Daily Skin Fix

Skin and Sin

There are sins of omission, sins of commission, and just sin.

Sins of omission, is not doing something. For hair that could be not getting enough iron intake and having hair loss as a result. For nails it might be not keeping the edges filed, and getting splits at the ends. For skin it could be not wearing sunscreen daily and using a targeted anti-aging skin care program so your skin ages faster than it needs to, or having severe acne, but not treating it, and then getting scarring.

Sins of commission are things you do that are just the result of bad decision making, that affect the skin, hair and nails, and badly. For hair it is that really unfortunate hair color, or decision to resurrect your 80’s perm. For nails it is wearing acrylics continuously, rocking the ends and super gluing the loose areas yourself. For skin it is going to the tanning bed 5 times a week.

And just sin is when you do something you know is damaging, and that serves no purpose, but you do it anyway. For hair it could be over plucking the eyebrows until you look like a silent movie star from the 1920’s. For nails it is biting them to the quick and ripping the cuticles off so that you can’t show your hands in a job interview. For skin it could be picking at that pimple 4000 times using your 15 power magnifying mirror, when you know nothing will come out of it, but you can’t stop picking. And then when it is trying to heal, picking at it again.

Of course, there is a lot of overlap, as when you don’t do something, and it is bad decision making, and it really serves no purpose but you do it anyway. Like not wearing sunscreen on your face, neck, forearms and hands every day. Yes, it does take 20 seconds to do. As opposed to the 5 minutes it takes to apply a heavy foundation to cover up the effects of sun damage. Clear cut categories of sin are sometimes in the eye of the beholder. And some of my “skin sins” are really other sins that affect your skin, but as my grandmother used to say to me: “Little missy, don’t try to talk your way out of this one, I am on to you. Just admit you are wrong, say you are sorry, and don’t do it again.” And as usual, she was right. So without further ado, here are my top 10 Skin Sins.

Top 10 Skin Sins

1. Unprotected Sun Exposure. You knew it would be #1. I am not going to go into my usual tirade about the aging and damaging effects of the sun, except to say—daily sun exposure is one of the top 2 most aging things you can do to your skin, and causes skin cancer. It causes discoloration, broken blood vessels, wrinkles, large pores, loss of elasticity and that stiff, yellow cross hatched skin that is characteristic of chronic sun exposure. You know this, so put on your sunscreen every day.
2. Smoking. Do I really have to say this? Smoking reduces blood flow in the skin, exposes you to direct toxin exposure on the skin and in the blood. And, if that’s not bad enough, the facial expressions repeated over and over etch lines in the skin. It is the other sin in the top two most aging things you can do to your skin. Whatever you do– don’t do 1 and 2 together. The effects of chronic sun exposure in smokers are much more damaging than either one alone. The results aren’t pretty.
3. Procrastination. I see this frequently. Young people in their twenties and early thirties are more worried about hair style, eye shadow, and outfit than they are about the health of their skin. That’s because they are young, and by and large have good skin. And then in their thirties and early forties they are raising a family, busy at work. Mornings are too rushed to apply sun screen, and evenings never end so active skin care is not applied. Then all of a sudden at 45, they have an “OMG what has happened to my face” moment. And end up in my office. All of the easy stuff to slow down aging of the skin work best when you do them while your skin is still good. And they are not really complicated—sun screen every day, a retinoid (tretinoin, retinol etc.) every night, a peptide lotion and a combo botanical and fruit acid serum once a day. Add a little Botox when those frown lines start showing and a little dermal filler for smile lines and you are good. Yes, those things help later too, but it is always easier to prevent than try to fix the damage.
4. Following every fad. There are patients who jump from doctor to doctor and back again. They try this new procedure, that new skin care ingredient they read about. Some may be appropriate for them, some are not and some are bogus. But they never stick with anything long enough to see the results they could see if they picked one doctor, committed to a treatment plan and then followed through.
5. Ignoring your teeth. We all lose bone structure in our face as we age. When we do there is less structure to the eyebrows, cheeks, around the mouth and at the jawline. Soft tissues and skin sag when there is less underlying structure. Tooth loss leads to loss of supporting bone structure around the mouth. Teeth wear down and become discolored over time. The result is a collapsed mouth without enough underlying structure to fill out the skin. So take care of your teeth. You need them.
6. Yo-yo weight fluctuations. The weight goes on. The weight comes off. The weight goes back on again. Repeat. Skin is pretty elastic, up to a point, when you are young, but it loses elasticity over time. At any age, too many episodes of weight gain and stretching, or too large of weight gain and skin loses its ability to shrink back. The result is sagging skin on the face, and sagging and stretch marks on the body.
7. Picking, picking, picking. One of my pet peeves. So much so I wrote a whole series on why you should step away from the magnifying mirror before someone gets hurt.
8. Accentuating asymmetry with bad eyebrows. Another of my pet peeves. Eyebrows frame your eyes and balance your face. Symmetry is the hallmark of a young face. We all get more asymmetrical over time but funky eyebrow shape accentuates it. The biggest mistakes are tweezing the brow too thin, tweezing the center margin too far outward and starting the arch too far centrally giving a comma shaped eyebrow. Hold a pencil parallel to the outside corner of your nostril through the inside corner of your eye to your eyebrow. Only tweeze center of this line. Rotate the pencil through the outside corner of your eye to your eyebrow. This is where your eyebrow should end. Rotate through the outside edge of the colored part of the eye to the brow. This is where you arch. Do it right and it will make a big difference.
9. Wearing heavy, mismatched foundation. Heavy foundation actually makes texture abnormalities like large pores, lines and wrinkles look worse. It can cover red discoloration. So lighten up on the foundation. It you want to fill in some of the texture abnormalities like lines and pores, and then use silicon based translucent foundation primer, followed by a lighter liquid foundation or mineral powder applied with a sponge.
10. Rushing around, doing too much and not getting enough sleep. During sleep many of the body’s natural repair mechanisms are more active including those that repair your skin. Sleep deprivation leads to both decreased levels of some beneficial hormones and less time to repair damage. Missing sleep for one night makes you look bad the next day and missing sleep on a routine basis can affect your appearance long term. So let everyone else do some of the work and go to bed.

