By Harold A. Lancer, MD, FAAD
THERE ARE ALL KINDS OF THINGS you can do to make your skin look younger—but why bother creating an illusion when, with a good skin care routine, you can make your skin actually be younger? I’m talking about a true turning back of the clock. As you restore good health to your skin, all the machinery that’s slowed down due to natural aging or damaging environmental effects (such as the sun) will kick back into gear, creating real physiological changes. Your skin will behave like its former, more metabolically upbeat self. As a result, it can be firmer, smoother, more uniform in color, and altogether more radiant.
Whether skin “looks” young or “acts” young might seem like splitting hairs, but there’s a significant difference between the appearance of young skin and skin that frequently and naturally refreshes itself, regularly churns out the fibers that give it structure and elasticity, and rapidly repairs itself when necessary—all hallmarks of youthful, undamaged skin. Let me put it to you this way: You can slip into a pair of Spanx to disguise a flabby belly, but that doesn’t make you fit and slim. Once you slip out of the Spanx, there is that flabby belly, back again. In the same way, you can rub a moisturizer onto your skin and get it looking dewy and even give yourself a bit of a glow. Or apply makeup that deflects light, drawing attention away from the lines and wrinkles on your face. But these are fleeting, superficial solutions. What you really want to do is change what’s going on beneath the surface of your skin so that you get it working properly again, just like it used to work twenty years ago. A proper skin hygiene program is truly age reversing. And, in most cases, no involved procedures are necessary.
Your skin, of course, is the cover of the “book” of who you really are. It gives clues to your inner physical and psychological self. But if we’re honest about it, we primarily pursue that youthful appearance because in all cultures, youthfulness is synonymous with beauty and beauty is synonymous with good health, fertility, success, and a good life.
Although beauty is in the eye of the beholder (and never has a greater truth been spoken), I think you’d be hard pressed to find anyone who doesn’t admire smooth, glowing skin. It’s universally held by every culture, every ethnicity, both genders, and the wealthy and the less fortunate that firm, resilient, even-toned, radiant skin communicates well-being and beauty. Good skin is sexy. Great skin is sexier! It’s your best calling card, the attribute that’s going to make the most indelible impression on everyone you meet.
One way you can recognize well-maintained skin is by its radiant glow. When it’s in top form, light skin will have a rosy gleam to it; dark skin will look luminous. This is a sign that the skin is getting adequate blood flow and is readily replenishing and repairing itself. So if you want to look twenty years younger, you need to go for the glow. And the bounce. Universally admired skin also has elasticity. Push gently and it will rebound without a mark. It has a healthy fullness to it, too. How plump is the pillow? Are all the feathers in there and fully fluffed? And what do the pores look like? Small (the more imperceptible, the better), uniform pores are the gold standard in skin, a sign that it’s looking and acting young.
I’m not just talking about the skin on your face. Most people think skin care starts at the hairline and stops at the chin, but if you think about it, and especially if you’re a woman, your neck and chest area are often just as exposed to the perceptive public. I tell my patients that the neck, chest, and shoulders (as well as the upper part of the back, if you want to be completely thorough) frame the face, and that those areas deserve the exact same tender loving care. Sometimes I’ll see a patient who needs to pay more attention to her neck-chest zone than to her face, no doubt the result of having spent years lavishing care from the chin up while ignoring everything beneath it. All areas of your body, right down to your fingertips, should reflect the same maintenance and repair. Environmental damage happens all over, so I’m going to be reminding you again and again not to forget the terrain beneath your chin. Get the glow and make sure it extends down below!
Despite what you may have heard, there is no one miracle in a bottle, magic-bullet ingredient, dramatic procedure, or highly elaborate regimen that will reverse aging. What it takes instead is a combination of the healthy practices outlined throughout this book—regular exercise, nutritious eating, and good sleep—with a simple, at-home, anti-aging skin care plan. You don’t need to spend a lot of money and you don’t need to spend a whole day caring for yourself. Simplicity will get you cost-effective, visible results from head to toe.
