Here’s an evidence-based skincare routine that I use and recommend to my patients in the clinic. It starts with the fundamentals, and we’ll look at some of the latest evidence for their impact.
Then we’ll move through some additional, more advanced therapies. This way, you can pick and choose the best mix for you when it comes to preventing—and even reversing—the signs of skin aging.
Table of Contents
- Building Blocks: Skin Health From Inside Out
- Extrinsic Factors: Maintenance and Protection
- Extrinsic Factors: Treatments
- Conclusion
- References
Building Blocks: Skin Health From Inside Out
To combat skin aging most effectively, it’s important to understand what’s driving it.
Everyone knows the sun can age our skin. But some of the key factors contributing to skin health go unaddressed because they’re far less obvious.
Researchers divide the factors behind skin aging into two types: intrinsic and extrinsic. The sun is extrinsic—it comes from the outside. But there are important intrinsic factors at work, too.
There is a natural, genetically driven aging process that unfolds slowly as we grow older. Several things happen simultaneously:
- Cells age, and their activity slows down.
- Fibroblasts, which make collagen, don’t produce as much. Collagen is a crucial protein that gives structure to the skin [1].
- The upper layer of the skin—the epidermis—thins out.
-
The skin gradually loses its ability to retain moisture. This is due to degeneration of elastin, fibrillin, collagens, and even oligosaccharides [2].
These changes at the cellular level produce the hallmarks of aging skin: loss of elasticity and firmness, fine lines and wrinkles, dryness, and uneven coloration.
We already know the bad news—we can’t stop the aging process. But here’s the crucial point: our choices can have a big impact on how slowly or quickly it happens. They help create the environment for our skin. Some environments promote healthy, youthful skin. Others do the opposite.
So what do we need to pay attention to?
There are three fundamental internal factors that help create that skin-supportive environment. These don’t just impact skin—they are also among the most important determinants of overall health.
1. Diet
How you eat impacts how your skin looks.
One study found that simply increasing fruit and vegetable intake over six weeks led to measurable improvements in skin color, which were seen as healthier and more attractive [3].
But let’s explore this on a deeper level.
We know that getting adequate amounts of essential vitamins and minerals is critical for healthy skin, just as it is for all organ systems. But there are also less obvious connections.
One of the most fascinating is the link between gut health and skin health—also known as the gut-skin axis.
The food we eat affects the balance and activity of bacteria in our digestive tract. These gut microbes then influence the delicate balance of microorganisms on our skin. When the gut microbiome is disrupted—due to poor diet, for instance—it can cause inflammation and worsen skin health [4].
A detailed review identified a list of key nutrients connected to healthy skin:
- Vitamin A
- Carotenoids
- Vitamin C
- Vitamin D
- Vitamin E
- Zinc
- Copper
- Selenium
- Silicon
- Polyphenols (a group of 8,000+ plant compounds)
-
Essential fatty acids [4]
The dietary pattern that supports skin health will look familiar:
- Minimize processed foods
- Emphasize fresh fruits and vegetables
- Choose whole grains
- Include nuts, seeds, and lean proteins
-
Patterns like the Mediterranean or DASH diet are excellent choices [4]
Another study adds that we also want to drink enough water and minimize refined sugar intake for optimal skin function [5].
Specific Nutrients and Supplements
Let’s take a closer look at a few compounds shown to support youthful skin.
Collagen Peptides
A 2023 meta-analysis of 26 randomized controlled trials involving 1,721 participants found that hydrolyzed collagen peptides significantly improved:
- Skin hydration: Z = 4.94, p < 0.00001
-
Skin elasticity: Z = 4.49, p < 0.00001 [6]
These are two of the most important markers of collagen’s effect on the skin.
Hyaluronic Acid
This is a naturally occurring substance in the skin, joints, and eyes. It acts like a sponge—just ¼ teaspoon can hold 1.5 gallons of water.
It provides structural support to keep skin plump, hydrated, and smooth.
