Everyone by now knows the value of using sunscreens in lowering the risk of getting skin cancer. By decreasing the amount and duration of ultraviolet light skin exposure, the skin cells have more time to repair themselves and less chance of permanently damaging the natural healing mechanisms of the cell’s structure. In addition, it has now been proven that sunscreens also result in less skin aging and less skin wrinkles over time. In the June issue of the Annals of Internal Medicine, a study out of Australia (a country that really knows about sun exposure) reported on the effects of the use of sunscreen in over 900 fair-skinned people under age 55. They either used SPF15 sunscreen daily or only as they desired. The group that used daily sunscreen showed little increase in skin aging after nearly five years compared to the group that used it on a more discretionary basis. These findings are really no surprise in that skin aging and wrinkle development is known to be the result of irreversible cellular damage of the elastin fibers and decreased collagen production from ultraviolet irradiation. Decreasing the risk of skin cancer and slowing down the visible signs of skin aging are the direct result of blocking UV rays. This is why many modern skin moisturizers and even makeups contain UVA and UVB protection.
Any patient that undergoes a facelift has understandably great expectations given the commitment involved. But a facelift alone can not correct all facial aging problems. Preparing for a facelift is not only a matter of education but also benefits from before and after surgery skin care. When a patient is looking for and is ready for a facelift, their skin is also ready for a makeover as well.
Because a facelift only treats the sag in the skin and underlying tissues due to effects of gravity and other environmental factors, additional skin issues such as finer wrinkles, brown spots, large pores, red spots and generalized poor skin texture are not treated. Simply lifting up and pulling the skin tight will not get rid of every facial imperfection. Undergoing skin treatments both before and after a facelift can really put the ‘icing’ on the effects of the surgery.
Treatment options before a facelift can include microdermabrasion combined with light chemical peels (what I call a medical microdermabrasion) or medium-depth chemical peels like a Vi peel or the Perfect peel. These should be done no sooner than three or four weeks before surgery. These skin treatments will really freshen up the skin and an immediate improvement in skin texture will be seen.
In addition, the use of Retin-A is a great topical daily treatment in addition to or in lieu of the patient’s existing skin care regimen. While Retin-A has been around for decades and is not a sexy new topical agent, its benefits to the skin are well proven. It makes the skin healthier by thickening the dermis and improving its vascularity. This makes it heal better after surgery or just skin resurfacing. The strength of the cream or gel and how many times to apply it daily depends on the patient’s skin. The thicker the skin, the greater strength and number of applications it will tolerate without becoming too irritated.
After facelift skin care initially can include oral and topical Arnica and mineral makeup to cover the bruising. A return to one’s normal skin care regimens should wait a few weeks after surgery until the bruising is gone and most of the swelling has subsided. A month to six weeks after a facelift is a good time to have a microdermabrasion treatment to exfoliate the skin and buff up the facelift result. While there are many skin care product lines available, the use of topical Retin-A at some frequency of application after a facelift is always a good product to incorporate into one’s skin care regimen.
For many facelift patients, this surgery may be done only once in their lifetime. Many of these patients have never had a good skin care regimen and this surgery provides an opportunity to embark on one. Helping the facelift patient enhance and protect their surgery efforts is a valuable educational service.
Everyone knows the benefits of drinking water for hydration and ultimately for survival. But what is the deal with mineral water? While tap and many bottled waters have a modest amount of minerals, it is just a fraction of what is found in various mineral waters. Such water is derived having flowed through rocks and other natural materials so that it contains high levels of dissolved minerals. The FDA regulates how much dissolved solids are in mineral waters and they do not allow the bottlers of it to claim any specific health benefits from it. But such minerals in water has numerous health benefits beyond hydration which includes naturally balancing electrolytes such as potassium, magnesium and chloride as well as providing antibacterial and antifungal benefits. Mineral waters often have significant levels of calcium and magnesium which can be hard for some people to get enough of in their diet alone. Some mineral waters may also contain levels of silica which have numerous skin benefits including reducing inflammation and giving it a smooth silky feel.