You’ll notice that I said “skin care.” This do-it-yourself approach is a new way of thinking about anti-aging as it relates to appearance. It’s been a long time since anyone talked about home-based skin care. Instead, people concerned about aging are being urged to make a beeline to the nearest purveyor of line fillers and wrinkle-freezers, or to head for a clinic offering skin resurfacing laser treatments. It’s not uncommon for patients to come in for the first time and ask straight away for Botox or a laser procedure that a friend had done, without any thought to their own particular needs. I think that’s a big mistake, and I always ask them to at least start with good skin hygiene before advancing to the next step. Though there is a place for doctors’ office peels, injectables, and laser treatments, you probably won’t need any of them if you have an effective skin care program like the one I’m going to introduce you to. And, while there are famous faces that have obviously “had work done” (and then some!), I think you’d be surprised at how many lovely, glowing faces you see on the screen, in business, and in politics that are attributable to nothing but a proper method of skin care. And this seems to be a growing trend.
What constitutes good skin hygiene? The method I developed for my patients involves three basic steps for your face, neck, and chest—polishing the skin, cleansing it, then nourishing it—and two steps for your body, hands, and feet. The simple steps I recommend work to make the skin biologically more youthful in many ways, including by boosting the circulation in the skin so it receives more oxygen and reparative nutrients, revving up the turnover of skin cells to banish dullness and dryness, and rousing the sleepy collagen- and elastin-making factories to diminish lines and wrinkles.
There are a few reasons why this system is different from others and why it works so well, but foremost is the fact that it targets the stratum corneum, the outermost part of the epidermis, which is the top layer of the skin. Almost every product and procedure you hear about targets the dermis, the layer of the skin that lies below the epidermis. A lot of skin repair does take place in the dermis. However, when you focus solely on that layer, you miss the boat; not much reparative activity can take place if you ignore the stratum corneum. I’ll tell you more about the physiology of the skin beginning here, but in brief, the stratum corneum has long been thought of as an inactive, virtually plastic film covering the dynamic parts of the skin. Now we know that many of the signals that generate anatomical change in the skin come from the cells in the stratum corneum. What’s more, in order for active ingredients to get into the dermis, they must have a clear path through that top layer.
To that end, the first two steps in the anti-aging skin care method I’ll be introducing to you clear away impenetrable debris (a combination of dead skin cells, cosmetics, and dirt) that’s accumulated on the surface of the skin, allowing the nourishing components in step three a direct route into the lower layers. When those nourishing ingredients are able to get in and do their work, significant change occurs.
The most important thing about this method is that… it works! But of no small consequence is that it also allows you to fight aging while still maintaining aspects of your appearance that reflect who you are. You still look like you. To most of the patients over the age of forty that I see in my office, that’s essential. I’ve never had a patient tell me that she’d like to look eighteen again. What I do commonly hear is “I simply want to look healthy—because I am healthy. I just want my skin to reflect that.” Many people I talk to have also seen the consequences of being overstretched, overplumped, or overneutralized and they know that’s not what they want. Instead, they want to look refreshed—like a more rested version of themselves—and they want to take an active role in caring for their skin. They see it as part of taking control of their own overall well-being, and they’re right: Committing to good skin care goes hand in hand with committing to the other strategies in this book for achieving total body health.
Sticking to the polish-cleanse-nourish method is something anyone can fit into his or her life. And if you like, you can also go further, taking it to the next level by adding other, more specialized (but still simple) steps to deal with specific problems like deep lines, acne, rosacea, or excessive dryness. After you see improvements in your complexion from consistent care, you may even find that you have the desire for greater changes. Dermatologist-provided anti-aging “touch-ups”—chemical peels, laser treatments, and injectables—can be part of a healthy skin care regimen, too, as long as the procedures you have done are appropriate to your particular skin and executed with care. But I would never recommend that you seek any interventions without first trying the three-step method in this book.
What you put on your skin is important. Lotions, creams, exfoliators, toners, serums, and so on, provided you choose good ones, can have a visible impact on your skin. But I don’t believe they are as important as the method of skin care you use. The right method—that is, the polish-cleanse-nourish method—both stimulates changes in the skin and ensures that the therapeutic compounds you put on it hit their targets. You can have the best skin care products in the world, but if the active ingredients can’t get into the deeper layers of the skin, they’ll simply sit there on the surface, inert and ineffective. The skin hygiene secret is in the sequencing—puzzle solved!
