The skin throughout our bodies is often perceived as being fairly similar. Although the basic makeup of the skin (epidermis and dermal components) is the same from the face to the toes, there are substantial differences in their ratios and thicknesses at different bodily locations. These differences can not only take advantage of , but require, the benefits many topical products that are available. This is particularly relevant in the unique skin around the eyes and the lips. These areas are often where cosmeceuticals can have the greatest impact on their appearance.

The skin around the eyes, particularly the eyelids, is very thin and one of the thinnest on the entire body. What makes it so thin is that it has an epidermal layer on the dermis that is substantially thinner than that found on the rest of the face. This scant epidermis is exposed to the constant effects of blinking, squinting and smiling which easily lends to the formation of wrinkles. This is exacerbated by the lack of any substantative oil glands in eyelid skin to keep it supple. While Botox can help with reducing the dynamic component of eye area wrinkles, moisturization of eyelid and periorbital skin is critical. Because of the thinness of the epidermis, it is also an area that can be exquisitely sensitive to exfoliating and peeling agents. This is why every skin care product line has specific eye topical agents which usually have lower concentrations of and milder exfoliating agents to reduce reactive redness and the flaking of the skin.

The skin on the lips is also unique. Besides being less thick than the surrounding facial skin, the lips have no sweat or oil glands. As such there is no natural protective barrier to keep the lips smooth. When exposed to the enzymes that the saliva in our mouth contains, the lips can be a facial area of constant dryness and irritation. This becomes exacerbated in colder weather where moisture loss occurs more rapidly and the lips become drier. Similar to the eye area, lips have their own need for topical products that both hydrate and exfoliate. Lips need more hydration than exfoliation so a topical lip product contains different ingredients than that used around the eyes. This has led to many types of lipstick containing more than just color. Reactive inflammation is better tolerated aesthetically in the lips due to the swelling which can occur. The creation of a temporary enlargement of the lips is more pleasing then swelling around the eyes.

The eyes and the lips are unique areas of facial skin that are prime targets for the benefits of topical products. Such products are an integral part of any skin care maintenance program as well as after aesthetic eyelid (blepharoplasty) and lip augmentation procedures.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

1.      What is the best approach to make my skin look better?

To make your skin look and feel more healthy and attractive, one must reduce or prevent wrinkles, sun spots and loose skin, improve skin texture and color, and remove blotches or damaged blood vessels.

Such total skin rejuvenation requires a program approach. Skin care is very similar to exercise and dieting…there is not one single thing that makes the big difference. It is a combination of different methods over the long-term which attains improved and better looking skin. One needs to avoid the idea that a single product applied daily is what works the best.

A comprehensive skin care program includes a daily topical regimen (at-home products), periodic exfoliative maintenance and refreshening (microdermabrasion and superficial chemical peels) and therapeutic laser and light treatments if needed. (deeper wrinkles, brown spots, and red lesions and vessels) Putting a individualized program together with the right products and types of treatments requires a skin care professional. (aesthetician) The skin care world is full of thousands of products and treatments. Knowing which is best for you requires a professional guide.

2.      How does microdermabrasion work?

The concept of microdermabrasion (often referred to as getting a  microderm) is to remove the most outer layer of the skin. (known as the stratum corneum which is dead skin cells) This is done by light abrasion usually using a wand with a roughened surface. It is not a painful procedure and requires no anesthetic. It is done either as a stand alone procedure but more commonly, and effectively, as part of a comprehensive facial treatment procedure.

Besides being a refreshening skin procedure, removal of the outer skin cells allows applied topical products, like light chemical peels, to penetrate deeper for more of an effect. It is part of a periodic maintenance facial skin treatment which is done every six to twelve weeks. Microdermabrasion is often touted has having benefits for scars and other superficial skin lesions but this is not true. It simply doesn’t go deep enough or remove enough skin layers to have any significant effect on these problems.There is no evidence that it can stimulate collagen formation either so it does not have a ‘rejuvenative’ effect on skin. Microdermabrasion can also be used as part of a treatment program for acne but chemical peels are usually more effective and less irritating. Because it is a superficial exfoliation treatment, there is no recovery needed.

