Tips & Tricks

Healthy skin is the foundation of anti-aging.  This starts with the right regimen tailored to each person’s specific skin needs and goals.  Read below for tips and tricks on maintaining healthy, glowing skin.

Let’s talk about the science behind skin.

Skin aging is inevitable.  There are many complex physiological factors that contribute to aging skin. 

 

Let’s start with a little anatomy. 

The main functions of the skin are feeling of touch, pressure, and pain; maintenance of fluid and electrolyte balance; temperature management (sweating, shivering, etc.); and protection of internal organs from the environment. 

There are three main layers of skin. 

The outermost layer is called the epidermis.  This layer contains skin cells, melanocytes (pigment producing cells), proteins (keratin) that maintain the skin barrier, and Langerhans cells (immune cells that help fight infections).

The middle layer is called the dermis.  This is the layer that contains skin cells, blood vessels, nerves, hair follicles, and sebaceous glands.  The dermis is the layer that provides blood supply and nutrients to the epidermis.  This layer contains collagen, the protein that provides structure to the skin.  Think of this as the scaffolding of your skin.  Collagen fibers also create the infrastructure for hyaluronic acid (hydration).  This layer also contains elastin, the protein that provides elasticity, or bounce back, of tissue. 

 The deepest layer is called the subcutaneous layer.  This layer contains sweat glands, blood vessels, fat, and some hair follicles. 

 

Now, let’s talk about what happens as we age. 

 With increasing age, the epidermis thins.  The number of melanocytes (pigment producers) decreases, but the size of remaining melanocytes increases.  Therefore, aging skin is thinner, and formation of sunspots (lentigos) appears.  The number of keratinocytes decreases, making the skin more fragile and less elastic. 

Collagen production slows as we age which means thinner, drier skin leading to increased wrinkle formation.  Think of this as a loss of scaffolding so there is less structure for the skin to sit on.  This process starts at age 30!

Elastin production slows as we age which means the bounce back of tissue decreases.  Think of a rubber band that has been stretched too many times.  It stretches out and loses its ability to snap back to its original size.

Starting at age 30-35, the natural aging process causes loss of about ten percent of subcutaneous fat. This process continues and we lose approximately five to ten percent of facial fat volume every five to ten years. 

 

How do environmental factors affect this process?

UV exposure is responsible for up to eighty percent of visible signs of skin aging.  Exposure to the sun will increase the skin’s production of melanin (this is why we get tan in the sun).  Over time, some areas of the skin can develop hyper-proliferation of melanin, which will result in a sunspot.  

UV exposure can cause collagen break down at a higher rate than normal aging.  This is because UV rays penetrate through the epidermis into the dermis and increase the formation of reactive oxygen species (ROS).  ROS damage collagen and elastin and this damage leads to wrinkled, leathered skin.

 

Why does all this matter?

The skin is a complex structure that not only functions to protect our organs and help our bodies maintain homeostasis, but also functions as a component of external beauty and health. 

Preventing skin aging is much easier that treating damaged skin.  This means a daily routine personalized to your own skin needs and goals, in office treatments for maintenance, and SUNSCREEN, SUNSCREEN, SUNSCREEN!

 

Sun and Skin

We’ve all been told how important sunscreen is, but the question is: why?  Let’s discuss what UV radiation is, why it is harmful, and what we can do to prevent harm from the sun.

UV radiation is a form of electromagnetic radiation that comes from the sun and sun-like sources (tanning beds). 

The definition of radiation is the release of energy from a source.  There are different ranges of radiation from high energy radiation (x-rays) to low energy radiation (radio waves).  UV radiation is in the mid-range level – less energy than x-rays, more energy than visible light.

 

What are the different types of UV radiation and what do they mean?

There are three different types of UV radiation categorized by how much energy they emit.  Higher levels of UV radiation (UVB/UVC) have so much energy that they are able to de-ionize cells leading to DNA damage. DNA damage = skin cancer!

 UVA rays are the weakest of the three types of UV radiation. This means that they can cause indirect damage to cellular DNA and can play a role in some skin cancer formation.  However, most of the damage from UVA rays leads to accelerated cellular aging and long-term skin manifestations such as wrinkles and leathery skin. 

 UVB rays are the mid-range energy producers.  This type of radiation can damage DNA, cause skin cancers, and cause sunburns.  This type of radiation is most likely to cause skin cancer.

 UVC rays emit the most radiation out of the three types of UV rays.  However, these rays react with the ozone layer and don’t reach the ground.

 

Now, let’s talk about factors that increase risk of damage from UV radiation.

  • UV rays are strongest between 10AM and 4PM.

  • UV rays are strongest during the spring and summer months.

  • UV rays are stronger at higher elevations.