It takes little or no money to correct these 10 skin sins. Just consistency and a little determination. So follow my grandmother’s “advice”—admit you are wrong, tell your skin you are sorry, and don’t do it again.

So now we are on the last of the 5 R’s of treatments in a cosmetic dermatologist’s anti-aging aesthetic plan: Repair, Relax, Restore, Resurface, Redrape

• Repair Sun Damage–Reduce Lines, Wrinkles, Spots, Sagging
• Relax Muscle Action–Reduce Lines
• Restore Volume–Reduce Lines, Restore Fullness and Lift Sagging Skin
• Resurface Skin Texture–Reduce Lines, Wrinkles, Pore Size, Scars
• Redrape Sagging Skin–Lift and Firm Sagging Skin

On to Anti-Aging Skin Rejuvenation Plan Step #5–Redrape Sagging Skin

It is an unfortunate fact of life–gravity will win. But we can put up the good fight in the meantime.

Young skin is tight skin. It has a natural elasticity that causes it to rebound to its original position quickly when it is stretched. It holds everything up where it is supposed to be. The natural fat pads are held up under the eyebrow, up tight under the eye, and up high on the cheek. Skin feels firm. Eyelids are smooth and tight. The jaw line is tight, with the skin up against the bone. The operative word here is “up”.

With aging, collagen and elastic fibers are broken down and the skin looses elasticity as a result of repeated exposures due to damaging effects of the sun, gravity, smoking, environmental toxins, glycemic diet, weight fluctuations, and hormonal changes. Skin feels too loose. Everything starts to sag. Patients say “my face, and everything else, is falling”. The fat pads end up dragging the eyebrows down, as bags under the eyes, and the cheeks end up at the lower face as jowls. Neck is flabby. And let’s not even go below the neck.

Adding to the loss of elasticity is the loss of volume in the face. With aging, loss of fat, collagen and bone structure cause the skin to be too loose around too little volume. When this happens, gravity takes over and the skin sags. When this occurs, the skin needs to be tightened and everything needs to be lifted–it needs to be redraped. Sometimes volume needs to be replaced in the areas where it has been lost. Tightening, lifting,  and redraping restores tighter more youthful skin.

Lifting and tightening skin can be divided into: methods to prevent or slow down sagging, treatments to give modest tightening, and  procedures that are required when sagging is more pronounced.

