Between acceptance and defiance there's a middle way of relatively small tweaks that will make an old face look younger.

Age affects every nook and cranny of the body, but nowhere are the consequences on such open display as on our faces. Dozens of changes take place as the years add up, some of them obvious and familiar: Foreheads expand as hairlines retreat, for example. Ears of an older vintage often get a bit longer because the cartilage in them grows. Tips of noses may droop because connective tissue supporting nasal cartilage weakens.

There are also structural rearrangements going on behind the scenes. When we're young, fat in the face is evenly distributed with some pockets here and there that plump up the forehead, temples, cheeks, and areas around the eyes and mouth. With age, that fat loses volume, clumps up, and shifts downward, so features that were formerly round may sink, and skin that was smooth and tight gets loose and sags. Meanwhile, other parts of the face gain fat, particularly the lower half, so we tend to get baggy around the chin and jowly in the neck.

The bones in the face also change with age. Like the rest of the skeleton, the upper jaw, lower jaw, and cheekbones shrink. Less bone can make a face look wider and more angular and contributes to looser skin.

And, of course, there are the wrinkles. Those deep ones in the forehead and between the eyebrows are called expression, or animation, lines. They're the result of facial muscles continually tugging on, and eventually creasing, the skin. Other folds may get deeper because of the way fat decreases and moves around.

Finer wrinkles are due to sun damage (more on that below), smoking (which has some of the same effects on skin as sunlight), and natural degeneration of elements of the skin that keep it thick and supple.


If our faces show our age, so be it—in fact, we should celebrate it. Some lines here and there connote character. That's one—and perhaps the best—response to age etching itself into our faces. And American attitudes toward an older look seem to be shifting now that many baby boomers are in their 60s.

Counter to "old and proud of it" is the age-defying facelift, which surgically removes excess tissue and —as the name indicates—lifts sagging skin in the lower part of the face. Facelifts have improved, so people look more natural afterward. But the surgery is expensive (the surgeon's fee alone averages just under $7,000), and other procedures may be needed to make the top half of the face look just as young as the lower half.

Plenty of Americans still get facelifts. According to the American Society for Aesthetic Plastic Surgery, about 94,000 people got one in 2009. But the procedure is only the 20th most popular cosmetic procedure, and now there are plenty of alternatives for altering an aging face.

Most of these rejuvenating procedures are nonsurgical. And while they're not inexpensive—especially when you factor in the need for repeat treatments—you don't need a movie star-sized income to afford them, nor a star's vanity. "Getting a little work done" has become increasingly mainstream.

Here's just a sample of the things that you can do—or get done—to give your face a more youthful appearance:

Sun protection

As we get older, the collagen in the dermis—the next-to-the-top layer of the skin—changes character, so the skin feels thinner and stiffer. Add sun exposure and you get solar elastosis: tangles and clumps of collagen and elastin (a protein that, as the name suggests, makes skin springy). With solar elastosis in the dermis, the skin loses its flexible, supporting structure, so fine wrinkles form around the mouth and across the cheeks. Sun exposure is also the main cause of crow's feet, the wrinkles at the outside corners of the eyes.

Protecting your face from the sun is the single best way of keeping it youthful, according to Dr. Kenneth Arndt, a member of the Harvard Health Letter's editorial board and a dermatologist at SkinCare Physicians outside of Boston, Mass. Much of the damage comes from the UVA part of the light spectrum, so you need to put on sunscreen that protects against it and UVB light, which causes sunburn. Wearing a wide-brimmed hat is also a good idea.

Creams and lotions

Moisturizers soothe dry skin and may temporarily make wrinkles less noticeable. Moisturizers for the face contain water to make them less greasy, and many have substances—glycerin, for example—that may help bind water to the skin. Exfoliant creams can improve the appearance of older skin by getting rid of dead skin cells that don't slough off as readily as they did when we were young.

Several prescription creams (Avita, Avage, Renova, Retin-A) have been shown to reduce wrinkles and so-called liver spots caused by sun exposure. These FDA-approved creams contain retinoids, compounds related to vitamin A that seem to work by inducing collagen production in the dermis and altering melanin, the pigment that causes liver spots. There are several varieties of retinoids. Tazarotene and tretinoin are the ones used in the FDA-approved products.

Using a retinoid cream is a fairly pricey proposition. A single tube costs between $100 and $200. The cream must be applied pretty much daily (usually at bedtime) and continually for the wrinkles to stay away. Less expensive generic versions of some of the prescription retinoid products are now available. Over-the-counter creams containing retinol, another retinoid, may be worth a try but are probably not as effective as the prescription products.