Anti-Aging Skin Care

One of the questions we are commonly asked in dermatology is “What can I do to keep my skin looking younger?” There is much inevitability to the natural aging process, and we are all in the same boat. As we age, chronic UV exposure accumulates, leading to skin changes such as flat brown sun spots (solar lentigines) in sun-exposed areas. Our dermal collagen decreases, with skin-thinning and sagging. A lifetime of emotional expression becomes written in the fine lines and wrinkles which grow gradually deeper over time. We lose volume under our skin as normal fat pads shrink and descend, from the cheeks down to the jawline.


Like many dermatology practices, OnSpot provides not only medical and surgical, but also cosmetic services, and we are always happy to help keep people not only feeling but also looking their best. Indeed there is significant overlap between medicine in the traditional sense and cosmetics; how one looks can affect their self-esteem and psycho-social well-being, important determinants of overall health. And some of the most important things you can do to keep your skin looking younger are also key to skin health. In this month’s blog, we’ll discuss some of the common things you can do to “age gracefully,” beginning with some easy general measures, then looking at common over-the-counter and prescription topical creams, and finally some effective injectable treatments and procedures.

anti-aging skin care

General Measures

There is a saying in dermatology: “The skin is the window into the body.” Many internal diseases can manifest in the skin, and conversely, one of the best ways to keep your skin looking younger is to focus on your general health. Don’t smoke, and avoid drinking too much alcohol. Get a good night’s sleep (it’s called “beauty rest” for a reason), and practice good “sleep hygiene,” as by avoiding screens for an hour or two before sleeping. Drink plenty of water, eat a healthy, balanced diet rich in green, leafy vegetables, and take a daily multi-vitamin.


Nicotinamide is a great vitamin supplement shown to not only improve your skin’s appearance (reduced brown spots, red blotches and sallowness) and elasticity, but also protect against skin cancers and pre-cancers. This B3 vitamin is available over-the-counter in 500 mg capsules. Take one capsule daily for anti-aging, or twice daily if you have a history of skin cancer or pre-cancers.


Try to avoid excessive stress and anxiety. Stress raises your cortisol levels, and elevated cortisol over time is bad for your skin. Of course, oftentimes, stress is caused by real challenges in life which we can’t avoid. But there are things we can do to minimize stress. As mentioned above, a good night’s rest allows the body to restore itself and awaken refreshed. Don’t skip breakfast; cortisol levels are highest in the morning, and a healthy breakfast will boost your energy, allowing your body to meet the day with less stress hormone. For those who are religious, a period of quiet, daily prayer time has been shown to greatly decrease cortisol levels. If a quotation from the Bible may be permitted, one is reminded of Jesus’ words in Luke 12: “Therefore I tell you, stop worrying about your life.” For those who are not religious, a period of silent meditation or deep breathing exercises is shown to have the same cortisol-lowering effect. And last but not least, exercise is excellent for reducing stress and anxiety, especially when done outdoors, in nature.


Try to get at least 30 minutes of exercise 5 days each week. Often people share a concern that their exercise actually poses a risk to their skin health, because they are spending more time in the sun. Walking or jogging outdoors, swimming, and pickleball are popular forms of exercise in sunny Florida, and while they do increase UV exposure, the overall health benefit greatly outweighs the risk of sun exposure. Still, you can mitigate that risk by using sunblock, physical protection such as clothing, sunglasses and brimmed hats, and by avoiding peak hours of UV exposure, between 10 am and 4 pm.

anti-aging skin care

Topical cream being applied on woman.

Topical Creams

Speaking of sun protection, the routine, daily use of sunblock is not only key to avoiding skin cancer – it really is your most important beauty product. Nothing ages the skin so much as sun damage. Tinted mineral sunscreen with SPF 30+ is best, but anything is better than nothing.


