Our entire “suit” of skin replaces itself approximately every 6 weeks. It does this by sloughing off old, dead skin cells on the surface of the skin, which stimulates the production of new skin cells in the deep layers of the skin. The new skin cells then undergo some changes as they migrate gradually to the surface of the skin. Once the skin cells reach the surface of the skin they are then in the category of old, dead skin cells, and they are ready to slough off. This process, known as skin cell turnover, slows down as we get older; so that the old, dead skin cells accumulate at the surface of the skin making the skin look dull and coarse. Newer skin cells are not as rapidly or frequently produced and skin loses the healthy glow it once had.
As we age many other undesirable changes begin to occur in our skin unless we take the time to encourage our skin to remain healthy. Because skin is the largest organ in the body, keeping it healthy makes a big difference in how we look and feel. Along with the slowdown in skin cell turnover there is a decrease in the production of collagen and elastin, two of the proteins that give skin its shape and elasticity. Loss of collagen and elastin leads to sagging and wrinkling. The decrease in skin cell turnover also means the skin heals more slowly and does not protect itself as well from damaging sun rays. There is a decrease in production of glycosaminoglycans (GAGS, for short) such as hyaluronan which bind water and give our skin plumpness or juiciness. Hyaluronan also participates in tissue repair and hydrodynamics, as well as migration and proliferation of cells. This extremely important polysaccharide acts as a free radical scavenger and drives collagen formation. Two of the most damaging influences for our skin are UV or ultraviolet light (sun and/or tanning bed exposure) and tobacco use (smoking). Both of these environmental exposures accelerate the changes of aging in the skin. Prolonged UV exposure creates additional signs of aging in the skin such as age spots, diffuse uneven pigmentation, spider veins and eventually dermatoheliosis or photoaging, a term usually describing the leathery, pebbly texture of skin that has been chronically and extremely damaged by the sun.
Unfortunately, the damaging effects of sun exposure do not really appear until 10-20 years into the exposure. This can make it difficult to convince a person in their 20’s that tanning will eventually result in some very ugly and unhealthy skin changes. It is often difficult to convince a person over 40 that it is the sun that has caused all of the changes they would now like to improve. I tell my patients that using really good skincare products, consistently, every day, at home is the most cost effective way to begin their journey to healthy skin. Any other treatments or procedures they choose to do will be far more effective if we prepare their skin with good skincare.
There are basically 3 elements of good skincare that everyone can incorporate into their daily routine. We use the S.E.C. acronym and advise taking a sec to improve the health of the skin twice a day.
S is for sun protection. This is an absolute must if you are serious about maintaining healthy skin. It does mean using a sunblock every day (yes, winter too—have you never gotten a sunburn in the snow?); but this is really only meant to protect you during brief forays into the outdoors, such as walking from your house to your car. When you are spending an extended period of time outdoors (walking, gardening, attending a sports event, etc.) you actually need to cover your skin with protective clothing and provide your own shelter in the form of a large-brimmed hat or parasol (no, a baseball cap is not good enough for obvious reasons—it only shades about 25% of your head and neck and exposes your vulnerable ears). The argument I usually hear in favor of sun exposure is the need for vitamin D. Vitamin D is an extremely important vitamin produced in the skin in UV light that actually behaves as a vital hormone (see previous vitamin D blog), but here’s the thing: you cannot get enough sun exposure to create adequate amounts of vitamin D in your system without damaging your skin. Normally I am all for living like a caveman or caveperson, but not in this case. Cave people had an intact ozone layer to protect them, which we do not; and cave people died by the time they reached the age of 35, which we do not. It is best to simply take your vitamin D3 as a supplement, at least 5,000 u per day as an adult, and avoid the damaging rays of the sun.
If you do nothing else, an increase in sun protection will improve your skin.
