Lifestyle and Youthful Looks
Lifestyle and Youthful Looks
Here, we find significant evidence for association of sun exposure, sunbed use, smoking, oral care, skincare and BMI with perceived facial age in two white populations. These associations were independent of each other and together could predict up to 11 years of difference in perceived age. Lifestyles of particular note were sun exposure and oral care, as they were significantly associated with perceived age in both sexes and both populations, and in the same direction (greater sun exposure and poor oral care result in looking older). These studies are the first to link oral care and sunbed use with perceived age in a white population, and to examine whether facial wrinkling is predominantly responsible or not for the links between lifestyle and perceived age.
Wrinkling has been noted for many years to be more prevalent in sun-exposed body sites than sun-protected sites, sunscreens have been demonstrated to prevent the appearance of wrinkling, and ultraviolet (UV) radiation causes a wide range of cellular damage, particularly to DNA. In support of this, we found that sunbathing habits and sunbed use were strongly associated with increased wrinkling in women. In men, being outside in the sun during the summer was associated predominately with wrinkling, and sunbed use was equally associated with increased wrinkling and face shape changes. Hence, the use of sunbeds or sunbathing for beauty purposes (a tanned appearance is associated with attractiveness in white populations) in the short term is actually likely to be counterproductive in the long term.
How skin responds to sun exposure after the winter is due mainly to genetic differences, with those who say their skin goes red (after exposure to an hour's sun after the winter) being more prone to sun-induced premature skin ageing. Indeed, Dutch men and English women who reported that their skin goes red in the sun looked older than those who said their skin tans. However, no significant association was found in the Dutch women, and skin type was strongly associated with face shape changes in the men, whereas it was more strongly associated with wrinkling in the English women. Hence, the exact role that skin type plays in the development of facial ageing features is unclear, possibly in part as the skin type question responses were also likely indicative of sun exposure behaviour (e.g. those whose skin goes red in the sun could be more likely to avoid sun exposure than those whose skin tans). More accurate measurements of skin type and sun exposure are now required to dissect their influences on facial ageing features.
Smoking is strongly linked to skin ageing features independently of potential confounders such as sun exposure, BMI and social economic status, and smokers have greater skin elastosis, lower levels of skin oxygenation and reduced collagen, but enhanced collagenase production response in vivo to UV radiation. Here, smoking was significantly associated with perceived facial age in Dutch women and men, but was more strongly associated with wrinkling in the women, compared with face shape changes in the men. Evidence for differences between sexes for smoking effects is limited, although one previous study found that female but not male smokers had more wrinkles than nonsmokers. Overall, this study supports the overwhelming evidence that smoking is a driver of skin ageing, but further study is required to determine whether there are sex differences in the effects of smoking on the skin.
A higher BMI was previously found to be significantly associated with a lower perceived age and reduced wrinkling. We found the same association in women; a similar trend was found in the men, but this was not statistically significant (data not shown). BMI was also more strongly associated with wrinkling than face shape changes in the women. Increased facial fat could reduce the appearance of wrinkles by expanding the skin outwards in a similar manner to facial fillers. Hence, although obesity has a negative impact on ageing systemically, in the face this effect is likely masked (at least in middle-aged to elderly populations) by the reduction in skin wrinkling. Indeed, we found evidence that once the wrinkling grading was adjusted for, a higher BMI was associated with a higher perceived facial age (Table S2; see Supporting Information>). In support of this, facial sagging is linked to increased subcutaneous fat in the face, and mice fed on a high-fat diet had increased skin elasticity and reduced dermal thickness. Thus, although an increased BMI could help reduce the appearance of wrinkles it could well lead to premature facial sagging.
Although the subjects had their mouths closed, aspects of oral care were significantly associated with perceived facial age in all groups studied, and were also associated with perceived facial age in a Chinese cohort using an identical perceived age methodology. A causal link between oral care and perceived age cannot be determined from this study and, thus, it is possible that the oral care questions were just proxies of other lifestyle factors (e.g. diet). However, the number of teeth and the condition of the surrounding gums are known to have a direct influence on the appearance of overlying tissues. For example, people look younger with their mouths closed after receiving new dentures than before, and the number of teeth or the use of dentures has been linked to lip size and the appearance of the labiomental fold. Hence we postulate that the oral care questions, irrespective of the question specifics, were proxies of the overall condition of the mouth, which, through its support to the overlying tissues and their subsequent appearance, can influence perceived facial age.
