The correct answer is 20, and that might cause you some concern, and indeed, until about ten years ago, most neuroscientists believed that once you entered young adulthood, your brain inevitably began going downhill, with no potential for new brain cell growth. But fortunately, it’s clear now that your brain, even though it does shrink in size over time, can retain most of its functional capacity, and even form new cells.

It turns out the shrinking brain issue is really not such a problem after all, because if we treat our brains right, the loss in brain volume can be compensated by new connections (called synapses) between brain cells, and in many cases these synapses—the connections—are more important than the number of brain cells. At least in some areas of the brain, new tissue can be formed. This ability of the brain to change and develop in positive ways is called brain plasticity (“plastic” as in the ability to re-shape itself as needed).

One of the best ways to age better is to encourage this brain plasticity, which is done by: 1) maximizing physical health; and 2) continuing to exercise our brains after age 20! You undoubtedly know the classic advice to “do crossword puzzles”, but there are so many other activities that you can do that are just as good. You can have a wonderfully functioning brain in your 80s without doing one crossword puzzle, ever.

But to keep a good brain, you need to exercise it or the new connections, the synapses, will not form well, and your brain will deteriorate just like muscles that sit unused. In LLAW, I will devote many posts regarding ways to keep our brains working well, and today I hope you read this Psychology Today blog post from Stanton Peele, Ph.D. Taking life seriously: How to preserve your mind, raise intellectual children, be a constructive citizen, and get laid more. He gives lots of ideas about how to stimulate your brain and improve your relationships at the same time.

We are all probably aware of the huge popularity of botox for smoothing facial wrinkles, but you might not realize how big is the next new wave in cosmetic dermatology: “facial fillers”—substances injected into slightly depressed areas and wrinkles in the face to fill and smooth and give a younger appearance. Amazingly, about 1.5 MILLION of these procedures were performed last year. Most patients seems satisfied with the results but still, there are risks, and if you think you might ever consider one of these procedures, read this report and talk to your doctor first about the possible complications before getting plumped up.

“Health Care Town” In South Korea

Another surprising figure is that some 750,000 Americans last year sought medical treatment outside the U.S., typically because surgery here, even if you are covered by insurance, can be exorbitantly expensive. Americans are traveling for everything from open-heart surgery to hip replacements to face-lifts. The total cost, even including travel, can be a fraction of the cost in the U.S. It’s estimated that within several years, millions of Americans will be traveling abroad yearly for care.

It’s a trend worth watching, especially if you ever require an expensive operation. (Of course, quality and follow-up of care might be your primary concerns.) Read this fascinating New York Times article for a look at this phenomenon. Featured is the newest of the countries welcoming foreign patients, South Korea, where the government is building “Health Care Town” on a resort island, complete with prime beaches and a 18-hole golf course, presumably for whomever goes along with you on your trip.

Yes, even now it’s not uncommon that a surgeon can turn away an older individual who needs critical surgery. Instead of really fixing their problem, the patient gets some pills or other palliative treatment that really doesn’t solve their condition; just lets them limp along. This age discrimination is based on the belief that people in their 80s or 90s are just too fragile to survive or recover from major surgery, but this current research suggests that even some 90 year-olds can do just as well as much younger people.

These two studies analyzed the surgical records of nearly 10,000 elderly patients who underwent heart surgery in Florida and in the Northeastern U.S. The results were quite amazing; many of those who had surgery survived as long as individuals their age who did not have heart disease. The elderly took longer than younger people to recover (and as heart surgery is risky, some did not survive), but the large majority who successfully recovered later overwhelmingly reported a good quality of life. Of course, not all 80- or 90somethings are healthy enough for major surgery, but many are, and chronological age alone should not be a determinate of who is a surgical candidate. Further, while these two studies concerned heart operations, the results should also apply to other surgeries.

These studies are important for our society as the 75 and older age group is the fastest-growing segment of our population, and important for you because if you take care of yourself, you will also hopefully arrive at 80 then (sooner than you realize) your 90s, and you will want every option for the best treatments possible, even major surgery if needed. So no matter what our age is now (keep this in mind for ourselves or for our parents)—the research supports: end age bias in surgery!