Microdermabrasion should not be confused with dermabrasion, a much deeper form of skin removal. This requires some form of anesthesia, is effective for deeper scarring and wrinkles and requires a recovery period.

3.      How effective are IPL (photofacials) and what skin problems are they good for?

Light-based treatments are non-invasive procedures that are known by a variety of names, most popularly IPL or intense-pulsed light or BBL. (broad- based light) Unlike focused wavelength light (lasers), IPL treatments use non-focused broad-spectrum light targeting red and brown pigment which commonly develops from sun-damaged and aged skin. These treatments can leave skin with a more even colored complexion.  They are a safe and effective method to improve the signs of aging from the face, neck, chest, arms and hands.

Pulsed-light treatments have been credited for improving fine wrinkles and skin texture but theses effects are minor and not their primary benefits. One newer use for pulsed light is to help tighten skin. Without damaging the skin’s surface, pulsed light can safely heat the inner layer - dermis - of the skin, inducing the formation of collagen causing some mild skin contraction.

4.      What is a good skin product?

The plethora of over-the-counter skin care products is overwhelming and certainly confusing. Yet there are some significant similarities amongst many of them. The majority of them are basically moisturizers with additional components of sunscreen and botanicals. The moisturizer component (petrolatum, dimethicone and/or glycerin) acts both as a humidifier for the skin as well as a delivery vehicle for the other active agents.

The botanicals, such as soy, silymarin, curcumin, green tea and retinol  provide antioxidant properties that may help in the reduction of facial lines and wrinkles. The botanicals have tremendous marketing appeal but they are not the most important component of the skin care preparation.

Whether the product is an anti-aging night cream or a facial foundation, find one that does not irritate your skin and contains sunscreen protection and some antioxidant agent.

Prescription skin care products have significant proven potency, particularly in wrinkle treatment and prevention and in skin lightening. (bleaching) Vitamin A (Retin-A) and hydroquinone and kojic acid are well known for their effectiveness. A prescription product used with a moisturizing over-the-counter cream can be a very useful combination.

5.      How do lasers help reduce wrinkles and improve skin texture?

Removing layers of the skin, like sanding wood, can help get a  more even and smooth skin surface. Lasers do this by literally burning off the outer layers. Unlike microdermabrasion, lasers go much deeper being capable of removing up to one-third of the skin’s thickness. This is known as deep or CO2 laser resurfacing and requires some form of anesthesia. The effects of the heat of the laser on the dermis can also cause some skin tightening. It will usually take a week for the skin to heal after this laser treatment.

To decrease the recovery and make it an office-based procedure without anesthesia (topical is still needed), the concept of microlaser or erbium peeling has become popular. Going less deep than the CO2 laser, this treatment requires a series of laser peels done every six to eight weeks. They require just a few days to heal and, when done over time, can create a skin result that may approximate a single deep laser peel in some cases.

A newer variation of laser skin treatments is that of fractional skin resurfacing. It strives to decrease the time it takes for the skin to heal after a treatment but to stimulate the deeper collagen layers of the skin. Fractional laser does this by only treating a small percent of the skin’s surface but goes much deeper. By cutting deeper holes in the skin that are spaced out (like aerating a lawn), less skin surface is treated but those areas that are have deeper channels cut into them.

Laser skin resurfacing today can be done at different depths which can be tailored for the patient’s lifestyle. Significant wrinkle reduction and skin texture improvement can be achieved by computer-controlled skin layer removal.

6.      What role does chemical peels have in improving skin?

Chemical peels have a long history of use as a skin improvement treatment. They work by the acid acting with the top layer of the skin, ultimately resulting in it being sloughed off. The acid penetrates into the skin until it is neutralized. This controls its depth of penetration.

Chemical peels come in three basic types based on how deep they penetrate, superficial, medium, and deep. Salicyclic lactic, and glycolic acids are superficial, trichloroacetic acid (TCA) is medium, and phenol is deep. They are differing concentrations of each. Superficial peels are part of most aesthetic facial and at-home treatments, require no anesthetic and heal in a day. Medium-depth TCA peels are done by physicians, require at least a topical anesthetic, and heal in less than a week. Phenol is a deep chemical peel that has largely been replaced by CO2 laser resurfacing.