Light has been know to be therapeutic for the human mind and body for thousands of years. Whether it is the psychological aspect of emerging from winter for the springtime sun or the use of ultraviolet light therapy for certain skin conditions, sunlight has well established health benefits. But sunlight and its ultraviolet spectrum of rays can also have very negative effects as well such as skin cancers and wrinkles. So it is possible to have too much of a good thing. But artifically created ‘non-sunlight’ light, without the harmful effects of ultraviolet radiation, has been harnessed for various cosmetic improvements. These medical light therapies are based on the specific color spectrum or wavelength of light. The red light spectrum fights aging by stimulating blood circulation.This in turn stimulates new collagen growth to create healthier skin. The very well known intense pulsed light (IPL) or broad band light (BBL) uses short pulses of filtered red to green wavelengths (hence the name broad band) to remove brown and red spots. The colored spots in the skin absorb the light based on color (known as selective photothermolysis) and this light helps break up the colored skin imperfections. The blue light spectrum helps treat acne. Tha absorbed light forces the cells to release oxygen which in turns kills bacteria. This can also be added by the application of a dye (levulan) which is absorbed down into the oil glands which draws the light inward, causing the oil glands to shrink reducing future acne outbreaks.
High-intensity pulsed light has become a very popular method of treating a wide variety of skin conditions. From pigmentation issues to rosacea, the beneficial effects of pulsed light have shown great clinical benefits. One of the its even more widespread uses has been in the overall improvement of aging skin. Numerous clinical and histological studies have shown significant skin rejuvenation effects from repeated broad band light (BBL) treatments.
While visible skin improvements are seen in such treated skin, the question becomes why. What about the light that causes the skin to change? In the October 2012 issue of the Journal of Investigative Dermatology, a study entitled ‘Rejuvenation of Gene Expression Pattern of Aged Human Skin by Broad Band Light’ reported on this very question. Using the left forearms of female patients who were treated three times at four week intervals, skin biopsies were compared between these treated areas and adjacent skin. The skin biopsies were used to obtain genetic material. Biopsies were also taken at a handful of untreated females under the age of 30 to serve as a baseline comparison of youthful skin.
The study results showed that the treated skin had changes in a number of genes that are linked to the aging process. They specifically called these changes gene ‘rejuvenation’. It appears that BBL treatments affect gene function to create an anti-aging effect. It is important to point out that this is a preliminary study and it is not known whether the effects seen persist or are just short-term changes from the treatments. My suspicion is that it will take some regular maintenance treatments for persistent gene alterations. It is also not clear as to what causes these effects, the light or the heat from the treatments.
This study is very relevant as it is one of the few studies that show genetic alterations in the skin from BBL therapy. We know from clinical experience that regular BBL treatments do reduce the signs of skin aging. Now we have a peak into understanding why. Whether similar results are seen with other energy therapies such as ultrasound and radiofrequency is not known as they have not been studied.
Topical skin care has come a long way since the days of my mother’s Ivory soap and Noxzema. Beyond the explosion in available products from drug stores, retailers and doctor’s offices, the potential capability and claims of contemporary skin products at times seem extraordinary if not unbelieveable in many cases. But the hope that miracles do exist in a jar or bottle will always continue to drive consumer sales of these products which topped $10 billion dollars in 2011.
While the number of exotic ingredients in skin care has continued to expand, so has what they promise to do and what consumers now expect them to do. This is discussed in a recent article in the August 23rd 2012 Wall Street Journal entitled ‘When Skin Cream Gets Bossy’. As skin care products have made increasingly bigger claims, the level of expectations of consumers has similarly increased. And with the price tag that many of these products have, they had better deliver or consumers will stop buying. This is where better instructions are needed in how to properly use the products to get the best result. (the bossy part)
How to improve and ensure compliance with today’s skin care products is essential to seeing their potential benefits. From package inserts, the design of the dispensers to online webpages and videos, companies are educating and coaching consumers like never before. Consumers no longer need to rely on the sales person at the department store counter to learn how to use them. This is not as true for physician-dispensed products as there is more of a one-on-one relationship with the doctor or aesthetician and a higher level of credibility given their education and expertise. There is also the opportunity for follow-ups and monitoring progress in the amount of skin improvement.
One of the cleverest marketing and educational approaches that I have seen from manufacturers is the inclusion of laminated cards with either instructions, skin color or wrinkle tracking photos and phone numbers to call skincare advisors. This allows the consumer to engage with the company and provide some measure of their progress. Consumers buying over-the-counter products are much more fickle and will quickly abandon a product if they don’t see very quick results. This is why I tell many female patients that I can go to their bathroom and finds half-empty jars, bottles and tubes of products that they no longer use but won’t throw away. (until they are all dried up and useless to anyone)
Despite the improvements in over-the-counter skin care product lines, most of what they can accomplish is still largely preventative or maintenance. That feat is not to be minimized. But real improvement in brown spots, wrinkles, pore size and skin texture require topical skin care supplemented with more aggressive exfoliative therapies .(e.g., microdermabrasion, chemical peels, light and laser therapies) This is particularly true in those who already have some significant skin damage and aging changes.
