Before and After: Aging process mostly beyond our control, experts say

We know the most obvious signs of aging. Wrinkles. Gray hair. Sags and bags.

But for some of us, entering into our later years means some surprises.

Most women will grow thicker through the middle and flabbier in their thighs and arms. The hair on their head might thin while the fine, pale hair on their faces might grow heavier and darker.

Men, too, tend to thicken through the middle with age. Many will lose hair on top of their heads and gain hair in their noses and ears.

While men and women will shrink in height, their noses and ears will grow.

Their eyelids will droop, their jowls will sag, and their skin will grow thin. They will develop freckles, age spots and spider veins on their faces.

And their brains will actually shrink.

Oh, joy.

I talked to three doctors -- Dr. Chip Celestino, Dr. William Palmer Jr. and Dr. Suzanne Hess -- about what happens to people as they grow older.

Celestino is a professor of family and community medicine at Wake Forest University School of Medicine and the director of the department of geriatrics at Wake Forest University Baptist Medical Center. Palmer is a doctor of rehabilitation medicine at Whitaker Rehab Center. Hess is a dermatologist.

Aging comes from internal forces, such as genetics, and external forces, such as smoking and sun exposure. We can slow the clock by maintaining good health habits, and we can also take advantage of cosmetic surgery to keep ourselves looking youthful.

But some forces of nature simply cannot be denied. They are born within us.

Take the loss of height, for example. Celestino said that the discs between our vertebrae contain a lot of water; the amount of water decreases as we age, and the vertebrae squeeze closer together, diminishing our height. Even if they do everything right, Celestino said, people at age 70 are not the same height that they were at age 25.

Even people who exercise and eat well will have a hard time keeping the same hard body that they may have had when they were 30, he said. As men and women age, the fat content of their bodies goes up, and muscles atrophy. A while back, when photographs surfaced of Arnold Schwarzenegger, the governor of California, in a tiny swimsuit, it was obvious that his bodybuilding days were far behind him. He looked like a lot of men older than 50, with sagging skin and flab around his middle.

It's the rare person who can work hard enough to keep a trim, muscular body into old age. Some people get lucky with genetics and stay slim. But most of us go at least a little to seed.

Losing and Gaining Hair

Many of us will lose hair on our heads and sprout hair where we don't want it.

Fifty to 60 percent of men will undergo male-pattern baldness, Celestino said. "They will grow it extensively out of their noses and ears." Women don't usually go bald, but their hair can thin as they age. And they may notice dark, bristly hairs appearing on their chins and upper lips. The hairs aren't new, he said. But the changing balance of hormones that comes with aging cause the hair follicles to produce "terminal" hairs, thick, coarse and dark, rather than the soft, downy "vellus" hairs that were there before.

Even as we are producing dark hairs on our faces, we are likely to be growing gray hair on our heads. People go gray because the pigment-producing cells in the hair stop their work, Celestino said. How soon and how much we gray is determined by genetics. We might begin to turn gray in our teens, as did Taylor Hicks, an American Idol winner. Or we might be able to hold on to our natural hair color well into middle age. Most people have developed at least some gray hair by their 40s and 50s.

Now, on to the skin.

Our skin starts to age while we are still young, Hess said. In our 20s, we start to slowly lose collagen, a fibrous protein that provides firmness and strength to our skin. In our 30s and 40s, gravity and repetitive movements, such as frowning and squinting, begin to affect the skin, causing lines and furrows. The decreased elasticity of the skin becomes more apparent when we reach our 50s.

The older we get, the more saggy and fragile our skin becomes. We bruise more easily, Palmer said. We develop all sorts of unsightly things on our faces, such as freckles, age spots, spider veins and keratoses, thick, wart-like growths. The tips of our noses start to droop, and our ears elongate. Our eyelids sag and the fat pads beneath our eyes become more prominent.

People who undergo cosmetic surgery on their eyes often look significantly younger, Celestino said, "just because eyes are such a window of youth."

Invisible Changes

But many of the issues of aging are not visible to the eye.

Bone density and muscle strength decrease, as does our reaction time, Palmer said. The lenses of our eyes become more dense and less elastic, which makes it harder for our eyes to change focus quickly. That is where bifocals come in.

As men and women lose hormones that affect the immune system, including testosterone and estrogen, their ability to fight infection decreases, they are sick more often, and they take longer to recover from illnesses.

The gastrointestinal system slows down when we get old, Palmer said. "When you talk to old people, everyone focuses on their bowels." With age comes increased risk of hernias, reflux and constipation. We don't taste food, smell odors or sleep as well when we get old.

And then there's that brain thing. The size of the brain shrinks, Palmer said, and the blood flow to the brain can be decreased by hardening of the arteries. Therefore we don't think or reason as well.

When it comes to aging, Celestino said, we can't change our genes, "at least not now." What we can do is avoid the sun and cigarettes, exercise regularly, eat smart, maintain a good body weight and get enough sleep

And grow old gracefully.

■ Janice Gaston can be reached at 727-7364 or at jgaston@wsjournal.com.