After sunblock, your next most important skin cream is moisturizer. As we age, our skin becomes drier, and dry skin worsens fine lines and wrinkles. It also itches and can worsen certain skin diseases such as eczema. Moisturizer protects your skin barrier and locks moisture within the skin, keeping it healthier and more youthful over time. No need to overspend here. Many over-the-counter beauty products are over-priced, moisturizers especially, claiming superiority with esoteric ingredients. Find something affordable that you can use every day. That said, it may be helpful to find a product which matches your skin type, and you may want separate moisturizers for face and body. Heavier moisturizers are best used on the body, legs, and arms, while facial moisturizers should be lightweight. If you are prone to acne, milia, or clogged pores, make sure your facial moisturizer says “non-comedogenic.” Comedone is the medical word for pimple, and non-comedogenic means “doesn’t make pimples,” which could happen if you use a heavy moisturizer on your face. If you have sensitive skin or eczema, look for moisturizer for sensitive skin; if you have oily skin, look for moisturizer for oily skin. If your skin itches frequently, look for moisturizers with 1% pramoxine, which can reduce itch.


Sunblock and moisturizer are by far the most important topical creams for your skin, and certainly the place to start for any anti-aging regimen. It’s ok to use a combination SPF/moisturizer, especially if keeping things simple will help you to be more consistent. For those wishing to take further steps, you can add a topical vitamin C serum to your morning regimen. These serums help to prevent and reverse sun damage. Use it after cleansing, and before applying moisturizer and SPF.


And to add one last topical to your nighttime routine, consider trying either over-the-counter retinol or prescription strength tretinoin (Retin-A). These are both vitamin A derivatives called retinoids, which have multiple beneficial effects for your skin. Retinol is the gentler version widely available in stores and is the primary reason why most over-the-counter beauty products actually work. Tretinoin is a stronger version available only by prescription. Retinoids increase cell turnover in your skin, essentially causing it to shed faster, while also stimulating collagen and reducing inflammation. The result is smoother, clearer skin over time, with reduced fine lines and wrinkles, brown spots and clogged pores or acne. We frequently prescribe tretinoin for cosmetic use, and while it doesn’t work overnight, the difference is quite striking in someone who has used it for years.

anti-aging skin care

A woman undergoing micro-needling.


For those wishing to take the next step after topical creams and serums, there are a number of cosmetic injectables and procedures which can offer a dramatic anti-aging effect. These can be categorized in terms of wrinkle prevention, skin-resurfacing, re-volumization, and lifting. For most people, that is also the order I would recommend adding them to your regimen.


For wrinkle prevention, there is no substitute for injectable neurotoxins, such as Botox, Xeomin, Dysport or Jeuveau. All four work the same way, stopping specific muscles from contracting in the face, and thereby preventing the wrinkles caused by contracting those muscles. If you can’t contract the muscles of the brow between the eyes which cause the vertical “11’s” or frown lines, then you can’t create those wrinkles, and the area remains smooth. The same is true for horizontal forehead lines, and smile lines by the eyes. These 3 areas are the most commonly treated with neurotoxins, and the result is prevention of wrinkles which can help your face look decades younger. All four major neurotoxin brands last roughly 3 months and are essentially interchangeable, although there is a new neurotoxin call Daxxify which is reported to last 6-9 months.


These days, most people have heard of Botox, and oftentimes people come to OnSpot interested in trying it, but wary of certain issues they have seen or heard of. Most commonly, people are worried about ending up with an artificial look, or an exaggerated, cartoonish one. This is a completely legitimate concern, and we have all seen enough examples to know that it does happen. But the truth is that no experienced injector wants to create that look, and with proper technique, neurotoxin treatments preserve natural facial expression, and simply create a smooth, youthful, refreshed look which can be quite subtle. Indeed, I believe most would be surprised to learn how many people they see every day who are getting neurotoxin treatments without them knowing. For every one person with an obvious, exaggerated look, you probably see 20 with skillfully done treatments, helping them look younger with none the wiser. There is much more we could say about neurotoxins, but cosmetic injectables are actually the topic of next month’s blog, so we will hold off for now and dig deeper next month.


Now the primary limitation of neurotoxins such as Botox, is that they are much better at preventing wrinkles than they are at removing wrinkles which are already set into the skin. If your wrinkles only appear when you make a certain expression, that’s called a dynamic wrinkle, and neurotoxins can eliminate those. But if your wrinkles are visible with your face at rest, those are called static wrinkles, and neurotoxins can help smooth them a bit, but really clearing them requires adding another modality for skin re-surfacing and collagen stimulation. We already discussed topical tretinoin cream, which is a good place to start.