  • UV rays can bounce off surfaces (water, snow, sand, concrete, grass) leading to more exposure than we’re aware of.

 

What does all of this mean for our skin?

 Exposure to UV radiation causes damage to the DNA of our cells.  Over time, this damage builds up causing cells to grow out of control.  Out of control cell growth = cancer. 

 UV exposure accelerates breakdown of collagen and elastin.  Less collagen and elastin = wrinkled, leathery skin.

 

Now that you’re scared of the sun, how do you live your life without hiding in the shade?

Obviously avoiding the sun is the best protection.  However, this is just not feasible for most people.  We want to enjoy our lives while also giving our skin the best chance at cancer prevention and anti-aging. 

 

Here are some tips:

  • Wear sunscreen on your face, chest, arms, and hands every day.  This is important even when you are not planning on direct sun exposure. Think about when you’re driving, walking in and out of buildings/offices, going for walks, gardening, etc.  You are exposed to the harmful rays of the sun even when you aren’t intentionally getting sun exposure.

  • Make sure your sunscreen has both UVA and UVB protection and is SPF 30+.

  • Always wear a hat when you are intentionally getting sun exposure (at the pool or beach, laying out, exercising outdoors, etc.).

  • Limit direct sun exposure to 30 minutes per day while intentionally “sunning” (on vacation, laying by the pool, laying out at the beach).  Laying in a lounge chair under an umbrella is very relaxing and you can pat yourself on the back for protecting your skin.

The sun is a beautiful thing that is meant to be enjoyed, let’s just be smart while we enjoy it!  

What’s the hype with retinoids?

What is a retinoid?

Retinoids are products that are derived from vitamin A.  This product is an exfoliant used to treat many different skin conditions. 

There are different strengths of retinoids from retinols to retin-A.  Retinols tend to be over the counter and able to be purchased through a medical practice.  Retin-A is a prescription strength medication.

 

How do retinoids work?

Retinol is a derivative of vitamin A.  This product is used to treat many different skin conditions from texture issues to acne.  Retinol helps to keep skin exfoliated and stimulates cellular turnover. This means retinol helps the body rid itself of old skin cells and produce new skin cells at a more rapid rate than without retinol use.  Retinol penetrates to the depth of the dermis where it works to neutralize free radicals and boost production of collagen and elastin.  This process helps to reduce appearance of fine lines, wrinkles, and enlarged pores.   

 

What do retinoids treat?

  • Fine lines

  • Wrinkles

  • Hyperpigmentation/Sunspots/Photoaging

  • Uneven skin texture

 

Why does the skin need to adjust to retinoids?

Retinoids cause the skin to purge itself of old, dead skin cells.  Your skin may become red, dry, and flaky.  This is typically when people stop using retinoids and tell their provider that they had a reaction.  However, this reaction is a sign of repair within the skin.  As the skin adjusts and is in the maintenance phase as opposed to the repair phase, these symptoms subside, and you are left with plump, glowing skin. 

 Your skin will get worse before it gets better but stick with it!  Give your skin 4-6 weeks before you see subsiding of the reaction and improvement of skin.

 

How should retinoids be applied?

Retinoids should be applied to clean, dry skin.  You can follow the rest of your skin care routine after a retinoid is applied.  Retinoids can be applied to face, neck and chest.  A thinner layer should be applied to the under eye.  The skin there is thin!

Retinoids should be applied once per week when just starting out.  You can gradually increase to 3 times per week after your skin adjusts to the initial reaction phase.  If you get off retinol for an extended period, restart using as if it was the first time. 

 

What things should be considered when using retinoids?

Retinoids will make your skin more sensitive to the sun.  Sunscreen is your best friend in all skin care routines, but especially with retinoids. 

If your skin is having difficulty adjusting to retinoid use, try a thicker, richer moisturizer at night. 

 

Why are medical grade retinoids better than over the counter?

Over the counter skin care typically aren’t regulated by the FDA. 

Medical grade products are “over the counter” in that you do not need a prescription to obtain them.  However, medical grade products are backed by clinical studies and FDA regulations. 

Over the counter retinoids (drugstores, etc.)  may be highly concentrated, but are not as powerful as medical grade products. Medical grade products are higher in concentration of active ingredients and have clinical studies to back up the effectiveness of the product. Moral of the story: don’t skimp on skin health. Take care of your skin just like you take care of your body.

 

Let’s talk about product application.

When developing a skin care routine, multiple products are usually used to target multiple concerns.  For example, an anti-aging skin care routine can include products to combat environmental toxins, soften lines and wrinkles, lighten and prevent sunspots, restore skin barrier, and moisturize skin. 

 

When using multiple products, does application order matter?