Today we consider other creams you can use for your hands. First you might ask: should I see a dermatologist? Yes, if you have spots you are concerned might be cancerous, or you already have extensive aging changes. A dermatologist has many stronger treatments than you can find over-the-counter; her arsenal includes (from easiest to most complicated): prescription-strength bleaching agents and Retin-A, chemical peel, intense pulsed light, laser resurfacing, and injection of filling agents. Your doctor can combine several of these, and they tend to be very effective.

If you are younger and your hands currently look quite good and you want to keep them that way, or you have only mild changes at this point, there are effective products you can buy “OTC” (over-the-counter).  First are the alpha-hydroxy acids, and with these you can give your hands a mild chemical peel. They may give some mild benefit, but by far the most effective creams are the retinoids, derived from vitamin A (Retin-A is the prescription-strength form).

Retinoids are, well, fantastic, and I will devote a future post just to them and how they work, but in short, they are the very best agents we have to restore the collagen framework—the firmness and elasticity that your skin loses from aging and sun. The best OTC form is retinol, and I recommend the Neutrogena line because they are high quality and not overpriced (in skin creams, you can spend a fortune for a chic package and a psueudo-European name complete with accent marks, but often these are far inferior to the less flashy brands such as Neutrogena). One good choice is Neutrogena Healthy Skin Original Formula or the stronger Neutrogena Anti-Wrinkle Intensive.

Spread about a pea-sized amount on your hands, at first every several days, and if you don’t get any irritation, slowly increase to every night use. The main side effect is redness and irritation, and if that occurs, use it less often, then after a few weeks again try to use it more frequently. You need at least a month to see any improvement, and if you aren’t happy with the results after three months, see a dermatologist. You might benefit from a stronger retinoid or other types of treatment.

Finally, retinoids have the catch-22 that they make your skin more sensitive to sun damage, so it’s best to use them at night, and you need to be really serious about using a sunscreen. Monday I mentioned Lubriderm with SPF 15, but if you are using retinoids regularly, you might move up a notch in sun-protection to something like Neutrogena Norwegian Formula Age Shield SPF 30 Hand Cream. Carry a tube in your bag to use whenever you wash your hands, so even on-the-go keep up your younger hands program!

I hope you now have a good idea how to get younger-looking hands, and Friday, we leave the most superficial part of the body and dig towards a much deeper subject.

As detailed in this New York Times article, more than a few people are spending a small fortune trying to reverse the natural tissue shrinkage (which gives a “bony” or “veiny” look) that occurs in some people’s hands over time. The cost of filling procedures for the hands can range from $3,000 for results that last about a year, to $12,000 for results (using fat) that might last a decade. Certainly not a trivial amount, so you will be happy to know there are several simpler, cheaper, and less painful routes to help prevent, and then treat, some of the age-related changes that might occur.

Besides the atrophy, or shrinkage, problem, other age-giveaways are hand wrinkles and brown spots. Prevention is best of course, and if you are in your 20s or 30s still with perfect hands, notice your grandparents’ hands and consider: sun damage may have caused much of the changes you see, and in large part, it’s preventable.

Point one: faithfully use at least an SPF 15 sunscreen (with both UVA and UVB protection), on the backs of your hands and fingers…wrists and arms too if they are sun-exposed. Do this no matter if you are young and unwrinkled, or already have a problem…even if you already have wrinkles, this will help slow down their progression.

Two: moisturize and hydrate your hands, and your body in general. For a daytime hand moisturizer, best is to use a moisturizer-sunscreen combination. One quality, economical, and convenient choice is Lubriderm Daily Moisture with SPF 15. Leave a 16 oz press-top dispenser handy, and make a habit of using a couple squirts before you go out into the sun and weather.

Then hydrate your skin from inside by drinking enough water. Especially with winter approaching, the indoor heated environment can be very drying, wrecking havoc on your skin, so consider purchasing a portable humidifier or two for your home. It’s slightly inconvenient to deal with filling up the device, cleaning it, changing the filters, etc., but the results are well worth the effort. Your wrinkled skin might noticeably “flesh-out” as the humidity rises in your environment. And the increased humidity has other health benefits that will be detailed in a future post.

On Wednesday… several specific creams that work well for age spots and wrinkles!