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There is a Japanese proverb that says “Kind hearts are better than fair faces.” It’s a nice sentiment, but, as anyone with a skin concern knows, playing nice when it comes to blemishes, wrinkles, sagging and discolouration can only get you so far.  “Everybody should practice good skin care, but there can come a point where [products] alone can’t do the job anymore,” explains Dr. Frank Lista, a Toronto-based plastic surgeon.  “It might be something we can fix with lasers, injectables or, if necessary, surgery.”

The good news is that there are many new procedures and techniques that deliver natural –looking results with less downtime as well as great high-tech topical products for those taking the DIY route.  ELLE asked some leading experts for advice on how to fight four of the most common skin concerns, from the drugstore to the derm’s office.

SPOT ON

If concealing pimples at an age when you’re also contemplating eye creams seems like one of Mother Nature’s cruelest jokes, you’re not alone: According to a recent study, the median age for acne sufferers has risen from 20.5 to 26.5.  Characterized by pustules and cysts around the jaw and neck, female adult acne usually has a hormonal origin, says Dr. Nowell Solish, an assistant professor of dermatology at the University of Toronto.  Hormones stimulate the production of oil, which combines with bacteria to clog pores and create inflammation.

AT HOME Your first instinct might be to spot-treat your pimples, but that’s the wrong strategy, says Dr. Rolanda Johnson Wilkerson, a P&G Beauty Scientist.  “Drying out the skin is the old way of treating acne, but it makes you more susceptible to wrinkling, irritation and sun damage.”  Instead, the newest remedies take a gentler, all-over approach.  Olay Professional Pro-X Clear Acne Protocol is a three-step system that has replaced old-school benzoyl peroxide with salicylic acid and niacinamide; the former eradicates oil and prevents future breakouts, while the latter fades spots and improves skin texture.  Kellett Clear Skin Care System, developed by Dr. Lisa Kellett, a dermatologist based in Toronto, employs a similar philosophy, featuring not only acne-fighting ingredients but also antioxidants and anti-inflammatory herbs.  For a fast fix, hand-held zit zappers such as Zeno Hot Spot, which delivers a controlled, low-level dosage of heat to kill acne-causing bacteria, can also be effective, says Dr. Mark Lupin, a dermatologist based in Victoria, B.C.

ON YOUR LUNCH HOUR A new and popular doctor’s office treatment is Isolaz, which uses vacuum and broad-band light to wipe out sebum and dead skin cells over four to six sessions, with no downtime.  Other options include vascular Gemini laser and salicylic-acid-based SilkPeel, although many derms prefer oral medications such as antibiotics, spironolactone (an anti-androgen drug) or the birth-control pill as a first line of defense.  “Whatever you do, the cornerstone of treatment should be a topical routine with vitamin A,” says Lupin.  Combination retinoid-antimicrobial preparations are the big news on that front.  One example, Tactuo-a vitamin A and benzoyl-peroxide blend-was launched this spring.  If your acne is causing scarring, however, you could be a candidate for a course of vitamin A taken orally in the form of Accutane.

ON YOUR WEEK OFF If you have exhausted other options or are averse to medications, photodynamic therapy can put acne in remission for months at a time.  Levulan, a topical photosensitizing agent, is applied and left on skin for one to three hours before being activated under blue light.  You will need 48 hours of downtime, during which you will have the appearance of a sunburn and be sensitive to light.

FRONT OF THE LINE 

Avoiding the sun and smoking will help keep collagen stores intact, fending off wrinkles until your 40s or later.  But genetics also determine when lines first show up, as do facial expressions, which can trigger dynamic wrinkles-crow’s feet and frown and forehead lines-as early as age 30, says Solish.