While plastic surgery procedures have increased significantly over the past decade, it is no surprise that the simplest form of cosmetic enhancement, cosmeceuticals, has increased as well if not more. Applying a topical lotion, cream or serum to prevent, improve or cure cosmetic concerns has been used since Egyptian times. Retail sales of cosmeceuticals in the U.S. was nearly $10 billion in 2011 and undoubtably will be higher in 2012. It is estimated that the growth of cosmeceuticals will exceed $12 billion in the next few years. Besides the aging baby boomer population, younger generations have grown up and are bombarded with image-conscious marketing and the value of preventative health care strategies. These younger patients have opened up a whole new sales market that was not as expansive or as great in numbers as just a decade ago. Both the old and young, and everyone in between, is rapidly expanding the cosmeceutical market. This has led to a bewildering array of products to choose from which, understandably, baffles most consumers. The providers that can help consumers dissect through this product maze is a great asset.
Everyone knows that an ounce of prevention is better than a pound of cure. That is certainly true for wrinkles and an even worse consequence of too much sun, skin cancer. Protecting your skin from excessive sun exposure is one of the best ways to avoid the long-term deleterious effects of its penetrating radiation rays. While most everyone’s know this, two common mistakes are made with the use of sunscreen that substantially reduces its protective benefits. Applying liberal amounts of sunscreen every few hours is needed for optimal protection, Sunscreen gets rubbed off, is removed by sweating and water and its molecules break down. Most sunscreens do not last beyond two hours. Reapplication is necessary to put back a good protective layer. The sunscreen you use must block both UVA and UVB rays. Sunscreens with SPF only block UVB. Newer broad-spectrum sunscreens block both UVA and UVB rays. As of December 2012, broad-spectrum sunscreens that meet FDA guidelines with SPFs 15 or higher can formally make the claim that the product reduces the risk of skin cancer and early skin aging as well as helps prevent sunburns.
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 theenzymes 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.
The use of lasers and light therapies has dominated the talk about skin retexturing and resurfacing over the past decade. While they do produce some wonderful results, their use has overshadowed the historical approach of chemical peeling of the face. Chemical peeling today has been largely relegated to the superficial peels done by aestheticians and not physicians. When combined with microdermabrasion, they are known to produce a nice refreshening effect but the results are not comparable with laser treatments.
Most chemical peels that produced any significant results, such as trichloroacetic acid (TCA) and phenol, have involved significant recovery and discomfort. Medium to deep-depth peels done by physicians required significant skin penetration to produce their results. This produces significant upper layer skin sloughing and downtime. Personally, I had assumed that ‘state-of-the-art’ chemical peeling was more about technique than the chemical compositions of the solutions.
My understanding of chemical peeling has undergone a change in the past year since we have begun using the Vi Peel. This chemical peel is an innovative combination of different ingredients. Cleverly combining TCA, phenol and salicylic acid peels with retinoic acid, Vitamin C and a proprietary mineral blend, a very interesting chemical peel has been created. It can create a significant skin change (repair) without the associated pain on application and with very little downtime. I am not sure of the chemistry of exactly how it works since skin results from peeling have been historically associated with the concept of ‘deeper = better results = more pain and recovery’.
My Indianapolis plastic surgery experience with the Vi Peel has shown that it is a real revolutionary peel. I say this for the following four reasons. First and initially important is that the peel produces a significant anesthetic effect on the skin on application. So one can have the peel without pain. That is really important to patients and encourages them to return for further treatments. I assume that the anesthetic effect is from the phenol component of the solution. Secondly, it does produce real skin improvement that appears to be equivalent to that obtained from micropeel laser treatments. (less than 50 microns) A series of Vi Peels can be a comparatively cost-effective skin rejuvenation program. Third, it can be safely used on all skin types (even a Fitzpatrick V or VI) as well as on the more sensitive areas of the neck and the chest. (historical ‘no-peel’ zones) Eliminating sunspots from the hands and chest and decreasing wrinkles in the décolletage areas has always been problematic with traditional peel solutions. Lastly, the peel can be safely applied by a trained aesthetician and does not require a physician to do so.
The Vi Peel is not a complete substitute for laser and light therapies. But it is a valuable addition to skin rejuvenation by providing a real effective option for the under 100 micron retexturing needs in the face. For the neck and chest, however, this might be the best option that currently exists for real improvement without the risk of scarring.
Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.