Improving Your Appearance

Skin Care

There are two types of aging; chronological aging (with time) and photoaging associated with chronic exposure to the sun and ‘elements’.  There are several easy steps you can take at home to improve the appearance of your skin with both types of aging. Basically these are sun avoidance (sun blocks), moisturizers, bleaching agents, retinoids, a healthy diet and exercise. Topical products can rejuvenate your skin and promote a more youthful appearance. In addition, new advanced techniques can help eliminate fine lines, uneven pigmentation, and brown spots.

Keys to a Better Complexion

First choose the right parents! So much of one’s appearance is genetic. A certain degree of acceptance is required. You have to make the most of what you have! Enough of the philosophizing …  While skin color, sensitivity, tone and texture are part of who you are, some skin imperfections can be improved or eliminated with proper skin care and with certain cosmetic or laser procedures.

The readers should understand that Dr Zachary is not really into the cosmeceuticals, and consequently there is not hard sell in the office situation. But there are some simple things you can do. Avoid scrubbing the skin with abrasive materials. Wash with a gentle soap or cleaner twice daily (morning and night). Use a moisturizer which includes a sunscreen protecting you against both UVB and A, SPF factor 30 or higher. Use non-comedogenic oil-free makeup. Use creams with slight peeling activity such as glycolic or beta-hydroxy acids such as Prevage twice a day, or use a topical retinoid cream such as Retin A, Renova, Tazorac, Avage, or Differin at night. Eat a healthy diet, maintain an appropriate weight.   I see no evidence that topically applied anti-oxidant creams do any good whatsoever, and I regard them as a fad.

Glycolic Acid Skin Peels

In addition to home remedies, in-office procedures can provide additional improvement using stronger peels such as 20 – 70 % glycolic acid. Glycolic acid is a natural substance derived from sugar cane, and is particularly useful in rejuvenating sun-damaged skin giving it a smoother, younger, fresher look. It also can help control mild acne, and improve skin discoloration associated with acne. The procedure takes between 15 and 30 minutes, and 4 to 6 treatments are usually necessary to achieve the desired effects. Most patients tolerate the treatment well and report only slight stinging and temporary redness as the side effects.

Jessner and TCA Chemical Peels

A more aggressive medium-depth chemical peel can be performed with trichloroacetic acid (TCA) and Jessner’s solution resulting in the removal of the sun-damaged surface layers of the skin. They can also eliminate precancerous skin lesions such as actinic keratoses, as well as fine lines and brown spots. These peels are very effective and have shown to be very safe. The down side to these stronger peels is a certain amount of downtime, between five to ten days, during which you will need to keep out of the public eye and take care of your new skin. TCA peels are stronger than glycolic acid peels, and are typically used for patients with more advanced photoaging. It is an excellent, safe, time-tested procedure in the hands of skilled physicians.

Dr Zachary will take the time to discuss the details of these procedures, ensuring that you have all the information you need to make an educated decision, and plan for a successful outcome.

Microdermabrasion

Think of a device that sandblasts grime and debris off granite buildings, and you get an idea of microdermabrasion, with the emphasis on ‘micro’! Small particles passing through a vacuum tube remove the top layer of the skin and are said to stimulate new cell growth. Dr Zachary is not super impressed with the long term benefits of microdermabrasion alone for acne scarring, but it can certainly help when used in combination with other topical agents such as Retin-A, bleaching agents, and other rejuvenating creams.  Because of the superficial nature of this technique, patients with mild scarring are the best candidates, and multiple treatments are usually required to achieve subtle results.

The latest development in microdermabrasion with the DermaSweep device gives much for significant results. It uses a nylon or steel brush infusion technique which gives surprisingly good results in patients with mild to moderate acne and acne scarring.

Laser Rejuvenation

These days there are many laser and light devices that can rejuvenate the skin in a gentle but highly effective manner. This might be appreciated as improved skin texture and tone, better light reflectance with a nice glow, reduced pore size, removal of irregular pigmentation and blood vessels, and an improvement in acne scars and fine lines. Using a broadband light/laser source, the entire face is treated in a near painless, 30 to 60-minute procedure. The treatment is repeated about every four weeks for a total of six treatments. Laser rejuvenation stimulates production of new collagen (when damaged over time from sun exposure, altered collagen accounts for wrinkling.). Patients note improvement in skin tone even after one treatment. After the sixth treatment, textural imperfection including fine wrinkles, red blotches and even superficial scars generally improve.

GentleWaves LED Photomodulation:
A Simple New Skin Therapy

Light emitting diode (LED) devices are becoming much more relevant to laser surgeons as we understand more about their mechanisms of action. Dr Zachary is bit of a ‘doubting Thomas’ in many ways about many of the new technologies, but he has been persuaded that these devices can make a difference.  The first such device to be marketed, GentleWaves LED, delivered yellow light to the skin in a pulsed manner which was painless, rapid, and produced subtle results. It is said to reduce redness after laser surgery, and to ‘protect’ the skin against UVB. It has also been described as a device that can reduce fine wrinkles, improve texture and tone, color and vascularity.  Pretty impressive, wouldn’t you say …. Which is why Dr Zachary is a bit skeptical of the clinical outcomes. However, as stated above, there are some significant signs that LEDs do indeed have a specific effect on fibroblastic activity.

GentleWaves does not rely on thermal (heat) energy, so there is no potential damage to the skin, no pain or discomfort, and no side effects. The main benefit, it is said, is a smoother, softer and creamier looking skin with reduction in the appearance of fine lines and wrinkles, freckles, brown spots and skin redness. A series of eight to ten treatments is recommended, and you can be treated up to once a week.
Studies have shown some decrease in wrinkles leading to FDA approval for the treatment of periocular lines and photodamage. This can also be used in conjunction with other procedures such as microdermabrasion, Intense Pulsed Light, Thermage, injections of soft tissue fillers (such as Restylane), and Botox or Dysport to enhance their results.