goodbye wrinkles and age spots

STYLE
GOODBYE WRINKLES
AND AGE SPOTS
52 act two magazine Winter 2012
BY JASON MCBEAN, MD
Have you ever lied about your age? Have you
turned a certain age multiple times? Many men and
women in the U.S. are afraid of getting older.
Numerous over-the-counter antiaging products
promise smoother tone and texture, fewer wrinkles
and younger looking skin. And many products and
minimally invasive procedures can help your skin
look and feel more youthful. How do you choose
what’s right for you?
EXTRINSIC VS. INTRINSIC AGING
Extrinsic aging refers to the effects of external
influences on the skin, such as ultraviolet radiation
(sun exposure), tobacco smoke, environmental
pollutants, excessive alcohol and stress. These are
preventable triggers that lead to the hallmarks of
extrinsic aging, which include fine lines or wrinkles;
rough texture; dry, thin appearance; tiny red blood
vessels and focal areas of brown spots. Extrinsic
triggers may also lead to pre-cancers and skin
cancers, particularly in fair-skinned individuals.
Intrinsic aging, also known as chronological or
natural aging, is beyond our control and is linked to
our anatomy as well as our genetic make-up. Intrinsic
aging is manifested by loss of volume around certain
areas of the face, loss of elastic tissue accentuated by
gravity and remodeling of underlying bony tissue and
cartilage. The areas around the eyes, nose, mouth
and temples recede, leaving a hollow, aged
appearance. Under-eye circles or bags, lines around
the lips and heavier jowls are due to loss of the
youthful fat, elastic tissue, bone and cartilage that
once supported the skin and provided a more
homogenous appearance.
THE SOLUTION
Topical therapies: sunscreen, retinoids, antioxidants
Sunscreens
Sunscreen is the most important and obvious
antiaging product available. The best sunscreens
block both UVA and UVB (the sun’s long and short ultraviolet waves) and contain an SPF of 30 or greater. A facial
moisturizer that contains an SPF is a great way to use sunscreen on a regular basis and squeezes two steps into one.
Some brands are taking it a step further, packing wrinkle-fighting ingredients, such as vitamins C and E and plant extracts,
into their sun-protection formulas.
Retinoids
Retinoids, such as Retin A and tretinoin, are vitamin-A-derived compounds available through a prescription. They are the
only creams the Food and Drug Administration (FDA) has approved for treating wrinkles. Retinol is a less potent over-thecounter alternative. Vitamin-A-derived products promote collagen production, improve skin tone and color, and reduce
mottled patches (hyperpigmentation) on the skin. These products may create initial dryness and flaking, as well as sun
sensitivity; however, most individuals acclimate to these changes days to weeks after use. It’s important to wear moisturizer
and sunscreen when using these products.
Winter 2012 act two magazine 53
STYLE
Antioxidants
Antioxidants are substances that neutralize free radicals — unstable oxygen molecules that break down human
cells and degrade DNA. Damaged skin cells can lead to accelerated aging in the form of wrinkles, dry skin,
dark circles under the eyes, dull skin and more. Common antioxidants used in skin care regimens include vitamin
C and E serums, coffee berry and green tea extracts.
Chemical peels
A chemical peel is one of the least invasive ways to improve the appearance of your skin. Although chemical
peels are used most often on the face, they can also be used to improve the skin on your neck and hands. In this
treatment, dermatologists use agents such as lactic, glycolic, salicylic or trichloracetic acids to cause a forced
exfoliation that leaves the skin with smoother tone, texture, color and glow. Chemical peels may also improve
fine lines around the eyes and mouth, as well as improve acne scars and mottled pigmentation. Although
minimally invasive, chemical peels may cause the new skin to be temporarily more sensitive to the sun, and
deeper peels risk complications, including discoloration.
Microdermabrasion
Microdermabrasion is another nonsurgical method of facial rejuvenation. Microdermabrasion uses tiny particles
that pass through a vacuum tube to gently scrape away the aging skin and stimulate new cell growth. Because of
the superficial nature of this technique, patients with mild to moderate skin damage and wrinkles are the best
candidates, and multiple treatments are usually required to achieve subtle results.
Laser procedures
Numerous laser procedures are available, depending on the ailment being treated. Specific lasers now exist for
hair removal, brown spots, blood vessels, skin tightening and even fat reduction. The latest laser rejuvenation
techniques involve a method referred to as fractional laser treatments. Fractional laser treatments create
thousands of micro-channels (holes or zones) into the skin, leaving equal areas unaffected. In other words, for
every zone created by the laser, a zone of skin is left untouched. This method of “fractional” rejuvenation allows
the skin to heal much faster than if the entire area was treated at once, using the body's healing process to
create new, healthy, tighter skin that replaces imperfections.
54 act two magazine Winter 2012
Figure 1. Fractional CO2 laser patient. Note improvement of wrinkles around eyes and corrections of facial
imperfections.
Injectables
Injectables are products injected into the skin that
correct the intrinsic causes of aging discussed
above. Botox, Collagen and Restylane are the
most common examples of injectables. Newer
injectables include Dysport, Juvederm, Juvederm
Ultra Plus, Perlane, Radiesse and Sculptra. A
review of all of these products is beyond the
scope of this article; however, we will discuss the
more common fillers, Botox/Dysport and
Restylane, and their use.
Figure 1
Dynamic Wrinkles vs. Static Wrinkles
So when and where do we use Botox and when and where do we put Restylane? To answer this question, the difference
between dynamic wrinkles and static wrinkles must be clear. Dynamic wrinkles are caused by contractions of the
underlying facial muscles as you smile, laugh or frown. Frown lines or 11’s between the eyebrows, upper forehead lines
and crow’s feet around the eyes are examples of dynamic wrinkles. Botox corrects or minimizes these lines.
Static wrinkles, on the other hand, are those formed by volume loss and appear while the face is not moving. Examples
include laugh lines between the nose and the corners of the mouth and lines around the lips. Restylane corrects these lines
and restores volume under the eyes and to the lips and cheeks.
Figure 2. Botox glabella
Figure 2
Figure 3. Restylane laugh lines
Talk to your board-certified dermatologist or
dermatologic surgeon about your choices and
what works best for you. These techniques can
make your skin look and feel as youthful and
healthy as possible.
Figure 3
Jason McBean, MD, is a board-certified
dermatologist and a specialist in cosmetic
dermatology at Fairfield Dermatology in
Fairfield. www.fairfieldderm.com
Winter 2012 act two magazine 55