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.
Indianapolis, Indiana