T oday’s dermatologists have more options than ever before to correct aging of the skin. Advances in basic science research have resulted in improved pharmacologic agents and cosmeceuticals that improve skin’s health and appearance. Technological advances in lasers and pulsed light sources now complement older, more established procedures such as chemical peeling. But even with so many advances, dermatologists understand the basics of good health such as proper nutrition, hydration, and lifestyle and how they relate to overall health and appearance. This “global” approach is the best approach for long-term anti-aging benefits for our patients. Planning a Program When patients visit us to treat aging skin, the clinical goals should be to make the skin smooth and radiant or luminous, plump and tight. We have many choices and options, which is a good thing. But how do we make decisions? First, look at the patient and ask, “What does the patient need?” And then try to rectify that by asking, “What does the patient think that he or she needs?” You need to be on the same page with the patient to get optimal results. Assess, evaluate and identify a goal together. Then design a plan of action. Be sure to discuss what expectations are for each individual procedure or technique so that they understand. Go over timelines and any possible complications of selected plans. A skincare protocol is necessary for all patients in order to help reverse aging and maintain anti-aging remedies. You can wave a laser all over the patient’s face and make him or her look a lot younger very quickly within 6 months, but if the patient isn’t really taking care of his skin, that aging process is just going to be revved up all over again. Develop a long-term plan with the patient. Make the patient at least a 50-50 partner. You’re acting as a trainer for these patients, giving them a program and providing them with support. See them at periodic intervals and evaluate what the program has done for them, and make adjustments as needed. Here’s a look at some of the most important components of an anti-aging program to share with patients. • Don’t Smoke. You cannot emphasize that enough to your patients. • Implement a Skincare Protocol. Sometimes patients already have a skincare protocol before they visit you. If they’re happy with it and it makes sense, you may just want to make suggestions for adjustments to it. But, many people come in with no real plan. And just as you have to have a plan when you cook, and you have to have a plan when you want to be fit, you have to have a plan if you want your skin to look younger. • Choose the Best Sleeping Position. Tell patients never to sleep on their faces. People who sleep with their faces on the pillow age faster than people who sleep on their backs. • Manage Stress. Mental state is critical. Stress causes release of cortisol, which is deleterious to our collagen. I recommend yoga, massage and sitcoms that make you laugh. • Follow a Healthy Diet. Dark green, leafy vegetables, such as broccoli, brussels sprouts, etc., and fruits such as berries, kiwi, pineapple and melons are good for skin. Patients also need an adequate amount of protein; it’s extremely important for muscle mass as we get older. Recommend whole grains and legumes. Patients need some fat to keep them from aging too quickly. Patients do need to be careful about the fats they eat, though. For those who aren’t compulsive in their dieting, you may want to recommend supplements, especially a good multi-vitamin, as well as an antioxidant complex. • Drink Plenty of Water. Tell patients to drink at least eight glasses a day. It improves the ability of the system to remove toxins that occur from the environment. • Use UV Protection. Patients should use an SPF of at least15 every day. Patients should also use SPF clothing, hats and sunglasses when possible, and avoid being outside during peak sun hours. And, as we need to keep reminding our patients, they can’t have good skin and use tanning beds. The two are incompatible. Prescriptions and Cosmeceuticals Beyond the steps above that patients can follow every day, you can also use various prescriptions and cosmeceuticals. Which to use is really a matter of preference of the doctor, preference of the patient, and what works, because individual responses do vary. We all have a different set of genetic triggers, and what may work well for one person will not work well for another. Remain objective and individualize each patient’s program. As far as prescriptions, we have tretinoin (Avita, Renova, Retin-A Micro, Solage, Tri-Luma) and tazarotene (Avage, Tazorac), but the key to using these products is to have the patient also use something to protect the skin barrier, such as borage or safflower oil. Often, especially in the first month or so of retinizing the skin, patients’ skin experiences a lot of redness and dehydration. Essential fatty acids, such as linoleic acid, topically can improve the appearance of skin quickly and also improve tolerance to these medications. Blotchy pigmentation can be dramatically improved with a hydroquinone (Alustra, Claripel, Glyquin, Lustra, Melanex, Tri-Luma). For some women, hormone replacement therapy is an option. Also, an off-label lower dosage of isotretinoin (Accutane, Amnesteem) for patients in their late 40s and in their 50s is an option. If you use an isotretinoin, perform bone density checks on your patients and make sure they’re taking good sources of vitamin D. Some data indicate that this therapy can cause bone thinning. This is also an effective treatment for improving melasma. Fluorouracil (Carac, Efudex) can also be used in an anti-aging topical program, especially if your patient is older and has a background of severely actinically damaged skin. We also have vitamins available. We all know about vitamin A and retinol. Vitamins C and E have also been shown to have anti-aging benefits. Vitamin K is in some of the products that help with telangiectasia and under-eye circles, especially if these are vascularly induced. There are also alpha hydroxy acids. A combination of a tretinoin and alpha hydroxy acid, especially used in conjunction with proper direction and hydration of the skin, work better than either alone. We also have niacinamide and panthenol. Niacinamide is anti-inflammatory in patients with pellagra. And panthenol has been used as an humectant. There are a number of antioxidants that you can choose from — there’s lipoic acid, flavonoids, soy derivatives, polyphenols from plants and green tea, spintraps and nitrones. It’s a matter of trial and error for each individual patient. Firming agents, like DMAE (dimethylaminoethanol), and de-pigmenting agents fit a niche that nothing else fits. There are also topical human growth factors are out there. Then there’s furfuryladenine (Kinerase), a type of plant growth hormone and restorative compound that also seems to have some anti-oxidative capabilities. And then there are peptides. We have copper peptides and some companies are working on proprietary short-chain peptides that seem to stimulate collagen growth. Other Treatments But as we already know, most patients don’t need just one thing — they need a combination. Anti-aging therapy is about a global approach. You may need to supplement a regular anti-aging regimen with one or more of the following treatments. There are number of fillers already available and more on the way. Botox works, especially for the glabellar area and very hyper-dynamic areas of the skin. We can use filling materials, fat and collagen. Collagen shows immediate improvement. It works for scars, for nasolabial folds and for lips. Also, you can get very nice and much longer lasting results with fat than you can with foreign filling materials. Chemical peels and microdermabrasion both still have a place in anti-aging treatments. Chemical peels are very good for epidermal damage and for dyspigmentation. Microdermabrasion is very popular and it’s particularly good as an adjunctive treatment for pigmentation. Mechanically, it removes the epidermal pigmentation, and secondarily it facilitates penetration of bleaching agents and antioxidants. Using a non-ablative treatment with microdermabrasion can improve some of a patient’s blotchy pigmentation. There are many non-ablative treatments to choose from. After treatment, patients still have lines, but there are improvements that patients enjoy and appreciate. When using a non-ablative treatment by the eye, you can improve results if you also use Botox. It’s also recommend that you use Botox after ablatives, so that as that new collagen is being laid down you have the area at rest so that the collagen can be laid down more smoothly. Microdermabrasion is a good treatment choice for patients with darker complexions. Intense pulsed light (IPL) therapy is an effective treatment for telangiectases, but certainly not the only option. The CO2 laser is very good for ablative and long-term collagen improvement. Key to Success There is no one right way to correct aging facial skin. The most truthful words in advertisements and infomercials are that fine print at the bottom that says individual results may vary. They will vary. Our job as dermatologists is to figure out how that person can get the best possible result with a combination that you choose for them.
Recipe for Treating Aging Skin
T oday’s dermatologists have more options than ever before to correct aging of the skin. Advances in basic science research have resulted in improved pharmacologic agents and cosmeceuticals that improve skin’s health and appearance. Technological advances in lasers and pulsed light sources now complement older, more established procedures such as chemical peeling. But even with so many advances, dermatologists understand the basics of good health such as proper nutrition, hydration, and lifestyle and how they relate to overall health and appearance. This “global” approach is the best approach for long-term anti-aging benefits for our patients. Planning a Program When patients visit us to treat aging skin, the clinical goals should be to make the skin smooth and radiant or luminous, plump and tight. We have many choices and options, which is a good thing. But how do we make decisions? First, look at the patient and ask, “What does the patient need?” And then try to rectify that by asking, “What does the patient think that he or she needs?” You need to be on the same page with the patient to get optimal results. Assess, evaluate and identify a goal together. Then design a plan of action. Be sure to discuss what expectations are for each individual procedure or technique so that they understand. Go over timelines and any possible complications of selected plans. A skincare protocol is necessary for all patients in order to help reverse aging and maintain anti-aging remedies. You can wave a laser all over the patient’s face and make him or her look a lot younger very quickly within 6 months, but if the patient isn’t really taking care of his skin, that aging process is just going to be revved up all over again. Develop a long-term plan with the patient. Make the patient at least a 50-50 partner. You’re acting as a trainer for these