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Aging Skin: Nature Does Not Trump Nurture

Have you used that app that shows you what you might look like as an old person? It can be a bit grotesque and downright scary. My advice? Don’t believe it.

People all age differently from one another, even within the same family. I have found this to be true not only in my practice, but there is consensus in the medical community as well. In an article in the New York Magazine’s The Cut,  plastic surgeon Dr. Dara Liotta talks about how your genes and ethnic makeup affect the way you age — everything from skin tone to the fat content of your skin, to the DNA that can keep you naturally babyfaced longer. Or not.

“Aging isn’t just about wrinkles,” say The Cut’s Kathleen Hou. “Most of us hear the word aging and think one thing: wrinkles. Or at most, two things: wrinkles and sagging skin.”  She goes on to say that the majority of people experience a combination of wrinkles, hyperpigmentation, loss of elasticity, and loss of volume (meaning the opposite of flatness), as they age. How much of that enters into our own equation might not be known until we see it happening. I have seen patients who swear they will age the way their mothers did (good or bad) only to find that their skin did not reflect the same combination of factors. “On top of that, the texture and color of your skin affect the likelihood of it exhibiting these characteristics,” say Hou. “With the march of time, elastin and collagen become looser (collagen even eventually stops being produced over time). Fat cells also start to shrink.”

Anyone ever tell you that you have thick skin? Consider it a compliment. The thicker skin, the slower the signs of aging.  I have a client nearing age 70 whose skin is so thick that  you’d swear she was a 45- year old. I treat her with Broadband Light (BBL) for hyperpigmentation, have given her Halo® treatments, and have done some Juvederm®  contouring, but I can’t find a place on her face that actually needs Botox as she approaches her seventh decade. Even her fine lines and wrinkles are hardly noticeable. Her Mediterranean roots have served her well, even though she does not possess olive skin.

If you have plump skin, consider yourself lucky. “In South Korea, the beauty ideal for skin is something called chok chok — a term that means ‘plump and moist,’” says Hou. Genetics have a role here as well, as some ethnic groups tend to have higher fat content in their skin.

Melanin is, of course, a huge factor in how your skin ages. It’s the pigment that gives your skin and hair its color.  While Dr. Liotta says lots of melanin offers a degree of UV protection, having melanin-rich skin doesn’t mean you can throw away the sun screen. It just means you (luckily) have some built in SPF as you age. Melanin-rich skin, however, has its own variety of issues. It tends to show aging by leaving you the gift of hyperpigmentation and sun spots. Dark spot correction can be addressed in my office and require BBL treatments that take place over a series of appointments. 

Then there is the part I can’t help with: “Nutrition, skin care, exercise, all still play a huge part — these are all things that help keep your skin and body from showing signs of molecular damage and being reparative to your DNA,” says Dr. Liotta in the article.  While we do tend to age like our mothers, it’s truly a combination of nature (genetics) and nurture (how we treat our bodies and faces) that come into play when evaluating how your skin might age.

The longer I am in practice, the more I am realizing, however, that a commitment to good skin care is like a commitment to anything else. People are not only living longer because of diet, exercise and having a sense of purpose. If they care about how their skin ages, they can be just as committed, using many of the tools I offer to keep them looking younger longer. BBL, Halo®, Juvederm, Botox®, and hydrofacials, when properly administered, can actually make you feel as if the clock is going backward.

There is no doubt about it: skin is in. Self care for skin and anti- aging are no longer smoky buzzwords; they are realities.  I am not a fan of the “boutique” med spa experience — a quick in-and-out appointment with a practitioner simply doing what a patient has ordered up. My practice is built on the amount of  care taken to explain not only what is being done, but also to explain to you how it will age as we go forward. I see myself as a partner in your health and beauty care, with a solid commitment to giving you all the time as well as the education you need to make wise anti-aging decisions. 

A boutique, individualized approach where the experience is as satisfying as the results


Dr. Andrea Tse is a board certified physician who focuses on the total person.

She offers the finest anti-aging laser treatments by Sciton, proven to provide anti-aging benefits at the skin's deepest levels. Dr. Tse also performs several non-surgical procedures to tighten, brighten, and make the skin look like it did years ago. Her specialized aesthetic training as well as her artistry combine to assure the most beautiful results.

Dr. Tse is also a passionate proponent of physician-grade supplementation to restore the body and, simply stated, make life better.

She provides her patients even more—a compassionate ear and a true partnership. Her patients know they are both cared for and cared about.