Yes, it does.  In general, products should be applied from thinnest to thickest.  This allows the thinner products to absorb into the skin without being blocked by thicker serums or creams. 

 

One exception to this rule: Sunscreen should ALWAYS be the last product applied in the morning. 

 

So, your routine should start with cleanser and end with your moisturizer or sunscreen.  Everything in between should follow the “thinnest to thickest” rule.

 

 

Dermal fillers vs collagen boosting treatments

First, let’s talk about what one syringe of filler is. 

One syringe of filler is equal to one fifth of a teaspoon.  That’s a minuscule amount when we’re looking at the big picture!  Being that one syringe of filler is such a small amount, it is hard to look over done when one, two, or even three syringes of filler are used. 

Next, let’s talk about what filler is meant for. 

There is a common misconception that filler is used to fill lines and wrinkles.  While this was the practice back in the day, times have changed.  Filler should be used to replace volume loss in the face that occurs continuously with each passing year.  Volume loss refers to loss of bone volume and deep fat pad volume.  Ligaments also stretch and loosen over time.  These factors lead to less structure to hold the skin up, and therefore leads to wrinkles and deep folds. 

Now, let’s talk about the difference between wrinkles and deep folds. 

Wrinkles happen due to volume loss and ligament loosening as discussed above, however, there are other factors leading to wrinkle formation.  As we age, we lose collagen and elastin which causes thinning of the skin, hollowness, and wrinkles. Think of collagen as the skin’s scaffolding and elastin as the skin’s ability to bounce back to its original position.  Young skin has an average epidermal measurement of 37.4 micrometers versus 17.6 micrometers in aged skin.  What does this mean?  The epidermis, which is the skins outermost layer, is the target in product application, in office procedures, and laser treatments.  These treatments cause controlled injuries to the skin to stimulate collagen and elastin production which will thicken the epidermis back to a measurement close to younger skin.  This leads to less wrinkle formation.  Quality skin care and in-office collagen and elastin building treatments are what should be done to treat the epidermis and therefore treat and prevent wrinkles.  There are some lines that can be filled with filler, however the mainstay for treating fine lines and wrinkles is quality skin care.  The best treatment for wrinkles: prevention, not filler!

Deep folds happen due to volume loss in bone and deep fat pads and loosening of ligaments over time.  These are the prime candidates for facial filler.  No in-office treatment can replace bone and fat pads, which is why filler is the perfect option for these types of issues. 

Wrinkles are the more superficial lines in the skin like in the forehead, on the lateral cheeks, around the mouth, or on the neck.  Deep folds are the folds seen around the nose (nasolabial folds), lines next to the mouth (marionette lines), flattened cheeks, loss of curvature in the cheeks, and other areas.  Filler is also great to enhance features, such as the lips.  Filler can be used to feminize or masculinize the chin and define the jawline.  There are many awesome uses for filler, but wrinkle chasing is not one of them!

If filler is done right with the right type of filler and right knowledge of facial anatomy, it can be done beautifully for a natural improvement in facial features! 

Radiofrequency micro needling

What is it?

Microneedling with radiofrequency is a minimally invasive cosmetic procedure that uses tiny needles and radiofrequency waves to rejuvenate facial skin.  Results from this treatment come from controlled skin injuries.  The controlled damage stimulates collagen, elastin, and GAG protein production and generation of new skin. 

Microneedling

Microneedling uses tiny fine needles to create millions of micro-injuries in the skin.  These micro-injuries generate an immune response in which brand new collagen and elastin are produced.  The production of collagen provides the skin with the infrastructure needed for plump, tight skin.  The production of elastin provides the skin with the bounce back, or elasticity, needed to soften and prevent fine lines and wrinkles. 

Radiofrequency Microneedling

Radiofrequency microneeding uses specially insulated needles that deliver high-intensity radiofrequency energy into the targeted tissues deeper than microneedling alone.  This gives a uniform warming effect to deep tissue which further stimulates new collagen fibers to grow, leading to significant improvement in overall skin health. 

 

Radiofrequency treatments improve skin tone and texture by increasing collagen, elastin, and hyaluronic acid.  Radiofrequency waves also serve to tighten skin and lighten pigment.

What will this treatment do for your skin?

Microneedling with radiofrequency can address the signs of aging, significantly reduce wrinkles and age spots while tightening and lifting the skin on the face and neck.  This minimally invasive procedure has little to no downtime.  This procedure also functions to reduce pore size, retexture skin, and soften acne scarring.

What to expect post-procedure?

Most patients experience minimal downtime and fully recover within seven days following a radiofrequency microneedling treatment.  Common experiences post procedure are 24 hours of redness followed by up to 5 days of dry skin. 

Addition of vitamin C and retinol are recommended for best results.