Want flawless skin? Do like the vampires do, and only come out at dusk!
Although relatively rare in Manhattan, I do occasionally have the pleasure to meet individuals who come to my office that have never had a cosmetic procedure of any type performed on their skin. Imagine my delight to have been chosen as the beneficiary of their trust! Generally, the first glimpse into the field of physician-based cosmetic medicine comes from people, both male and female, who are looking for ways to improve their skin texture and to reverse the signs of aging from past sun exposure. Luckily, the majority of Americans have paid attention to the warnings from physicians regarding the risks of sun exposure and more and more people who come to my office are using a sunscreen daily, even if only to walk around the city streets. The skin is the largest organ of the human body, and it is responsible for protection against disease, prevention of fluid losses, and Vitamin D metabolism. The uppermost surface of the skin is called the epidermis, where we get the freckles and burning associated with sun exposure. Directly beneath the epidermal layer is the dermal layer, where the structural proteins collagen and elastin reside. Collagen gives our skin its strength, and elastin gives the skin its flexibility. Every year past the age of thirty years old, our skin makes 1% less collagen per year, and the enzyme that destroys collagen, called collagenase, goes up. So, collagen production goes down, destruction goes up, and once we women hit menopause and the levels of estrogen decline the skin gets thinner still [how unfair]! Therefore, my main goals for obtaining skin rejuvenation are to build more collagen in the skin and to prevent the breakdown of existing collagen. Cumulative exposure to sun remains the largest factor in aging skin and is responsible for most of the unwanted aesthetic effects. Photoaged skin is characterized by wrinkles, skin laxity, brown spots, broken capillaries, increased pore size, and a leathery appearance. Dermal damage induced by ultraviolet radiation is principally manifested as the disorganization of collagen fibrils and the accumulation of elastin containing scars (solar elastoses). The associated fiber breakdown is responsible for the wrinkle formation associated with sun-damaged skin. The accumulation of matrix metalloproteinases in response to sun exposure are responsible for the specific degradation of collagen and elastin and are believed to initiate the molecular pathway underlying the changes seen in photodamaged skin. Prevention of breaking down collagen is simple…wear sunscreen. The higher the SPF, the better. There is a difference between sunscreen and sunblock. I prefer to use products that contain Zinc Oxide and/or Titanium Dioxide because these agents are a total sunblock. Personally, I like the SkinCeuticals line because it is rapidly absorbed and non-greasy. Sunblock needs to be applied liberally every thirty minutes while in situations of strong sun exposure. The topical application of anti-oxidants such as Vitamin C, Vitamin E, and Idebenone have also been shown to boost the protection of the skin by scavenging free radicals responsible for the DNA damage caused by UV radiation. Skinceuticals makes a product called C+E Ferrulic that is a liquid antioxidant that can be patted onto the face prior to the application of sunscreen. Prevage MD is a moisturizing product introduced by Alleran in conjunction with Elizabeth Arden, and is available through a physician’s office. Prevage MD contains 1% Idebenone which is an exceptional antioxidant. I generally use the Skinceuticals C+E Ferrulic and sunscreen during the daytime, and then I use the Prevage MD at bedtime while the skin undergoes it’s repair processes.
Now that we have protected our skin from losing any further collagen, we can turn our attention towards jump-starting our skin to make more collagen. As I said earlier, once we get past the age of 30 years our skin doesn’t make as much collagen because our fibroblast cells have gotten lazy. The easiest thing that anyone can do to help his or her skin to build more collagen is to make sure that there are plenty of building blocks for collagen formation floating around in the bloodstream. By “building blocks” I mean vitamins, the most important of which is Vitamin C. In order to build collagen, you need vitamin C. Vitamin C is to collagen as bricks are to a house. You can build a much bigger house if you have a lot of bricks. Likewise, you can make more collagen if you have more vitamin C floating around in your system. I generally advise people to take 1000 mg of Vitamin C three times a day. I take 2000 mg at breakfast, and another 1000 mg at lunch. Anything more than this should be regulated by a physician since Vitamin C can cause stomach upset in suceptible individuals. Omega-3 essential fatty acids found in cold water fish such as salmon or supplement form are also a wonderful way to get a natural glow to the skin. The old adage goes that if you want your skin to glow for when you are on television, you should eat salmon three times a day for one week prior to your television appearance. I take 600 mg of a combined formula with EPA (eicosapentaenoci acid) and DHA (docosahexaenoic acid) two times a day, and I love salmon! Other nutrients that are beneficial to the skin include silica, CoQ10, Vitamin E, and resveretrol. I will be coming out with my own formulation of vitamins geared for the skin that contains the purest, most potent forms of these agents, as well as some other goodies, so stay tuned!