AT HOME “A lot of what we perceive as fine lines and wrinkles is really just a lack of moisture,” says Celeste Lutrario, vice-president of research and development for Burt’s Bees.  Upping your water consumption can help, but since the outermost layer of skin takes more water from the atmosphere than the body, a cream that locks in hydration, such as Burt’s Bees Skin Solutions Sensitive Daily Moisturizing Cream, should be your first priority.  Alternatively, Shiseido’s new Bio-Performance Advanced Super Revitalizing Cream moisturizes (via hyaluronic acid) and reduces visible lines with a stem-cell technology that regenerates elastin fibers.  To build stores of collagen, “peptides, specifically Matrixyl [found in Indeed Lab’s Snoxin], are probably the best over-the-counter ingredients available right now,” says Solish.  For instant results, look for formulas with optical diffusers, such as Olay Regenerist Wrinkle Revolution Complex. “[They] reduce the appearance of winkles by manipulating the light that bounces off the skin,” says Johnson Wilkerson.  And as for prevention, a broad-spectrum SPF 30 sunscreen is your number one weapon.

ON YOUR LUNCH HOUR Although Solish recommends supplementing your topical peptide regimen with prescription-strength vitamin A, it’s no surprise that “the next step up is injectables.”  Botox remains your best bet for temporarily weakening the muscles that cause dynamic wrinkles, while hyaluronic acid is the dermal filler of choice for deeper, static lines.  Still, the formula itself is only half the battle: “The most important thing is the [technique of the] person on the other end of the needle,” says Solish, so choose your practitioner carefully.

ON YOUR WEEK OFF A series of fractionated laser treatments-Lupin suggests the Fraxel re:store for fine lines and Fraxel re:pair for deep lines-can yield significant improvements.  They only target a portion of the skin at once, so you’ll need just a few days of healing time while the skin (and collagen) regenerates.  For serious texture issues, consider a fully ablative laser, which removes the entire top layer of skin and requires two weeks for recovery.

LOOSE CHANGE  

Skin tends to get thinner as we age, losing volume, firmness and elasticity.  It usually starts to bother us in our 40s, says Dr. Nick Carr, head of the division of plastic surgery at the University of British Columbia.  Sun damage and smoking are at fault, as is a slowdown in collagen production and the hormonal changes associated with perimenopause.

AT HOME There is no harm in using topical products that promise to lift sagging skin-as long as you’ve got realistic expectation.  “They can thicken the dermis a bit, and maybe when you pinch your skin it will feel firmer, but the results won’t be dramatic,” says Solish.  Products like Dermalogica Age Smart Overnight Repair Serum and Chanel Ultra Correction Lift-Intensive Lifting Concentrate can have a modest impact, thanks to peptides that increase production of skin-plumping collagen, hyaluronic acid and elastin.

ON YOUR LUNCH HOUR The newest facelift alternative for lax skin around the eyelids and jaw is Ulthera, a 30-minute treatment that uses ultrasound therapy to lift and tighten.  Aside from mild flushing and sensitivity, there’s no downtime-but not everyone’s skin responds says Solish.  A surer bet may be hyaluronic-acid fillers, such as Juvederm or Restylane.

ON YOUR WEEK OFF If derm’s-office procedures can no longer firm loose skin, “surgery is the best treatment,” says Carr.  “The biggest new thing is fat transfer, which involves taking a fat graft from the tummy or thighs [via liposuction] and then re-injecting it around the brows, eyelids, cheekbones or lips.” Downtime is about one week, but expect to have two or three procedures, since less than one-half of what is injected survives the transfer.  The other development is in facelifts and brow lifts, which have become both less invasive and more natural-looking.  “Surgeons now know how to avoid that windblown look,” says Carr.  “They use the deep plane facelift, which places tension in deeper fat and fascia layers instead of just the skin on top.”  Plan on several weeks of recovery time, or consider a short scar facelift or endoscopic brow lift: Both involve fewer incisions and less downtime (about two weeks) and produce a subtler effect.

LOCAL COLOUR

Freckles are cute on the under-10 set, but hyperpigmentation-their grownup counterpart-can add years to an adult face.  Typically brown in colour, it strikes all ages and may appear as sun spots, age spots or larger patches (melasma).  “The sun, hormones, pregnancy, birth-control pills and genetics are all factors, but in the case of melasma, some people are just prone to it,” says Lupin.

