Your face reflects who you are and where you’ve been, and time spent in the sun may have left its mark in more ways than one. If you don’t like what you see, you can improve the appearance of your skin with some simple steps from our expert dermatologists.
Have you ever looked in the mirror and thought, “Why do I look older than I feel?” The truth is, the way your skin looks may have more to do with how much you’ve basked in the sun than how many birthday orbits around it you’ve made. “There is a gap in awareness about what causes the so-called ‘signs of aging’ on our skin,” says Deborah S. Sarnoff, MD, president of The Skin Cancer Foundation. “My patients are often surprised to hear that most of these signs are related to sun damage.”
You already know that ultraviolet (UV) light from sun exposure can lead to skin cancer — and that protecting your skin is the best way to prevent it. Shielding your skin from the sun is also the best way to keep your skin looking young, and it’s never too late to start. But what if damage is already done, from when you were a kid who just didn’t know any better, or when you had to work outside, or when you thought you would look better for a special occasion with a deep, dark tan?
Dr. Sarnoff has seen it all in her busy practice. So has Washington, D.C., dermatologist Tina Alster, MD, who helps explain the toll sun damage takes on our skin — and some suggested solutions.
Yes, These Are All Signs of Sun Damage!
Wrinkles: I tell my patients that more than 90 percent of wrinkles associated with aging are actually related to cumulative sun damage. Collagen and elastin are proteins that make your skin firm, supple and resilient, but UV radiation from sun exposure can destroy them. Dermatologists call chronic sun damage through the years “photoaging,” and, of course, it leads to wrinkles. Think about it: We don’t see many wrinkles on unexposed skin, such as the buttocks, breasts or other areas where the sun doesn’t shine. Exposed skin tends to be more wrinkled, and the sun plays a huge role in that.
Broken blood vessels: Have you noticed some red, spidery veins around your nose and cheeks? Yes, those are caused by exposure to UV light. When people say they have “broken” blood vessels, that’s a misnomer. If the blood vessels were broken, they’d bleed into the skin and cause bruises. In actuality, these vessels are enlarged. They’re “broken” in that they’re not doing what they’re supposed to be doing, which is pumping the blood from one area to the next and staying trim (or tight) and, therefore, invisible.
Elastin fibers normally hold the blood vessels taut. But when those fibers are broken down by sun exposure, they are unable to support the vessels and hold them tight. The blood vessels thus enlarge (or sag) — and become visible. Many patients present with enlarged vessels on the sides of their nose or cheeks, but it’s also common for large blood vessels to appear on the chest, which often gets a lot of sun exposure.
Brown Spots: No matter how many times my patients tell me that they’ve had brown spots or freckles all their lives, I gently reply, “No, you haven’t.” It’s just a fact. When a patient tells me, “Well, my mother said I was born with them,” I say, “No, you weren’t. When your mother put you outdoors and exposed your skin to sun for the first time, that’s when you developed freckles.”
Dermatologists call freckles “ephelides” and larger tan spots “solar lentigos.” Most people often refer to them as age spots, but they’re not related to age; they are related to sun exposure. Sometimes they can coalesce and become big brown spots — which are different from pigmented brown birthmarks or scaly lesions called keratoses.
Hyperpigmentation: Patients often complain of blotchy or mottled skin, with evidence of dark and light patches. Sometimes there may be evidence of red discoloration as well. This is a common cosmetic concern and does not indicate an underlying medical condition. Inflamed skin can become hyperpigmented, and a frequent cause of such skin inflammation is sun exposure.
Hyperpigmentation and skin blotchiness drive many people to seek treatment. Most patients are not aware that the dark discoloration is related to chronic sun damage. Many may have used over-the-counter skin lightening products that can often increase skin irritation and inflammation, leading to yet more pigmentation.
With so many people wearing masks during the pandemic, facial skin that often receives incidental sun exposure has been more protected. Regrettably, most people don’t apply enough sunscreen or use it consistently. However, because masks provide a physical block to the sun, they have had an unintentional positive effect: I have noted far less hyperpigmentation on the lower face of my patients over the past two years!
Melasma: Wearing a protective face mask has also helped with signs of melasma, which appears as dark patches on sun-exposed facial skin, particularly on the cheekbones. While hormones such as estrogen can worsen melasma, its appearance is primarily caused by skin inflammation induced by chronic (or repeated) sun exposure.
