth and more like someone in their I do feel blessed . However I begin to notice my hands are a bit rougher and not as youthful as before and for this I am thinking of a cream to use and perhaps on my body to help prevent aging..right now its tight and very little sagging at all..legs..thighs arms etc. Appreciate hearing your thoughts especially for hand care..thank you in advance, Karen

  11. Kris Palmer
    9 years ago

    I would love to know more about your skin care that you use on your eyes to make bags go away.

  12. Magnificent goods from you, man. I’ve be aware your stuff prior to and you’re simply extremely great. I actually like what you have received here, certainly like what you are stating and the best way during which you assert it. You’re making it entertaining and you still take care of to keep it sensible. I can not wait to read much more from you. This is really a tremendous web site.

  13. Audrey Wolverson
    9 years ago

    The skin on my Arms are like paper, please can you advise me,I am 70 years old, and have rhematoid arthritis, i know tablets don’t help, i just want to know if i can thicken them. thank you

  14. Tina Winkley
    9 years ago

    Hello and thank you for your helpful information (I’ve made a shopping list from your site!).

    I was taking very high doses of Prednisone for 3 years (completely stopped 01/2014) and, as a result, my body suffered (and continues to do so, in some respects). My appearance has changed quite a bit. I am 49 years old and weigh 120 lbs now (my norm) but weighed 205 for months. My skin on my legs and arms resembles scales/tiny lines. I apply a homemade topical combination of organic coconut oil, vitamin E, shea butter, olive oil. I also eat organically. My tummy and underarm stretch marks have faded, and I’m optimistic I’ll continue to make progress. Do you have any suggestions of what I should do (or not do) to help this issue? Thank you so much in advance!

  15. Rosa
    9 years ago

    I was using lemon juice and yogurt as mask to lighten skin. However, I have now noticed that my brow skin is saggy and some under eye skin as well. I also have more darkening, especially around the eyes. I was not aware that sunscreen should be worn when using the lemon juice. I was not in the sun a lot, but it probably does not take much. I am wondering if to penetrated to the dermis and damaged the collagen in my skin. I am very anxious and depressed. Please advise.

  16. kim
    9 years ago

    I was wondering what skin care line you would recommend for aging skin. I am in my early 50’s and i have the start of dry bumpy skin and some wrinkles. I know that you recommend Dr. Perricone however do you have a second best to cover all the basics in Canada that isn’t quite as expensive.

    I remain forever a fan, just finished your book The Wisdon of Menopause.
    Thank you for helping through this rough time.

  17. Jill
    9 years ago

    Dr. Northrup,
    I would love to know if you have found a make up line that you love and personally use. Your skin is amazing! I have been searching for years. I use Usana for skin care, but have yet to find a natural foundation. Thank you for sharing your knowledge, experiences and light with all of us.
    Jill Fleming

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