Aside from nutritional supplementation, the second biggest question that I get asked in my practice is what skin products that I recommend. Well, I have essentially two types of patients, those who use LaMer or la Prarie, and those who use Dove soap and Almay moisturizer. There really is no difference in my opinion on what over- the- counter products that you use, and here is why. Remember, our main goal is to build collagen in the skin. The collagen resides in the dermal layer, which is directly below the epidermal layer. The outermost layer of the epidermis is called the stratum corneum, also known as the “horny layer” because its cells are toughened like an animal’s horn. In order for a skin product to influence collagen formation it must penetrate the stratum corneum layer. If the product penetrates the stratum corneum layer, then it is considered a drug and is regulated by the FDA and is available only through a physician’s prescription. Therefore, if a product is available over-the-counter, it does not penetrate the stratum corneum and it will not have any effect on collagen formation. So, whether you buy an expensive cream at a fancy department store, or an inexpensive cream at the local drugstore, it doesn’t matter a hill of beans which you use, as long as your skin likes it. I remember walking through one of the “tonier” department stores on Fifth Avenue here in the city and the salesperson honed in on me like a beacon, “try this!” she exclaimed, “it’s better than Botox!” “Really?!” I squealed, “okay, put a little on one side of my crow’s feet, and l’ll go to the ladies room and see if there is any difference.” “Oh, I promise you, it will be completely improved!” she cackled as she gingerly dabbed copious amounts of this miracle product onto my skin. Laughingly, I strolled into the ladies room, and of course saw no improvement whatsoever. When she accosted me on my way out of the cosmetics department, I had to restrain my urge to devilishly pass her my business card and say, “try this, this IS Botox!” But, I like shopping there, so I just smiled and thanked her.
That being said, there are some products that you can use that do penetrate the stratum corneum and that can help to build collagen (Halleluah)! As far as prescription products are concerned, the hands down winner and gold standard is Retin A. The woman that I saw in my office who had the best skin was 50 years old and her skin was thick, plump, and without a single wrinkle. She grew up in Spain, so I was nosy and asked her what her secret was, to which she responded “Retin A.” I asked her how old she was when she started using Retin A and she told me “twenty-two.” Oh well, like retirement, it’s never too late to start doing something for your skin involving Retin A. I began using it when I was 24 years old for anti-acne purposes, but lower doses are used for anti-aging purposes. Retin A is a form of Vitamin A (tretinoin) that binds to and activates intracellular retinoid receptors. Once activated these receptors regulate the expression of genes that control the process of cellular differentiation and proliferation of skin cells. Retin A goes by many names and is available through prescription only as Retin-A Micro, Renova, Panretin, Panrexin, etc. Retin A should not be used by women who are pregnant or trying to become pregnant or who are breast feeding, primarily because the risks to the baby are not known in human trials. Retin A is something that the skin needs to get acclimated to, and therefore it is always best to start with the lowest dose and build up the skin tolerance to every evening application. Retin A can also increase the skin’s photosensitivity, so it is not a good idea to start using this product the week before your vacation to Maui! Personally, there is a product that I like that is made by Avene that uses retinaldehyde, the precursor to Retin A. It is gentle enough for me to use every day without the inherent redness and skin flaking that come with the initial use of Retin A. The retinaldehyde acts in a time-release manner, continually forming Retin A on the skin. I generally start my patients with this product, then ramp them up to prescription strength Retin A after they have become accustomed to the milder retinaldehyde.
Somewhere in-between the over-the-counter skincare products and prescription products lies the field of cosmeceuticals. A cosmeceutical is a term for a product that combines features of both a cosmetic and a pharmaceutical. These cosmeceuticals are not proven to affect the structure and function of the human body, and are therefore not regulated by the FDA as a “drug” per se. However, there is usually some underlying evidence that these products can penetrate the stratum corneum layer of the skin to deliver a myriad of nutrients to the skin. Usually, cosmeceuticals are available for distribution through a physician’s office. Two of the cosmeceutical lines that I carry include Skinceuticals and Avene products. I am also in the process of developing my own cosmeceutical line that uses custom designed liposomes to deliver essential proteins and peptides to the skin, so stay tuned for these! Between my vitamin line and skincare line that I am working feverishly to bring to you all, several of my patients whom I’ve known for years keep telling me that my skin looks terrific and are demanding to know what I am doing. Well, now you all know, and soon you can all have it too!!
So, that’s how to keep your skin beautiful from the inside out from the comfort of your own home. Next time I’ll tell you about some office-treatments that I perform to further boost your collagen production and to correct the effects of sun exposure.
Have a Beautiful Day!!
-Dr. Lisa