patients, giving them a program and providing them with support. See them at periodic intervals and evaluate what the program has done for them, and make adjustments as needed. Here’s a look at some of the most important components of an anti-aging program to share with patients. • Don’t Smoke. You cannot emphasize that enough to your patients. • Implement a Skincare Protocol. Sometimes patients already have a skincare protocol before they visit you. If they’re happy with it and it makes sense, you may just want to make suggestions for adjustments to it. But, many people come in with no real plan. And just as you have to have a plan when you cook, and you have to have a plan when you want to be fit, you have to have a plan if you want your skin to look younger. • Choose the Best Sleeping Position. Tell patients never to sleep on their faces. People who sleep with their faces on the pillow age faster than people who sleep on their backs. • Manage Stress. Mental state is critical. Stress causes release of cortisol, which is deleterious to our collagen. I recommend yoga, massage and sitcoms that make you laugh. • Follow a Healthy Diet. Dark green, leafy vegetables, such as broccoli, brussels sprouts, etc., and fruits such as berries, kiwi, pineapple and melons are good for skin. Patients also need an adequate amount of protein; it’s extremely important for muscle mass as we get older. Recommend whole grains and legumes. Patients need some fat to keep them from aging too quickly. Patients do need to be careful about the fats they eat, though. For those who aren’t compulsive in their dieting, you may want to recommend supplements, especially a good multi-vitamin, as well as an antioxidant complex. • Drink Plenty of Water. Tell patients to drink at least eight glasses a day. It improves the ability of the system to remove toxins that occur from the environment. • Use UV Protection. Patients should use an SPF of at least15 every day. Patients should also use SPF clothing, hats and sunglasses when possible, and avoid being outside during peak sun hours. And, as we need to keep reminding our patients, they can’t have good skin and use tanning beds. The two are incompatible. Prescriptions and Cosmeceuticals Beyond the steps above that patients can follow every day, you can also use various prescriptions and cosmeceuticals. Which to use is really a matter of preference of the doctor, preference of the patient, and what works, because individual responses do vary. We all have a different set of genetic triggers, and what may work well for one person will not work well for another. Remain objective and individualize each patient’s program. As far as prescriptions, we have tretinoin (Avita, Renova, Retin-A Micro, Solage, Tri-Luma) and tazarotene (Avage, Tazorac), but the key to using these products is to have the patient also use something to protect the skin barrier, such as borage or safflower oil. Often, especially in the first month or so of retinizing the skin, patients’ skin experiences a lot of redness and dehydration. Essential fatty acids, such as linoleic acid, topically can improve the appearance of skin quickly and also improve tolerance to these medications. Blotchy pigmentation can be dramatically improved with a hydroquinone (Alustra, Claripel, Glyquin, Lustra, Melanex, Tri-Luma). For some women, hormone replacement therapy is an option. Also, an off-label lower dosage of isotretinoin (Accutane, Amnesteem) for patients in their late 40s and in their 50s is an option. If you use an isotretinoin, perform bone density checks on your patients and make sure they’re taking good sources of vitamin D. Some data indicate that this therapy can cause bone thinning. This is also an effective treatment for improving melasma. Fluorouracil (Carac, Efudex) can also be used in an anti-aging topical program, especially if your patient is older and has a background of severely actinically damaged skin. We also have vitamins available. We all know about vitamin A and retinol. Vitamins C and E have also been shown to have anti-aging benefits. Vitamin K is in some of the products that help with telangiectasia and under-eye circles, especially if these are vascularly induced. There are also alpha hydroxy acids. A combination of a tretinoin and alpha hydroxy acid, especially used in conjunction with proper direction and hydration of the skin, work better than either alone. We also have niacinamide and panthenol. Niacinamide is anti-inflammatory in patients with pellagra. And panthenol has been used as an humectant. There are a number of antioxidants that you can choose from — there’s lipoic acid, flavonoids, soy derivatives, polyphenols from plants and green tea, spintraps and nitrones. It’s a matter of trial and error for each individual patient. Firming agents, like DMAE (dimethylaminoethanol), and de-pigmenting agents fit a niche that nothing else fits. There are also topical human growth factors are out there. Then there’s furfuryladenine (Kinerase), a type of plant growth hormone and restorative compound that also seems to have some anti-oxidative capabilities. And then there are peptides. We have copper peptides and some companies are working on proprietary short-chain peptides that seem to stimulate collagen growth. Other Treatments But as we already know, most patients don’t need just one thing — they need a combination. Anti-aging therapy is about a global approach. You may need to supplement a regular anti-aging regimen with one or more of the following treatments. There are number of fillers already available and more on the way. Botox works, especially for the