There is currently little evidence that variation of alcohol consumption within recommended intake levels affects skin ageing, and we could find no association between self-reported alcohol intake levels and perceived facial age. We also found little evidence for any association between sleep length or quality and perceived facial age, in contrast to studies showing how acute sleep deprivation can influence facial appearance. This could be due to the fact that self-report is not a good indicator of actual sleep length and quality (or alcohol intake), or that long-term differences in sleep length and quality have only a small impact on facial appearance. Larger studies with more accurate measures of alcohol intake and sleep are now required to determine whether they influence facial ageing.
Regular skin moisturization was significantly associated with a lower perceived facial age in the English but not the Dutch cohort. There is some evidence that skin moisturization is capable of directly influencing skin ageing. For example, it has been shown to improve skin hydration and condition, to reduce the presence of inflammation markers and, in a Chinese study, to associate with lower perceived facial age. However, as self-reported moisturizer use did not significantly associate with perceived facial age in the larger Dutch cohort, and the studies were cross-sectional, the causal nature of moisturizer use with skin ageing cannot be determined. Other limitations to the studies here include the reliance on self-report for lifestyle exposures (e.g. frequency of teeth cleaning captured current rather than historical habits) and the fact the Dutch subjects consisted partly of individuals from long-lived families. However, the families are long lived due to genetic and early-life experiences, rather than their adult lifestyle, and similar perceived age differences were found within the controls as per the whole cohort (data not shown), suggesting that similar results should be found in other Dutch cohorts, although replication is warranted. Although the lifestyle factors were additive within the multivariate model, we lacked the statistical power to detect interactions between the lifestyles (e.g. sun avoidance ameliorates the effects of smoking), and larger studies are required to detect such interactions.
Chauhan et al. demonstrated that cosmetic surgery can reduce an individual's perceived age by up to 8 years. Here, we find up to 11 years' difference between those who report an 'optimal' lifestyle and those with the least 'optimal' lifestyle. This indicates that lifestyle could have a larger influence on youthful looks than cosmetic surgery. Although caution is warranted due to the associative nature of the relationships found, these data support the notion that lifestyle can have a large impact on the preservation of youthful looks and could be a motivating message for some to adopt a more healthy lifestyle.
Discussion
Here, we find significant evidence for association of sun exposure, sunbed use, smoking, oral care, skincare and BMI with perceived facial age in two white populations. These associations were independent of each other and together could predict up to 11 years of difference in perceived age. Lifestyles of particular note were sun exposure and oral care, as they were significantly associated with perceived age in both sexes and both populations, and in the same direction (greater sun exposure and poor oral care result in looking older). These studies are the first to link oral care and sunbed use with perceived age in a white population, and to examine whether facial wrinkling is predominantly responsible or not for the links between lifestyle and perceived age.
Wrinkling has been noted for many years to be more prevalent in sun-exposed body sites than sun-protected sites, sunscreens have been demonstrated to prevent the appearance of wrinkling, and ultraviolet (UV) radiation causes a wide range of cellular damage, particularly to DNA. In support of this, we found that sunbathing habits and sunbed use were strongly associated with increased wrinkling in women. In men, being outside in the sun during the summer was associated predominately with wrinkling, and sunbed use was equally associated with increased wrinkling and face shape changes. Hence, the use of sunbeds or sunbathing for beauty purposes (a tanned appearance is associated with attractiveness in white populations) in the short term is actually likely to be counterproductive in the long term.
How skin responds to sun exposure after the winter is due mainly to genetic differences, with those who say their skin goes red (after exposure to an hour's sun after the winter) being more prone to sun-induced premature skin ageing. Indeed, Dutch men and English women who reported that their skin goes red in the sun looked older than those who said their skin tans. However, no significant association was found in the Dutch women, and skin type was strongly associated with face shape changes in the men, whereas it was more strongly associated with wrinkling in the English women. Hence, the exact role that skin type plays in the development of facial ageing features is unclear, possibly in part as the skin type question responses were also likely indicative of sun exposure behaviour (e.g. those whose skin goes red in the sun could be more likely to avoid sun exposure than those whose skin tans). More accurate measurements of skin type and sun exposure are now required to dissect their influences on facial ageing features.
