At what age to start caring for first wrinkles

It is one of the questions most often asked in a skin consultation: "Should I already be using something?". And there are two common wrong answers. One is "only when wrinkles appear", which ignores that most of the damage that causes them builds up years earlier. The other is "the earlier, the better", which has led to 10-year-olds having anti-ageing serum routines today.

The right answer lies in the middle, and depends less on the age on your ID card than on the skin, sun exposure and each person's habits. This article proposes a guide by decade, with what has evidence and what is mainly promise.

Skin age or ID age?

Two 35-year-olds can have skin ten years apart. Chronological age counts, but the "visible" age of the skin depends greatly on factors that accumulate from childhood:

• Sun. By far the most important modifiable factor. In a study of Caucasian women, sun exposure was associated with around 80% of the visible signs of facial ageing (Flament et al., 2013).
• Tobacco. It accelerates the breakdown of collagen and reduces blood supply to the skin. Twin studies show visible differences between smoking and non-smoking siblings (Guyuron et al., 2009).
• Phototype. Fair skin wrinkles earlier; darker skin has more natural protection and tends to show dark spots and loss of volume first.
• Genetics. It explains part of the difference between families.
• Sleep, stress, pollution, weight changes and, in women, the menopause, which accelerates collagen loss in the first years (Brincat, 2000).

What happens, over decades

Collagen production in the dermis begins to decline slowly from early adulthood. Classic studies estimated a loss of around 1% a year in the skin's collagen content, although the figure varies between studies and between people (Shuster et al., 1975). At the same time, renewal of the epidermis becomes slower, elastic fibres fragment and, later, the volumes of fat and bone in the face change.

The important point is this: the wrinkles visible at 40 began to form at 20. Prevention, therefore, is not about "treating" young skin, but about not accumulating avoidable damage.

Before 20: sunscreen, not serums

On social media it has become common to see children and pre-teens with multi-step routines, including retinol, exfoliating acids and "anti-ageing" serums. Paediatric dermatologists in several countries have warned about this phenomenon, for several reasons:

• Young skin does not need these actives. There are no wrinkles to treat nor demonstrated benefit in starting retinoids or acids at this age for anti-ageing purposes.
• Irritation and dermatitis. Combinations of acids, retinol and fragrances cause redness, flaking, stinging and, at times, contact allergies that can persist.
• Wrong message. It tells children that ageing is a problem to be fought from an early age.

What makes sense in childhood and adolescence:

• Sunscreen and physical protection (hat, shade, clothing). Sunburn in childhood increases the risk of skin cancer and later photoageing.
• Gentle cleansing and a simple moisturiser, if the skin needs it.
• Treat acne with medical follow-up, when present. Here, topical retinoids may be indicated, but for acne, under medical guidance.

In your 20s: building the foundation

At 20 the skin is at the peak of its repair capacity. It is not the time to treat wrinkles, but it is the best time to build habits, because what you do now has a cumulative effect over decades.

Priorities:

• Broad-spectrum sunscreen every day, on the face, neck and hands. It is the anti-ageing measure with the best evidence.
• Do not smoke (or vape). The effect of tobacco on the skin is cumulative.
• Gentle cleansing and hydration suited to the skin type.
• Treat acne and avoid picking at spots, to prevent scars and dark marks.
• No sunbeds.

Optional, depending on the skin: an antioxidant in the morning (for example, vitamin C), or a gentle retinoid towards the end of the decade if there is early sun damage, a lot of exposure or acne. It is not essential.

What is not necessary: expensive "anti-wrinkle" creams, specific eye creams, preventive medical treatments.

At 30: the time to add a retinoid

It is often in this decade that the first persistent expression lines appear (crow's feet, forehead, between the eyebrows), the first sun spots and some loss of radiance. Cell renewal slows and the skin recovers more slowly from bad nights' sleep.

Priorities:

• Keep up daily sunscreen. Nothing you add replaces this.
• Introduce a topical retinoid at night. Retinoids are the actives with the best evidence for improving fine wrinkles and stimulating collagen (Mukherjee et al., 2006). Start with a gentle retinol, two to three nights a week, and increase gradually. On highly exposed skin or skin with marked damage, the doctor may prescribe tretinoin. Do not use in pregnancy or when trying to conceive.
• Antioxidant in the morning, under the sunscreen, as a complement.
• Hydration and barrier, especially if the retinoid irritates.
• Care for the eye area: sunscreen up to the edge, sunglasses.