Next: the best ways to prevent or slow down sagging skin

Skin Resurfacing
Prevent and Correct Early or Moderate Changes
With Dermatology Office Treatments

When you are starting to see changes that you don’t want to see, it’s time to start with some of the lower intensity in-office resurfacing procedures. You are in this category of early to middle changes if you are seeing loss of glow, dullness, clogged pores, fine lines and the beginning of brown spots.

Options are light to mid-depth chemical peels and medical microdermabrasion.

Chemical Peels

Although chemical peels have been around for awhile, they are still very helpful. Chemical peels use surface agents to exfoliate and regenerate tissue by destroying layers of the epidermis. They can be divided into 3 levels corresponding to the depth of penetration in the skin. How deep they penetrate is directly responsible for what kinds of problems they can treat, the recovery time and the risk of side effects. Superficial peels include the alpha hydroxy acid peels (Glycolic Acid), beta hydroxy acid peels (Salicylic Acid). Mid level chemical peels include low strength Trichloroacetic Acid (TCA). Deep chemical peels include high strength TCA and Phenol.

With the advent of lasers, we, and many dermatologists are no longer performing mid or deep level chemical peels because of the increase in complications and reduced predictability compared to laser resurfacing.

Superficial chemical peels are used to sun damage (photoaging), acne, melasma, brown spots, texture and dullness. They may improve fine lines over time. These peels usually require a series of treatments at an of 6 treatments at 2-4 week intervals. They may be combined with acne surgery, which is the gentle removal of blackheads and pimples with sterile instruments.

Usually your face is red for a few hours and has small crusts if blackheads or pimples were removed. The skin feels tight for a day or two and then lightly peels at day 5. Patients who are treated for anti-aging return to normal activities immediately.

SilkPeel Particle Free Precision Microdermabrasion With Dermal Infusion

Microdermabrasion involves a controlled stream of particles to exfoliate the skin. SilkPeel particle-free microdermabrasion treatments use a refined diamond tip to precisely exfoliate and infuse the skin with topical dermaceuticals at a controlled intensity that improve results. There are specific dermaceutical solutions for bleaching, acne and anti-aging.

SilkPeel Dermalinfusion is used in anti-aging treatment to exfoliate dull dead skin, increase smoothness and glow, treat melasma, some brown spots and give your skin an overall healthy appearance. Treatments may improve fine lines over time. SilkPeel treatment usually requires a series of treatments at an average of 8 treatments at 2-4 week intervals.

After SilkPeel treatment your skin may be flushed for an hour. Otherwise it usually has no flaking, tightness or peeling. Patients return to activities immediately with no down time. It is especially popular before a big event, like a wedding, reunion or holiday.

Both Chemical Peels and SilkPeel are great skin resurfacing options for early to moderate aging changes.

But sometimes you need more than a tune up.

Next: Skin Resurfacing–when you need an overhaul.

The easy way–preventative maintenance with at home treatment

Preventive maintenance, ideally beginning in your early twenties, is the easy way to resurface your skin–before you even need it. At home treatment on a daily basis can prevent many of the changes that would require more aggressive treatment later. Even if you start later, either because the options weren’t around earlier, or because you just didn’t get around to it, you can get a good amount of improvement from relatively simple home treatment.

The key to success with this option is consistent and daily treatment with anti-aging cosmeceuticals, botanicals, exfoliants, retinoids and sunscreen. I see patients who start and stop programs, don’t stick with it, and blow off many days of treatment because they are too rushed to stick to a routine or who only wear sunscreen “when I am going to get a lot of sun”. There really is no reason not to get on a program and stick with it. It will pay off in the long run.

The 5 key components are:

• Cosmeceuticals
• Botanicals
• Exfoliants
• Retinoids
• Sunscreen

Cosmeceuticals are cosmetics that have effects on the skin. The main groups are the peptides, antioxidants, growth factors, and vitamins. They improve fine lines, roughness, blotchy pigment, loss of elasticity, dullness, acne, and stimulate collagen production.

Botanicals are plant derived compounds that are used for their antioxidant, anti-inflammatory, exfoliant, moisture balancing, and collagen stimulating properties.

I will talk about skin care, cosmeceuticals, and botanicals more in a future column with specific information about the individual compounds. In the meantime, there is a complete listing of cosmeceuticals and botanicals with their historical use; scientific, botanical, and trade names; and the scientific evidence of activity on the website in our Education Center.