In a 2021 study, oral hyaluronic acid supplementation reduced wrinkles by 18.8%, compared to only 2.6% in the placebo group [7].
A larger 2023 study with 129 participants showed:
- Improved hydration in both young and older participants
- Skin tone improvements after 4–8 weeks
-
Increased epidermal thickness after 12 weeks [8]
Because of this evidence, I include both collagen peptides and hyaluronic acid in MicroVitamin+ Powder to support my own skin. But you don’t have to take supplements just because I do.
2. Exercise
After diet, exercise is the next big factor influencing skin health.
A 2023 study put 61 sedentary middle-aged women on a 16-week program. Half did aerobic training, the other half resistance training [9].
Results:
- Both groups improved skin elasticity and upper dermal structure
- The resistance training group also increased skin thickness—important, since thinning is a hallmark of aging skin
And it didn’t stop at the surface.
Blood samples revealed that both forms of exercise boosted gene expression for:
- Collagens (COL3A1, COL6A1, COL14A1)
- Hyaluronan synthase (HAS2)
-
Proteoglycans (decorin [DCN], versican [VCAN], chondroitin polymerizing factor [CHPF])
These are critical for healthy skin architecture [9].
Conclusion: To maximize benefits, combine both aerobic and resistance training.
3. Sleep
Sleep is when the body focuses on repair and regeneration—including skin cells.
One review found that the repair of sun-damaged DNA in skin peaks at night [10].
Poor sleep is associated with:
- Increased signs of aging [1]
- Greater trans-epidermal water loss
- Slower recovery from UV-induced irritation [11]
-
Lower skin elasticity, reduced hydration, and increased oxidative stress [12]
In fact, one study showed that just two nights of sleep restriction led to:
- Reduced hydration
- Increased TEWL
- Higher skin acidity (pH)
-
Delayed extensibility and elasticity [12]
So sleep is not just beauty rest—it’s biological repair time.
Extrinsic Factors: Maintenance and Protection
We’ve covered the internal fundamentals. Now let’s look at external protection and maintenance, starting with the single most essential product in any skincare routine:
Sunscreen
UV radiation is the #1 extrinsic cause of skin aging—accounting for up to 80% of facial aging [2].
A 2013 randomized trial with 903 adults found that those who applied sunscreen daily showed no signs of new skin aging over 4.5 years [13].
A 2016 follow-up showed even better news: sunscreen didn’t just prevent aging—it reversed signs like pigmentation and skin texture [14].
To illustrate this visually: a photo of a 92-year-old woman who applied sunscreen only to her face—but not her neck—for decades shows dramatic differences in skin aging between the two areas [JDV photo].
Chemical Sunscreen Absorption
However, some chemical sunscreen ingredients raise concerns.
A 2020 study found that six common sunscreen chemicals were absorbed into the bloodstream above the FDA’s safety thresholds [15].
This doesn’t prove harm, but it means that long-term safety is unclear, and additional testing is required.
Safer Sunscreen Options
Mineral sunscreens, such as zinc oxide and titanium dioxide, are not absorbed through the skin. A 2024 study concluded that they are the safest, most well-tolerated options with the fewest potential adverse effects [16].
Some newer chemical sunscreens are also promising. They’re broad-spectrum, minimally absorbed, and more stable.