The method I’m going to tell you about is uncomplicated and requires very little actual time to complete—but you do have to stick to the routine without fail. And you can’t depend on polishing, cleansing, and nourishing alone. Staying out of the sun, shedding the tobacco habit, reducing your alcohol intake, eating a more selective diet, developing a regular exercise program, striving for significant and restful sleep, and, finally, managing stress, are all important as well. So is drinking at least six glasses of water a day, and by water I don’t mean a beverage that contains water like coffee or iced tea. (I can always tell which of my patients have fallen off the “lifestyle wagon” by the quality of their skin.) When you have all these proactive and precautionary measures in place, you’re going to see a real turnaround in the health of your skin. Let’s talk about why.
I like to call skin your “best accessory” because, while a stunning ring or a striking scarf or a great watch attracts attention, nothing catches the eye quite like beautiful skin. But the truth is, as the body’s largest organ and with miles and miles of capillaries and nerves, millions of oil and sweat glands, and countless hair follicles and cells all communicating with one another, skin is more like an entire outfit. It’s all-encompassing, a community unto itself.
Understanding a little bit about the anatomy of skin can help you better grasp the changes you’ve seen as you’ve gotten older, as well as give you a clearer picture of how certain techniques, products, and procedures work to change how it functions. As you might guess, the skin is a very complex organ, and it’s not necessary to know how every sweat gland and blood vessel works. So let’s just go over the parts of the skin’s makeup that are both instrumental in aging and particularly responsive to anti-aging measures.
If you were to look under a microscope at a tiny swath of skin, you’d see layer upon layer upon layer. The stratum corneum alone, which is the utmost top of the skin, has more than twenty layers. It’s easiest, though, to think of the skin as divided into three parts: the epidermis with its top “sheet,” the stratum corneum; the dermis; and the subcutaneous tissue.
Glance down at your hand. What you’re looking at is the stratum corneum, a brick-and-mortar construction of flat, tightly packed cells called keratinocytes (the bricks) enveloped in lipids (the mortar). The stratum corneum is thicker on the areas of the body that need greater protection, such as the soles of the feet and palms of the hands.
In some ways this topmost layer (or layers, really) functions a little like a raincoat, keeping excessive moisture and harmful microbes and environmental toxins out. However it also has the very important task of keeping adequate moisture in the skin. It does this with the help of a biological stew of amino acids and other elements, including one called natural moisturizing factor (NMF). NMF absorbs water from the atmosphere, keeping the stratum corneum soft and preventing it from developing cracks.
Although they still serve an important purpose, by the time keratinocytes reach the surface of the skin, they are actually dead cells. They’re created in the layers beneath the stratum corneum, then work their way to the top, aging and dying along the way. This process—called cell turnover—can take anywhere from twenty-six to forty-two days. Like shells washing up on the shore of a beach, the dead cells arrive at the very top layer of the stratum corneum, where they’re routinely sloughed off. It’s this sloughing-off process that helps the skin stay radiant.
When cell turnover slows down, which it does naturally with age and also as a result of injury such as sun damage or a lack of moisture in the skin, the old cells stick together and accumulate on the surface. That’s why older or injured skin often looks lackluster and the reason it becomes more impenetrable, making it harder for therapeutic skin care products to do their job.
The good news is that though the stratum corneum is made up of primarily “dead” cells, it is far from a lifeless entity. When properly stimulated and cleared of the very top cells, it sends various signals down to the layers below, among them orders for increased production of new cells. When that occurs, cell renewal speeds up again and the skin regains its glow.
One of the main activities going on in the epidermis is the production of compounds that keep the skin hydrated. The epidermis is where NMF and fats such as cholesterol, triglycerides, and ceramides are produced, then used to create the “mortar” in the stratum corneum.
The epidermis is also a melanin-making factory. Melanin, otherwise known as pigment, is made by cells called melanocytes. It not only colors the skin and hair, but it helps protect against damage from ultraviolet (UV) rays. The more melanin you have (and thus the darker in appearance your skin and hair), the more protection against UV rays your skin will provide. So skin actually has its own sunscreen—but not nearly enough, especially white skin. Black skin has been shown to have a sun protection factor (SPF) of 13.4, whereas light Caucasian skin has only an SPF of 3.4. Yet no matter where you fall on that spectrum, you don’t want to depend solely on your natural SPF. Everyone should wear sunscreen, and I’ll talk about it at length beginning here. Also bear in mind that, except in small areas where it forms age spots, the amount of melanin produced in the epidermis decreases with age, which can give the skin a pallor. Tanning, though, isn’t the answer to restoring vibrancy to your complexion—it actually has the opposite effect.
