Aging Skin Treatments
Skin changes in appearance as a consequence of aging regardless of how well it has been cared for. Aging itself is probably programmed into the genetic information meaning it is unalterable, at least until genetic engineering becomes a practicality. Various proteins which provide elasticity to the skin deteriorate. Glands that lubricate the skin dry up. Water content decreases and so on. This can be accelerated by sun exposure, smoking, and other forms of trauma. The process moves faster in individuals of fair complexion due to their susceptibility to ultraviolet sun damage.
In the end, the rate of visual aging is the sum of normal biologic aging plus alterable factors (eg. sun exposure). True reversal of aging with various treatments is minimal, at best. However, with a combination of prophylactic care and intervention treatment, skin can reclaim some lost years and look more youthful.
Prophylaxis - An Ounce of Prevention
Until some genetic breakthrough occurs, the best treatment for aging skin is prophylactic care. Since the biological clock ticks inexorably, one can only avoid the acceleration of aging brought on by external factors. The most significant of these factors is ultraviolet light. Most people receive some exposure by sunlight, but the recent popularity of tanning beds adds another source of skin damaging UV radiation. Those who think that UV light from a tanning bed is not harmful are badly mistaken. All ultraviolet light should be avoided as much as possible.
Because sun damage is only partially reversible, and because it accelerates the aging process (which is irreversible), the best way to preserve youthful skin is to avoid sun exposure. Since an exclusively indoor lifestyle is not practical, religious use of sunblock should be undertaken. Sunburns and direct exposure for the purpose of getting a deep tan, which may be temporarily attractive, add to the accumulation of skin injury. Over time, these insults to the skin build resulting in aged, leathery, spotty skin.
All skin care regimens should include some form of sunscreen or sunblock. Some skin treatments or medications (Retin-A) may actually make the skin more sensitive to the sun. It is important that patients understand the ramifications of various skin care regimens, particularly when they spend a good deal of time outdoors.
In a less specific sense, good nutrition influences overall body health and therefore the health of the skin. Patients should be cautious about various "natural" substances, both applied to the skin and taken by mouth. Although there may be benefits (unsubstantiated as they may be), there may also be negative side effects.
Smoking poisons the skin directly by tars and similar substances deposited directly onto the skin and, indirectly, by its detrimental effects on health in general and circulation in particular. Patients who are heavy smokers have a certain "look" to their skin that comes from poisoning it and suffocating it. "Smoker's lines" are creases around the mouth that are particularly severe in heavy smokers. Furthermore, patients who are anticipating aesthetic procedures to correct the effects of aging (aggravated, of course, by smoking), subject themselves to greater risk for any operation. For these reasons patients should simply not smoke.
There are other environmental factors that may influence the character of the skin. Industrial chemicals may be damaging to workers that are exposed to them. Other medical conditions may also effect the appearance and texture of skin.
Treatment - Skin Care Products
There are a variety of topical medications that help maintain the vitality of skin. Unfortunately for the patient, there are a great number of them in various concentrations that have different effects on different types of skin. These effects are even more diverse when the medications are used in combination with one another. For this reason, it is wise to have topical skin care supervised by a skin care specialist. Patients should also visit a dermatologist periodically for examination of the skin and a review of the solutions that are being used.
Retinoins (Retin-A) and other related compounds increase turnover of the outer layer of skin and enhance blood supply to the same area. Patients sensitivity to these medications varies dramatically. Therefore, doses must be carefully individualized. Furthermore, these compounds come in various forms of administration that may have specific benefits as well as disadvantages from one patient to the next.
Various mild acids (glycolic acid) help dissolve the bonds between cells in the epidermis (the outer layer of skin). This allows the dead cells in this layer to shed more easily. Enhancement of exfoliation is particulary useful in combination with Retin-A since that medication may cause the epidermis to build up. The acids are mildly irritating and thereby enhance blood supply to the area of application to a certain degree. Other topical medications will penetrate better in the presence of these acids since they are loosening up the connections between the dead cells.
Bleaching agents may be useful in elimination unwanted brown patches. They are a family of drugs called quinones which compete with melanin (the brown color in skin) in the melanocyte (the cell that produces melanin). Quinones are used both as treatment and as prophylaxis. Patients anticipating resurfacing (such as with the laser) may be pretreated with a quinone if they are felt to be at risk for hyperpigmentation as a consequence of the resurfacing treatment.
Topical vitamins (such as vitamin C) have been proposed as rejuvenating agents. Although there might be benefit, there is for now little scientific information backing up their use. It is unlikely that much harm will come from their application but they do cost money- probably better spent on a good sunscreen. Every week it seems some new product hits the market. Patients should not subscribe to the use of these agents before checking with a skin care specialist or physician. Although most are harmless (and useless), they do merit professional scrutiny before application.
Resurfacing of the skin can be accomplished in a variety of ways. The skin can be sanded (dermabrasion), burned with a laser, or injured by chemicals. All types of resurfacing involve injury. This is planned injury but it is injury nonetheless. With this type of second-degree wound, the desired consequences outweigh the unwanted ones. Skin is made smoother and more youthful looking but at the expense of increased photosensitivity, possible color changes, and other consequences. The aging features in the skin calling for the resurfacing, the location, and skin characteristics determines which approach to resurfacing will be used. Not all patients are suitable candidates.
Patients must also keep in mind that personal preferences, experience, and philosophy from one physician to the next will influence the type of treatment even though the desired endpoint may be the same. The side effects and risks will be different for each type of treatment and must be understood so that an intelligent choice of therapy can be made.
The expense of resurfacing varies from one modality to the next. Certainly, even though money should not be the premier consideration, any increase in cost should be justified by advantages of the form of treatment.
Once again, proper management of the patient must involve the input of a knowledgeable professional. Skin condition, lifestyle, previous treatments, anticipated treatments and skin type all influence the choice, if any, of skin resurfacing. Patients must understand that some changes may be permanent and be prepared to make adjustments in their routines to accommodate them.
Chemical peels describe a variety of ways to induce second degree injury to the skin. The depth of the peel, and thus the depth of the injury, depends upon the agent used and the manner in which it is employed. Peels can be quite shallow. Shallow peels heal quickly, remain red for short periods of time, have little risk, and seldom cause any color problems. The problem is, they don't do much. For patients who don't need much, they're perfect. For deeper wrinkling, they are a waste of time. Organic acid peels and shallower TCA peels fall into this category.
Intermediate peels have intermediate results, side effects, and risks. Their utility depends upon the severity of the skin problem in question. TCA peels are of the intermediate variety depending upon how the solution is applied.
Deep peels, of which the most classic is a phenol peel, do a wonderful job of smoothing even very deep creases and wrinkles in the skin. They do, however, have a greater risk of scarring, commonly lighten the skin, and take much longer to heal. The treating physician must balance these factors to decide if this modality is proper for a patient.
Dermabrasion describes resurfacing by sanding. Most of the time this is done with a high speed rotary surgical dermabrader specially designed for this task. Depth is determined by the length and repetition of treatment. Most of the time dermabrasion works better than the other methods of resurfacing when irregularities exist in a given area. For example, if a scar is elevated in an otherwise smooth region, sanding the scar preferetially will lower it relative the the skin around it. By way of comparison, chemical resurfacing is best suited for uniform treatment of discreet anatomic areas.