Chemical peels are another option, which can not only smooth the skin’s surface, but also help clear it of brown spots from sun damage. During a chemical peel, a medical grade acid such as trichloroacetic acid (TCA) is carefully applied to the skin, left on for a brief time, then removed. The procedure is not painful, but there is a burning sensation similar to getting a sunburn. Also like a sunburn, the superficial skin will peel off over the next few days, resulting in a smoother, clearer skin surface. Chemical peels are best done in series, for example, once every 2 months for 6 months. Some people get a chemical peel every few months long term as part of their routine regimen.


Another excellent option for smoothing the skin’s surface is micro-needling. This procedure uses a mechanical device shaped like a large pen, with very small needles projecting rapidly from its tip, to cause small micro-trauma to the dermis beneath the skin’s surface, where the collagen is. This stimulates collagen growth, and results in firmer, tighter, smoother skin. It is quite safe, but in contrast to a peel, micro-needling can be painful, especially on the forehead. For those with tattoos, the sensation is quite similar. As with chemical peels, micro-needling is best done in series, at least 3 treatments spread over 6 months or so.


And last but not least, a variety of laser treatments are available which can dramatically improve the skin’s surface, eliminating fine lines, wrinkles, and dyspigmentation, but these require a motivated patient willing to invest in their appearance, not only financially, but also in terms of recovery time. Some superficial lasers which treat brown spots and sun damage have relatively brief recovery periods of a few days to a week, while other more powerful lasers require a month or longer of recovery, but with more significant effects. OnSpot does not offer laser treatments, but most dermatology practices who offer cosmetic services do, as well as most plastic surgery offices.


The third category of cosmetic procedures concerns re-volumization, as with injectable fillers. Again, this topic will be covered in next month’s blog, so a brief introduction will suffice. The goal with fillers is to correct or enhance key facial features by strategically placing naturally occurring and bio-compatible hyaluronic acid products within or beneath the skin, in order to counteract the loss of facial volume which is part of the natural aging process. Sunken-in temples can be smoothed out, cheek bones and jaw lines can be defined, noses can be smoothed and simplified, lips can be plumped up, chins can be enhanced, lines by the nose and mouth can be smoothed, hands can be smoothed. We will discuss the potential benefits and risks of injectable fillers next month.


Finally, the fourth category of anti-aging procedures includes those meant to lift the skin, as by literally pulling it back, and tighter, to treat the loose, sagging skin which is again part of the natural aging process. Oftentimes I see a patient for neurotoxins or filler or both, and when I ask what their goals are for their face, they quickly reach up with both hands and pull the skin back, tighter. Unfortunately, neither Botox nor filler can achieve this, although they can create an illusion of lift when placed skillfully. But to truly lift and tighten the skin, one must invest in either plastic surgery, or a new and rapidly growing technology called threads. With threads, a variety of dissolvable suture threads are placed underneath the skin, where they pull it back and lock it in place, then dissolve over time. Threads are less invasive and less expensive than a face-lift, with no cutting or stitches and minimal recovery time.


I hope you have found this list helpful. Please feel free to schedule a consultation with OnSpot for cosmetic treatment options tailored your goals, and until then, I wish you and your loved ones a Happy New Year.

nicholas tocco, pa-c

Nicholas Tocco, PA-C

About the Author

Nicholas Tocco, PA-C is a graduate of Florida Gulf Coast University, where he completed his Master of Physician Assistant Studies degree. Trained in general, surgical and cosmetic dermatology, he is now proud to join the OnSpot Fort Myers team. He is a member of the American Academy of Physician Assistants, the Florida Academy of Physician Assistants, and the Society of Dermatology Physician Assistants. He currently resides in Naples with his wife and four children.


The information provided on this site is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.  OnSpot Dermatology is not providing personalized medical assessments or recommendations for individual cases in this post. The content presented here is based on general knowledge and should not be considered a substitute for a consultation with a qualified healthcare professional.  The use of information provided is solely at your own risk. OnSpot Dermatology and the author make no representations or warranties, express or implied, regarding the completeness, accuracy, or usefulness of the information presented.  By reading this post, you agree to the above disclaimer and understand that any action you take based on the information provided is at your own discretion.  If you have specific questions or concerns about your skin or any medical condition, please consult a healthcare professional for a personalized assessment and recommendations.