Written by Dr. Lisa Vuich, Renew MediSpa
With the myriad of skincare products and facial interventions available these days, it can be confusing as to where to begin when the goal is to prevent or reduce the effects of age and sun damage on the skin of the face. The goal is rarely “I want to look 20 again,” but rather “I want to look smooth, refreshed, ‘not tired’ and younger than my biologic age.” All of this is possible with attention to five key elements.
1. Collagen Protection- From our late 20’s onward, we are steadily losing collagen at some rate. How quickly that occurs depends on a number of important factors, such as genetics, sun exposure, mechanical stressors, and smoking. This is where the use of topical agents can be especially helpful, with the most effective being sunscreen, antioxidants (like topical vitamin C) and a medical grade retinol product.
Buyer beware though- most OTC skin care products contain insufficient amounts of and/or poor quality of the ingredients – in which case they will not have a real impact on your collagen. I call these products “glorified moisturizers”- they promise a lot but deliver very little. Consult with a licensed esthetician for the best recommendations so that you spend your money wisely. “Wrinkle relaxers” such as “botox” work well here-by relaxing muscles of facial expression they reduce the mechanical wear and tear on the skin, and low doses can even be used to prevent the formation of fine lines.
2. Collagen Stimulation- Fortunately, we have skin cells called fibroblasts which are capable of making brand new collagen. This is what happens when we cut ourselves and the cut subsequently heals (brand new collagen). Numerous procedures in aesthetic medicine seek to create a large area “microinjury” in the skin- thus stimulating the same healing response and adding collagen back to the dermis, resulting in smoother skin.
A very popular form of this approach is called medical micro-needling, which employs the use of an automated needling pen (with sterile, disposable tip) to generate the microinjury. This is often combined with growth factors- even those obtained from a sample of your own blood processed to remove the growth factor rich platelets which are then applied to the micro-needled skin (the so-called “Vampire Facial”) to further boost the collagen response. In recent years it has become popular for people to order their own micro-needling devices off the internet for a do-it-at-home version. There are several issues with this though, as a “roller” type of micro-needling can cause more of a tearing type of injury rather than the precises pinpoint healthy injury of the medical pen. Also, issues with rusting of the device, bacterial contamination, and dulling of the tips of the needles are significant concerns. Finally, many of them have needles which penetrate less than 1 mm which is likely insufficient in terms of stimulating the fibroblasts into action.
Another popular trend is to buy skin care products containing “collagen” and applying it topically. While this may sound like a great idea, it does not work. Collagen is too big a molecule to penetrate the skin barrier, so whatever you place topically will simply wipe or wash away and you will have no more collagen in the skin than you started with.
Finally, another big trend has been “drinking” collagen to improve skin quality. There is no evidence that drinking collagen will have any impact on the collagen content of human skin. Enzymes in your digestive system break down the collagen molecules into protein fragments. In some rodent studies there was an increase in skin hydration, not collagen content.
3. Resurfacing- This is a big topic, which overlaps several mechanisms. Resurfacing can be as basic as a medical grade chemical peel or other topical exfoliation enhancer (think “Retin-A,” which is a brand of topical tretinoin, a form of vitamin A which increases skin cell turnover). There are also procedures that can be done such as dermaplaning or microdermabrasion. These will all lighten the thickness of the stratum corneum- the “dead skin cell layer.” Skin will appear smoother for a time, and there may be a small amount of collagen stimulation. However, if you already have deep lines and sun damage, you will likely need to invest in a deeper resurfacing procedure such as Fractionated CO2 laser skin resurfacing. I will discuss this further in the next issue.
4. Replace Lost Volume – As we age we lose facial volume in addition to collagen. The use of dermal fillers is the most popular approach to correcting this issue. A full discussion of the options here is beyond the scope of this article. My best advice is to select your injector very carefully. Last week I had a nurse come to me who had gone to a “filler party” at her sister’s house a little over a year ago. She was injected with a non FDA approved substance and had a horrible reaction. She has had plastic surgery to attempt to remove the hard disfiguring lumps that developed, but it has been only marginally successful. She came to me to have appropriate filler placed in an attempt to “mask” the surface irregularities she has “I’ve lost a year of my life,” she said. “Just hiding in my house.”
5. Even Out the Skin Tone – Brown spots and unwanted blood vessels on the face age you more than you think. Reducing these pigment irregularities often requires laser therapy but can take five years off of a face with very little discomfort or downtime. When the eye is no longer distracted by all of that irregular color, it can pay more attention to your beautiful eyes or whatever other facial features are your best.
Facial aesthetics is certainly a lifestyle choice. Naturally, some choose to “do nothing”. If you are going to invest your hard-earned money into facial rejuvenation, I suggest that you consult with an experienced provider to develop an overall short and long term plan that fits into your budget and adequately addresses your concerns.