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Why and how does skin look old?

If you are one of those people who are looking for anti-aging solutions, invest in cosmetics and procedures, it may be useful to understand what is actually happening to your skin.

Dr. Margarita Kacheva gives her advice on the topic.

Skin aging is caused by two main factors:

1) Intrinsic aging, which is basically just a normal result of the passage of time.

This is the same process that all our organs undergo as we age, it happens to all of us, and it is part of the privilege of aging.

Intrinsic aging depends on genetic and physiological factors and is impossible to influence.

2) Extrinsic aging caused by external factors.

External factors are those that we can modify our exposure to and limit their effect on our skin.

Do you know someone who looks younger than their biological age and do you know what their secret is?

Usually, these people start their fight against the biological clock early and rely on preventive routine care.

Studies show that the most important factor in extrinsic aging - by far - is exposure to UV rays.

So limit your time in the sun, don't use tanning beds, apply sunscreen every day.

Other major culprits are smoking and pollution.

Smoking causes skin aging through two main mechanisms: Through the effects of exposure to cigarette smoke (eye irritation, developing crow's feet wrinkles, and repetitive facial movements associated with the act of smoking).

Also with damage to the deeper layers of the skin by causing oxidative stress, increasing the levels of matrix metalloproteinases (enzymes that break down collagen), reducing the synthesis of new collagen and breaking down elastic fibers.

A growing number of studies suggest different approaches to reducing the harm of smoking.

An example of this is tobacco heating products and other similar categories that lack the tobacco combustion process.

The latest available research claims that the emissions created by these alternative products contain significantly lower levels of harmful toxins and chemicals than smoke from regular cigarettes.

However, this does not mean that these types of products are without risk and therefore complete abstinence is preferable. 

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The skin is an important body barrier to reduce the effects of pollution on our health, as we don't just eat and inhale toxins from the environment, we also absorb them through it.

Every day, our skin comes into contact with microscopic pollutant particles that are up to 20 times smaller than our pores.

They go deep into the inner layers of our skin, where they cause inflammation, dehydration and premature aging.

The best way to prevent this process is to maintain a healthy skin barrier function with a proper skin care routine.

Diet also ranks among the factors for extrinsic skin aging.

The use of refined sugar and foods with a high glycemic index, which quickly turn into sugar, affects not only the figure, but also the condition of our skin.

Your body breaks down simple carbohydrates like refined sugars and white flour and turns them into glucose, which then enters the bloodstream.

When this happens, the body produces insulin to counteract the high blood sugar levels, which leads to inflammation – producing enzymes that bind to collagen through an oxidative process known as glycation.

With constant high blood sugar, this process breaks down collagen and elastin, contributing to the aging process.

This does not mean that you should completely give up sugar - in moderation, it is completely safe.

Avoid extremes like completely cutting out sugar, as this can also have a negative effect on your body.

Lifestyle changes should always be achievable and sustainable.

Other extrinsic skin aging factors include stress, lack of sleep, etc., all of which contribute to collagen depletion, elastin dysregulation, and pigmentation changes.

But skin aging isn't the only cause of wrinkles.

As we age, subcutaneous changes occur, such as loss of facial fat and thinning of the bones.

Therefore, if you want to preserve your youth for longer, over time you may think about more invasive procedures.

In conclusion: Much of the aging process is beyond our control, but there are external factors that we can control.

Start taking care of your skin even before you have signs of aging, because prevention is the most effective antiaging choice. 

Who is Dr. Margarita Kacheva?

Dr. Margarita Kacheva graduated in medicine with honors at Sofia Medical University.

He is part of the team of the Clinic for Skin and Venereal Diseases at Achibadem City Clinic Tokuda Hospital Sofia.

Successfully passes the exam of the European Board of Dermatovenereology (EBDV), whose goal is to achieve a high standard of dermatovenerology care in all European countries.

Dr. Kucheva received the board's highest honor - the title of Fellow of the European board of dermatology and venereology (FEBDV).


He is a doctoral student at the Medical University of Sofia to acquire the scientific degree "Doctor of Medicine".

In 2018, he specialized in Dermatohistopathology at the University Hospital Zurich, Switzerland.

He is an assistant at the Faculty of Medicine at Sofia University.

Dr. Kacheva has improved herself at international trainings and practical seminars in the country and abroad.

In 2016, he participated in the Academy of Laser Technologies in Marbella, Spain.

In 2017, he was a fellow of the European Academy of Dermatology and Venereology (EADV), Geneva, Switzerland.

June 2018

conducts training in dermatohistopathology at Ghent University Hospital, Belgium.

December 2018

conducts training in sexually transmitted diseases at the University Hospital Amsterdam, the Netherlands.

Dr. Kacheva's professional interests are in the field of clinical and pediatric dermatology, sexually transmitted diseases, oncodermatosurgery and dermatohistopathology.

To improve his medical qualifications in these areas, he annually attends international congresses and courses.

He is a member of the Bulgarian Dermatology Society and the European Academy of Dermatology and Venereology.


skin care

dermatologist