Elle Canada Magazine September 2011 Issue: Skin Saviours
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.
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.
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.
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 Est?e 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.