The dermis is home to the primary scaffolding of the skin: collagen, proteins that give the skin shape and durability; and elastin, proteins that give it resilience. Primary production of these structural protein fibers grinds to a halt at about age twenty-five, the reason skin begins to lose its bounce and fullness and starts forming lines and wrinkles. With age and environmental offenders such as the sun, collagen and elastin break down, causing an even greater loss of the healthy plumpness that makes skin look smooth and unlined. It shouldn’t be surprising, then, that a lot of anti-aging skin care is aimed at “waking up” fibroblasts, the cells that create collagen and elastin.
Fibroblasts in the dermis also produce compounds called glycosaminoglycans (GAGs). GAGs are gel-like and form the “soup” in which the collagen and elastin reside. As the production of GAGs slows with age, the cushioning in the skin that they form flattens out and causes the skin to wrinkle and depreciate. Since GAGs—and in particular one called hyaluronic acid—also help the skin hold on to water, their loss can make the skin dry and flaky.
Woven into the dermis are sweat glands, nerve endings, and blood vessels that bring nutrients to the skin and remove wastes. Hair follicles also originate in the dermis and are connected to the sebaceous glands, which create the oily substance sebum. Sebum helps keep the skin soft and impervious to water, and it’s also one of the culprits behind acne. When sebum is overproduced, it clogs the hair follicles and pores (through which it’s secreted) and mixes with bacteria, causing an angry inflammatory response.
Aside from providing insulation and cushioning, the subcutaneous fat layer gives the skin volume and shape. You may want to lose fat in other areas of your body, but not here. Unfortunately, the subcutaneous layer does shift and diminish as the years go by, causing certain areas of the face and other parts of the body to sag. Folds near the nose (called nasolabial folds), jowls, and wrinkles are all related to the movement and loss of subcutaneous fat.
The specific makeup of your skin will reflect your ancestral heritage as well as your gender and lifestyle. Black skin, for instance, tends to have a thicker stratum corneum and dermis, a denser fabric of collagen and elastin fibers, and more tightly packed pores, oil glands, and sweat glands than white skin. For all these reasons—and because greater melanin content makes people of color less susceptible to the ravages of UV rays—dark skin shows less conventional signs of aging. However, dark skin has a much more reactive biology than light skin, leading to different problems with skin repair. For this reason, dark skin often scars rapidly and dramatically.
Brown skin, such as that of people of Asian, Mediterranean, Middle Eastern, Latin American, and American Indian heritage as well as combined ethnicities, typically has the best of both worlds. It shares a similar structure with black skin, which makes it visually age more slowly, and, like white skin, it’s generally much less likely to scar. Brown skin also responds somewhat more predictably to lasers and other procedures than black skin.
There are some slight differences between male and female skin, too. Men usually have thicker skin, more collagen and elastin tissue, and more sweat and oil glands than women. However, men also tend to get more exposure to the elements, so any advantage they have in skin construction is often canceled out by environmental factors. It’s sometimes thought that men don’t show their age as obviously as women, but I’m inclined to believe that’s more perception than reality. Some of the most successful movie actors have craggy, timeworn faces; an actress who wore her age as noticeably would be lucky to get a walk-on part. I believe that’s simply because we’re more accepting of facial aging in men than in women—not because men age better.
True or false: Lines, wrinkles, and all the other hallmarks of aging skin are just a sign that nature is taking its course. The answer is true and false (I admit, it was a bit of a trick question). Here’s the part that’s true. Some of the aspects of aging are unavoidable; you might say they’re part of the human condition. And genetics certainly plays a role, so if your parents’ skin aged well, yours may age nicely, too (and, of course, if their skin aged badly there’s an increased likelihood that yours won’t fare so well either). So, yes, in some sense, lines, wrinkles, sagging, dryness, dullness, spider veins—all that is just nature doing what nature does. That’s called intrinsic (“from inside”) aging.
However, in most people, the degree to which those signs of aging I just mentioned are apparent is determined by environmental factors—things such as sun exposure, smoking, diet, air pollution, and other things that you frequently have some control over. That’s called extrinsic (“from outside”) aging, and it can even override genetics to some degree. Your skin may behave like your mother’s in almost all respects, but if she’s a smoker and you’ve never indulged, she may end up far more wrinkled than you. Conversely, if she avoided the sun all her life and you sunbathed in the yard with a reflector every summer of your teens and twenties, you’re not likely to have as smooth a visage as your mom.
