Should I Consider Using Retin A and Glycolic Acid? | If I use this treatment will I be more susceptible to sun damage? | What Will AHA's Do For My Skin?
How Does It Improve the Appearance of My Skin? | Where Else Can I Use Alpha Hydroxy Acids? | Do AHA Creams Make Me More Sensitive To Sunlight? | IPL=Photorejuvenation | Botox | Thermage
Skin Treatments
The advertising dilemma: Fact vs. Fiction
Millions of dollars a year are spent on very expensive, well marketed, fancy moisturizers and rejuvenating magic formulas. Most of these are no better than fancy smelling mayonnaise.
There are decades of medical documentation that alpha hydroxy acids (AHAs), especially Retin-A and glycolic acid, are medically proven to moisturize and thicken the top layer of your skin, and produce more collagen and elastic fibers in the deeper layers of your skin.
While you can buy AHAs in the drug store, through TV guides and magazine ads and TV promotions, Doctors can prescribe stronger alpha hydroxy acids and prescription Retin-A to better fit your skin care needs. This time, you will have products that are proven to work.
You should start with a glycolic acid wash and moisturize with a combination of a glycolic and Retin-A acid combination.
More importantly, use a sunblock with real skin cancer protection: a physical barrier. Only then will you have the protection you need against long range UVA waves that cause cancer, wrinkles, and pigment. The best are zinc oxide, titanium dioxide, parsol 1789 (avobenzone), or mexoyl. They are not present in most sunblocks. The delivery system of zinc oxide and titanium dioxide uses nanotechnology with microspheres, which changes these chemicals' properties so they would not be opaque on your skin. There is scientific controversy about these products, because no one knows what happens to the microspheres once they are absorbed by the skin and release their packets of zinc or titanium. Therefore I prefer avobenzone (parsol 1789). The problem with avobenzone is that it only works for 80 minutes, as it is an unstable product and inactivated by the sun in 80 minutes, therefore it needs to be applied every 80 minutes!! Neutrogena 55 lotion or spray is my favorite.
Why Should I Use Retin A and Glycolic Acid Together?
Retin A is an inflammatory acid that irritates your skin and can cause it to be red, sore and scaly. Used alone, 50% of people abandon the treatment because of this. Glycolic acid's mode of action is anti-inflammatory. Because glycolic acid has such a totally different pathway to restore the skin and achieve results similar to Retin-A, the two acids, when used together, are synergistic or additive. This has been microscopically documented in the literature using skin biopsy proof.
If I use this treatment, will I be more susceptible to sun damage?
Research has shown glycolic acid to have a skin protection factor (SPF) of 3. Retin A does sensitize you to the sun and makes you more likely to burn, so you do need a good sunblock to protect your skin while you are on this regimen.
What Will AHAs Do For My Skin?
Facial Skin Treatments
Medical research has proven that alpha hydroxy acids microscopically change our skin to a younger appearing skin. Microscopically three things happen. The surface of the top layer (epithelial layer) of your skin has dead cells that make it feel rough on the surface and these dead cells are removed with the alpha hydroxy acids. The thin top layer of your skin is replaced with a much thicker, plumper layer of healthy cells. In the deeper layers of the skin, the collagen and elastic tissue is restored dramatically, not only in larger amounts, but also in the tissue realignment to a more youthful parallel even alignment. For this reason, fine wrinkles can be softened, and your skin rejuvenated.
How Does It Improve the Appearance of My Skin?
Basically, AHAs decrease the "glue" that holds dead cells on the surface of the skin. This allows the dead cells to slough off, leaving behind a layer of smoother, softer skin.
A thick layer of dead cells on the surface of the skin gives the complexion a rough, dull appearance. When these cells are removed, they expose a layer of fresh new cells. This layer has a smoother texture and a more uniform color. In addition, AHAs help to dissolve the material that clogs pores. This allows the pore to drain better, decreasing the tendency for acne lesions to form.
Continued use of Alpha Hydroxy Acids appears to stimulate new cell growth. Some recent scientific studies have shown that continued use of AHAs over time can cause the top layer of living cells to actually become plumper, creating a more youthful tightening of the skin. In some AHA users, this tightening can even lead to a reduction in fine wrinkles or scars.