glabellar area and very hyper-dynamic areas of the skin. We can use filling materials, fat and collagen. Collagen shows immediate improvement. It works for scars, for nasolabial folds and for lips. Also, you can get very nice and much longer lasting results with fat than you can with foreign filling materials. Chemical peels and microdermabrasion both still have a place in anti-aging treatments. Chemical peels are very good for epidermal damage and for dyspigmentation. Microdermabrasion is very popular and it’s particularly good as an adjunctive treatment for pigmentation. Mechanically, it removes the epidermal pigmentation, and secondarily it facilitates penetration of bleaching agents and antioxidants. Using a non-ablative treatment with microdermabrasion can improve some of a patient’s blotchy pigmentation. There are many non-ablative treatments to choose from. After treatment, patients still have lines, but there are improvements that patients enjoy and appreciate. When using a non-ablative treatment by the eye, you can improve results if you also use Botox. It’s also recommend that you use Botox after ablatives, so that as that new collagen is being laid down you have the area at rest so that the collagen can be laid down more smoothly. Microdermabrasion is a good treatment choice for patients with darker complexions. Intense pulsed light (IPL) therapy is an effective treatment for telangiectases, but certainly not the only option. The CO2 laser is very good for ablative and long-term collagen improvement. Key to Success There is no one right way to correct aging facial skin. The most truthful words in advertisements and infomercials are that fine print at the bottom that says individual results may vary. They will vary. Our job as dermatologists is to figure out how that person can get the best possible result with a combination that you choose for them.
T oday’s dermatologists have more options than ever before to correct aging of the skin. Advances in basic science research have resulted in improved pharmacologic agents and cosmeceuticals that improve skin’s health and appearance. Technological advances in lasers and pulsed light sources now complement older, more established procedures such as chemical peeling. But even with so many advances, dermatologists understand the basics of good health such as proper nutrition, hydration, and lifestyle and how they relate to overall health and appearance. This “global” approach is the best approach for long-term anti-aging benefits for our patients. Planning a Program When patients visit us to treat aging skin, the clinical goals should be to make the skin smooth and radiant or luminous, plump and tight. We have many choices and options, which is a good thing. But how do we make decisions? First, look at the patient and ask, “What does the patient need?” And then try to rectify that by asking, “What does the patient think that he or she needs?” You need to be on the same page with the patient to get optimal results. Assess, evaluate and identify a goal together. Then design a plan of action. Be sure to discuss what expectations are for each individual procedure or technique so that they understand. Go over timelines and any possible complications of selected plans. A skincare protocol is necessary for all patients in order to help reverse aging and maintain anti-aging remedies. You can wave a laser all over the patient’s face and make him or her look a lot younger very quickly within 6 months, but if the patient isn’t really taking care of his skin, that aging process is just going to be revved up all over again. Develop a long-term plan with the patient. Make the patient at least a 50-50 partner. You’re acting as a trainer for these patients, giving them a program and providing them with support. See them at periodic intervals and evaluate what the program has done for them, and make adjustments as needed. Here’s a look at some of the most important components of an anti-aging program to share with patients. • Don’t Smoke. You cannot emphasize that enough to your patients. • Implement a Skincare Protocol. Sometimes patients already have a skincare protocol before they visit you. If they’re happy with it and it makes sense, you may just want to make suggestions for adjustments to it. But, many people come in with no real plan. And just as you have to have a plan when you cook, and you have to have a plan when you want to be fit, you have to have a plan if you want your skin to look younger. • Choose the Best Sleeping Position. Tell patients never to sleep on their faces. People who sleep with their faces on the pillow age faster than people who sleep on their backs. • Manage Stress. Mental state is critical. Stress causes release of cortisol, which is deleterious to our collagen. I recommend yoga, massage and sitcoms that make you laugh. • Follow a Healthy Diet. Dark green, leafy vegetables, such as broccoli, brussels sprouts, etc., and fruits such as berries, kiwi, pineapple and melons are good for skin. Patients also need an adequate amount of protein; it’s extremely important for muscle mass as we get older. Recommend whole grains and legumes. Patients need some fat to keep them from aging too quickly. Patients do need to be careful about the fats they eat, though. For those who aren’t compulsive in their dieting, you may want to recommend supplements, especially a good multi-vitamin, as well as an antioxidant complex. • Drink Plenty of Water. Tell patients to drink at least eight glasses a day. It improves the ability of the system to remove toxins that occur from the environment. • Use UV