Retinoids include over-the-counter retinol, and the prescription synthetic vitamin A derivatives tretinoin (Retin-A, Renova, Refissa), tazarotene (Tazorac), and adapalene (Differin).

Retinoids enhance collagen and elastin production thereby diminishing wrinkling, improve discoloration and roughness, and reduce pore size.

Retinoids do make you more sensitive to the sun, and should be used with daily sunscreen. We used to tell patients not to use them if they were going to get sun exposure but now we know that, within reason, you may use them as long as you use good sun protection. If you are going to the beach, lake, or skiing discontinue them for a few days before exposure.

They shouldn’t be used by pregnant or nursing mothers.

The current cost of Refissa (1 tube, 40 gm) $146.00; for Tazorac (1 tube, 30 gm) $170.00-180.00; Differin (1 tube, 45 gm) $260.00. One tube of either of these should last you about 4 months or more.

The biggest drawback, and the reason people discontinue them, is that they are irritating to the skin. I often start patients off on every other or every third night use and work up to every night. Another option is to start with the least irritating, Differin, and move up to the more irritating Refissa (for normal-dry skin) or Tazorac (for oily or acne prone skin). In addition you can either mix moisturizer half and half with them or apply moisturizer before (if you are having redness, itching or irritation) or after (if you are just dry) you apply them at night.

You should apply a pea size amount to the face after cleansing and toning in the evening. The skin should be completely dry before application. You should also apply it to the neck, back of the hands and forearms although most people can only apply it there every other night because of irritation. Those areas get aged from sun exposure just like your face. You don’t want to be one of those women who say “I hate the spots on my hands”. And while you are at it remember the sunscreen to neck, forearms and backs of hands. You need both.

Mild stinging, mild redness and mild peeling and flaking may occur during the first several weeks and on occasion when using Refissa, Renova, Retin-A, Differin or Tazorac.  This is normal.  Flaking is normal, soreness and irritation are not. To help reduce irritation, do not use washcloth, facial brushes, mesh scrubs, daily facial cloths, mineral powder brush or granular exfoliants on the face.

Discontinue these products to affected area 1 week before waxing or bleaching, or before other procedures (peels, microdermabrasion, facial, acne surgery, hair removal, laser treatments as directed.) You don’t want to end up like the bride who waxed three days before the wedding and disaster ensued.

I am a strong advocate of daily retinoid use, I feel that almost every patient desiring to prevent aging, or correct existing damage should use them. There is so much proven scientific data behind them they are still considered the gold standard in topical anti-aging treatment.

Daily, year round, sunscreen use is essential or you are just undoing what you are trying to do. Once again I refer you to my post “Quit complaining and wear your damn sunscreen”. Just do it.

If you start early on a home preventative anti-aging program you will have to do less later on and you will look better both today and tomorrow. It is never too late to start, you will see improvement. Stick with it. It is really a no-brainer.

Next: A tune up: In office treatment for early  or moderate changes

Cosmetic dermatologists achieve a youthful, aesthetically pleasing, attractive face by following the 5 R’s of anti-aging treatments: Repair, Relax, Restore, Resurface, Re-drape.

• Repair Sun Damage–Reduce Lines, Wrinkles, Spots, Sagging
• Relax Muscle Action–Reduce Lines
• Restore Volume–Reduce Lines, Give Youthful Fullness and Lift Sagging Skin
• Resurface Skin Texture–Reduce Lines, Wrinkles, Pore Size, Scars
• Re-drape Sagging Skin–Lift and Firm

Let’s go on to Anti-Aging Skin Rejuvenation Plan— –Step #3–Restore Volume

One of the most aging changes that happens over time is the loss of volume in the face. With age there is a loss of  fat, muscle and bone causing an aged, hollowed out, haggard appearance. In youth fat is under the eyeballs, in the cheeks, the temples, and the eyebrows. Over time this is reduced and drops which causes a “flat” face. This can be seen most dramatically in profile. Patients tell me “my face is melting.”

In youth the widest part of the face is the cheekbones, narrowing to the chin; called the “triangle of youth.”  With aging, volume is lost under the eyes leading to under eye bags,  hollows, and dark circles. The eyebrows fall when fat is lost, causing hooding of the eyelids. The high apple of the cheek falls. As the cheeks descend they cause deep lines from the side of the nose down past the corners of the mouth. These lines are like an arrow pointing downward, and appear to drag the face and neck downward.  The temples are hollowed, often with visible veins. The jaw line widens and the upper face narrows. The “triangle of youth” becomes the “pyramid of age.”  The skin’s “envelope” becomes loose over too little underlying structure leading to sagging, a flat and aged appearance and with jowls.

