Fanny or face? Ladies, you just might need to choose

It's another sunny day in Miami Beach, and the waiting room of cosmetic dermatologist Leslie Baumann, M.D., is packed with lean, bronzed women, lined up like pretzel sticks in a box. Among them is Sarah,* the 39-year-old host of a local TV show, who's frantic about her glabellar lines—that's skin-speak for the vertical lines (a.k.a. 11's) that tend to show up between the eyebrows when you hit your mid to late thirties. She seems a little annoyed, but that's partly the lines' fault.

See, in addition to making you look older, they can give you a slightly pissed-off appearance. Old and angry isn't a look any woman covets, certainly not one who makes her living as a personality on a morning television show.

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From the neck down, Sarah could pass for a high school athlete. Weighing in at 120 pounds, with a tight little butt and flat abs, she's fitter than she was as a teenager. The old face/young body contradiction is one that's familiar to Baumann, who has been known to tell clients in the past, "Sorry, you just might have to choose between your face and your rear end."

Her words echo a quote that is often attributed to French actress Catherine Deneuve, who reportedly said, "After a certain age, you have to choose between your fanny and your face." Here's what she meant: Many of the things you do in the name of staying in shape—counting calories, tallying fat grams, logging hours at the gym—begin to do a number on your face as you close in on 40. You start to lose facial volume, which can cause eyes to look slightly sunken, cheeks to hollow out, and skin to lose its firmness and elasticity. Maintaining a low body mass index (BMI) exacerbates the problem because fat is the very thing that helps plump out lines and wrinkles.

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"When you lose weight, the face is the first place that shows it," says Baumann, who conducts research at the Baumann Cosmetic & Research Institute, in addition to treating patients in her office. "The fat pads under the eyes go first, then you see it above the smile and down to the chin, then the cheeks." At the same time, gravity comes into play, and the elastin and collagen fibers that allow skin to stretch and spring back weaken, causing skin to sag.

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All of which leaves Sarah (and women like her) with a rather unappealing choice: carry an extra 10-plus pounds to keep her face looking youthful, or keep her weight down and wear an extra 10-plus years on her face. But do we have to compromise? Or is there a way to have both our face and our derriere fight gravity? We turned to experts in the fields of dermatology, nutrition, and exercise physiology to find out.

Facing the music
As early as your mid-twenties, faint creases start to appear on your face—usually across your brow and around your eyes. In your mid-thirties, those creases kick off their shoes and make themselves at home, settling in as full-fledged lines. Soon after, crow's-feet and smile lines join the party, and the dreaded 11's hit you where it hurts: right between the eyes. As you lose volume in the upper part of your face, the lower part starts to sag. Tending to these changes can feel like a game of Whac-A-Mole—as soon as one problem is addressed, another pops up.

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"To maintain youthfulness, the human face begs to have fullness," says Rod Rohrich, M.D., professor and chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center. And by fullness he means fat—whether it gets there the old-fashioned way or with the help of a dermatologist or plastic surgeon.

In 2007, Rohrich led a groundbreaking study at UT Southwestern that shed light on just how important fat is for the face. Prior to his research, skin-care experts believed that subcutaneous facial fat (the fat just below the surface of the skin) was one confluent mass that aged at the same rate. Rohrich and his team discovered that the face is actually made up of 21 individual fat compartments, each of which ages at a different pace. Imagine your face as a three-dimensional puzzle, with fat divided into distinct units around the forehead, eyes, cheeks, and mouth. The way your face ages is at least partially characterized by how these separate compartments evolve as you grow older. Staying too thin can eventually cause some or all of those compartments to sag like day-old party balloons.

To keep those fat compartments looking as if they're positioned beneath the skin of a twenty-something, you need to maintain about 15 percent body fat, says Doris Day, M.D., a clinical assistant professor of dermatology at New York University Langone Medical Center and author of Forget the Facelift. Women with naturally fuller faces have more leeway because they have more fat in each compartment. On the flip side, "women with thin, angular faces may need 20 to 25 percent body fat to keep a youthful face," says Day. Especially in their forties.

