Skin Care Basics

American spends billions of dollars each year on topical anti-aging creams. Many products advertise dramatic results, but in reality, little evidence support these claims. Ideally, a healthy lifestyle should be combined with a morning and evening skin care routine. The routine starts with a facial cleanser and toner, which remove excess oils and residue. On a clean, dry face, corrective anti-aging products should be applied, followed by moisturizer and daily sunscreen. The therapeutic products below can by layered and alternated as desired and tolerated. Here’s a list of corrective, anti-aging products that really work:

Retin-A, Retinoic Acid is listed first because it is one of the proven best anti-aging, corrective products available. This vitamin-A derivative sweeps away dead cells, increases collagen, and increases skin thickness. It has been shown in many scientific studies to improve global skin appearance, wrinkling, roughness, and pigmentation. It is also non-comedogenic and can help prevent breakouts. It should be applied nightly and is not recommended for patients who are breast-feeding or pregnant, or those with a philosophy of excessive sun exposure. Strict use of sunscreen daily is required. It is a mild exfoliant, and can cause mild intermittent skin irritation (redness and flaking). If skin irritation occurs, skip a few nights until symptoms resolve and then resume as tolerated. A 0.5%-1% topical cream is recommended.

Hydroquinone is the most effective product for bleaching skin and fading hyperpigmentation (dark spots). Dab it directly on your dark spots, or over your entire face, but also make sure to apply sunscreen relentlessly. If UV rays hit your unprotected skin, the spots you’ve faded will resurface. Hydroquinone can be applied 1-2 times per day at strengths of 2-4%.

Vitamin C (Ascorbic Acid) is one of the most well- studied vitamins in anti-aging and has been proven effective in multiple studies. It is an important antioxidant and anti-inflammatory agent. Improvements in surface texture, wrinkles, laxity, and sallowness are well documented. Look for effective concentrations at 3-10%.

Alpha Hydroxyl Acids (AHAs) such as glycolic acid and lactic acid exfoliate the skin while regenerating new cells. This translates into a smoother complexion with less photodamage, while allowing other anti-aging ingredients to penetrate faster and work more effectively. At higher concentrations (25%), collagen and skin thickness increase. The effectiveness of glycolic acid is proportional to the duration of application and concentration. The FDA limits AHA concentration to less than 10% in over-the-counter products. Peels of 10-40% strength can be used in offices and salons by trained aesthetians. Plastic surgeons can perform even stronger glycolic or lactic acid peels with more than 40% AHA concentration. Regular application of lower concentration AHAs still significantly improves the appearance of skin without causing as much irritation and peeling.

Antioxidants scavenge free radicals, preventing their ability to damage and age skin. Vitamin E products such as tocopherols and tocotrienols are commonly seen on cosmetic labels. There are no studies showing an anti-aging benefit of topical vitamin E products. However, combining Vitamin E with Vitamin C enhances overall antioxidant capacity. Other antioxidants including green tea, pomegranate, coffeeberry, alpha lipoic acid, ubiquinone, and idebenone are commonly seen in skin care products. Their role is to save cells from environmental damage. Products with multiple antioxidants act synergistically and target free radicals in different ways, minimizing damage to the skin from the environment. However, the overall effect on the appearance of skin after regular use is probably more subjective, as studies are equivocal.

Vitamin B derivatives such as Niacinamide have been shown in a few studies to improve wrinkles, hyperpigmentation, red blotchiness, skin yellowing, and increase skin elasticity. Nicotinamide, another Vitamin B analog, improves skin hydration by increasing the synthesis of ceramide in the skin. Ceramides prevent water loss. Skin hydration is obviously important for the overall appearance of the skin. A newer Vitamin B derivative, 2-dimethylaminoethanol (DMAE), in 3% strength was shown to improve wrinkles, under-eye dark circles, and sagging skin.

Pentapeptide (pal-KTTS) is a fragment of collagen, and has been shown to be effective in decreasing facial wrinkles and roughness. Look for a 3% concentration in skin care products for maximum benefit.

Any individual is capable of having youthful, healthy looking skin. Incorporate a regular skin care routine along with your healthy diet and exercise and try to avoid too much sun exposure and cigarette smoke. Get regular sleep, and take time to relax and minimize stress. Be compliant, and start sooner rather than later. Keep in mind that many over-the-counter topical products claim ingredients that have no proven scientific benefit and do not live up to the fancy advertisements. Do your research and check for key ingredients with adequate concentrations before spending a fortune on products that do very little except perhaps moisturize the skin. It is true that keeping the skin hydrated and moisturized does a lot to help the overall appearance of the skin. If in doubt, consult with your plastic surgeon about skin care lines and products that have proven benefit. Don’t forget daily sunscreen with SPF of 15 or more and UVA and UVB protection, whether you are indoors or outdoors, rain or shine.

Dr. Hayley Brown MD, FACS
Plastic Surgeon Las Vegas
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada

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