E is for exfoliation. This is a term given to the act of removing the outer layer of coarse, dead skin cells and is usually done mechanically or chemically. Mechanical exfoliation is simply performed by abrading the surface of the skin in a gentle manner. Methods of mechanical exfoliation include washing with a loofah or buffing pad, washing with scrubbing granules, or using a microdermabrasion device. Chemical exfoliation is performed by applying an agent that loosens and removes the surface skin cells. Alpha hydroxy acids (AHAs) are commonly used for exfoliation. All of the AHAs are derived from natural substances such as fruit, nuts, or milk. The most effective AHA is glycolic acid, derived from sugar cane. Glycolic acid is the smallest molecule in the AHA category, which allows it to penetrate more deeply into the skin for greater effectiveness. In a glycolic acid solution, the pH or acidity of the solution and the concentration of glycolic acid determine how strongly the solution interacts with the skin.
Whatever method of exfoliation is chosen, the end result is that the gentle removal of the outer layer of coarse, dead skin cells stimulates the creation of new, fresh skin cells in the deeper layers of the skin. There is an increase in skin cell turnover, so that more new skin cells are coming to the surface of the skin. Consistent, daily exfoliation means that new skin cells are constantly being sent to the surface of the skin. Why is this a good thing? Because new skin cells are better at making collagen and glycosaminoglycans, and new skin cells are better at protecting you from damaging UV rays. In fact, regular exfoliation can decrease your risk of skin cancer.
My personal favorite methods of exfoliation include use of Rx Systems glycolic acid wash and cream because this line has a lower pH (more acidic) and includes alpha lipoic acid, a very potent antioxidant (see previous antioxidant blog) that has even more protective effect versus UV rays; use of the Clarisonic device for cleansing because the brush is gentle and nonabrasive yet the sonic energy applied to the skin is super cleansing and stimulating; and the occasional (monthly) treatment with an in office glycolic or combination chemical peel (see previous chemical peel blog) alternating with treatment with vibradermabrasion because this is the absolute best of the microdermabrasion world (each patient has their own treatment paddle made of surgical steel and the polishing effect of the paddle is enhanced by the application of vibrational energy for maximum skin transformation.)
C is for collagen stimulation. As I noted above, many of the more undesirable changes of aging in the skin involve a decrease in the amount of collagen produced by the skin. Therefore, when addressing fine lines and wrinkles, enlarged pores, and sagging or draping of the skin it is all about the collagen. Regular exfoliation will have an effect on collagen production, but we can do better still.
If you are young and relatively line-free you can get by with a low level collagen stimulator for maintenance and prevention such as vitamin C serum. My personal favorite is the Rx Systems vitamin C serum because it is packaged in such a way as to prevent contact with air and light until you actually use it. This is advantageous because the exposure of vitamin C serums to air and light not only begins the breakdown of the vitamin C; it actually creates free radicals that are harmful to the skin (see previous antioxidant blog.) Vitamin C applied to the skin also helps to prevent skin cancer.
The most powerful of the collagen stimulating topicals are the retinoids, or molecules related to vitamin A. I love the retinoids because they do so many things for the skin. They reverse sun damage, they stimulate collagen and so are anti-aging, they are anti-acne (and let’s face it, many of us fight both acne and lines), and they take any other product you use with them deeper into the skin. My personal favorite is Retrinál from Avene because it is a top performer when it comes to collagen stimulation, but does not have many of the undesirable side effects of the other retinoids such as redness and peeling with regular use and sun sensitivity, making it OK to use year round.
There may be a need for a fourth element of good skin care if you have pigment issues. If you have freckles or solar lentigos (superficial depositions of darker pigment indicating your skin is very sun sensitive) or if you have what is known as actinic bronzing (pigment variability with both dark and light spots from chronic sun exposure) you will want to include a lightener twice a day to encourage pigment evening and extra attention to sun protection. I have my personal favorites here as well—for a lightener with hydroquinone I like Blanche from Neocutis and for a lightener without hydroquinone I like Vibrance from Vivité by Allergan.
It may sound like a lot of effort, but taking a S.E.C. to improve your skin twice daily and maybe even adding in an office procedure once a month or so will result in skin that is healthier and skin that looks healthier. Your skin will have fewer lines and will be tighter, the pigment variations will be improved and your skin will have a new luminescence or glow.
Additional recommendations:
Use a good eye cream twice daily.
Consider a good lip treatment twice daily.
Don’t forget the neck and décolleté!
