Skin Care

DAILY SKIN CARE REGIMEN

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1. Most of the characteristics that we associate with an aged appearance actually result from long-term sun exposure.   These unwanted changes include extra blood vessels on our face (commonly referred to as broken blood vessels), brown spots, enlarged pores, and most distressingly wrinkles and sagging skin in sun exposed areas.   Proof that these changes result from long-term sun exposure can be easily acquired when looking at sun-damaged and sun protected skin in the same individual.   It is very difficult to differentiate sun protected skin from a seventy year old from sun protected skin taken from a twenty year old, when looking at it under the microscope, but skin taken from sun damaged sites tells the true story.

2. The changes that we associate with aging truly do result from long-term sun exposure, or in some instances smoking.   Evidence of this is the fact that most people are aged more severely on the side of their face that faces the window in the car.   Thus, drivers will be more aged on the left side while passengers will be more aged on the right side.   This also illustrates the fact that skin aging is a daily process that sadly does not occur on the beach, but more often in the car.   This is because we spent the majority of our time outside in the car.   Patients with significant sun damage around the mouth are often smokers, and I can identify these people before they tell me their smoking history.   This is not, as commonly believed, due to pursing ones lips to draw upon a cigarette.   Instead, this aging is from the formation of free radicals, which occur when smoke is absorbed directly into the skin. In addition to free radicals   causing skin damage as a result of smoking, approximately 50% of sun damage is due to the formation of free radicals.   This damaged skin then becomes furrowed where our facial expression lines move our skin. If we didn't smoke or never went into the sun, we could move our mouths, foreheads, and brows as much of we like without getting permanent creases in our skin.   These creases only occur because our skin becomes permanently changed by long-term sun-exposure and smoking.

Sun-protected skin showing healthy pink collagen and thin black elastic fibers.

Sun-damaged skin from the same person as shown above, demonstrating abnormal elastic fibers replacing the normal collagen and elastic fiber network.

3. Because of the role of free radicals in skin aging, and the high prevalence of acquiring sun exposure in the car, sunscreens with special ingredients that block the UVA rays coming through the car window are necessary for protection on a daily basis. Burning UVB rays are blocked by the car window, while the UVA rays are allowed to pass through.   Thus, driving makes us experiencing the aging effects of the sun without enjoying the benefits of being at the beach, going skiing, or just plain having fun outside. Blocking UVA rays is somewhat more difficult than blocking the UVB burning rays.   To block these UVA rays we use special sunscreens such as Parsol 1789 (avobenzone), or the chemical-free   physical blocking sunscreens that block all wavelengths including the aging UVA rays coming through the windows of our cars (zinc oxide and titanium dioxide).  

4. When we get sunburned, it is easy to see that the damaging effects of the sun last long after the sun has set.   However the same is true when we don't get sunburned and just get simple sun exposure.   Although we do not see the redness of a sunburn after incidental exposure to the sun such as driving to work in our car or going to the mailbox to check the mail, there is a low level inflammation in our skin after minimal sun exposures. In addition, severely sun-damaged skin can be inflamed all of the time even without sun exposure. Thus our circulating cells can continually damage our skin long after the sun has set.   For this reason, adding an antioxidant to our skin care regimen can fight the free-radical damage our inflammatory cells do to our skin, during and after the sun goes down.   This is the reason I recommend incorporating antioxidants into one's skin care regimen in the morning and evening as well.   In addition to preventing damage, antioxidants can also help repair the skin.

Variations in sun damage are apparent due to different levels of sun-protection.

5. I recommend a sunscreen containing product with significant UVA protection each and every morning. Then in the evening I have patients apply an AHA lotion, followed by a mild nurturing antioxidant product. We use special AHA products that have antioxidant properties as well as the typical exfoliating effects seen with typical AHAs. To supplement this treatment, we add a gentle antioxidant that further protects the skin.

For dry skin on the body, it's best to apply a moisturizer WHILE WET in the shower or bath, and towel off after. This traps some of the water on the skin and pushes it in the skin. Applying a moisturizer after toweling off will prevent some evaporative loss, but not drive as much water into the skin. I recommend applying AHAs at night, but not immediately after a shower since they can sting if applied then. These products strip away dead skin and cause GAGs to form in skin promoting hydration from the inside out.

This person has an inherited disorder that causes excess scaling of the skin. The left half of this person's back is untreated while the right half has been treated with AHAs demonstrating their ability to remove the surface layer of skin.

Microscope slide of the skin from the person above. The left side shows an abnormally thick surface to the skin (stratum corneum), while the right side looks more normal following treatment with an AHA. This demonstrates the ability of AHAs to remove excess scale from the surface of the skin.

6. In addition to topical lotions, we offer special AHA peels which are not actually peels but treatments to the skin which make the skin somewhat pink for the period of an hour or so.   These are commonly referred to as "lunch time peels".   In addition we offer non-ablative laser skin rejunivation to augment the topical products and sometimes combine that treatment with citric acid peels for maximal effects.  

7. WHO IS A CANDIDATE?

Every person regardless of the status of their skin is a candidate to use sunscreens every morning, as well as products to help rejunivate their skin and help protect it in the evening. The incidental exposure we get in the car, going from the car to work etc. is enough to cause skin aging and damage our skin. Patients with mild to moderate photodamage are the best candidates for laser skin rejunivation or citric acid peels. Patients with very severe wrinkling are best treated with the traditional laser resurfacing.

8. HOW DO I USE THE PRODUCTS?

People often feel a mild tingling after applying an AHA lotion. This often decreases over time. Some people upon staring a mild AHA product will not experience any tingling or irritation and can move up to a stronger formulation. I recommend patients start using AHA products every other night to determine if they are going to be too sensitive to it. If not, after about a week increase to nightly use. After using the face lotion for a month, you can consider moving up to the higher strength face lotion. This should be alternated for a week or two every other night with the original face lotion to determine if the stronger product is right for you. In addition, some people often need to decrease the strength of their face lotion during dry, winter months. Some products such as the strongest AHAs or Retin-A may need to be discontinued or used less frequently during the winter. Dry skin is more sensitive, and the dry winter air holds a lot less water than in other times of the year.

9. WHAT CAN I EXPECT?

Following initial use of our skin products, your skin will feel softer and smoother almost immediately or within a few days. This effect is due to the ability of AHAs to remove the dead skin layer (called the stratum corneum). Removing this layer makes our skin more healthy looking, vibrant and supple. It also helps hide shadows on our skin better, and shadows are what cause fine lines, wrinkles and acne scars to show. These skin problems (unlike brown spots and spider veins) are the same color as our surrounding skin, so the reason we see them is that they cast shadows on our skin. Getting rid of the surface dead skin makes our skin more reflective, hiding fine lines, wrinkles and acne scars. Continued use of AHAs can actually cause an increase in skin thickness, generating new skin formation. Work done in our laboratory has demonstrated an increase in GAGs and collagen gene expression in skin treated twice daily with AHAs. GAGs are the sugars in our skin that babies are loaded with. They are also the one of the first components of new skin formation in a healing wound. Products like AHAs and Retin-A and its relatives produce a healing response in the absence of an actual wound. Thus, continued use of these products will improve the appearance of fine lines and wrinkles initially through surface changes, and eventually through changes throughout the skin.

To answer your specific questions or schedule a consultation, call Dr. Bernstein today at 610-581-7400.