Protection. Patients should use an SPF of at least15 every day. Patients should also use SPF clothing, hats and sunglasses when possible, and avoid being outside during peak sun hours. And, as we need to keep reminding our patients, they can’t have good skin and use tanning beds. The two are incompatible. Prescriptions and Cosmeceuticals Beyond the steps above that patients can follow every day, you can also use various prescriptions and cosmeceuticals. Which to use is really a matter of preference of the doctor, preference of the patient, and what works, because individual responses do vary. We all have a different set of genetic triggers, and what may work well for one person will not work well for another. Remain objective and individualize each patient’s program. As far as prescriptions, we have tretinoin (Avita, Renova, Retin-A Micro, Solage, Tri-Luma) and tazarotene (Avage, Tazorac), but the key to using these products is to have the patient also use something to protect the skin barrier, such as borage or safflower oil. Often, especially in the first month or so of retinizing the skin, patients’ skin experiences a lot of redness and dehydration. Essential fatty acids, such as linoleic acid, topically can improve the appearance of skin quickly and also improve tolerance to these medications. Blotchy pigmentation can be dramatically improved with a hydroquinone (Alustra, Claripel, Glyquin, Lustra, Melanex, Tri-Luma). For some women, hormone replacement therapy is an option. Also, an off-label lower dosage of isotretinoin (Accutane, Amnesteem) for patients in their late 40s and in their 50s is an option. If you use an isotretinoin, perform bone density checks on your patients and make sure they’re taking good sources of vitamin D. Some data indicate that this therapy can cause bone thinning. This is also an effective treatment for improving melasma. Fluorouracil (Carac, Efudex) can also be used in an anti-aging topical program, especially if your patient is older and has a background of severely actinically damaged skin. We also have vitamins available. We all know about vitamin A and retinol. Vitamins C and E have also been shown to have anti-aging benefits. Vitamin K is in some of the products that help with telangiectasia and under-eye circles, especially if these are vascularly induced. There are also alpha hydroxy acids. A combination of a tretinoin and alpha hydroxy acid, especially used in conjunction with proper direction and hydration of the skin, work better than either alone. We also have niacinamide and panthenol. Niacinamide is anti-inflammatory in patients with pellagra. And panthenol has been used as an humectant. There are a number of antioxidants that you can choose from — there’s lipoic acid, flavonoids, soy derivatives, polyphenols from plants and green tea, spintraps and nitrones. It’s a matter of trial and error for each individual patient. Firming agents, like DMAE (dimethylaminoethanol), and de-pigmenting agents fit a niche that nothing else fits. There are also topical human growth factors are out there. Then there’s furfuryladenine (Kinerase), a type of plant growth hormone and restorative compound that also seems to have some anti-oxidative capabilities. And then there are peptides. We have copper peptides and some companies are working on proprietary short-chain peptides that seem to stimulate collagen growth. Other Treatments But as we already know, most patients don’t need just one thing — they need a combination. Anti-aging therapy is about a global approach. You may need to supplement a regular anti-aging regimen with one or more of the following treatments. There are number of fillers already available and more on the way. Botox works, especially for the glabellar area and very hyper-dynamic areas of the skin. We can use filling materials, fat and collagen. Collagen shows immediate improvement. It works for scars, for nasolabial folds and for lips. Also, you can get very nice and much longer lasting results with fat than you can with foreign filling materials. Chemical peels and microdermabrasion both still have a place in anti-aging treatments. Chemical peels are very good for epidermal damage and for dyspigmentation. Microdermabrasion is very popular and it’s particularly good as an adjunctive treatment for pigmentation. Mechanically, it removes the epidermal pigmentation, and secondarily it facilitates penetration of bleaching agents and antioxidants. Using a non-ablative treatment with microdermabrasion can improve some of a patient’s blotchy pigmentation. There are many non-ablative treatments to choose from. After treatment, patients still have lines, but there are improvements that patients enjoy and appreciate. When using a non-ablative treatment by the eye, you can improve results if you also use Botox. It’s also recommend that you use Botox after ablatives, so that as that new collagen is being laid down you have the area at rest so that the collagen can be laid down more smoothly. Microdermabrasion is a good treatment choice for patients with darker complexions. Intense pulsed light (IPL) therapy is an effective treatment for telangiectases, but certainly not the only option. The CO2 laser is very good for ablative and long-term collagen improvement. Key to Success There is no one right way to correct aging facial skin. The most truthful words in advertisements and infomercials are that fine print at the bottom that says individual results may vary. They will vary. Our job as dermatologists is to figure out how that person can get the best possible result with a combination that you choose for them.