Where Else Can I Use Alpha Hydroxy Acids?
All areas of the body appear to respond well to treatment with AHA. However, the hands, arms, neck and chest, and legs all improve at a slower rate than the face. Therefore, many patients elect to treat these areas more aggressively, by using stronger products containing higher concentrations of AHA, or having several light AHA peels or intense pulsed light treatments done.
Do AHA Creams Make Me More Sensitive To Sunlight?
The use of Alpha Hydroxy Acid products rarely causes sensitization to the sunlight. The vast majority of people can use AHAs with very little or no redness, irritation, or flaking, as is often seen when starting with a strong Retin-A first. This is especially true if you start with retinol and build up your strengths on glycolic and letin-A acids. In addition, some recent scientific studies suggest that using AHAs may actually make your skin less sensitive to other chemicals. Again, sunblocks are more important to protect the skin than AHA's alone.
WHAT IF I HAVE BROKEN BLOOD VESSELS VISIBLE ON MY SKIN, OR RESISTENT BROWNS IN MY SKIN??—TRY IPL
IPL=PHOTOREJUVENATION
ABOUT IPL:
Photorejuvenation treatments are full face, neck, chest, hands, and even arm treatments using pulses of VISIBLE LIGHT that effectively improve facial redness and flushing as well as the visible signs of sun damage and aging.
INDICATIONS FOR IPL:
- Treatments effectively reduce redness and flushing from broken capillaries.
- Sun damage (photoaging) treatments reduce fine wrinkling, freckling and irregular pigmentation.
- Treatments smooth skin, reduce pores and even skin tone.
- Rosacea IPL treatments reduce the overall redness, flushing and dilated capillaries and improve the breakouts of this common chronic facial condition.
- Enlarged pores are very tough to improve. IPL with gentle wave and Retin-A will give the best results.
- Oily skin and acne are markedly improved, especially if aminolevulinic acid (ALA) peels are used to boost the results.
- Precancerous lesions, like actinic keratoses, absorb the ALA and regress.
WHAT ARE THE ADVANTAGES OF IPL OVER LASER, CHEMICAL PEELS AND MICRODERMABRASION?
- Only IPL reduces dilated capillaries, redness and flushing. With IPL there is less discomfort and no downtime or disruptions to normal activities.
- IPL can be beneficial after laser resurfacing or facelift surgery to improve the results.
- Because IPL targets deep skin damage, and chemical peels and microdermabrasion treat the skin surface, these treatments are often used together to enhance your skin rejuvenation.
- Enlarged pores are very tough to improve. IPL with gentle wave and Retin-A will give the best results.
- Acne and oily skin can be supressed, especially if aminoleulinic acid (ALA) peels are done in conjunction with the light treatments.
This is because the ALA is selectively absorbed by the sebaceous glands which produce oil and clog up creating acne cysts.
- Precancerous lesions like actinic keratosis also selectively absorb the ALA chemical and are ablated by the light treatments.
Vasculite IPL by Lumenis is a beyond-laser medical device used to deliver a series of gentle pulses of light to the deep skin. Specific settings are selected to customize each treatment to your specific skin type and condition to maximize improvement. The light energy is absorbed by the damaged target tissue, and stimulates the production of collagen. This flexible, interactive approach to treatment cannot be reached using any other non-invasive treatment currently available. A series of 5 or more treatments are performed at three-week intervals. These treatments can also be maximized by applying an aminolevulinic acid (ALA) peel 45 minutes prior to your 30 minute light treatment. This acid is also absorbed by precancerous tumors like actinic keratosis, which will resolve without hypopigmentation.
The BENEFITS of photofacial treatments are consistent, visible improvement in the skin with NO DOWN TIME, little discomfort, and minimal risk. With IPL treatments, for the first time the embarrassing redness and flushing of rosacea can be dramatically reduced, and sun damaged, aging skin can be noticeably improved without the down time of laser or chemical peels.
GENTLE WAVE light treatments are often recommended to supplement the skin improvements of IPL. This is especially true if you are targeting enlarged pores and your redness.
