It’s a common situation: A woman somewhere between the ages of 40 and 70 comes to see me in the office during a break in her day and says, “I’m here! Make me look ten years younger!,” immediately followed by, “buuuuut I have a dinner function tonight at 7, so nobody can know I’ve had anything done.”
This is a frustrating situation for procedural or cosmetic dermatologists, because what most people do not understand is that while there are many options for minimally invasive cosmetic interventions, the approach to skin rejuvenation is a process. It is a combination of changes in behaviors and the way you treat your skin that each make incremental changes that ultimately, over the course of months or even years, contribute to that youthful appearance we do so desire.
So while there are definite things we can do that can address an individual bump, a lump, a blemish, a wrinkle – you have to change the way you approach the care of your skin, with certain fundamentals that allow for lifelong, healthy, youthful appearing skin.
Navigating the tens of thousands of skin care products out there can be overwhelming. There are, however, certain changes you can make without ever having to go to the dermatologist that have been proven to make a difference. The one constant through all the things you can do, however is time. Be wary of products that purport immediate or overnight effect. By incorporating the changes below, you will find that a simple skin care regimen is best, but weeks to months are needed to see these changes take effect. But the real beauty, is that these changes are lasting…
If you’re going to do one thing, this is the one. The importance of protecting your skin from the ultraviolet (UV) rays of the sun cannot be overstated. We know the role that UV has on the development of skin cancer, but don’t forget the other things it does – wrinkles, dark spots, light spots, blemishes, scaling, flaking. Your skin is your only protection from the sun’s constant bombardment of your body, and sunscreen is the best way to prevent this damage.
I always tell patients the skin has a memory – it literally keeps a running meter of all the sun exposure you have gotten since the day you were born. It doesn’t matter if you get your sun in 12 5-minute blocks or 1 60-minute block, it’s all the same. There is no such thing as a healthy or protective tan and it doesn’t matter if you’re getting UV from natural sunlight or a tanning booth. My advice is to get a light facial lotion or foundation with sunscreen in it for everyday use… Then you never have to think about it and you won’t get burned on that day you leave for work and it’s cloudy but the sun is blazing by the time you go out for lunch.
When it comes to taking care of facial skin, gentler is almost always better. The microscopic skin cells that line the delicate pores of the face are easily irritated, and once these pores are clogged this can lead to break-outs, acne, and other types of blemishes.
Avoid using “scrubs” that contain the small grit-like particles within them, as these can further irritate the skin. As with all facial skin care products, look for those that display the words “oil-free” and “non-comedogenic” (doesn’t cause blackheads) on their labels. An occasional facial with a qualified esthetician is fine, but as with anything, don’t overdo it.
This class of medications are wonder drugs for the skin. In fact, I’m sure there are very few dermatologists out there that don’t use one of the topical retinoids on their skin on a regular basis.. The differences in these products are related to the strength and concentration of the active ingredient as well as the vehicle in which it is delivered (e.g. a cream vs a gel).
Retinoids are related to vitamin A and have a wide range of actions in the skin, largely related to their ability to regulate growth and turn over of skin cells. When used properly and for sufficient duration, they are potent anti-acne agents, stimulate collagen growth, reduce fine wrinkles and blemishes, and even out skin pigmentation. Tretinoin is the most popular of this class and is available by a variety of trade names including Retin-A and Renova, but requires a prescription from your doctor.
There are retinoids that are available in over the counter preparations, and while their efficacy has not been proven to the degree of prescription retionids, they have been shown to demonstrate improvement in fine wrinkles and increased collaged production. Of these, retinaldehyde and retinol have been studied the most, as they are converted into the same downstream products as tretinoin once absorbed by the skin. Ingredients such as retinyl palmitate and retinyl-acetate are generally not considered effective.
Keep in mind that several weeks of use are needed before an improvement in the skin is seen, and this is often preceded by a period of acclimation that may include some irritation, redness, or scaling. Gradually, the skin gets used to the retinoid and these symptoms ameliorate. For these reasons, it is best for your dermatologist to decide which retinoid is right for you, and this may change as you progress up the “retinoid ladder”.
These components of skin maintenance and rejuvenation are the most simple and basic foundation for lifelong changes, and more importantly – steps you can incorporate just from your neighborhood pharmacy. None of these changes occur quickly, requiring weeks to months before visible differences are seen. The next installments of facial rejuvenation will focus on light-based devices such as lasers and intense pulsed light (IPL) systems (occasionally referred to as a ‘photo-facial’) and injectibles such as botulinum toxin and various filler substances.