Generally, intrinsic and extrinsic aging combine to give you the face you see in the mirror. I have a ninety-five-year-old patient who illustrates the point beautifully. This woman is some kind of English royalty and she has been pampered since birth. She has outlived four, maybe five husbands and is always asking me to set her up on dates, though she won’t date anyone over sixty-five. But here’s the thing: She could be sixty-five herself. She’s never really been in the sun and her skin is smooth, pink, and baby fresh. There is not a single brown spot on her face. She has never had surgery, laser resurfacing, or chemical peeling, although she does religiously follow the skin care recommendations I’ve given her. There is one area in which my patient does show signs that she’s a “woman of a certain age”: volume—everything that contributes to the skin looking full and taut like a well-filled balloon. The plumpness of her skin has depreciated, creating some sagging and folds. Given her age, I’d say that my patient still has a genetic predisposition to slow volume loss, but she, like everyone, couldn’t avoid it altogether. Even so, her meticulous care of her skin all these years has paid off.
Let’s take a closer look at how some intrinsic and extrinsic factors age the skin.
Genetics holds a lot of sway over how well you fare in the natural aging process. Some people’s cell turnover doesn’t slow down as quickly as others’, and their skin is simply better equipped to weather insults such as sun and pollution than people from a less fortunate gene pool. Their telomeres, the end pieces of chromosomes that help keep cells healthy, are long, and their bodies are inherently good at repairing cell DNA. And, as I discussed here, they may have a slower-aging racial heritage in their favor.
I see the biggest influence of genetics on my patients in the amount of volume they lose from their faces as they grow older. I believe that about 80 percent of the depreciation of soft tissue, particularly in the face, is intrinsic. Even if you care for your skin as well as my ninety-five-year-old patient, there is not much you can do with skin care products alone to stop volume loss from happening. (You can, though, fill the “pillow” back up with injectables.)
Depreciation of collagen and elastin as well as the gel-like GAGs they swim in contributes to volume loss, but the real culprit is the shifting and decline of fat in the subcutaneous layer. In other words, it’s not the pillowcase; it’s the feathers inside. Some bone loss and changes in muscle can occur, too, further collapsing the structure beneath the epidermis.
Together with gravity and years and years of facial expressions, these factors alter your features and even the shape of your face. A youthful face is an inverted pyramid, with peaked cheeks and the chin as the pinnacle. As the cheeks start melting downward—the air is let out of the balloon—an older face tends to look more like a regular pyramid. The nose can also look bigger with volume loss (partly because the cheeks are smaller), and even the position of the eyebrows can shift.
More marks of the natural aging process:
thinner, more fragile skin
drier, mottled skin
wrinkles, furrows
fine lines
lack of bounce
increased pore size
lack of uniformity of color
loss of luminescence
Think, for a minute, of a few classic types. On the one hand, you’ve got the Irish rose, someone who, living in northern climes, has had little sun exposure. On the other hand, you have the rugged cow wrangler, the person who has spent virtually a lifetime outdoors in the heat. One is blessed with near flawless skin; the other’s face is as tough and wrinkled as an old leather jacket. Need I say anything more? Well, actually, I do need to say more, because many people still don’t get (or maybe don’t care) how insidious the sun really is.
Your skin’s deepening in color when exposed to the sun is a sign that UV rays are not welcome. A tan occurs when the epidermis and dermis produce more melanin as a way of protecting the skin against UV damage. (Sunburn is a sign that UV damage has already occurred—skin turns red when living cells in the epidermis and dermis become damaged.) But melanin can only protect you so much. UVB rays, those responsible for sunburn and tanning, penetrate deeply into the skin, but UVA rays go further, and once they get there, they create free radicals, rogue forms of oxygen that degrade collagen and elastin and make it difficult for the skin to rebuild them. Free radicals caused by sun exposure also create something known as cross-linking: chemical bridges between protein molecules in the skin. This makes the skin harder and less elastic (think again of that leathery cowboy) and contributes to the development of wrinkles.
Something else you should know about UVA rays is that they’re sneaky—they stream right through glass. Along with UVBs, they’re the primary cause of age spots, raised clumps of pigment or other skin cells often found on the hands but which can crop up anywhere on the body. As further insult, UV rays thin the blood vessel walls so that they bleed and show through the skin. The blood vessels also dilate when collagen breaks down, causing red blotchiness to appear, too.