How deep a chemical peel goes is affected by a variety of factors other than the concentration of the acid. Chemical peeling is very much an art form that requires a lot of experience to get consistent and safe results. Medium and deep depth chemical peels should only be done by an experienced physician.

7.      Which is better for improving wrinkles, chemical peels or laser resurfacing?

Both can significantly improve wrinkles and the quality of facial skin depending upon the type and concentration of the chemical peel and the depth of laser resurfacing. In well-trained and experienced hands, both treatment methods are effective. Laser resurfacing is better for the treatment of scarring and skin irregularities.  

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While aging is inevitable, how it affects the way your face looks and wrinkles is not predetermined or set in stone. You did get the type and quality of skin from your parents, but how you treat it over time will affect how it looks as you get older. A new study of twins confirms that factors such as too much sun exposure, being overweight, and smoking has much to do with the wrinkles, brown spots, and telangectasias that eventually appear in all.

Twin studies are always interesting because their genes are identical and the influence of different environmental factors can be more easily seen. In the December issue of Archives of Dermatology, Dr. Baron and colleagues from Cleveland performed an analysis of environmental skin-damaging factors in pairs of twins by using a questionnaire.

Baron’s team examined facial skin of 130 twins, 18 to 77 years old, who lived mostly in the northern Midwest and Eastern regions of the U.S. who were attending the Twins Days Festival in Twinsburg Ohio in 2002. The study group consisted of 52 fraternal and 10 identical twin pairs, plus 3 pairs who were unsure of their twin status. Identical twins share all of their genes and fraternal twins share only about half. The survey collected information about each participant’s Fitzpatrick type, history of skin cancer, smoking and drinking habits, and weight from a cohort of twins. Clinicians then assigned a clinical photodamage score to the face of each participant.  

From these data, the study noted a strong association between smoking, sun exposure and history of skin cancer, and being overweight with facial skin that had more signs of environmental damage as evidenced by wrinkles, brown spots, and visible blood vessels. Interestingly, by contrast, sunscreen use and alcohol intake provided more of a protective effect with better skin quality scores.

 The study of twins provides a unique opportunity to use genetic similarity in order to isolate how the environment influences facial skin aging. This important study shows that well known risky behaviors do make a difference in how the face looks. While one can debate about how significant those differences are, the cumulative effects of smoking, sun exposure, and weight lead to more cases of skin cancer and facial skin damage. It is not clear how or why alcohol may have a ‘protective’ effect other than most alcohol is probably consumed indoors.

In conclusion, skin aging is related more to environment and lifestyle than genetic factors. So protect yourself from the sun starting when you are young, don’t smoke, and stay in shape…you face will thank you for it!

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As this decade heads to completion, the single technological ingredient touted in skin care products is that peptides. Peptides are active molecules that have the potential to regulate or control the skin’s biological activity….in essence altering the interaction between the dermis and epidermis. Such messaging could have a big impact on skin wrinkling and how it appears externally.

Peptides are compromised of a mere 20 amino acids. But the mathematical  combinations between these 20 variables could theoretically be in the millions. But which combination(s) will be effective is the daunting question. Equally problematic is the issue of penetration into the skin. Since peptides are linked amino acids, the shorter the chain the better the penetration. Long chain peptides penetrate the skin very poorly.

One way that peptides may work is its effect on collagen, having a repairing influence.  Skin is made up mostly of collagen which gives it support and thickness. Young people have lots of collagen and taut, smooth skin. As we age, collagen is destroyed but not replaced well.  When collagen breaks down, it forms specific peptides. These peptides act as a signal to tell your skin it was damaged and to make new collagen. Applying the right peptide to your skin as we age is a way to make your skin think it needs more collagen. This is the theoretical approach to the use of palmitoyl pentapeptide (Matrixyl) for example.  It can be found in many contemporary skin products and may have a positive effect on lessening the appearance of fine facial lines.