AT HOME Most products that target discolourations work by slowing or stopping underlying melanin production as well as fading the existing pigment.  The most common-and, arguably, effective-ingredient is hydroquinone, which is available without a prescription in concentrations as high as four percent.  But it shouldn’t be used for more than two years, says Lupin, because “long-term use can induce a blue colouration in the skin, and it has been banned in Europe because it can be mutagenic [potentially carcinogenic] in lab animals.”  Less potent over-the-counter options include vitamin C and glucosamine (found in Estée Lauder’s new Idealist Even Skintone Illuminator) as well as kojic acid, azelaic acid, licorice extract and arbutin.  Others work by speeding up the turnover of abnormal layers of skin where hyperpigmented cells accumulate.  Look for alpha-hydroxy acids (AHAs), retinols or [LR 2412]-the newest retinol alternative.  This breakthrough patented molecule in Lancome’s newest Visionnaire [LR 2412 4%] Advanced Skin Corrector may deliver similar results on unevenness without irritation.

ON YOUR LUNCH HOUR Derms are buzzing over Lumixyl, a peptide-based system that studies have found to be 5.5 times more effective at inhibiting melanin as an equivalent dosage of hydroquinone-without the irritation.  It’s available through doctor’s office and medispas as both a topical at-home treatment (no prescription required) and a SilkPeel infusion treatment.  For more resilient skin types, Lupin also prescribes hydroquinone (up to an eight-percent concentration) or retinoids like Tazorac and Retin-A.

ON YOUR WEEK OFF “If bleaching creams fail, we typically use a Fraxel laser,” says Solish.  “It works best on significant pigment and dull skin-usually people in their 40s who have a lot of sun damage.”  Not up for several days of intense redness and swelling?  Chemical peels and intense pulsed light (IPL) treatments need less (if any) downtime but are better for younger skin with only minor pigment issues.

Ladies and gentlemen of Victoria, BC: maybe you have noticed - you are aging.  The rosy apples of your cheeks are heading south; years of smiling and frowning are permanently imprinting on your face; youthful facial contours are giving way to gravity, striking a semblance to your mother’s or (maybe worse) your father’s skin.  The nature of aging sets us on a slow, declining course after the age of about 19 yet, this day in age, we are living longer than ever before.  What that means is we will likely face the extremes of inherent and sun related aging.

Cosmetic or plastic surgery, like facelifts and browlifts, and anesthesia are not for everyone.  The booming industry around non- or minimally invasive cosmetic procedures is a testament to the growing interest in ‘no-downtime’ anti-aging measures and the developing trend of prevention.  Leading this industry in Victoria, BC is BOTOX Cosmetic® - a now household name in ‘wrinkle science.’  BOTOX®, commonly misrepresented in celebrity media, is a treatment to relax muscle movement associated with wrinkling and drooping.  When administered well, the look achieved is “refreshed and rested,” not the dreaded “frozen.”  BOTOX® is a popular treatment option for softening frown and forehead lines, crows’ feet, lifting the eyebrows and turning up the corners of the mouth.  BOTOX® can even improve a ‘gummy smile’ allowing the upper lip to relax over the upper gum line.  Results take shape gradually between 4 and 21 days after treatment and are expected to last an average of 4-6 months.

BOTOX® has many clinical applications including relief from muscle spasms, facial asymmetry, hyperhidrosis (excessive sweating) and migraine or chronic headache.  By all accounts, BOTOX® is one of the most researched drugs with over 4000 peer reviewed studies globally – attesting to its high safety profile when administered by an experienced specialist. 

