Premiere Dermatology

Aging Skin: What Causes It and How Do We Fix It?

 In an attempt to fight the aging process and look our best, we are often confused by the huge number of personal care products claiming to be the fountain of youth.   In this article I hope to explain the causes of skin aging and help to simplify the approach to maintaining healthy, youthful skin.
 There are two main types of aging that the skin encounters over our lives.  The first, called intrinsic aging is due simply to the onslaught of time.  This type of aging causes the skin to become thinner and more fragile, with fine lines, dryness and skin laxity. Intrinsic aging also leads to a loss of the deeper support structures of the skin.  Short of living in a bubble however, we all also develop some extrinsic aging of the skin.  Extrinsic aging is the result of exposure to the sun and other environmental stressors, such as pollution.  This type of aging causes deep creases in the skin, dilated blood vessels, pigmentary changes (sunspots) and a loss of elasticity of the skin.  In addition, with enough damage, extrinsic aging causes precancerous and cancerous lesions of the skin.
 As Thomas Jefferson once said, “An ounce of prevention is worth a pound of cure.”  However, most of us as teenagers and young adults have been very poor at the prevention part of caring for our skin. Fortunately, there are numerous very safe, non-invasive office procedures which can help us rejuvenate our skin and reverse the signs of aging.  I will discuss some of the most popular types of treatments available today.
 First, the ever popular Botox Cosmetic.  Botox Cosmetic has a long term safety record when used by skilled practitioners.  Botox is indicated for wrinkles due to muscle movement, like the vertical lines which arise due to frowning between the eyebrows. Treatment is quickly performed, involves a series of tiny injections and has minimal risk of side effects.  There is truly no other product which offers such amazing improvement in wrinkles in areas of movement and therefore I expect this procedure to remain extremely popular for years to come.
 Second, are dermal filling agents which are used to correct etched in lines and wrinkles of the skin.  The most popular of these agents are the hyaluronic acid fillers such as Restylane and Juvederm.  These agents are extremely effective at filling lines and enhancing areas like the lips.  They are made of a natural substance which holds water and supports the collagen and elastic tissue of normal skin.  These fillers look extremely natural and have virtually no chance of allergic reaction.  Immediate improvement can be obtained with these products which lasts between six and twelve months.  Treatment only requires a short office visit and a few small injections.  Risks are minimal and include a  chance of swelling or mild bruising which resolve within a few days.
 Third, are agents which repair volume loss and stimulate collagen rebuilding of the skin.  The most widely used filler in this category is Sculptra.  Sculptra is made of poly-l-lactic acid, a natural compound, that when injected into the skin builds a support structure which stimulates the persons own skin to rebuild collagen.  This leads to significant volume restoration, wrinkle reduction and improved skin tone.  Treatment requires at least 2-3 office visits with a series of virtually painless injections into the skin.  Improvement is gradual because the product is stimulating the person’s own collagen , not simply filling a line.  The results are long lasting and significant improvement can still be seen as far out as 3 years after initial treatment.
 Finally, I will discuss non-ablative laser treatment and laser resurfacing.  For years laser technologists have been searching for a laser treatment that requires no down time and takes decades of damage off the skin. This has proven to be quite a challenge.  Many lasers provide what is called non-ablative skin tightening.  This type of procedure leaves the surface of the skin intact and directs laser energy to the dermis where collagen and blood vessels are found. Therefore they can be done and the person can immediately return to normal activity. Non ablative lasers do improve skin texture, minimize fine lines and improve skin coloration. However, they require many treatments to achieve any measurable results.  Old resurfacing lasers like the Erbium and Carbon dioxide lasers lead to dramatic results with one treatment because they destroyed the skin surface.  However, because of the level of damage they caused, they required weeks of wound care and incredible risk of infection, pigment change and scarring.  Fortunately, we now have one laser that  supplies the best of both worlds, the Fraxel: repair laser.  Unlike other Fraxel lasers that are non-ablative, this laser provides the equivalent of 1/3 of a facelift with one treatment.  This remarkable procedure is made possible by fractionated carbon dioxide laser technology. This laser treats the skin in the same manner as one would aerate their lawn.  It deeply treats an area of skin and then leaves a tiny adjacent area untreated.  This allows for significant tissue tightening and remodeling and also rapid healing time.  I believe this laser is the holy grail in non-surgical rejuvenation because it delivers unbelievable improvement with only one week of down time and very few side effects.
 
 In addition to the above in office treatments to renew the skin, many products are available today which help us to improve and protect our skin and to maintain the improvement we get with in office procedures.   I will discuss some of the key products available which help to prevent the aging process. This is by no means a complete list, but rather the product categories that I believe people of all skin types should incorporate into their daily routine. 
 The first product category is a broad spectrum sunscreen.  Daily sunscreen use should be a part of every persons’ skin care regimen because it is fundamental to preventing long term damage of the skin.  I recommend a product with at least an SPF 15.  However, the active ingredient a product contains is much more important than the SPF.  SPF is simply a measure of the protection a product offers from UVB or the burning rays of the sun.  It does not give any information about protection from UVA rays.  UVA rays, like those in indoor tanning booths, actually penetrate more deeply into the skin than UVB rays and cause significant damage to the cells of the skin and the skin’s support structure.  A good sunscreen should block both UVB and UVA rays well.  The active ingredients I recommend are titianium dioxide, zinc oxide, Parsol (avobenzone)or  mexoryl  as all of these compounds block both UVB and UVA rays effectively .  Products containing helioplex are also good, as this compound helps to stabilize the other sunscreen ingredients and make them more effective.
 The second product category I recommend is an antioxidant.  Antioxidants neutralize compounds called free- radicals.  Sun exposure and exposure to environmental toxins such as pollution and cigarette smoke generate free-radicals which cause damage to the DNA of the cells of our skin.  This damage leads to signs of aging and skin cancerous changes.  Antioxidants like vitamin C and E help to neutralize harmful free radicals.  However, due to stability problems with topical vitamin C or E, these compounds only remain active on the skin for a very short time.  My favorite antioxidant is idebinone because it is the most powerful antioxidant on the market and it maintains stability on the skin much longer than other anti oxidants.  Idebinone is available in an over the counter strength in Elizabeth Arden’s Prevage.  For about the same price however, you can get the prescription strength form, called Prevage M.D. from your dermatologist.
 The final product category that I recommend are retinoids.  Retinoids are derivatives of vitamin A which have the most powerful anti-aging properties of any group of products.  Retinoids are anti-oxidants and help protect the skin from free radical damage.  In addition, retinoids also help to rebuild the skin.  With continued use these products help to rebuild dermal collagen which supports the skin.  They also help to smooth the surface of the skin making fine lines less noticeable.  Finally, because these products are antiproliferative, they have actually been shown to help prevent the progression of pre-cancerous changes of the skin. There are many products which contain retinoids.  Over the counter the most commonly found retinoid is retinol.  Many prescription strength retinoids are available from your dermatologist.  I usually recommend starting with one of the lower potency products  and gradually increasing strength every few months.  This tends to decrease the amount of irritation which can occur with these products.