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A Deeper Look at Extrinsic Aging

By: Jennifer Linder, MD
Posted: February 27, 2013, from the April 2013 issue of GCI Magazine.

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The nicotine in cigarette smoke causes vasoconstriction (blood vessel contraction). In addition, the carbon monoxide in cigarette smoke bonds with oxygen in the blood, restricting the amount of oxygen delivered to the body. This deadly combination of nicotine and carbon monoxide not only constricts capillaries trying to carry oxygen, but also reduces the availability of oxygen to flow through them.

Smoking just one cigarette restricts blood flow for up to 90 minutes. During this 90-minute period, the amount of oxygen that is available to pass through the skin is dramatically reduced. If a person smokes more than one cigarette during this 90 minutes, then the time the skin goes without proper oxygenation is multiplied exponentially. The telangiectasias—small, dilated blood vessels near the skin’s surface—that are characteristic of a smoker’s skin are a result of the body attempting to get more blood to the skin by producing more vessels. In addition to the vascular effects on the skin, exposure to the pollutants present in cigarettes accelerates the degradation of the ECM by increasing MMP—specifically MMP-1—production, causing the unwanted breakdown of healthy and necessary matrix components, such as collagen and elastin, leading to wrinkling and laxity.

It is important to be certain consumer are educated on the realities of what you can achieve with their skin if they continue with their habit. Similar to consumers with hyperpigmentation who insists on continuing to lie in the sun, treating for sallow, deoxygenated, telagiectatic skin when they continue to smoke is futile. Any forward progress that you make will be sabotaged by the nicotine and carbon monoxide that continue to barrage the skin. Once someone has quit smoking, professional detoxifying and oxygenating treatments can promote increased circulation and oxygenation of the skin cells. These types of treatments, as well as superficial chemical peels, can make an impressive visible improvement in skin tone. In addition, consider adding L-ascorbic acid, retinoids and peptides to a past smoker’s regimen to increase collagen deposition and help reduce wrinkling. Some ingredients, such as capparenols from caper bud and certain types of algae, can support and strengthen capillaries to reduce their hyperpermeability.

A Good Night’s Sleep

Another contributing factor in extrinsic aging is based on sleep. Although proper sleep, or the lack thereof, has been cited as the cause of many health issues, it is rarely discussed as an important part of keeping skin healthy and youthful. During sleep, the nervous system shifts from the sympathetic system that is dominant during waking hours to the parasympathetic system. The parasympathetic system increases blood flow to the skin, allowing it to repair and restore itself more effectively.5 It has also been noted that those who have a high rate of alcohol intake have disturbed parasympathetic activity and poor sleep quality.6 So, excessive alcohol consumption not only dehydrates the skin, but also reduces the amount of oxygenation and restoration the skin can perform during quality hours of sleep.

Helping to ensure consumers get their eight hours is important to good health in general. Of course, a good night’s sleep isn’t enough on its own, but it is the easiest and least expensive way to fight extrinsic aging and will help support other ongoing protective and corrective efforts.

Knowing that the vast majority of cutaneous aging is external, prevention should be your first line of defense, as well as your consumers’. Daily use of broad-spectrum sunscreen is an imperative first step in fighting extrinsic aging. Regular chemical peels and other types of professional treatments can help to keep surface texture at its best, stimulate collagen and elastin deposition, reduce skin discoloration and lead to overall healthy skin. With the right lifestyle choices, beauty products and professional treatments, together you can make a difference. Educate consumers on the importance of compliance with their specified regimens, and empower them to know that looking younger and healthier is within their control.


  1. J Herschtal and J Kaufman, Cutaneous aging: A review of the process and topical therapies, Expert Review of Dermatology 2 753–761 (2007)
  2. G Fisher, S Kang, et al., Mechanisms of Photoaging and Chronological Skin Aging, Archives of Dermatology 138 1462–1470 (2002)
  3. GJ Fisher, ZQ Wang, et al., Molecular basis of sun-induced premature skin aging and retinoid antagonism, Nature 379 335–339 (1996)
  4. ZD Draelos, Active agents in common skin care products, Plast Reconstr Surg 125 719–24 (2010)
  5. (Accessed Sept 7, 2012)
  6. (Accessed Sept 7, 2012)

Jennifer Linder, MD, is a dermatologist and Mohs micrographic skin surgeon, serving as CSO for PCA Skin. She holds a clinical faculty position in the department of dermatology at the University of California, San Francisco; is a spokesperson for The Skin Cancer Foundation; and is a member of the American Academy of Dermatology (AAD), the American Society for Dermatologic Surgery (ASDS) and the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO).

Secrets to staying young: Live honestly, avoid too much sun, moisturize like crazy and lie about your age.

Aging Skin: Current and Therapeutic Strategies, a reference book by Linda D. Rhein, PhD and Joachim W. Fluhr, MD is aimed at providing the latest information and directions of future strategies to treat and prevent skin aging.

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