Looking good in the skin you're in

One dermatologist’s perspective on aging skin

Contrary to what the cosmetic industry would have you believe, there is not a magical fountain of youth secretly disguised as a bottle of moisturizer at the cosmetic center in the mall. More often these “revolutionary products” do not contain secret ingredients, just high price tags.

By far the most effective way to maintain youthful skin is to avoid the accumulation of damage to the skin caused by solar radiation. The UVA and UVB rays found in sunlight breakdown collagen and elastic fibers in the skin and lead to premature aging. These rays also contribute to the development of brown spots and pigment irregularities that greatly increase the appearance of age of the skin. A priority for any effective skin care regiment is the daily use of a good sunscreen product with Broad Spectrum SPF 30 to SPF 50.

Damage does accumulate despite even the most diligent attempts at proper sunscreen use. Products such as Retin-A and Retinol have credible scientific and clinical data establishing the ability to make valuable and measurable effects on the skin’s production of new collagen and elastic fibers. Additionally, the active ingredients of these two products are able to slough abnormal skin and even-out the pigment irregularities that accumulate with time. Ultimately, these types of products are the most proactive means of addressing solar damage and the accumulation of free radicals in the skin. Given the ability of one's skin to tolerate and accommodate to the use of these products, I utilize them as the workhorse in every skin care regimen.

How does Retin-A work? Retina-A is a general term used to refer to prescription products that contain the active ingredient tretinoin. The tretinoin molecule is capable of penetrating the skin barrier and binding to specific skin cell receptors. The ultimate effect is the increased production of elastic and collagen fibers and stabilizes normal skin activity. It speeds up the turnover of skin thus preventing the accumulation of abnormal cells. Tretinoin can typically be successfully added and tolerated if incorporated slowly into a skin care regimen.

For skin types that do not tolerate tretinoin it may be more beneficial to start with a mild and non-prescriptive form of a retinoid called Retinol. Retinol does not provide the same degree of effect on the skin as tretinoin due to a difference in its molecular properties. However, it is valuable in smoothing out pigment irregularities and is likely to provide positive effects on collagen and elastic fiber production. The benefit to this product is that it can be found over the counter and is easily tolerated. I would recommend the slow incorporation of either product initially into one’s regiment on a weekly basis and increasing to a daily basis.

For those who hope to accomplish more with their skin care regiment, the cosmeceutical industry has begun to bombard the market with products that contain higher levels of antioxidant ingredients. These ingredients are aimed at scavenging free radicals in the skin that result from daily exposure to radiation, pollution, sun, and general aging. It is believed that the accumulation of these free radicals lead to skin cell DNA mutation, loss of elasticity, and pigment irregularities. We know the skin has the intrinsic ability to scavenge these free radicals in an effort to minimize the accumulation of cellular damage. However, we believe many of these intrinsic mechanisms are overwhelmed by numerous assaults on the skin by modern lifestyles as well as numerous sources of pollutants in today’s world.

These synthesized or purified antioxidants have been proven to be effective in the lab, however, not all products are created equally and consumers should be aware of expensive products with little data to substantiate the claims made by the manufacturer. I do not believe that one antioxidant can cure all of the damage accumulated over the years; however, I do find a great deal of value in incorporating an antioxidant product into general skin care maintenance. I encourage our patients to meet and discuss options with our estheticians as they are an up-to-date and trusted source of information who can help determine the most effective regimen and appropriate products to choose for one’s skin and areas of concern.

Unfortunately, there are some “sins” from the past that even a good skin care regimen cannot address and for these issues we rely on the “big guns” for results. The use of superficial chemical peels can help to address stubborn sun induced pigment irregularities. Additionally, lasers can be selected to target specific troubles and used to successfully improve a severely sun damaged complexion or to resurface the upper layers of the skin. These particular tools are selectively applied to patients after careful consideration, examination, and thorough evaluation of their specific needs.

The visible signs of aging are rarely just skin deep. Genetic predisposition as well as UV exposure can lead to bone re-absorption and loss of the fat pads of the face. These changes result in the “sagging” look that plagues many patients. Addressing these signs of aging often requires the assistance of fillers, skin tightening lasers, or surgery. Most importantly, these modalities if applied in a conservative, experienced, and thoughtful manner can also help patients continue to “look young for their age.” I feel passionate that looking good in the skin you are in requires:

1. A consistent skin care regimen with an effective sunscreen and retinoid product as the main work horses.

2. An appreciation that some aspects of aging cannot be avoided or cured with a magical cream.

3. Involvement and collaboration with a Board Certified Dermatologist or Plastic Surgeon to discuss surgical and nonsurgical options for signs of aging that are more than skin deep.

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Staci Hestdalen is a FAAD Board-Certified Dermatologist and Associate Clinical Professor at the University of Washington. For more information about Advanced Dermatology, call (208) 770-2822.