There is also confusion about professional skin care because different dermatologists
and plastic surgeons offer different treatments with peels and lasers. There
is more scientific evidence for some treatments than for others.
Protection & Prevention
Even though talking about sunscreens has become boring by now, study after
study show that people do not use sunscreens properly. Patients typically apply
one fourth to one half the recommended amount and they don't reapply sunscreens
frequently enough when outdoors.
Also remember that the sun protection factor (SPF) of a sunscreen indicates
only its ability to block ultraviolet B (UVB) light. UVB light causes sunburn
and skin cancer, but ultraviolet A (UVA) light penetrates deeper into the skin
and causes aging. Be sure to use a sunscreen that absorbs both UVA and UVB
rays. I believe that non-chemical broad-spectrum sun blocks, such as transparent
zinc oxide, are best. One good example is: Ultimate UV Defense by SkinCeuticals.
In addition to sun blocks, retinol creams protect against sun damage by preventing
harmful chemical reactions and also by preventing loss of
collagen. There is also evidence that antioxidants such as
vitamin C protect against sun damage when applied to the skin.
Skin Creams to Treat Wrinkling and Pigmentation
Rx-A (Tretinoin Cream)
Tretinoin is a Vitamin A derivative. Multiple studies have shown that tretinoin
(the active ingredient in Retin-A and Renova) is effective in the treatment
of sun damage and skin aging. Tretinoin increases collagen production in the
skin, reduces pigmentation, and produces a rosy glow.
Our cream (Rx-A) contains 0.05% tretinoin and is compounded in our office
by a pharmaceutical company. Its advantage is that it has a much better base
for skin penetration. Patient education is very important, because some patients
stop using the cream before it has had a chance to work. It can take 3 to 6
months to see the full results. Some patients find that the tretinoin cream
irritates the skin with redness and peeling initially. The key is to start
very slowly. Apply Rx-A every third night to build up tolerance. Even using
Rx-A once a week will help. If to stick with it for several weeks, the cream
can then be used nightly. We also have an effective tretinoin-based bleaching
cream (Tri-fade).
Other Vitamin A Products
As mentioned above, tretinoin is a Vitamin A derivative. Retinol is Vitamin
A itself, and we find it useful for patients with very sensitive skin who cannot
tolerate the Rx-A cream, because Retinol is milder. Retinol is also effective
for patients with rosacea. We use La Roche Posay (Biomedic) Retinol Cream.
There are two other Vitamin A derivatives (Tazorac and Differin) which are
useful skin creams, but there is less experience with these. Tazorac may be
even more effective than tretinoin but it can also be more irritating.
Glycolic Acid
Glycolic acid and other alpha hydroxy acids are very popular in skin care
products. However, there really is no good scientific evidence that glycolic
acid in cream form is effective. What we do find effective are glycolic acid
wash and lactic acid wash. These cleansers prep the skin before applying retinol
cream or Vitamin C serum. Which wash is best for you will depend on your skin
type. We use Purifying Cleanser by LaRoche-Posay-(Biomedic) and Refinity Purifying
Cleanser by Cosmederm.
Antioxidants
Antioxidants, such as vitamin E, can be effective in treating aging skin.
The problem is that in many products the antioxidant molecules are not in a
form that can be absorbed by the skin. However, there are two products, Active
C Cream by LaRoche-Posay and Topical Vitamin C Serum by SkinCeuticals, which
indeed do enter the skin in active form. The Active C cream is better for more
sensitive skin.
Estrogen Cream
Estrogen cream significantly improves the skin after menopause. It can be
used by women who are not on hormone replacement therapy and who are not at
risk for estrogen responsive cancers such as breast cancer. Women use vaginal
estrogen cream on their face because there are no estrogen creams specifically
developed for facial skin. In post-menopausal women, estrogen cream may be
a useful adjunct to retinol and vitamin C serum.
Professional Skin Treatments
For prevention and treatment of mild skin damage, skin care at home may be
enough. A typical home regimen consists of sunblock, retinol, and Vitamin C.
When the wrinkles and pigmentation begin to get worse, we use both superficial
chemical peels and MicroPeel Dermaplanning.
Superficial chemical peels reduce pigmentation and fine lines. For patients
with delicate skin, the Refinity Glycolic Acid Peel is good. For other patients,
The MicroPeel Plus Salicylic Acid Peel penetrates a little deeper.
MicroPeel Dermaplaning is another good procedure for treating sun damage,
superficial lines, and pigmentation. It also improves the texture of your skin.
In MicroPeel Dermaplaning, the skin is first cleansed with lactic acid and
then a blade is used to exfoliate superficial damaged cells. Then a papaya
extract is applied to the skin as an anti-inflammatory. There is no down time
with either superficial chemical peels or MicroPeel Dermaplaning. Superficial
chemical peels are alternated with the MicroPeel Dermaplaning every six to
eight weeks.
I feel that for most patients, superficial peels and Dermaplaning are more
effective than microdermabrasion.
Intense Pulsed Light (IPL) treatments and non-ablative (no down time) lasers
are widely used but, in my opinion, the improvement produced by these procedures
is very subtle and we do not use them.
Intermediate and Deep Resurfacing
For marked skin damage with wrinkling and pigmentation, I use laser resurfacing.
I believe that the laser is safer, more predictable, and more effective than
either deep chemical peels (TCA, Phenol) or dermabrasion. But, which laser
is used is very important. Carbon Dioxide (Co2) lasers leave the skin red for
too long and can cause permanent skin bleaching. Conventional short pulse Erbium
lasers are only good for superficial wrinkles. I use the Contour Variable
Pulse Erbium Laser. The Contour laser delivers short pulses and higher energy longer
pulses as needed. So that with the Contour laser, I can individualize the treatment
for each patient and for each part of the face. You can have laser resurfacing
of the whole face or just around the mouth or around the eyes.
For Sagging Skin
The treatments described above work for superficial skin aging: that is for wrinkling and pigment changes. The only effective non-invasive treatment for sagging skin is the Thermage skin tightening procedure. Thermage causes collagen contraction and collagen production in the deep layers of the skin and just below the skin. Thermage improves sagging in areas such as the jowls, brows, arms, and abdomen.
Restylane