Smoking is strongly linked to skin ageing features independently of potential confounders such as sun exposure, BMI and social economic status, and smokers have greater skin elastosis, lower levels of skin oxygenation and reduced collagen, but enhanced collagenase production response in vivo to UV radiation. Here, smoking was significantly associated with perceived facial age in Dutch women and men, but was more strongly associated with wrinkling in the women, compared with face shape changes in the men. Evidence for differences between sexes for smoking effects is limited, although one previous study found that female but not male smokers had more wrinkles than nonsmokers. Overall, this study supports the overwhelming evidence that smoking is a driver of skin ageing, but further study is required to determine whether there are sex differences in the effects of smoking on the skin.
A higher BMI was previously found to be significantly associated with a lower perceived age and reduced wrinkling. We found the same association in women; a similar trend was found in the men, but this was not statistically significant (data not shown). BMI was also more strongly associated with wrinkling than face shape changes in the women. Increased facial fat could reduce the appearance of wrinkles by expanding the skin outwards in a similar manner to facial fillers. Hence, although obesity has a negative impact on ageing systemically, in the face this effect is likely masked (at least in middle-aged to elderly populations) by the reduction in skin wrinkling. Indeed, we found evidence that once the wrinkling grading was adjusted for, a higher BMI was associated with a higher perceived facial age (Table S2; see Supporting Information>). In support of this, facial sagging is linked to increased subcutaneous fat in the face, and mice fed on a high-fat diet had increased skin elasticity and reduced dermal thickness. Thus, although an increased BMI could help reduce the appearance of wrinkles it could well lead to premature facial sagging.
Although the subjects had their mouths closed, aspects of oral care were significantly associated with perceived facial age in all groups studied, and were also associated with perceived facial age in a Chinese cohort using an identical perceived age methodology. A causal link between oral care and perceived age cannot be determined from this study and, thus, it is possible that the oral care questions were just proxies of other lifestyle factors (e.g. diet). However, the number of teeth and the condition of the surrounding gums are known to have a direct influence on the appearance of overlying tissues. For example, people look younger with their mouths closed after receiving new dentures than before, and the number of teeth or the use of dentures has been linked to lip size and the appearance of the labiomental fold. Hence we postulate that the oral care questions, irrespective of the question specifics, were proxies of the overall condition of the mouth, which, through its support to the overlying tissues and their subsequent appearance, can influence perceived facial age.
There is currently little evidence that variation of alcohol consumption within recommended intake levels affects skin ageing, and we could find no association between self-reported alcohol intake levels and perceived facial age. We also found little evidence for any association between sleep length or quality and perceived facial age, in contrast to studies showing how acute sleep deprivation can influence facial appearance. This could be due to the fact that self-report is not a good indicator of actual sleep length and quality (or alcohol intake), or that long-term differences in sleep length and quality have only a small impact on facial appearance. Larger studies with more accurate measures of alcohol intake and sleep are now required to determine whether they influence facial ageing.
Regular skin moisturization was significantly associated with a lower perceived facial age in the English but not the Dutch cohort. There is some evidence that skin moisturization is capable of directly influencing skin ageing. For example, it has been shown to improve skin hydration and condition, to reduce the presence of inflammation markers and, in a Chinese study, to associate with lower perceived facial age. However, as self-reported moisturizer use did not significantly associate with perceived facial age in the larger Dutch cohort, and the studies were cross-sectional, the causal nature of moisturizer use with skin ageing cannot be determined. Other limitations to the studies here include the reliance on self-report for lifestyle exposures (e.g. frequency of teeth cleaning captured current rather than historical habits) and the fact the Dutch subjects consisted partly of individuals from long-lived families. However, the families are long lived due to genetic and early-life experiences, rather than their adult lifestyle, and similar perceived age differences were found within the controls as per the whole cohort (data not shown), suggesting that similar results should be found in other Dutch cohorts, although replication is warranted. Although the lifestyle factors were additive within the multivariate model, we lacked the statistical power to detect interactions between the lifestyles (e.g. sun avoidance ameliorates the effects of smoking), and larger studies are required to detect such interactions.
Chauhan et al. demonstrated that cosmetic surgery can reduce an individual's perceived age by up to 8 years. Here, we find up to 11 years' difference between those who report an 'optimal' lifestyle and those with the least 'optimal' lifestyle. This indicates that lifestyle could have a larger influence on youthful looks than cosmetic surgery. Although caution is warranted due to the associative nature of the relationships found, these data support the notion that lifestyle can have a large impact on the preservation of youthful looks and could be a motivating message for some to adopt a more healthy lifestyle.
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