Peptides comprised of copper have good evidence of being helpful in promoting collagen production as well as an antioxidant effect. Copper has been documented to be helpful in chronic skin wounds for some time. It is logical, therefore, that if copper is attached to a peptide that it may be beneficial for skin regeneration by having an up regulation effect on fibroblasts, the cellular manufacturing plant of collagen.

Beyond collagen regeneration, peptides have been investigated as a potential relaxation agent as another approach to prevent skin wrinkling. Certain peptides may have an effect on the interaction between nerves and muscle. By impeding neurotransmission, the nerves that work the facial muscles may be weakened, similar to Botox. (although with not nearly the same potency) A neuropeptide acetyl hexapeptide-3 (argireline) is the most well known and is used in numerous high-priced topical products. A similar relaxing approach is that of pentapeptide-3 leuphasil  (which blocks calcium uptake) and pentapeptide violox. (which blocks the receptors of acetlycholine) For now, these peptides seem like a theoretical addition to use with Botox but their real benefits as a stand alone treatment remain to be quantified.

The problem with peptides is not only their penetration issues but their activity levels. Without being able to pass through the stratum corneum, they will sit on the skin and be worthless. Much work has been done to attach peptides to penetrating agents. But having peptides that still have activity and bottling them into a jar or bottle is another hurdle. Because they are break-down products of proteins, they have to be stabilized or they will be essentially dead peptides  which will be eventually washed away.

For now, collagen signaling peptides and the neuropeptides seem the most promising. But more clinical evidence will have to be forthcoming to determine their clinical benefits and whether they are worth the increased price of the products. In my Indianapolis plastic surgery practice, I find their current use is best used as an adjunctive treatment after Botox (neuropeptides) or after any form of skin resurfacing. (signaling peptides)

Dr. Barry Eppley

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

As a plastic surgeon with several full-time aestheticians and multiple lasers, we perform a lot of skin care for our patients. As a result, I have had the opportunity to talk to many patients about their skin and what they do to it. From those discussions, I have learned many understandable myths and misinformation that patients have about their skin and skin care products.

1) There is no magic single product that does it all. Skin care is a matter of selecting a handful (not a cabinet full) of good products that can perform the basic functions of cleansing, moisturizing, protection, exfoliation, and stimulation. No one product, no matter how many ingredients it may have, can do it all.

2) Products that contain collagen or hyaluronic acid can get into the skin to buildup it up and thicken it. This is a classic ‘trueism’, meaning it sounds like it should work so it does. There is no scientific evidence that large molecules like collagen or hyaluronic acid can get into the dense dermis which makes up about 95% of skin thickness. These product ingredients feel good to the touch and they do moisturize the outer layer (epidermis) but that is as far as it goes. Topical collagen can not make your skin have more collagen.

3) Organic skin care products are better than synthetic skin care compounds. This sounds good but it is far from accurate. Many organic products are far from natural and are misrepresented. But that issue aside, synthetic compounds can look identical to natural compounds and often are more potent. The issue should not be whether a compound is natural or synthetic, but how well does it work. Skin care and skin care products are attempting to delay and improve upon a natural process, aging. Most of the time it takes an unnatural or synthetic approach to really do so.

4) The higher the SPF rating, the better the product is for sun protection. This is true, but only slightly so. The majority of sun protection comes at the SPF 15 level. Moving up to SPF 30 increases protection only by an additional 2% and SPF 45 an additional 1%. It is fair to say that SPF protection above 30 is only important if you are going to be out in the sun a really long time. Also SPF only covers UVB rays, not the more harmful UVA rays. New sun protection rating systems, including UVA, are forthcoming.

5) Antioxidants can help make wrinkles lessen or go away. This is probably the most common current misconception patients have about skin care technology. Since antioxidants have come onto the skin care scene, newer ones appear every year and their promises are great. The reality is antioxidants help battle free radical formation, a primary cause of skin damage, but it can’t repair skin damage that currently exists. Only some form of physical manipulation, such as Botox, microdermabrasion, chemical peels, or laser resurfacing, can significantly lessen or improve wrinkles. Topical Vitamin A and C can offer mild improvement over time also.

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 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