Adding to this is loss of volume in the lips as they become thinner and roll inward. Loss of bone around the mouth compounds the collapse of the mouth. Both cause a pinched and wrinkled mouth with radiating lines.

So basically, everything is falling. Cosmetic dermatologists call this deflation and descent.

And let’s not even talk about anything below the neck.

In the past, the looseness of the skin and the sagging was treated with a face lift alone, But that often lead to a gaunt, skeletonized, “caught in a wind-tunnel” look. The loss of volume needs to be corrected for a natural, rejuvenated appearance.

In any individual patient, either the volume loss or the looseness may predominate. But often it is a combination of both. If so, the problem of loss of volume and loose skin both need to be corrected. Although some patients certainly require a surgical face lift, we see many patients who successfully receive volume replacement only, or volume replacement combined with non-surgical tissue tightening with Thermage, sometimes called Therma-Fill. We will talk about this aesthetic option later.

Volume loss changes occur over time in us all, but may occur earlier in some than others. Of course, smoking or sun damage to collagen and elastic fibers cause the face to fall quicker and increases severity of facial lines. Individuals who have lost a great deal of weight, runners, and very thin individuals often show these changes earlier than others. I have a saying, “At a certain age, you have to choose between your face and your butt.” But actually you don’t– if you are willing to restore the lost fullness to your face.

So what on earth are we going to do?

Next: What we are going to do.

So now we move on to the next step of a cosmetic dermatologist’s anti-aging skin rejuvenation plan of Repair, Relax, Restore, Resurface, Re-drape.

Relax Muscle Action–Reduce Lines

We all have characteristic facial expressions which often run in families. Many patients tell me “my mom (or dad or grandmother) have horrible frown lines.  I am starting to get them too and I am afraid mine will be just as bad–help!” Characteristic facial expressions are set early in life, usually by 5 or 6 years old and sometimes even earlier. Once set in childhood they are very difficult if not impossible to change.

Frowns are often not due to anger as is commonly supposed but rather concentration. Unfortunately others subconsciously perceive the frowner as being angry. Patients say “I am so tired of people asking me why am I mad–it makes me mad”. Many people have what are called “hyperexpressive faces” and have a lot of frown activity, forehead expression and even crunch their noses up during animation (called bunny crunch or wolf lines). This gives horizontal forehead lines, frown lines and lines leading down from the bridge of the nose onto the cheeks.  Smiling or squinting leads to crow’s feet at the corners of the eyes. At first these lines appear only during expression. Over the years they become permanent, occur at rest and get deeper and deeper.

Now we are able to relax the muscles that cause these lines and reduce the angry, stressed or tired appearance. Injections of pharmaceutically prepared  botulinum toxin (Botox or Dysport) are used to treat the specific lines on the upper face that muscle related such as frown lines, forehead lines, and crow’s feet.  A “Botox brow lift” will lift the eyebows opening up the upper eyelid and reduce hooding. Some lines under the eyes can be improved. You look more rested and less stressed or angry.

In the lower face and neck Botox or Dysport are also used for anti-aging. Injections in the chin reduce muscle activity that leads to dimpling and to reduce the turn down of the corners of the mouth that occurs with age. They are also used to treat a “gummy smile” where the upper lip rises up too far with smiling showing more of the upper gum than is desirable. The muscles at the outside of the jaw which enlarge with teeth grinding can be slimmed. Bands of muscle in the neck can be softened reducing “cords” and improving the jowls.

• All in all Botox and Dysport have been great additions to our anti-aging treatments, allowing both reversal of signs of aging and prevention of progression. And contrary to the ads, nothings “better than Botox”.

Next–questions and answers about Botox and Dysport.

When I see a patient for an anti-aging skin rejuvenation evaluation, the first thing I look at is the quality of the skin. Spots, broken blood vessels, large pores, roughness, growths, milia cysts, brown discoloration, scars, acne scars, crépiness, elastosis, fine lines, wrinkles, loss of elasticity, and dullness all decrease the quality of the skin.  Most but not all of these are from chronic  sun damage.