In the clinic, if it makes sense: superficial peels for radiance, texture and dark spots; medical treatments for dynamic lines that bother you, after assessment.

Pregnancy, common in this decade, deserves a note: many actives (retinoids, some depigmenting agents) are not recommended. It is also a time of risk for melasma, which makes sunscreen even more important.

At 40: firmness and skin quality

Expression lines tend to become visible at rest, the first changes in volume appear (more marked grooves, a less defined jawline) and the skin becomes thinner and drier. In women, perimenopause can bring rapid changes.

Priorities:

• Keep up sunscreen and retinoid, adjusting the concentration to tolerance.
• Richer moisturisers, with ceramides and other lipids, if the skin is drier.
• Watch your spots and moles. It is the decade in which accumulated sun damage begins to show up also in lesions that should be assessed by a doctor.
• In-clinic treatments, depending on the goal: peels, collagen-stimulating treatments, and medical treatments for dynamic lines, static wrinkles and loss of volume.

After 50: thinner skin, gentler care

The menopause causes an accelerated loss of collagen in the first years, and the skin becomes drier, thinner and slower to heal. Static wrinkles and grooves are more evident, and loss of firmness comes to the fore.

Priorities:

• Sunscreen and a retinoid still make sense. In a trial in people over 80, topical retinol improved fine wrinkles and increased collagen production (Kafi et al., 2007). It is never too late.
• Barrier and hydration become central: very gentle cleansing, rich moisturisers.
• Regular skin examination by a doctor, because of the increased risk of sun-related lesions.
• Combined treatments in the clinic, with realistic expectations: improving the quality, tone and texture of the skin; firmness and volume require specific medical approaches.

Summary by decade

Early prevention: what has evidence and what is a promise

With good evidence

• Daily sunscreen. The Nambour trial in Australia is the strongest example: 903 adults under 55 were randomised to use sunscreen every day or only when they chose to. After four and a half years, the daily-use group was 24% less likely to show worsening skin ageing, and participants' age did not cancel out the benefit (Hughes et al., 2013). In other words, starting at any age counts, and starting earlier builds up more years of protection.
• Do not smoke. Studies of identical twins show that the sibling who smoked for more years tends to look older.
• Topical retinoids, to treat existing signs of photoageing. The evidence is strong for treatment; for pure prevention, in skin without signs, it is mainly biological logic.

With limited evidence

• Topical antioxidants (vitamin C, vitamin E, ferulic acid). They show additional protection against sun damage in the laboratory and in small studies. They complement, not replace, sunscreen. See Antioxidants for the skin: vitamin C, E and ferulic acid explained without exaggeration.
• "Preventive" botulinum toxin. The idea that relaxing muscles in young people, before lines become static, prevents wrinkles is plausible. The most frequently cited evidence is a report on a single pair of identical twins followed for 13 years, in which the sister treated regularly had fewer wrinkles on the forehead and between the eyebrows (Binder, 2006). It is an interesting case, but it is one case. There are no trials establishing from what age, how often and in whom it is worthwhile. It is an individual medical decision, not a general recommendation.
• Peptides, growth factors, oral collagen. Studies that are generally small, short and often industry-funded.

Makes no sense

• Anti-ageing products for children and pre-teens.
• Multi-step routines with several irritating actives at the same time.
• "Shortcuts" that promise the results of medical treatments with a cream.

Signs that it is time to start (whatever your age)

More than age, there are signs that indicate it is worth moving from the basics to targeted care:

If you recognise yourself in several of these points, an assessment helps to put together a proportionate routine, without spending on unnecessary products or starting too late. See also Fine lines, expression lines and wrinkles: they are not the same thing.

At Luxmed, the skin assessment does not start from age, but from what your skin shows. We help you define a simple, effective routine at home and, if it makes sense, in-clinic treatments suited to the stage you are at.

This article is for information purposes and does not replace a medical consultation. The results of any treatment vary from person to person.

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