The nice warm weather of the summer and the beauty of seeing the sun repeatedly over clear skies has made for a fun and productive season…and put a tan and a glow to that face. But with that good summer look lies some damage from the sun underneath. The suncreen you used (hopefully) and a hat were helpful but it can’t repair the ongoing damage to your skin cells from the UV rays that made it through or the damage that was there beforehand. To get skin healthier and looking better from sun damage requires the process of exfoliation. Whether this exfoliative process is superfical or deep will determine, how much recovery, cost, and the amount of improvement seen.

Medical facials are a good and pleasurable way to help nourish sun damaged skin. Light chemical peels and nourishing facial agents help infuse the skin with cell-boosting vitamins and minerals that will soften and hydrate dry facial skin. You will need a series of treatments in order to reap any long-term benefits but these need to be be repeated every few weeks as they are more about stimulation than exfoliation. Usually a facial is best combined with microdermabrasion or other skin resurfacing procedures (see below) for a more comprehensive treatment that gets a better result.

 
Microdermabrasion, a procedure which almost everyone has heard of, is a superficial exfoliating treatment that can help buff away dead skin cells and give your skin an immediate brighter gklow. It is usually combined with a light chemical peel to get a better result.Microdermabrasion can help brighten up a dull complexion and also boosts collagen production deep within the skin’s layers. You’ll see immediate results, and a noticeable difference in the texture and tone of your skin after a few days. Because it does not go very deep, it will not correct deeper wrinkles or heavily damaged skin. I like to think of microdermabrasion as a ‘maintenance’ treatment rather than a truly therapeutic one, meaning it is a good to other more aggressive treatments but do not expect miracles from it. Medical microdermabrasion treatments usually cost in the range of $125 - $175.

Resurfacing of your skin with the use of the laser is the most aggressive and successful approach to skin rejuvenation. By burning off the top layers, the outer layer of damaged skin is partially removed and the skin must heal by producing new skin cells. The result is a smoother, more youthful appearance and the elimination of sun damaged skin spots or patches of pigmented skin. The key to laser resurfacing, and the real progress made in this technology, is that you can control the depth of the exfoliation or burn. Measured in microns (typical facial skin is around 1000 microns thick), lasers can be adjusted to burn off as little as 6 to 100s of microns. Superficial laser resurfacing is around 6 to 20 microns, medium-depth laser resurfacing is 20 - 75 microns, and deep laser resurfacing is anything over 100 up to 200 or 300 microns. Superificial and medium-depth laser resurfacing can be done in the office under topical anesthesia and heals well in a week or less at a cost of $500 - $2000 for a full face treatment. Best results are obtained with a series of treatments over time. Deep laser resurfacing requires an anesthetic, usually a general, and takes weeks to heal and will run in the $3000 to $4000 range. Which method you would choose depends on the time you have for recovery, your budget, and how fast you want to get the best result.

Photofacials are a well known skin treatment method that is poorly understood. It is not laser therapy but a high-intensity light treatment. Some know it as IPL (intense pulsed light). We use a higher intensity treatment known as BBL or broad-band light. It’s single best benefit is in helping reduce sunspots, freckles, and superficial pigment changes. It is very effective for facial, neck, chest, and hand age spots and pigmented sun damage. It is not an exfoliative treatment, jut think of it as most effective for helping even skin tone. It is an adjunctve treatment to skin resurfacing and chemical peels, not a substitute.

A variety of good after-the-summer facial treatments are available that can clear up summer sun damage and provide protection during the colder winter months. Meet with a plastic surgeon who works closely with a medical aesthetician to get the best treatment program for your skin.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The development of dark circles under one’s eyes makes you look tired. Some people develop dark circles with aging, while others have had them from when they were young. Dark circles occur just as frequently in Caucasians as they do in more darkly pigmented people. Dark circles, contrary to popular thought, is not due to being tired, stressed, or worn out. (no matter how you feel!) Dark circles develop due to staining of the thin eyelid skin from pigments that have leaked out from your blood cells. The blood cell pigment, known as hemoglobin, oxidizes when it gets close to the skin’s surface due to light exposure and turns a bluish red color. (the hemoglobin turns to hemosiderin, an iron-based pigment) This discoloration subsequently looks like a bruise and is easily seen since the lower eyelid skin is very thin and almost transparent. Once the dark circles appear from the pigment deposits, they may likely be permanent.

 
What can one do for dark circles? First and foremost, eyelid surgery will not get rid of dark circles. Lower blepharoplasty, which removes excess lower eyelid skin and fat, does not directly target the pigment-staining problem. In the short-term, it may actually make it look worse due to the bruising from surgery and has the potential to place more blood products near the skin to be broken down. In some cases, there is some improvement in the appearance of the dark circles as the lower eyelid is tightened and there is less of an undereye hollow for shadowing to appear in. But one should never undergo lower blpeharoplasty if your main objective is to get rid of the darl circles. Any improvement in the dark circles should be considered a bonus but not the main objective of the surgery.

 
Secondly, peeling, burning, or exfoliation of the lower eyelid skin does not usually work well either. Whether it is done by a chemical peel or laser resurfacing, the removal of the outer layer of the lower eyelid skin does not reach the area where the pigment deposition lies. Resurfacing removes the outer epithelium of the skin but does not, or should not, reach the deeper dermis or the underside of the skin. (if it does, the lower eyelid will scar) While I don’t think there is much harm to a lower eyelid peel, with a 25% or 35% TCA solution, it is not particularly effective in most cases. And runs the risk of an additive problem known as hyperpigmentation which can contribute to the darkness of the lower eyelid skin.

 
Potential leaching of the skin through hydroquinone topical preparations seems like a reasonably safe approach, although how it works doesn’t necessarily specifically target the pigment issue. Hydroquinone works by suppressing the melanin or color production of the skin so it is easy to see how this may be effective for hyperpigmentation or age-related (sun exposure) brown spots. But this bleaching chemical is not known to specifically break down and clear hemosiderin pigments stains. So bleaching the skin sounds like it would work, but the chemistry behind it would suggest otherwise.

 
Lastly, many topical skin creams claim dark circle improvement and some are even labeled as dark circle repair serums. These contain agents such as arnica, haloxyl, and other enzymes that purportedly break down the pigments and help the dark circles fade. While theoretically appealing, there is very little good clinical or study information that would support these claims. Even if effective, it would be a slow process in which it would takes months to begin to see improvement. (which is ok if improvement actually occurs)

 
My frustration with dark circles has led me to try another approach. I currently am using light therapy (intense pulsed therapy, specifically broad band light) with vascular filters in combination with topical dark circle serums. It strikes me that something is needed to intiate the pigment break-up and light therapy can specifically target that without injuring the overlying skin. And without any recovery for the patient. I currently am doing a series of 3 light treatments spaced one month apart with nightly applications of the topical serum.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis