Anti-Aging Skincare: What Actually Works

Skin ages in two ways. Intrinsic aging is the gradual loss of collagen, elastin and fat that comes with time and genetics. Extrinsic aging comes from the environment, and sun exposure is by far the biggest factor, causing most of the wrinkles, uneven pigment, broken blood vessels and loss of firmness people notice.

Ultraviolet damage adds up over a lifetime, including everyday exposure on cloudy days and through car windows. Smoking, poor sleep and pollution add to it.

The basics do most of the work: daily broad-spectrum sunscreen, a retinoid at night and a good moisturizer. Antioxidants like vitamin C are a helpful extra. Everything else is optional.

Retinoids are vitamin A derivatives that speed up cell turnover and stimulate collagen. They are the best-studied topical ingredient for fine lines, rough texture and uneven tone. Over-the-counter options include retinol and retinal, and prescription retinoids are stronger.

Start with a pea-sized amount two or three nights a week on dry skin, and build up as your skin allows. Use sunscreen every morning, because retinoids can make skin more sensitive to the sun.

Dryness, flaking and mild redness are common in the first few weeks, and moisturizing before or after the retinoid usually helps. Check with your doctor before using retinoids if you are pregnant or planning a pregnancy.

Under-eye concerns usually fall into four groups: puffiness, dark circles, hollowing and crepey skin. Each has a different cause, so the right approach depends on which one you have.

Eye creams can help with hydration and mild texture, and caffeine can temporarily reduce puffiness. They cannot fill hollows or remove fat pads. Some lash-growth serums can shrink the fat around the eyes, which deepens hollowing.

For deeper hollows, bags or loose skin, in-clinic treatments or surgery are the options that make a lasting difference. An assessment helps match the treatment to the cause.

Facial massage, gua sha, face yoga and many gadgets are popular, but the evidence for lasting change in wrinkles or sagging is weak. They may temporarily reduce puffiness, but they cannot rebuild collagen or lift tissue.

Be cautious with products marketed as 'filler in a bottle' or new miracle ingredients. Some are interesting in early studies, but few have strong evidence in people.

Spend your budget on sunscreen and a retinoid first, then decide whether extras are worth it.