Turkey Necklace
Photo: Fernando Milani
Several years ago I wrote a story called 7 Things Nobody Ever Tells You About Aging. Lots of you commented on it. So the editors at Oprah.com thought it would be a good idea for me to write a kind of addendum to it. Something like "6 More Things Nobody Ever Tells You." "It'll be easy," they told me. "You won't even have to do any research." By which they meant that I could look back into the beauty story archives and pull out those pieces that had to do with specific challenges to your looks as you age. (And by which they didn't mean, as I immediately thought, that all I would have to do is to gaze down at my 60-year-old body to discover "6 More Things Nobody Ever Tells You." They didn't mean that. They swear it.) So here are six more decrepitudinous things you either have to look forward to if you're lucky enough to make it into your fourth, fifth, and sixth decades and beyond, or, well, if, like me, a glance in your mirror tells you unequivocally that things they are a-changing.

1. You may develop "turkey neck"

Why: The skin around the neck is particularly prone to the wear and tear of aging because it's thinner than facial skin and has a different collagen content, says Alan Matarasso, MD, clinical professor of plastic surgery at the Albert Einstein College of Medicine in New York City. Plus, it's one of the most sun-exposed parts of the body, making it especially vulnerable to UVA/UVB damage.

What to do about it: You can take preventative measures by using the same prescription or prescription-strength products on your neck that you apply on your face, including retinoids (such as Retin-A, Renova, or Tazorac), and, of course, sunscreen every day.

But the problem with turkey neck is that once you have one, you can't get dramatically improved results without taking dramatic action. Think of your neck as a skirt that needs hemming, suggests the metaphorically gifted Matarasso. You can iron the skirt (meaning treat it with various lasers, which can help smooth the skin) and reinforce the fabric of the skirt (meaning apply creams like retinoids that will encourage production of collagen and elastin), but unless you hem the skirt, you won't lose the excess fabric. What does "hemming" entail? An incision behind the earlobes, suctioned fat, lifted and tightened muscles, and a small scar from behind the ears into the hairline. (Not to mention a recovery time of 10 to 14 days, and a cost of about $10,000.)

Bottom line: If your turkey neck is in full swing, neither lasers nor creams will make an appreciable difference. However, before you send your neck to the tailor, think long and hard about what people see when they look at you. Your magnificent eyes and delicious smile may render your neck way less noticeable than you think.

2. Your hair gets frizzier and more brittle

Why: As we age, our scalp can become drier, which can make the hair drier, too; and when hair loses its pigment, turning gray or white, its texture often becomes frizzier, says David H. Kingsley, PhD, a board-certified trichologist.

What to do about it: Your hair needs moisture, and the best way to restore it is with a moisturizing shampoo and conditioning treatments. Use a leave-in conditioner daily and a deep-conditioner or a thick hair mask once a week (Oprah's longtime stylist, Andre Walker, launched a Keratin Mask and Treatment Pak that you can leave on for five minutes in the shower). Make sure you also eat well and regularly; include enough protein in your diet; exercise; drink enough water (so that you're not thirsty); and to hedge your bets, take a multivitamin, says Kingsley.

Bottom line: Maintaining a healthy diet and keeping your hair well moisturized will make it look healthier and shinier no matter what your age.

Related: Got thinning hair? Here's help.

Next: Are you starting to see spots?

3. You're more prone to facial redness

Why: Those great beach vacations you took in your teens are showing up on your face: You're beginning to see cumulative sun damage in the form of blotchiness, red spots, and ruddiness. Menopause can also cause a multitude of skin problems, including extreme dryness and rosacea.

What to do about it: To tone down the pink with makeup, start by applying a lightweight moisturizer with sunblock. On top of that, apply a silicone gel primer over your entire face, says Tim Quinn, Giorgio Armani Beauty makeup artist. (The primer creates a smooth surface for foundation.) Then blend a very small amount of green—yes, green—concealer over the areas that are most pink (try Physicians Formula Mineral Wear Concealer Stick). Finally, with a brush—because it gives you the best coverage—apply a yellow-based, long-wearing foundation. (Quinn says Giorgio Armani UV Lasting Silk Foundation in shade 4.5 flatters almost any skin tone.)

Rosacea can be treated with topical antibiotics—such as MetroGel and Rosac, oral antibiotics and lasers. If your biggest problem is broken blood vessels, usually two to three treatments with either the KTP, pulsed-dye, or diode laser will zap your veins, says Roy G. Geronemus, MD, clinical professor of dermatology at the New York University Medical Center. But, if you have rosacea, remember to avoid triggers that induce flare-ups, including the sun, stress, alcohol (especially red wine), spicy or thermally hot foods and drinks, and even exercise, says Jeanine Downie, MD, coauthor of Beautiful Skin of Color. (She advises patients to drink ice water when they work out, to cool the face.) It also helps to use gentle products and to avoid irritating your skin by scrubbing.

Bottom line: You can tone down the redness with a mix of lasers, oral and topical treatments and makeup, but if you have rosacea, avoiding your triggers is a must.

4. You may start to see spots

Why: Age spots can be either light (hypopigmentation) or dark (hyperpigmentation), says Wendy E. Roberts, MD, assistant clinical professor of medicine at Loma Linda University, and both are caused by sun damage and excess melanin in the skin.