Young skin is smooth, without blemishes, growths, cysts, brown spots, broken blood vessels, and elastosis. It has good elasticity and reflects light well giving it a luminosity. Interestingly studies have shown that people’s impression of the age of another person is primarily determined by the absence of spots, growths and the presence of luminosity. In other words a person with spots and growths but minimal wrinkles looks older than a person with few spots and more wrinkles.

That’s why it’s important in anti aging treatment to “clear the canvas and start over”.So we start with Step #1–Repair Sun Damage. Options to repair sun damage to look younger are:

At home topical surface treatments

• Cosmeceuticals and Skin Care
• Retinoids

In office aesthetic procedures:

• LED Photomodulation
• Particle Free Precision Microdermabrasion/Dermal Infusion
• Chemical Peels
• Intense Pulsed Light (IPL®)
• Fraxel® Laser Treatment

Treatments You Can Do At Home

• Cosmeceuticals and Skin Care

Antioxidants (like Green Tea, Grape Seed, Soy) help prevent and repair the damage from free radicals released by sun exposure. Hydroxy acids (glycolic and multi-fruit) exfoliate dullness and pigment, stimulate collagen production, increase elasticity. Anti-aging peptides (like  Matrixyl™ (pal-KTTKS) and Matrixyl™3000 ) reduce fine lines and increase collagen and elasticity. Stabilized vitamin C (Magnesium Ascorbyl Phosphate) reduces collagen breakdown and protects against UVB damage. To find out more about the science behind cosmeceuticals and the history and science of botanical ingredients in skin care check out our web site. And most important–Daily use of a broad spectrum sunscreen with a SPF of 30 or more is absolutely essential.

• Retinoids

Retinoids are prescription vitamin A derivatives that reverse the effects of photo aging. Over time daily use will improve fine lines, brown spots, dullness, roughness and will give some degree of improvement in pore size. There are several forms of retinoids, I find that for most adults Refissa, a 0.05 percent branded generic tretinoin formulation is the best choice. It is the same as the older 0.05 percent Renova which was discontinued when the patent ran out and replaced with a lower strength and a pump version.

Next: anti aging sun damage treatment procedures.

Most of us have had a lot of sun exposure over the years, either recreationally, occupationally or just here and there.  The sun powers all life on Earth, warms us, lets us see where we are going and cheers us up when we are down. Those are good things.  And a lot of fun activities are based outdoors, in the sun. But, like many fun activities, sooner or later there is a price to pay. With chronic sun exposure the price is premature aging, spots, wrinkles, sagging, rough skin, growths, pre-cancer and skin cancer.

There is a reason that human skin color is darker the closer the ancestral lands are to the equator–melanin is a barrier protecting against absorbing the sun’s energy which will damage  cellular DNA when the energy is absorbed.  People further from the equator had less need for this protection and needed to be able to produce enough vitamin D through sun exposure in parts of the world where the sun was much less intense, for instance northern Europe.  Some people’s skin is naturally more sensitive to daily sun exposure, especially redheads (who have a less functional kind of melanin) and those of Celtic backgrounds. The trouble comes when you take a person whose skin is adapted for northern Europe, say Ireland or Scotland, and move them to the sunny southwestern U.S. where native skin has a lot of pigment as protection.  As I tell my patients “your skin should have stayed in Ireland”.

We all have our natural level of pigment; our natural skin color at baseline. But when your skin darkens from the sun, that is in response to injury. Your skin will try to protect you the best it can. It is just that sometimes its best is not very good. And in absorbing the energy it is damaged. It’s all a matter of how much.

• The absorbed energy damages elastic and collagen fibers causing sagging, loss of elasticity and wrinkles.
• The broken elastic fibers give a yellowish bumpy surface called elastosis.
• The walls of tiny blood vessels are damaged causing broken and abnormal new veins and redness.
• The outer layer of skin, the epidermis, gets thickened and rough as damaged cells grow in a less orderly fashion.
• Pores get larger as the elastic fibers holding them closed are broken.
• Normal cell turnover is reduced, leading to dull skin.
• Irregular brown pigment and growths develop.
• The rough areas get worse as the degree of pre-cancerous changes advance.
• In some areas the cellular DNA may be damaged enough to develop into skin cancer.

Sounds delightful doesn’t it? And we have to deal with the fact that there is many years lag period between when we had the fun and when we pay the piper. I have many patients who have started to moderate their sun exposure when they start to see the damage but are dismayed that they continue to see new problems crop up. However, the very first step when we are in a hole is to stop digging. So read my previous post  “Quit complaining and wear your damn sunscreen” .  And put down the shovel.

