Top plastic surgeon from California ranks 10 biggest things ageing your face: Number 1 is ‘most preventable’

Late nights aren't your biggest enemy. US-based plastic surgeon Dr Amir M Karam broke down the 10 real reasons you look older — and what you can control.

Ever looked in the mirror and wondered why your skin looks like it’s aged six years overnight? You’re not alone. While we often blame late nights or missed skincare routines, the reality of facial ageing is far more complex. In a July 2026 Instagram post, California-based plastic surgeon Dr Amir M Karam shed light on what actually drives changes to our appearance over time.

Dr Karam explained that ageing isn’t caused by a single factor. Instead, it stems from a combination of 'genetics, lifestyle, skin quality, volume changes, and the natural ageing process'. To help people separate myth from medical fact, Dr Karam ranked the top 10 contributors to facial ageing, counting down from the minor culprits to the absolute biggest offenders.

The minor culprits: lifestyle triggers

Starting at the bottom of the list, Dr Karam highlighted everyday lifestyle habits that affect your appearance on the surface:

10. Dehydration: While staying hydrated is essential, Dr Karam noted it is 'not a huge contributor' to long-term structural ageing. However, lacking proper fluids 'can certainly make you look a little bit more tired, especially in the mornings', he said.

9. Alcohol: Short-term indulgences leave an immediate mark, he added. "Alcohol, after a bender, after a night of drinking, no matter what, you wake up looking a little bit rougher, more aged," he noted.

8. Diet: Long-term nutrition plays a vital secondary role in skin maintenance. Dr Karam stressed that 'ultra-processed foods, lots of sugar, etc., can have real effects on the skin', as healthy skin requires proper foundational nutrients.

7. Poor sleep: Skipping rest also takes a noticeable toll. "Even after one or two nights of poor sleep, you just wake up and you simply don't look as refreshed. Your skin is looking a little grey," he shared, warning that consistent sleep deprivation leads to lasting skin damage.

The accelerators: stress, genes, structural shift

Moving into the mid-tier factors, the surgeon pointed out deeper biological and structural shifts that alter facial appearance over time:

6. Chronic stress: "Believe it or not, that's a pretty big one," Dr Karam revealed. To illustrate the physical impact of cortisol, he pointed to high-profile examples: "Just look at what happens to presidents after a four-year term."

5. Genetics: Your DNA dictates much of your timeline, he added. "There's a big difference between when ageing happens for one person versus another, and a lot of it has to do with their genes," Dr Karam explained.

4. Volume loss: While many seek cosmetic fixes for facial hollows, Dr Karam considers volume loss slightly overrated as an isolated ageing factor. "It's important, but not as important as you think, because there are a lot of young people who have a little bit of hollows around their eyes, hollow temples, and flat cheeks, and they still look young," he noted.

The heavy hitters: major contributors

At the top of the ranking are factors that significantly affect facial structure and skin health:

3. Smoking: Ranked third, smoking is a severe threat to youthful skin. "Smoking is a very rapid ager of skin," Dr Karam warned, adding, "It breaks down collagen, you start to see lines and wrinkles around the lips. It's an important contributor."

2. Sagging: Taking the second spot is intrinsic structural gravity, particularly prominent during hormonal shifts. "This is just plain old age-related sagging," Dr Karam said. "Typically happens for women around perimenopause and menopause, and it changes the foundational facial shape. That's a huge contributor to facial ageing. Not a whole lot you can do about it," he added.

1. Sun damage: Taking the number one spot as the ultimate driver of facial ageing is UV exposure. Dr Karam highlighted that even advanced surgical procedures cannot fix poor skin quality caused by the sun. "Even when you have a great facelift done, vertical restore, whatever, if your skin is not in good shape, the results of that surgery are not nearly as powerful," he explained.

The silver lining? Sun damage is almost entirely within your hands. "Without that good skin — and the biggest contributor of poor skin is the sun — that's where it gets its number one, and it's the most preventable," Dr Karam concluded.

His ranking offers a grounded perspective on skincare. While genetic factors and natural sagging come with time, avoiding smoking and wearing sunscreen remain the most effective tools for maintaining healthy skin over a lifetime.

Note to readers: This report is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.

This article is for informational purposes only and not a substitute for professional medical advice.