Once you address the underlying movement causing wrinkles and lines, the skin is primed for volume restoration with dermal fillers like Juvéderm®, Restylane® or Teosyal®.  The beauty of these products is their natural formulations: plant derived sugar molecules that attract natural moisture within the skin.  Correction from filler treatment is instant and lasts upwards of 12-18 months or more in some areas.  Juvéderm®, Restylane® and Teosyal® can be used to further improve deep forehead and frown lines, restore natural volume to hollowing areas like the cheeks, sulcus (under eye) and temples, enhance the lips, recontour the nose and chin and fill the folds between the nose and mouth.  Filler corrections are easily tailored to the individual and can be as specific or global as any person desires.

Combination BOTOX® and filler treatments, like Soft Lift®, maximize result and prolong overall correction.  It has been proven, when used in conjunction, BOTOX® and filler will simultaneously last longer; BOTOX® will inhibit the muscle movement that contributes to the degradation of filler and with the added support and structure provided by filler, BOTOX® is metabolized at a slower rate.  Soft Lift® treatments at Cosmedica in Victoria, BC are provided by dermatologist Dr. Mark Lupin in our accredited non-hospital medical surgical facility – a clinic focused on delivering the highest quality of service and providing maximum safety.

Find out what Soft Lift® could do for you.  Contact the dermatology skin experts at Cosmedica in Victoria, BC and request a consultation today.   

Canadian dermatologists have had one more therapeutic option available for use in their rosacea patients, following the approval last summer of azelaic acid 15%.

"It seems to be working well," says Dr. Lyn Guenther, a professor in the department of medicine at the University of Western Ontario and a dermatologist in private practice in London, Ont.

"There is not one therapy that works in 100 per cent of patients 100 per cent of the time.  For some people, a treatment like metronidazole may not be sufficient.  It is nice to have another option."

Dr. Guenther notes some patients are very loath to taking oral antibiotics and want to try all possible topical agents before resorting to oral antibiotics.

Azelaic acid gel (15%), is a topical therapy designed to address the inflammatory papules, pustules and flushing or redness that characterize papulopustular rosacea.  Two randomized, placebo-controlled trials of the azelaic acid gel conducted in the U.S. demonstrated a reduction in redness and swelling in rosacea patients and demonstrated that the topical therapy was well-tolerated.

Finacea can be used as monotherapy to treat the papules, pustules, and redness associated with rosacea or it can be used in combination with therapies such as metronidazole, which is available as a gel or cream, according to Dr. Guenther.

Patients with rosacea typically have sensitive skin, and it is recommended that they use mild skin cleansers that do not sting, adds Dr. Guenther.

There are about two million Canadians living with rosacea, with the disorder being more prevalent among Caucasian women aged 30-50 years.  It typically affects those affected with fair skin.

Rosacea triggers can't always be avoided

One of the keys to preventing rosacea flares or exacerbating rosacea symptoms is to avoid the numerous recognized triggers such as spicy foods, alcohol, wind, sun, and strenuous activity, but patients can't insulate themselves from all of the triggers all of the time, notes Dr. Lisa Kellett, a Toronto dermatologist and medical director at DLK on Avenue Inc.

"People have to be reasonable," says Dr. Kellett.  "You have to live.  You just have to use your judgement.  Don't have a glass of wine before you are having your picture taken."

While rosacea is a chronic condition and represents a spectrum of disease, Dr. Kellett notes it can be treated.

"It cannot be cured, but it can be controlled," says Dr. Kellett, who advises that topical treatments represent first-line therapy and that physicians then seek oral antibiotics like minocycline, tetracycline, and doxycycline if patients do not see satisfying results with topical treatments. "You really do need maintenance treatment whether you are using a topical antibiotic, a systemic antibiotic, or a laser."

Light therapies, such as intense pulsed light, and lasers, such as the pulsed-dye laser, are used to treat the telangiectasia, erythema, and visible blood vessels that are present in patients with rosacea, says Dr. Kellett.

Pulsed-dye laser treatments can be more aggressive or less aggressive depending on the practitioner, notes Dr. Chris Keeling, a dermatologist in Edmonton and a clinical associate at the University of Alberta.

"You usually get the most improvement after the first treatment, but can continue to see decreased vessel numbers with succssive visits," says Dr. Keeling.