Examples include:
- TriAsorB (phenylene bis-diphenyltriazine): absorbs UV and some infrared, forms large aggregates (over 100 nm), so skin absorption is minimal [17]
-
Bemotrizinol (BEMT): shows very limited absorption with no buildup in the bloodstream [18]
Since I live in New Zealand, I have access to sunscreens without the 12 FDA-flagged ingredients. My current favorite is:
-
Beauty of Joseon: Relief Sun Aqua-Fresh: Rice + B5 SPF50+
Other great options include: - Round Lab: Birch Juice Moisturising Sunscreen
- Skin1004: Madagascar Centella Hyalu-Cica Sun Serum
- Haruharu Wonder: Black Rice Airyfit Daily Sunscreen
If I didn’t have access to these, I’d use:
- CeraVe 100% Mineral Sunscreen SPF 50, which uses titanium dioxide and zinc oxide, with none of the flagged ingredients
Make sure any sunscreen you choose offers:
- Broad-spectrum protection (UVA + UVB)
- SPF 50 or higher
Moisturizer
Moisturizers:
- Improve hydration
- Support the skin’s natural barrier
-
Reduce water loss
They usually contain:
- Humectants (pull moisture into the skin)
- Occlusives (prevent moisture loss)
-
Emollients (smooth and soften the skin surface)
A standout ingredient is ceramides—lipids that act like the “mortar” between skin-cell “bricks” [19].
One study found that ceramide cream improved water content by 30.6% in just 3 days in people with dry skin [19].
Another found reduced skin damage and improved barrier function compared to regular barrier creams.
I personally use CeraVe PM Facial Moisturizer, which includes ceramides and niacinamide (vitamin B3), a compound that can improve skin texture and reduce inflammation.
Retinoids
Retinoids are compounds derived from vitamin A. They play a major role in rejuvenating skin by:
- Blocking UV-induced collagen breakdown
- Stimulating new collagen production
- Strengthening the skin barrier
- Reducing water loss
- Inhibiting enzymes that degrade skin’s support structures
Think of retinoids as personal trainers for your skin cells. Just like a trainer helps you get stronger, retinoids push your skin to renew faster and produce more collagen.
The most well-known and well-studied is tretinoin, originally developed to treat acne. But patients using it also noticed improvements in skin texture, pigmentation, and signs of aging.
A meta-analysis of 180 studies found that topical tretinoin improves:
- Wrinkling
- Uneven pigmentation
- Sallowness
- Age spots
-
Overall skin appearance
...in as little as one month, with improvements continuing over 24 months [20].
Newer Retinoids: Less Irritation
Some people find tretinoin too irritating. This led to the development of third-generation retinoids like adapalene, which target skin receptors more selectively and cause less irritation.
Does this mean they’re less effective?
A 2018 head-to-head trial compared adapalene 0.3% gel and tretinoin 0.05% cream. The result?
- Equal effectiveness for treating wrinkles, pigmentation, and photoaging
- Similar safety profile [21]
How to Use Retinoids
-
Use at night, since they degrade in sunlight and increase sun sensitivity
- Apply every third or fourth night at first
- Gradually increase frequency as your skin adjusts
- Always follow with moisturizer
- Avoid during pregnancy
The most common side effects—dryness, redness, stinging—tend to subside over time. Go slow and be consistent.
Exfoliants
Exfoliants help remove dead skin cells and stimulate skin renewal. I use chemical exfoliants, which are more precise and less damaging than physical scrubs.
There are two main types:
- Alpha-hydroxy acids (AHAs) – e.g., glycolic acid, lactic acid
-
Beta-hydroxy acids (BHAs) – e.g., salicylic acid
These increase skin turnover and stimulate collagen and elastin production [22].
In one study, 12% lactic acid improved:
- Epidermal and dermal thickness
- Skin firmness
- Smoothness
-
Appearance of wrinkles [23]
I use two products from Paula’s Choice:
- 2% salicylic acid
-
8% glycolic acid
Important: Most people should not use exfoliants and retinoids on the same night. It can cause significant irritation. While my skin can tolerate it, that’s not typical. I advise my patients to start with only one active product per night.
Also, retinoids take time—think months, not days—to deliver visible anti-aging benefits.
Extrinsic Factors: Treatments
Now let’s cover advanced clinical or device-based treatments that produce the most dramatic results in the shortest time.
Fractional Non-Ablative Lasers
Laser treatments go back decades. Traditional ablative lasers remove the top layer of skin and stimulate collagen remodeling—but have significant downtime.
Fractional non-ablative lasers are a gentler, smarter approach.
