Healthier, Younger Looking Skin …A New You!

Kesha Buster, MD FAADDermatologyAdvanced Aesthetics & Plastic Surgery

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What is healthy, youthful skin?

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What is beauty?

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How do we age?

Photoaging UV-induced

Gravitational aging Stretching Sagging of soft tissue

Volumetric aging Fat and muscle atrophy (loss) Bone loss Unknown cause

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How do we age?

No.1 culprit for skin UVA (aging) – penetrates deeper, though windows UVB (burning) — most effective UV promoter of skin cancer

Both UVA and UVB cause DNA damage

Chronic sun exposure causes: Wrinkles, brown spots, blood vessels, loss of elasticity,

discoloration, leathery skin, facial volume (fat) loss, skin cancer Much slower and later in darker skinned people (melanin)

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How do we age?

Bolognia JL, Jorrizo JL, Rapini RP. (Ed.). (2008). Dermatology, Edition 2. Elsevier.

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How do I slow aging down?

Sun protection (most cost effective)

Sunscreen Sun avoidance Sun protective clothing

Antioxidants

Retinoids

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Slowing aging: Sunscreen

Sunscreen1,2

Multiple studies show both clinical and microscopic evidence of sunscreen prevention of photoaging

Can reduce damage (solar elastosis) that has already occurred Also prevents skin cancer and pre-skin cancer

Organic (chemical) — absorb UV and convert it to heat Common allergies Some forms are unstable (easily breakdown = less effective)

Inorganic (physical) — block UV Zinc oxide, titanium dioxide combined = broad spectrum (UVA, UVB)

1. Stenberg C, Larko O. Sunscreen application and its importance for the sun protection factor. Arch Dermatol 1985;121:1400-1402.

2. Sambandan DR, Ratner D.Sunscreens: an overview and update. J Am Acad Dermatol. 2011 Apr;64(4):748-58. Epub 2011 Feb 3.

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My favorite sunscreen

No. 1: SkinCeuticals Physical Fusion SPF 50 physical blocker, thin, tinted

No. 2: Neutrogena with Helioplex SPF 30+ photostabilized chemical blocker

No. 3: L’Oreal Anthelios with Mexoryl SPF 30+ photostabilized chemical blocker

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Slowing aging: Antioxidants

Can prevent and/or reverse photoaging due to free radicals1

Vitamin C (must be in stable, penetrating form) Phloretin Ferulic acid Vitamin E Green tea polyphenols, oral soy isoflavones,

coenzyme Q10 and many more …

1. Rabe JH, Mamelak AJ, McElgunn PJ. Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.

Growth factors and peptides can improve photoaging by reducing lines/wrinkles and supporting skin function

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Slowing aging: Retinoids

1. Rabe JH, Mamelak AJ, McElgunn PJ, Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.2. Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term treatment of photoaged human skin with topical retinoic acid improves

epidermal cell atypia and thickens the collagen band in papillary dermis. J Am Acad Dermatol. 2005 Nov;53(5):769-74.

Vitamin A and its natural and synthetic derivatives: Retinol Tretinoin Adapalene Tazarotene

Prevent and treat photoaging1, 2

Reduce fine lines, wrinkles, discoloration Boost collagen formation

Often causes irritation, redness, peeling

Minimize side effects with gradual increase in use, using moisturizer

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How do I turn back the clock?

The three Rs Relax Refill Resurface

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Relax

BOTOX® and Dysport ®

Botulinum toxin type A Block nerve impulses to treated

muscles thereby inhibiting muscle activity that leads to wrinkles

Effective in two to seven days Lasts three to four months Can be used in many areas

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Relax

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Relax

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Relax

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Relax

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Relax

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Relax

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Relax

Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010 Dec;63(6):1042-51.

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Refill

Fillers Many types: hyaluronic acid, calcium

hydroxylapatite, poly-L-lactic acid, fat, silicone, collagen, etc.

In general, hyaluronic acid (e.g., JUVEDERM®, Restylane®, Perlane®) are safest

Reversible Allergic reactions are rare

Can be used virtually anywhere on face to minimize wrinkles and replenish volume

Also used on hands, earlobes, depressed scars

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Refill

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Refill

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Refill

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Resurface

Superficial (epidermis only) Microdermabrasion Superficial chemical peels Microlaser peel

Medium to deep (epidermis and dermis) Dermabrasion Medium and deep chemical peels Fractional laser resurfacing Deep laser resurfacing

Nonablative (no downtime) Broadband light (a.k.a., intense pulse light)

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Resurface

Profractional

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Resurface

Microlaser peel

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Resurface

Broad band light

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Questions?