Patient guide
What accelerates skin ageing
Part of the process is written in the genes and in the hormones, so it is not open to negotiation. The other part depends on exposure and on everyday habits, and only that part can be changed without a treatment. It is worth knowing where this boundary lies before a decision about a treatment is made.
Published on 8 September 2020. Last verified 23 August 2026.
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Sun protection
Verification
23 August 2026
Two processes worth telling apart
Intrinsic ageing proceeds independently of what we do. It depends on genes, age and hormonal changes, and shows itself as a gradual decline in collagen production, a reduction in the fat pad and a change in tissue support.
Extrinsic ageing results from exposure: radiation, tobacco smoke, pollution, lifestyle. This is the only part that can be influenced without a treatment, and it is usually responsible for the difference between the age on paper and the appearance of the skin.
Telling the two apart has practical significance. With intrinsic changes, the approach is to work on the effect. With extrinsic changes, it also makes sense to remove the cause, because otherwise the effect returns.
Ultraviolet radiation
Among external factors, it is named most often and first. Its effects are described by a separate term, photoageing, because they differ from changes resulting from the passage of time: they concern colour, texture and the quality of fibres in the dermis. This is best seen in areas exposed all year round, that is on the face, neck and decolletage and on the hands.
The practical conclusion concerns consistency rather than the filter itself. Protection used for three months a year, on the face only, leaving out the neck and hands, does not match how exposure is actually distributed. Separate caution applies after treatments: skin after laser therapy or after deeper exfoliation is more sensitive to radiation, as we describe in the article about laser treatments in summer.
Tobacco smoke
The second factor with strong evidence. It is linked to changes in skin vascularisation and in collagen metabolism, and clinically with a worsening of colour and earlier appearance of wrinkles. Healing also matters: smoking is, in many treatment protocols, a factor that calls for more cautious planning and extends the expected recovery time.
Factors with weaker evidence
The following are listed among the contributing factors, but the evidence here is weaker than for radiation and tobacco smoke. We present them with this difference clearly marked, without promising an effect on the skin.
Sleep and regeneration
Sleep deprivation is listed among the factors that worsen the skin's appearance, mainly through its effect on regeneration and colour. Evidence on the long-term effect on skin structure is limited.
Diet
Significance is attributed mainly to deficiencies and extreme diets, not to individual ingredients. Claims about products that delay skin ageing go beyond the available evidence.
Alcohol
It is linked to hydration, an increase in redness and a worsening of colour. It also matters around the time of treatment, as it is sometimes temporarily stopped before injectable treatments.
Chronic stress
Described as an indirect factor: through sleep, skincare and behaviour, not as a direct cause of changes in the skin. Its effect on the course of skin diseases is better documented than its effect on ageing itself.
Air pollution
A factor better documented than the others in this group: in a cohort study, exposure to traffic-related particles was associated with an increase in signs of extrinsic ageing, mainly pigment spots. Management here is limited to cleansing and protection, not to a treatment.
Body weight fluctuations
Repeated stretching and contracting of the skin with weight changes affects its firmness, and with larger weight loss, excess skin can be permanent. This is a situation where the approach is decided not by age but by the condition of the tissues after the weight has stabilised. We have described it separately on the page about skin after weight loss.
What a treatment changes, and what daily habits change
A treatment works on an effect that is already visible: colour, texture, skin density, firmness. It does not stop the factor that caused that effect. If unprotected exposure continues, pigmentation comes back, and that is the most common reason for disappointment with the result, not the choice of device.
The reverse is also true: removing the factor alone does not reverse changes that are already established. Photoprotection introduced after years of exposure stops further build-up, but does not lighten existing pigmentation. These two things work together, not instead of each other.
That is why aesthetic medicine is not the only answer to ageing, and it is not worth treating it that way. Physical activity, a balanced diet and a balance between work and rest belong to the same equation, just seen from a different angle.
Order of action for visible changes
First an assessment of exactly what is visible, because pigmentation, sagging and texture changes call for different approaches. Then photoprotection, as a requirement, not as an additional recommendation. Only then a treatment, chosen to match the nature of the changes and the season.
With photoageing changes, this order is not a matter of preference. A treatment carried out without lasting protection works against a factor that acts every day.
Further on the site
- Effects of sun exposure: skin photoageing.
- If the topic is skin tone: skin pigmentation.
- If the topic is home skincare: cosmetology consultation.
- Prices: aesthetic medicine price list.
- Booking a visit: contact or online booking.
The questions we are asked most often
Which factor speeds up skin ageing the most
Among external factors, ultraviolet radiation is most often identified. Its effects are described as photoageing and differ from changes resulting from the passage of time: they concern skin tone, texture and the quality of dermal fibres.
Does a treatment stop ageing
No. A treatment works on an effect that is already visible. If the factor continues to act, for example exposure without sun protection, the changes return. That is why, with pigmentation, photoprotection is part of the approach, not an additional recommendation.
What can be changed without a treatment
Exposure to ultraviolet radiation and protection against it, contact with tobacco smoke, the regularity of home skincare and the stability of body weight. These are external factors, unlike the pace set by genes and hormonal changes.
Is sunscreen enough
Sunscreen is the basis, but on its own it does not replace limiting exposure during the hours of strongest sunlight or mechanical protection. Consistency also matters, meaning use throughout the year and on areas that are often skipped, such as the neck, decolletage and hands.
Do diet and sleep have a documented effect on the skin
They are listed among contributing factors, but the documentation here is weaker than for ultraviolet radiation and tobacco smoke. We present them as factors with a lower strength of evidence, without promising an effect on the skin.
Where to start if the changes are already visible
From an assessment of the nature of the changes, because pigmentation, sagging and texture changes call for different approaches. With photoageing changes, the order is always the same: assessment, photoprotection, then treatment.
What the research says
Three references on which the classification described in this article is based. We give them so it is clear what is a research finding and what is practice at the clinic.
A review organising the concept of the skin exposome, meaning the entirety of environmental exposures over a lifetime. The authors identify solar radiation, air pollution and tobacco as factors with well established documentation, and the remaining ones as potentially reinforcing.
Krutmann J, Bouloc A, Sore G, Bernard BA, Passeron T. The skin aging exposome. Journal of Dermatological Science. 2017;85(3):152-161.
A cohort study in 400 women aged 70 to 80. Exposure to traffic related particles was associated with an increase in signs of extrinsic ageing, most strongly pigment spots, less strongly wrinkles.
Vierkotter A, Schikowski T, Ranft U, Sugiri D, Matsui M, Kramer U, Krutmann J. Airborne particle exposure and extrinsic skin aging. Journal of Investigative Dermatology. 2010;130(12):2719-2726.
A paper describing the SCINEXA scale, made up of five features indicating intrinsic ageing and eighteen characteristic of extrinsic ageing. This tool is behind the classification we describe in this article: sagging is attributed to the passage of time, and pigment spots and elastosis to exposure.
Vierkotter A, Ranft U, Kramer U, Sugiri D, Reimann V, Krutmann J. The SCINEXA: a novel, validated score to simultaneously assess and differentiate between intrinsic and extrinsic skin ageing. Journal of Dermatological Science. 2009;53(3):207-211.
Sources
The literature for the division into intrinsic and extrinsic ageing, and for the contribution of radiation and pollution, is given in the section What the research says.
About this text
This text was prepared by the NL Clinic team. Published on 8 September 2020, verified on 23 August 2026.
The content is for information and does not replace a consultation.
Consultation
At the consultation, we separate what results from exposure from what results from the passage of time. This determines whether a treatment or a change in approach makes more sense as the first step.