Yes, it was fun; now the bill is due. So how are we going pay that bill?

Next time–Anti-Aging Skin Rejuvenation Plan Step #1–Repair Sun Damage

• Skin Care
• Prescription Retinoids
• Chemical Peels
• Lesion Destruction
• SilkPeel
• GentleWaves LED
• IPL
• Fraxel

If our anti aging rejuvenation plan is to consider the 5 R’s—Repair, Relax, Restore, Resurface, Re-drape–what does this mean?

Deciding how to proceed in an anti-aging skin rejuvenation plan it is remarkably similar to an interior decorator looking at a sofa and deciding what it needs to be fixed.

An interior decorator is trained to know what to do to your sofa. Cosmetic dermatologists are exterior decorators, trained to know what to do to improve your face. Just like your sofa it may be more one problem than another. And just like your sofa, there comes a point when it has had enough wear and tear that you are tired of it and want it to look like new.

The interior decorator asks:

1. Is the material good or does it need to be replaced? Does it have spots, stains? (Repair)
2. Is the material stretched too tight so there is pulling and wrinkles and ripples? (Relax)
3. Are the cushions plump or have they lost stuffing that needs to be replaced? (Restore volume)
4. Are there tears, and snags? Do I like the color? (Resurface)
5. Is the couch sagging? Do the springs and webbing need to be replaced? (Re-drape)

An interior decorator discusses your style and what you want, assesses the sofa, gives you an estimate of costs, and you decide how to proceed. Once we have discussed with you what you want and how you see the problem, we make an assessment, give you an estimate of costs, and together we decide how to proceed.

So what procedures can we use to accomplish our anti-aging facial rejuvenation goals?

• Repair Sun Damage–Spots, broken blood vessels, and roughness– skin care, prescription retinoids, chemical peels, lesion destruction, SilkPeel, GentleWaves LED, IPL,  Fraxel
• Relax Muscle Action–Reduce lines–Botox
• Restore Volume–Reduce lines, give youthful fullness, and lift sagging skin–Juvederm, Restylane, Sculptra
• Resurface Skin Texture–Reduce lines, wrinkles, pore size, scars–skin care, prescription retinoids,  chemical peels, SilkPeel , Fraxel
• Re-drape Sagging Skin–Lift and firm–Thermage, Juvederm or Sculptra Liquid Lift

Next time– how and why we need to repair sun damage.

The treatments that we perform in a cosmetic dermatology clinic are aesthetic–to improve the appearance. The most commonly requested treatments are facial anti-aging rejuvenation–restoring a youthful, aesthetically pleasing, healthy look.

The basic areas cosmetic dermatologists assess when developing an facial anti-aging skin rejuvenation plan are as follows:

• The condition of skin should be smooth, without broken veins, sallowness, brown spots, large pores,  bumps or growths.  Skin should have good elasticity and reflect light well with a youthful healthy glow.
• The distribution of fat in the face should be greatest at the upper cheeks. The cheekbone fullness on the side of the face should extend as an oval towards the end of the nose, ending above the corner of the mouth. The temples should not be hollowed.
• The lips should be full and without surrounding radial lines. The bottom lip should have more fullness than the upper lip.
• The skin should be smooth without lines and wrinkles.
• The expression should be relaxed not appearing angry or stressed
• There should be symmetry of the facial structures with one side matching the other
• The shape of the face should be the “triangle of youth” and widest at the cheekbones tapering down the chin.  It should not be rectangular or the “pyramid of age” with the widest area at the lower face.
• And most importantly the face should appear naturally youthful, not artificially enhanced.

Cosmetic dermatologists achieve a youthful, aesthetically pleasing, attractive face by following the 5 R’s of anti-aging treatments:

Repair, Relax, Restore, Resurface, Re-drape

• Repair Sun Damage–Reduce Lines, Wrinkles, Spots, Sagging
• Relax Muscle Action–Reduce Lines
• Restore Volume–Reduce Lines, Give Youthful Fullness and Lift Sagging Skin
• Resurface Skin Texture–Reduce Lines, Wrinkles, Pore Size, Scars
• Re-drape Sagging Skin–Lift and Firm

Stay tuned. Tomorrow I will begin to explain how we get there.