Lifestyle and Youthful Looks

D.A. Gunn; J.L. Dick; D. van Heemst; C.E.M. Griffiths; C.C. Tomlin; P.G. Murray; T.W. Griffiths; S. Ogden; A.E. Mayes; R.G.J. Westendorp; P.E. Slagboom; A.J.M. de Craen


The British Journal of Dermatology. 2015;172(5):1338-1345. 

In This Article

Abstract and Introduction


Background Lifestyle has been proven to have a dramatic effect on the risk of age-related diseases. The association of lifestyle and facial ageing has been less well studied.

Objectives To identify lifestyle factors that associate with perceived facial age in white north European men and women.

Methods Lifestyle, facial wrinkling and perceived facial age were studied in two cross-sectional studies consisting of 318 Dutch men and 329 women aged 45–75 years who were part of the Leiden Longevity Study, and 162 English women aged 45–75 years who were nonsmokers.

Results In Dutch men, smoking, having skin that went red in the sun, being outside in the sun most of the summer, sunbed use, wearing false teeth and not flossing teeth were all significantly associated (P < 0·05) with a total 9·3-year higher perceived facial age in a multivariate model adjusting for chronological age. In Dutch women, smoking, sunbathing, sunbed use, few remaining teeth and a low body mass index (BMI) were associated with a total 10·9-year higher perceived facial age. In English women, cleaning teeth only once a day, wearing false teeth, irregular skin moisturization and having skin that went red in the sun were associated with a total 9·1-year higher perceived facial age. Smoking and sunbed use were associated more strongly with wrinkling in women than in men. BMI, sun exposure and skincare were associated predominantly with perceived facial age via wrinkling, whereas oral care was associated via other facial features.

Conclusions Although associative in nature, these results support the notion that lifestyle factors can have long-term beneficial effects on youthful looks.


One of the goals of ageing research is to provide interventions that can reduce the rate at which damage accumulates in the body and, hence, to help individuals maintain their health and vitality as they age. Heritability studies of the general population indicate that longevity[1] and many age-related diseases[2,3] are influenced predominately by environmental factors. Although stochastic influences are likely to account for some of this environmental influence,[4] lifestyle choices also play a significant role. For example, Khaw et al.[5] demonstrated that four lifestyle factors were additively associated with a fourfold lower mortality risk in a 14-year longitudinal study.

The lifestyles most commonly linked with aspects of skin ageing are smoking[6] and sun exposure.[7] Sun exposure is the main environmental exposure that does not directly affect internal organs in the body, although the production of vitamin D in skin from sun exposure can give indirect beneficial effects.[8] There is evidence that nutrition[9] and sleeping position[10] are linked with the presence and severity of skin wrinkling. However, it is unclear whether variation in normal sleeping patterns affects skin ageing over the long term, although there is evidence that short-term sleep deprivation affects facial appearance.[11]

Facial ageing consists of changes to many tissue types and is, to a degree, reflective of systemic ageing.[12] Indeed, some lifestyle factors that influence human longevity also associate with facial ageing. Rexbye et al.[13] found that smoking, sun exposure, being unmarried, belonging to a low social class and having a low body mass index (BMI) were significantly and independently (of each other and chronological age) associated with a higher perceived age. In addition, Mayes et al.[14] found that sun exposure, low socioeconomic status, exercising every day and poor skin and oral care were significantly and independently associated with a higher perceived facial age.

However, caution should be taken when comparing these studies due to notable differences in their methodology. Youthful looks can apply to many aspects of appearance, such as particular skin sites (e.g. crow's feet), images of the face (with or without eyes/mouth closed) or even videos of individuals walking and talking. Hence, particular attention to the subject matter is important, in order to understand what particular aspects of youthful looks a lifestyle is influencing. Indeed, Rexbye et al.[13] studied the perceived age of elderly (≥ 70 years) white Danish men and women in passport-type images, whereas Mayes et al.[14] studied the perceived facial age of Chinese women aged 25–70 years in facial photographs (i.e. not including hair and clothing cues). Hence, further studies are required to determine which lifestyle factors associate specifically with which ageing features presented for the perception of age.

We investigated the associations of self-reported sleep, alcohol intake, oral care, skincare, sun exposure, sunbed use and smoking with perceived facial age in a white Dutch male and female cohort, and in a white English female cohort. The same perceived facial age methodology and statistical approach were used for the English study as for the Dutch study, and without the influence of any findings from the Dutch cohort.