What to do about it: To prevent age spots in the first place, wear an SPF of at least 15 every day. If you already have hypopigmentation, a self-tanner can help blend the spot into your complexion. If you've got hyperpigmentation, apply a topical prescription bleaching agent like Solagé (2 percent mequinol) directly to the spots, which will fade them gradually. A hydroquinone cream also inhibits melanin production—at prescription-strength (4 percent), it should fade darkness in four to eight weeks. An over-the-counter (2 percent) cream takes at least eight to 12 weeks. However, the most effective way to get rid of them is with a laser treatment—either the Q-switched ruby or alexandrite, says Anne Chapas, MD, clinical assistant professor of dermatology at NYU School of Medicine. It leaves a small scab where the spot was, but this disappears in a couple of weeks. Generally one or two treatments are needed, at $400 to $700 per session. If your spots are diffuse (like a Milky Way splash across your cheeks or chest), Chapas recommends the new Fraxel dual laser. One or two treatments, at $750 to $1,500 each, should do the trick. (And for that kind of money, let's hope so.)

Bottom line: Unless you wear a broad spectrum sunscreen every day, rain or shine, you'll be looking at new age spots no matter how often you visit the dermatologist.

Next: How to get rid of spider veins

5. Your legs start to resemble a roadmap

Why: Maybe you noticed a couple of faint squiggles around your ankles a few years back. Now you see blue lines, like kudzu gone wild, creeping behind your knees, over your thighs. Though no one knows exactly what causes them, visible veins are probably influenced by genetics and hormones. Obesity and standing or sitting for long periods may also exacerbate blood pooling in the legs, which can cause some veins to swell and rise toward the surface of the skin.

What to do about it: If the squiggles are relatively light, a coat of self-tanner will be enough to camouflage them. A leg bronzer will also mask veins or broken capillaries—and wash off at the end of the day. (Yves Saint Laurent Make-Up Leg Mousse imparts both a veil of color and a cooling sensation.) When you want more serious coverage, makeup artist Mally Roncal recommends blending a concealer on top of veins, painting the makeup on with a brush, and then distributing it evenly with your fingers. (Choose something pretty heavy, like Dermablend Leg & Body Cover Creme.) A few pats of translucent powder will set the color, but you'll still want to avoid water sports and games of footsie for the rest of the day.

Want to dissolve that roadmap altogether? The tiniest veins can be zapped with a Vbeam, YAG, or diode laser. The beam destroys the walls of the veins (it will feel like a few quick rubber-band snaps), causing them to disappear within about two weeks. You'll need about three treatments. If the veins are large enough to be threaded with a tiny needle, sclerotherapy—the injection of various solutions into the blood vessels—is the best option, says Tina Alster, MD, clinical professor of dermatology at the Georgetown University Medical Center in Washington, D.C. The solution irritates the vein's lining and the resulting tissue inflammation causes the blood vessel to collapse and fade. The treatment takes 10 to 30 minutes, depending on the number of veins, and is nearly painless, but you may experience mild redness and swelling along the course of the treated veins. (Avoid sclerotherapy immediately before or during menstruation because of heightened sensitivity.) Expect to pay about $300 to $500 per treatment. Hate needles? You could try vascular laser treatments instead, which are a little more uncomfortable because they zap the veins with heat, says Dr. Alster.

Bottom line: The best time to have treatments for spider veins is in the winter, when your legs are covered and more easily protected from the sun. Tanned skin reduces visibility of the veins during the procedures and increases the risk of post-treatment hyperpigmentation. Be forewarned: You won't be vein-free forever; after a couple of years, new ones will probably form.

6. Your lipstick starts to bleed into the lines around your mouth

Why: I have those lines, and they're called perioral rhytids. And because when I develop something—especially something undesirable—I'm always curious about how it got there, I asked Stuart H. Kaplan, MD, assistant clinical professor of dermatology at UCLA Medical Center, what causes them. He told me: repeated pursing of the lips; sun exposure; loss of subcutaneous fat, collagen, and elastin, which form the structural support of the skin, and of hyaluronic acid, which moisturizes; and genetic predisposition.

What to do about it: As for getting rid of these annoying lines, if you're a smoker, forget it. You don't smoke? Good! But if, like me, some of your favorite ways to pass the time include sucking a thick chocolate malted through a straw, kissing, slurping martinis, and kissing—oh, the louche life of the beauty editor!—you may be fighting a losing battle. On the other hand, you can prevent the lines from getting worse by applying sunscreen to the area between your lip and nose and using a topical retinoid, like Retin-A, Renova, Avage, or Tazorac, which helps build collagen and thicken the skin. If you believe you need the help of a power tool, then an ablative laser treatment, which resurfaces the skin, might be the ticket, says Kaplan. He also suggests injections of small amounts of Botox to prevent pursing, but warns of the risk of losing the ability to enunciate certain consonants. (That's all I needed to hear to reject that option.) Finally, Kaplan suggests the filler Restylane to plump up the creases. Results generally last up to six months.

Bottom line: A good offense is the best defense, so use sunscreen and a retinoid to prevent the lines from getting deeper.

Val Monroe Answers All Your Questions!
From the June 2011 issue of O, The Oprah Magazine.


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