A number of external factors can influence our normal aging process to prematurely age our skin. 

Extrinsic factors that accelerate premature aging include:

  • Sun exposure
  • Repetitive facial expressions
  • Gravity
  • Sleeping positions
  • Smoking
  • Alcohol, illicit drugs and some medications.

The Sun

Over time, just a few minutes of unprotected exposure to ultraviolet rays each day causes noticeable damage to our skin. 

Signs of sun damage include:

  • Freckles
  • Age spots
  • Spider veins
  • Rough and leathery skin
  • Fine wrinkles
  • Loose skin
  • Blotchy complexion / hyperpigmentation
  • Actinic keratoses (thick, wart-like, rough, reddish patches of skin)
  • Skin cancers / lesions.

Ultraviolet rays break down collagen and impairs the production of new collagen - responsible for maintaining our skin's elasticity. UV rays also damages our skin and its ability to repair itself, and so damage accumulates with time.   

The amount of "photoaging" that develops depends on your skin colour and your history of long-term or intense sun exposure.  Most sun damage occurs in your childhood years and usually you will not see signs of this until decades later.

Facial Expressions

Repetitive facial movements lead to fine lines and wrinkles.  Expressions cause the muscles on the face to fold and crease the skin.  As the skin ages and loses elasticity, the skin begins to take on the creases more permanently causing deep wrinkles in the face. 


Gravity constantly pulls on our bodies.  The effects of gravity become evident in our 50s when our skin's elasticity declines dramatically.  Gravity causes the eyelids to fall, jowls to form and the upper lip to disappear while the lower lip becomes more pronounced.

Sleeping Positions

Sleep lines become wrinkles after resting your face on your pillow in the same way every night for years on end. 

  • If you sleep on your side, you are most likely to see these lines appear on the chin and cheeks. 
  • If you sleep face down, you will notice the lines appear on your forehead. 
  • If you sleep on your back, your skin is not crumpled against the pillow and therefore you will not develop "sleep" lines.


Cigarette smoking causes biochemical changes in our bodies that accelerates aging. Nicotine intake increases the breakdown of skin cells. 

Research shows that a person who smokes 10+ cigarettes per day for a minimum of 10 years is statistically more likely to develop deeply wrinkled, leathery skin than a non-smoker.  Facial wrinkling can be seen under a microscope in smokers as young as 20.

In addition to wrinkles, a yellowish discolouration of the skin has been observed in smokers.  The good news is that those who stop smoking show less wrinkling and improved skin tone and complexion shortly after quitting.

Alcohol, illicit drugs and some medications

Alcohol dilates the fine blood vessels of the skin. Over time the damage from dilation of these fine blood vessels gives skin a flushed and older looking appearance. Liver damage from alcohol abuse can cause yellowing of the skin (jaundice) and an itchy rash. Damage to skin cells from frequent or constant scratching can cause thickened, pigmented skin.

Illicit drug use can damage the skin causing:

  • pigmentation, 
  • abscesses, 
  • rash, 
  • excoriations from compulsive picking,
  • scarring,
  • nasal ulceration,
  • jaundice.

Fatigue, weight loss and multi-organ damage from drug abuse also manifests as an unhealthy, aged and withered appearance.

Some medications have side effects that may cause skin:

  • pigmentation,
  • thinning,
  • dehydration,
  • eruptions,
  • necrosis,
  • blisters,
  • itching - scratching can damage the protective function of the skin giving rise to infected sores and scarring, 
  • impaired healing and increased scarring,
  • photosensititvity - increasing the risk of sunburn and pigmentation with sun exposure.

Most (but not all) drug-induced skin disorders resolve when the causative drug is withdrawn.