ENLARGED PORES are a very difficult target to treat, and are best treated with the combination of IPL+Gentle Wave light treatments and long term Retin A skin care. Gentle Wave treatments are painless, 45 second treatments to the skin in a series of 8, no closer than 1 week.
WHAT ARE THE TREATMENTS IPL (INTENSE PULSED LIGHT TREATMENTS) LIKE?
First an anesthetic cream is applied 30 minutes before your treatment, which takes approximately 30 minutes. There is minimal discomfort during the treatment session. Immediately after the pulsed light therapy, the skin may appear flushed and red, with tiny visible capillaries, and the dark spots will appear darker. These changes are readily covered with makeup. These changes in the skin gradually fade over several hours to days, leaving the skin smooth, healthy and young looking. The improvement can be quite dramatic, however, as with any procedure, there is always the possibility that only minor changes will occur, and in rare cases there is no response. This is why parameters may be changed or adjusted before each session.
BOTOX
Dr Hughes has been injecting Botox for medical and, later, cosmetic purposes for over 26 years! And, our patients in the New Jersey and Philadelphia area have benefited from the more youthful look Botox Cosmetic offers when injected by a skilled cosmetic doctor.
WHAT IS BOTOX COSMETIC?
Botox Cosmetic is a natural purified protein produced by the Clostridium botulinum bacterium approved by the FDA for wrinkle reduction. Very low doses are administered via a few tiny injections directly into the OVERACTIVE MUSCLES that cause worry lines, frown lines and crow’s feet. Botox works by blocking the transmission of nerve impulses to the injected muscles, causing a temporary paralysis so they are unable to contract. This allows the skin to remain smooth and unwrinkled. The effects of Botox are usually confined to the injected region; it does not travel throughout the body, and there are no systemic side effects.
TREATMENT
Botox is a simple, safe, 15 minute office procedure. A topical skin cream is applied first for 15 minutes, and a tiny micro-needle is used to inject the Botox directly over the muscle area to be treated. Discomfort is minimal and brief and most patients compare the sensation to a bug bite. Unlike surgery, Botox is fast, simple and minimally invasive, with no down time or recovery. Most people return directly to work or normal activity following treatment. Within 4 days, the results are at work, and last for 3-4 months.
SIDE EFFECTS:
Temporary bruising is the most common side effect, and can be covered up with makeup. Patients that bruise or bleed easily should avoid aspirin and other blood thinning products for 10 days prior to injections. Patients that bruise easily are offered SinEcchi, a potent homeopathic remedy of arnica montana and bromelain. Other possible side effects are headache, respiratory infections, flu syndrome and nausea.
In less than 2% of cases, the toxin can migrate and cause a temporary weakness of nearby muscles, such as a drooping eyelid or asymmetry of facial expression. Because the effects of Botox are completely reversible, side effects are temporary, lasting only a few weeks.
Pregnancy and breast feeding are contraindications for Botox.
THERMAGE
The new tissue tightening procedure. THEORY: Why does our skin age?
THEORY: Why does our skin age?
Collagen is a building block or foundation of the skin which supports its structure. Over time collagen becomes depleted or damaged by the sun or other environmental factors. The result is visible signs of aging such as the appearance of thinner skin or loose skin. The deep radiofrequency energy heats the deep levels of the facial skin and stimulates production of collagen in response to the heat energy insult. It can take up to 6 months to see a response from this procedure, which is often done in combination with fat transfer and or BOTOX cosmetic.
WHAT IS THERMAGE?
This new radiofrequency device is capable of delivering higher energy fluences to a greater volume of deeper skin than non-ablative lasers, and was evaluated for a number of clinical targets, including periorbital wrinkles, non-invasive eyebrow lifting, submental neck reduction and acne scaring. It is now FDA approved for upper, mid, & lower face tightening.
The problem with Thermage is it's disappointing success rate,< 10%. This is because Americans want great immediate results, and can be very critical of their results.
The Thermage company has recently developed 2 new heads, one for the face, and one for the body.
The results I have seen with these heads are better!
More importantly, the company has bought the Fraxel company, which has brilliant engineers.
This leads me to expect even more improvements in this technology.
