This is the second article about the inevitable aging process of our face. In Part 1, Robert M. Tornambe, a NYC plastic surgeon, categorized and described the phases of aging according to decade. The Intrinsic and Extrinsic aging pathways were defined; Intrinsic aging is essentially genetic and Extrinsic aging is dependent and influenced by external factors like sun exposure, climate, personal habits and lifestyle. These facets do vary within the population, but their influence on the aging face is undeniable. We have no influence on our genetic side of aging, but can do much to affect, control and manipulate those external factors.

Since the journey of facial aging starts in the second decade and continues relentlessly until death, the following recommendations apply to all ages, with modest tweaks between some decades. I urge younger readers to adopt these guidelines immediately, because you have the most to gain, and are in the best position to slow down the march of time. All others can still do so much to affect the process as well, no matter what decade.

The Basics-No Excuses!hydrate skin

1) Hydrate  Water really is the “fountain of youth”, readily available and ignored by us all. It is the primary chemical component in our body representing 60% of body weight. It helps prevent dry skin, so drink a minimum of eight 8 oz. glasses per day. It has additional benefits, like flushing out your organ systems; think of it as a cheap, simple daily cleanse!

2) Sun – Lots of sun may give you a ravishing bronze tan but tons of science guarantee that it causes dry, leathery wrinkled skin. Loss of the ozone layer and too much sun increases skin cancer incidence many fold. Use sun block and protective clothing, and if you must tan, do it early or later in the day when the rays are less strong. Don’t even consider tanning beds, as they are even worse than natural sun. A great alternative is self-tanners.

3) Smoking – A no brainer! Smoking constricts blood vessels to your face, restricting the delivery of important nutrients, hurrying the aging process to warp speed! Studies comparing twins who smoke offer shocking differences from their siblings who don’t. One twisted advantage of smoking? Statistics prove that smokers will die from lung cancer or heart disease at a younger age, halting the aging process completely!

4) Diet and Exercise – A balanced diet, including foods rich in anti-oxidants, help combat free radicals released by pollution in the air. Free radicals contribute greatly to the aging face. Alcohol abuse also speeds aging. Exercise enjoys numerous benefits, like increasing blood flow to the face by increasing the heart rate. Remember the sunscreen and protection when exercising outdoors.

5) Sleep and Stress – Studies show that lack of sleep and increased stress hastens aging. The body repairs itself during sleep and blood flow to all parts of the body, including the skin, increases during sleep. At least 7-8 hours of sleep is recommended. Stress causes premature aging by affecting skin at the cellular level, and can promote unhealthy habits like smoking and drinking alcohol. Effective stress busters include, exercise, meditation, yoga, a warm bath and thankfully, sex!

Skin Care-The Real Battle

I present to you a simple yet proven regimen to combat the extrinsic elements aging your skin.

1) Cleansing – Wash your face after removing makeup in the evening and choose a cleanser that is suited to your skin type. Avoid ones with fragrances, which can be irritating and avoid ordinary soap which can be drying. Don’t break the bank, expensive cleansers are not necessary. Don’t over-do it. Cleanse after a workout or a day in the polluted city to avoid breakouts, but washing too much dries out the skin by removing natural oils. Don’t bother with a toner, as they are alcohol based and can remove natural oils. A good cleanser is all you need.

2) Exfoliate – Find an exfoliation product that removes debris and dead skin cells but is not too caustic. Pain and irritation after exfoliation exposes a regimen that is too harsh for your skin. Some products may be used with a wash cloth or cleansing pouch to maximize results. Dermatologists recommend exfoliating 1-3 times a week, depending upon skin type and needs.

3) Moisturize – The cornerstone of a solid skin care routine is finding the right facial moisturizer and using it with frenzy. The first step involves determining your skin type. The options include; dry, oily mature, sensitive, normal, or a combination. The ideal moisturizer includes a sunscreen and marries your skin type with the appropriate active ingredients benefitting it. Other important choices involve specific ingredients and their characteristics like organic vs. natural, with or without fragrance. The most important attribute is one that protects your skin without harmful ingredients. Don’t be fooled by fancy advertisements, a good product should also be affordable, so you can use it every day! Specific moisturizers just for the skin around the eyes should be considered after 40, as the skin is thinner and a bit different from surrounding facial skin. When in doubt, consult your dermatologist.

4) Vitamin A – Topical vitamin A products increase collagen synthesis and tempers discoloration in the skin by peeling away the top dead layer. Essentially, it thickens thinning skin. Retinol is the milder, over-the-counter version and tretinoin or tazarotene is the more concentrated prescription brand. Before age 40, Retinol should be all you need, after that, the stronger tretinoin may be helpful, but consult your plastic surgeon or dermatologist, as you will need a prescription.

5) Anti-Aging Creams-Still somewhat controversial, these products include ingredients Vitamin C, Retinol, Hydroxy Acids, and anti-oxidants like Coenzyme Q-10. Individually, studies have shown that they help to reduce fine wrinkles and improve skin quality. Effectiveness depends upon concentration of specific ingredients and length of use. For this reason dermatologists opinions vary regarding timing of use.

As you can see, we don’t have to sit back and accept our wrinkles without a fight. Let’s age with dignity, but at a slower pace!

If I had known I was going to live this long, I would have taken better care of myself.” — Mae West

This article originally appeared in the Huffington Post and was written by Robert M. Tornambe, a NYC plastic surgeon.