The use of the pulsed-dye laser or IPL permits patients to return to their regular activities immediately, according to Dr. Keeling.

"You can get rid of the patient's [blood] vessels without downtime," he says.  "You can have laser treatment and go back to work in the afternoon."

The downside of pulsed-dye laser treatment is that there is some discomfort with the treatment that turns off some patients after one treatment, and for many patients, seeking broadband light therapy or laser treatment is a cost that they will have to pay for themselves.

"The sensation is like a rubber band snapping against the skin," says Dr. Keeling.  "It is uncomfortable, but most patients tolerate it."

Low self esteem common

Patients may return for as many as 10 treatments if they want to rid themselves of almost every visible vessel, but some may be satisfied with the resutls after a couple of treatments.  A series of pulsed-dye laser treatments will keep the blood vessels away for about four years, says Dr. Keeling.  It is recommended that patients undergo one or two pulsed-dye laser treatments per year as maintenance therapy.

Treating the papules and pustules or the telangiectasia and flushing that can accompany rosacea can improve quality of life for patients, some of whom experience low self esteem and frustration.

The unique aspect of azelaic acid 15% is that it is a natural product, says Dr. Keeling.

"It is derived from wheat, barley, and rye," explains Dr. Keeling. "It reduces skin cell proliferation, and it can be used in acne as well.  Some dermatologists use it to treat melasma."

One of the potential limitations of azelaic acid 15% is that it can increase facial hairs, warns Dr. Mark Lupin, a dermatologist in Victoria, director and founder of Cosmedica Laser Centre, a clinical instructor in the department of dermatology in the faculty of medicine at the University of British Columbia, and a fellow of the American Society of Laser Medicine and Surgery.

"That [possible side effect] may be a concern for women," says Dr. Lupin.

Ocular rosacea occurs in up to 50 per cent of rosacea petients, and some patients may not be aware that their eyes are affected, stresses Dr. Lupin.

"Patients may not know it," says Dr. Lupin.  "You may wake up with dry eyes and not think of it as a skin condition.  If they present with minor symptoms, a topical opthalmic lubricant should treat it."

If an ophthalmic lubricant is appropriate, Dr. Lupin refers patients with ocular rosacea to an ophthalmologist for treatment, but more severe ocular rosacea may be better treated with oral therapies.

"If they present with red eyelids, something more than just topical therapy may be required," explains Dr. Lupin.  "The advantage of a systemic therapy is that if we see someone with inflammation and ocular rosacea, the inflammation and their eyes will both improve [with systemic therapy]."

Some oral agents such as doxycycline are more photosensitive than other agents, and are not a judicious treatment choice in the summer months for rosacea patients, says Dr. Lupin.  In addition, IPL should not be applied to treat rosacea symptoms when patients are tanned, noted Dr. Lupin.  Sulfa drugs are also part of the pool of therapies that can be used to treat rosacea, but clinicians need to be aware that patients may have a sulfa allergy, which excludes them as candidates for sulfa drugs.

Amiodorone may cause rosacea symptoms

Flushing and redness can also be alleviated with newer anti-oxidant products, notes Dr. Lupin.

"They are designed to strengthen the collagen, and they do seem to help with diminishing the blood vessels," says Dr. Lupin.

Physicians should be aware that some pharmacotherapies contribute to the symptoms of rosacea, says Dr. Guenther.  A drug like amiodarone, an antiarrhythmic agent, is commonly prescribed, but can act as a rosacea trigger.

"You can prescribe alternatives [to amiodarone], and the rosacea will disappear," says Dr. Guenther.  "Often, we will speak to the cardiologist, and they then will switch the patient to another drug.  There are usually a few different choices."

Other therapies such as epidermal growth factor inhibitors, designed to treat particular cancers, can also worsen rosacea symptoms, adds Dr. Guenther.

Rosacea may be induced by steroid use, and therapies such as tacrolimus and pimecrolimus can be effective in those instances, Dr. Guenther added in conclusion.