Plastic Surgeon Lists Top Ten Reasons Your Face Ages

A California-based plastic surgeon shared a ranked list of the top ten things that cause the face to age. Dr Amir M Karam posted the breakdown on Instagram in July 2026. He noted that facial ageing comes from a mix of genetics, lifestyle, skin quality, volume changes, and the natural ageing process. At the bottom of the list are everyday habits. Dehydration is ranked tenth because it is not a huge driver of long-term structural ageing, though it can make you look tired in the mornings. Alcohol is ninth, leaving people looking rougher after a night of drinking. Diet sits at eighth, with ultra-processed foods and sugar having real effects on skin. Poor sleep is seventh, as grey skin and lasting damage follow sleep deprivation. Moving up, chronic stress takes the sixth spot, with cortisol impacts visible on leaders like presidents after a four-year term. Genetics is fifth, dictating your personal ageing timeline. Volume loss is fourth, which Dr Karam views as slightly overrated since young people can have hollow eyes or flat cheeks and still look young. The top three factors deal heavy blows to skin and structure. Smoking is third, quickly breaking down collagen and causing lines near the lips. Sagging takes second place as intrinsic structural gravity, which often happens to women around perimenopause and menopause and alters facial shape. Sun damage takes the number one spot as the ultimate driver of facial ageing. Dr Karam explained that poor skin quality from the sun ruins the results of even great surgical procedures. However, the silver lining is that sun damage is the most preventable factor on the list.