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Double trouble
Research on twins illustrates just how much weight affects the signs of aging. When they were young girls growing up outside of Gettysburg, Pennsylvania, no one could tell twin sisters Lisa Cline and Laurie Baun apart. Both had blond hair and button noses—and both were considerably overweight. During their senior year of high school, however, Laurie was diagnosed with a digestive disease and dropped 20 pounds. Over the next few years, she lost another 25 pounds. Initially, her slimmer body made her look much younger than her sister. Now, at 49, she appears several years older than Lisa.

The sisters were among 186 pairs of identical female twins enlisted for a 2008 study at Case Western Reserve University. Researchers set out to determine how much of facial aging is genetically predetermined and how much of it has to do with lifestyle. Turns out, only a small part has to do with genes; most of what ages you can be traced to lifestyle habits and environment. "Your heritage may initially dictate how you age, but if you introduce certain factors into your life, you will age faster," says lead study author Bahman Guyuron, M.D., professor and chairman of the department of plastic surgery at University Hospitals and Case Western Reserve University. "Likewise, if you avoid those factors, you can slow down the hands of time."

Guyuron and his team found that sun exposure is the biggest age accelerator, followed closely by smoking—hardly a surprise. What was eye-opening, however, was how big a role weight played in the aging process. Under the age of 40, the heavier twin (typically with a BMI four points higher than that of her sister, the equivalent of roughly 20 pounds) looked significantly older. But after 40, that same four-point difference in BMI made the heavier twin look significantly younger. And not just because the extra fat plumps up facial skin and fills out wrinkles, says Guyuron. It also makes skin look lighter, giving it a healthier glow. The findings tended to be even more dramatic among twins over 55.

Of course, Guyuron isn't recommending that anyone gain an unhealthy amount of weight in an effort to look younger. He admits one drawback of the study is that he and his research team made their evaluations using only photos of the twins' faces. If their bodies had been shown, a few years may have been shaved off members of the lean group and added to those in the heavier group. Regardless, "it was clear that excessive weight loss can be detrimental to youthfulness and attractiveness,'' says Guyuron.

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Exercise as an accelerator
If you happen to catch a footrace anywhere in America, you're going to see beautifully muscled legs, slim hips, and bikini-ready abs. But the picture gets less pretty as you scroll up. The assumption has always been that the constant pavement pounding associated with running breaks down facial collagen, but there's no research to support that. Experts now say a lower-than-average BMI is the likelier culprit, echoing Guyuron's findings. "It's true that runners often have a more weathered look, but it's not because gravity is pulling at their faces," explains exercise physiologist Ana Lourdes Gomez, Ph.D., a research scientist at the University of Connecticut. "It basically boils down to two factors: Runners tend to be lean, so they have less subcutaneous fat, and they spend more time in the sun."

Baumann concurs: "If you're always exercising outside, you're going to wind up with free-radical damage," she says. "And free-radical damage is what breaks down collagen." Still, it's a risk some tan-obsessed exercisers are willing to take. "Many people seek fitness not for health but for attractiveness—to get a sexy-looking body—and tanning is just another way to improve attractiveness," says Joel Hillhouse, Ph.D., a professor in the department of community health at East Tennessee State University who has done research on the psychology of tanning. "There is also the perception that being tan helps better define a toned body, that it shows off fit muscles."

That's not to say gym rats, yoga buffs, and other indoor exercisers are immune to accelerated aging. "If they're too thin because they're working out a lot and not eating enough, it will show in their faces," says Gomez, "but not to the degree of, say, runners, bikers, and tennis players, who have the sun to contend with too."

The sweet spot of attractiveness
In the quest to have both a fit bod and a firm face, Sarah has turned to injectables, which is the reason for her visit to Baumann's office today. These nonsurgical procedures include smoothers (like Botox or, in Sarah's case, Dysport, a newer version of Botox) that reduce lines and wrinkles by relaxing facial muscles, and fillers (Radiesse, Restylane, Juvederm, and Sculptra, among them) that use hyaluronic acid, synthetic substances, or even fat from your own body to target wrinkles and add volume to cheeks, temples, and other areas of the face. In other words, derms are able to inject your fanny into your face. How's that for irony?