Blackheads: We’re not talking about blackheads associated with acne, but about clusters of blackheads that appear on the temples and cheeks as a consequence of diminished skin elasticity due to chronic sun exposure. The loss of elastin fibers causes skin crevices and pores to enlarge, thus trapping dirt in them that turns black. This condition is called Favre-Racouchot syndrome and is most commonly seen in middle-aged men with a history of excessive sun exposure.
A red neck: This is different than getting an acute burn after recent sun exposure. A permanently red (and often net-like or spotty discoloration) on the lateral sides of the neck and central chest is a condition called poikiloderma.
People who spend a lot of time outside, such as gardeners, construction workers, truck drivers and athletes, are particularly prone to this condition because of the extended period of time those areas are exposed to UV light. The exposed neck and chest skin develops enlarged blood vessels, which permanently cause the skin to appear red. It’s interesting that the skin under the chin is often unaffected because of the shadow the chin casts on the front of the neck, thereby shading it from the sun.
Reversing Sun Damage
Consistent sun protection: I evaluate patients with sun damage all day long. Before I perform any treatment in the office, I encourage my patients to do their homework. The first thing is to prevent future skin damage by applying sunscreen on all exposed skin, but especially the face — every single day, all year long. I also recommend that additional sun-shielding measures be used, such as wearing protective clothing, hats and sunglasses and, whenever possible, seeking shade.
Better skin care: Additional homework involves adhering to a consistent skin care maintenance program. I recommend that my patients follow a good skin-care routine for at least one month prior to in-office treatments. It shows me that they are team members and doing their part to achieve the common goal of radiant, healthy skin! Here is my prescription:
- In the morning: Protect. Before you apply your facial sunscreen in the morning, put on a topical antioxidant vitamin C product. It will enhance your sunscreen’s ability to protect your skin from free radicals that can damage it. A vitamin C serum or gel can also help stimulate new collagen production, effectively making skin healthier.
- In the evening: Repair. To help repair or even reverse sun damage, your best weapon is a vitamin A derivative. What does that mean? Well, if your skin can handle it, you can use Retin-A. Many patients are unable to use Retin-A every night due to irritation (dryness), so I often recommend a retinol-containing cream or moisturizer that helps to stimulate new collagen production, brighten discolored skin and reduce fine lines.
If you want to add anything to this simple formula, I suggest an eye cream that contains peptides, to enhance collagen production in the delicate area around the eyes. Eye creams are best used at night (they rejuvenate while you sleep) but can also be used under makeup during the day.
If you consistently stick with this plan to protect in the morning and repair at night for a month, it sets the stage for any procedure that may be performed in the office. if you stick with it, you can make a difference in the sun damage you already have. It’s like going to the gym: You have to make it a habit.
Office procedures: To reduce wrinkles, there are many treatment options. Wrinkles can be filled in (or plumped up) with any of several cosmetic injectables, including Juvederm and Restylane. Most “fillers” are composed of hyaluronic acid, a natural substance that provides cushioning and structure to the skin. Microneedling of wrinkles with a motorized handheld device that inserts fine needles into the skin to improve skin texture is another treatment option. And, of course, there are a variety of lasers that can resurface the skin and literally vaporize wrinkles away and/or induce new collagen formation to reduce their appearance.
If so-called “broken blood vessels” or sun spots require treatment, specialized lasers are recommended to target and remove the unwanted blood vessels or pigment. It is important that patients avoid sun exposure before and after laser treatment to prevent side effects. Similarly, poikiloderma can be treated using lasers and intense pulsed lights (or IPL) that can treat diffuse skin redness and hyperpigmentation.
On the other hand, for hyperpigmentation or melasma, I recommend chemical peels in lieu of laser treatment because the heat produced by lasers in such sensitive skin can cause further inflammation which, in turn, can worsen pigmentation.
The bottom line: Almost everyone has some degree of photodamage. While there’s no magic wand to make the signs of that damage disappear, with these steps, you will see improvement. It’s never too late to start taking care of your skin!
About the Experts:
Tina Alster, MD, is director of the Washington Institute of Dermatologic Laser Surgery and clinical professor of Dermatology at Georgetown University in Washington, DC.
Deborah S. Sarnoff, MD, is a clinical professor of dermatology in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine. She is cofounder and codirector of Cosmetique Dermatology, Laser & Plastic Surgery LLP in Manhattan and Long Island, and president of The Skin Cancer Foundation.