- “Non-ablative” means they don’t remove the surface skin
- Instead, they penetrate below the surface and apply heat to stimulate renewal
-
“Fractional” means they treat columns of skin, leaving surrounding areas untouched. This promotes faster healing with less risk
The untreated skin between the columns helps speed up recovery.
I get fractional non-ablative laser treatments every 6 months.
Intense Pulsed Light (IPL)
Unlike lasers (which use a single wavelength), IPL uses broad-spectrum light to target:
- Freckles and pigmentation
- Small red veins
-
Sun-damaged skin
It’s especially effective at clearing redness and broken capillaries—common issues in aged, sun-exposed skin.
Minimal downtime. I get IPL treatments every 4 months.
Red Light Therapy (Photobiomodulation)
Red light therapy is becoming increasingly popular—and for good reason.
It uses LEDs to deliver red (660 nm) and near-infrared (NIR, 850 nm) light to the skin. These wavelengths have multiple benefits:
- Stimulate mitochondria to produce more ATP (cellular energy), especially via cytochrome c oxidase activation [24]
- Reduce inflammation by decreasing pro-inflammatory cytokines [25]
-
Stimulate fibroblasts to produce collagen and elastin—the building blocks of firm, youthful skin [26]
Wrinkle Reduction Evidence
In a 2023 split-face clinical trial with 137 women, red and amber light were applied to opposite sides of the face:
- Red light reduced wrinkle volume by 31.6%
-
Amber light reduced wrinkles by 29.9% [27]
Red light therapy is:
- Non-invasive
- Affordable
- Has no downtime
Botox
Here’s an irony: a toxin can help rejuvenate the skin.
Botox is a purified neurotoxin that blocks muscle contractions, preventing the formation of dynamic wrinkles.
When injected properly, it can:
- Smooth existing lines
- Prevent new ones
-
Maintain a natural facial appearance
A recent systematic review found Botox to be:
- Highly effective
- Minimally invasive
-
Safe when administered by trained professionals [28]
It works best on expression-related wrinkles, such as crow’s feet or frown lines.
Conclusion
A thoughtful, evidence-based skincare routine includes:
- Internal building blocks: diet, exercise, sleep
- Daily maintenance: sunscreen, moisturizer
- Nightly actives: retinoids, exfoliants
-
Clinical-grade treatments: lasers, red light, Botox
Consistency is key—results won’t happen overnight, but they will happen with time, effort, and science on your side.
References
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC11845971/
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC6047276/
3. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0032988
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11723311/
5. https://www.sciencedirect.com/science/article/abs/pii/S0899900723003787
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC10180699/
7. https://pubmed.ncbi.nlm.nih.gov/34933842/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661223/
9. https://www.nature.com/articles/s41598-023-37207-9
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC6777699/
11. https://pubmed.ncbi.nlm.nih.gov/25266053/
12. https://www.sciencedirect.com/science/article/pii/S1389945721005761
13. https://pubmed.ncbi.nlm.nih.gov/23732711/
14. https://pubmed.ncbi.nlm.nih.gov/27749441/
15. https://jamanetwork.com/journals/jama/fullarticle/2759002
16. https://pmc.ncbi.nlm.nih.gov/articles/PMC11022667/
17. https://link.springer.com/article/10.1007/s43630-023-00453-x
18. https://www.sciencedirect.com/science/article/pii/S0273230023000120
19. https://onlinelibrary.wiley.com/doi/10.1111/exd.70042
20. https://pmc.ncbi.nlm.nih.gov/articles/PMC9112391/
21. https://pubmed.ncbi.nlm.nih.gov/30105991/
22. https://pmc.ncbi.nlm.nih.gov/articles/PMC11268769/
23. https://pubmed.ncbi.nlm.nih.gov/8784274/
24. https://pubmed.ncbi.nlm.nih.gov/38309304/
25. https://pmc.ncbi.nlm.nih.gov/articles/PMC11049838/
26. https://pubmed.ncbi.nlm.nih.gov/33594706/