But if you aren't keen on resorting to extreme dermatologic interventions, here's the best advice:

While exercising outside can wreak havoc on your skin, working out in general has been found to help it. A 2008 study published in the Archives of Internal Medicine found that regular exercisers had longer telomeres, tags at the ends of chromosomes that shorten with age. People who did even a moderate amount of cardio—about three 30-minute sessions a week—had telomeres that looked like those of someone about six years younger. Other studies suggest that cardio reduces stress—another major factor in aging, according to Guyuron's twins study, which found that people who'd been through the rigors of a divorce looked almost two years older than their married, single, or even widowed siblings.

"When you're feeling stressed, you use muscles that are synergistic with the gravity effect," explains Guyuron. "Gravity pulls the neck, creating and deepening two lines between the chin and the neck. The more stress you go through in your life, the more visible those lines are going to become."

Some experts believe exercises specifically for the face can erase these lines. Facial yoga, for instance, combines traditional yoga poses that are believed to make your face look younger (downward dog, for one, increases blood flow to the head) with moves that take their cue from the yogic tradition of deep breathing (like puffing up your cheeks with air, then transferring the air from cheek to cheek while exhaling).

These moves supposedly boost the production of elastin and collagen. Baumann is conducting a study to determine whether they do or not, so we'll have to wait and see.

What's certain is that a healthy diet is as important for your face as it is for your fanny. Research suggests that noshing on foods packed with antioxidants—fish rich in omega-3 fatty acids, such as salmon, tuna, mackerel, and sardines, and richly colored fruits and veggies—may improve skin tone and boost metabolism too.

In fact, the fountain of youth appears to be filled with fish oil. The slippery stuff has been shown to act as an anti-inflammatory (which helps maintain elasticity and suppleness in the skin) and to lower levels of leptin, a hormone that regulates appetite and metabolism. A University of Wisconsin study found that subjects with low levels of leptin have faster metabolisms and are able to burn fat more quickly than those with higher levels. To reap the rewards, consume 2,000 milligrams of fish oil a day, suggests Stephen Gullo, Ph.D., a weight-loss expert in New York City and author of The Thin Commandments.

Conversely, eating foods that are loaded with preservatives—those unpronounceable ingredients listed on the labels of many prepackaged foods—"can irritate the digestive system, and the skin is the first place you'll see a change," says Ashley Koff, R.D., a nutritionist in Los Angeles. (The second place is your thighs, belly, or wherever else you tend to pack on pounds.) Many of Koff's clients turn to diet soda to satisfy a sweet tooth, but artificial sweeteners can lead to overeating, and the caffeine may act as a mild diuretic. Plus, a new study published in the Federation of American Societies for Experimental Biology Journal found that high levels of phosphates—found in many soft drinks and processed foods—accelerate the signs of aging. "It displaces calcium, and that affects skin health, among other things, because calcium helps regulate the skin's thickness and color," says Koff.

Perhaps one of the smartest things you can do throughout your life is to maintain a healthy weight, since so-called yo-yo dieting is brutal on the face. (Imagine stretching a rubber band over and over again; it eventually becomes less resilient and loses its elasticity altogether.) "If you've been gaining and losing weight for years—particularly if you're doing it rapidly—you shed not only body fat but also lean body mass and the supple underlying muscular structure in your face," says Susan Bowerman, R.D., assistant director of the Center for Human Nutrition at the University of California at Los Angeles. "That contributes to your face looking older. These kinds of fluctuations are bad for both your face and your health."

Making matters worse, your face responds to weight fluctuations the same way your body does: You lose it first where you need it most (mid-face—between the cheekbones and that area from your nose to the corners of your mouth) and that's where you gain it back last.

In the end, the secret to looking young and staying fit isn't really much of a secret at all, but something we've known all along: Eat right, exercise often, slather on sunscreen every single day (SPF 30, please), and follow the bonus advice in this article. Also, developing a healthy attitude toward aging doesn't hurt either. Everyone is going to wind up with a few wrinkles at some point, and those lines won't diminish your beauty. Want proof? Just take a look at Catherine Deneuve.