The darker your skin, the more protection your own melanin is going to afford you. However, even if you have very dark skin, UV light and heat still create damaging free radicals. And all types of skin are susceptible to sun-induced skin cancer, which I’ll talk more about here.
More marks of sun damage:
skin discoloration
uneven texture
Did you know that the skin of people who smoke takes longer to heal? Nicotine narrows the blood vessels in the skin, depriving it of the oxygen and nutrients it needs to repair itself. But the damage doesn’t stop there. Like sunshine, cigarette smoke degrades collagen and elastin and creates free radicals that harm skin cell DNA (air pollution can have this effect, too). Plus, every time smokers drag on a cigarette, they pucker up, an action that, over time, deepens the vertical lines above the lips.
You can really see the difference between smokers and nonsmokers, and researchers at Case Western Reserve University in Cleveland have done a good job of documenting that difference in several studies on twins. In one particularly striking case study, they looked at fifty-two-year-old identical twins, who had always lived in the same town, had about the same amount of sun exposure, and even had the same job. The difference between them is that one was about a pack-a-day smoker while the other never smoked. When you look at pictures of the two women, that difference is clear: On a photo damage (sun damage) scale of 1 to 5, the smoker was a 5 while the nonsmoking twin received a grade of 2. In photographs of the two women, the smoking twin has much deeper lines on her cheeks and above the lips—she looks at least ten years older than her sister.
More marks of damage from smoking:
an unhealthy pallor
wrinkling all over the body
dry skin
Acne? Probably about 20 percent of the people I see in my office never had adolescent or teen acne, yet now here they are in middle age as pimply as a sophomore on a prom date, crying, “It’s not fair. I get acne and wrinkles at the same time!” They’re right. It isn’t fair, but it can happen, and the culprit is the same one that bedevils kids: hormones. As menopause approaches, estrogen levels fluctuate, tipping the estrogen-testosterone balance in favor of testosterone. Testosterone pumps up the skin’s sebum-making machinery, causing an overproduction of oil that can ultimately clog the hair follicles and pores and trigger breakouts. Estrogen can help modulate the inflammation caused by acne, but when your estrogen levels dip as they do in menopause, you have less natural protection from breakouts.
Some people are also surprised to find that they develop rosacea as they get older. Rosacea is a chronic condition characterized by redness and inflammation typically caused by swollen blood vessels (primarily on the face, although sometimes in other places, too). In some people, the skin becomes dry and flaky, in others, oily and pimply. Rosacea usually develops between the ages of thirty and fifty and is more common in women and fair-skinned people. It’s thought to be passed along in families, and it’s far from rare—about 14 million Americans suffer from rosacea. Early signs of rosacea can include flushing when you drink alcohol and facial swelling, small visible bumps on the face and watery or irritated eyes. It’s important to see your dermatologist if you suspect you have rosacea, because it’s tricky to treat. It makes the skin extremely sensitive and it can be debilitating. One study found that 41 percent of people with rosacea said the condition caused them to avoid going out in public.
Acne and rosacea have a few things in common, and one of them is that stress almost always makes it worse. As part of the response to stress, the adrenal glands, ovaries, and skin produce more testosterone, stimulating the sebaceous glands, which can lead to breakouts. The skin may then become inflamed and heal slowly—two other conditions linked to the stress response. Stress can also impair the skin’s barrier function, making it easier for irritants to get in and moisture to get out. That’s one reason that stress also makes rosacea worse. In a survey of seven hundred rosacea-sufferers by the National Rosacea Society, 91 percent reported that their condition flares up when they’re stressed.
Another way stress may play a role in acne is by encouraging poor eating habits. Many people toss all dietary caution to the wind when they’re under pressure, and although there aren’t specific foods (chocolate included) that cause acne, some evidence suggests that a high glycemic and low protein diet can worsen existing breakouts. And diet does potentially have a significant influence on the complexion, so healthy eating is imperative for healthy skin. (For more on how diet affects the skin, check my website www.lancerskincare.com.)
Given the connection of stress to acne and rosacea, relaxation techniques such as meditation and yoga, as well as going on vacations—anything that helps ease the pressure of your daily life—can go a long way toward keeping your skin healthy. Lower your stress level and you’ll lower the wear and tear on your complexion, too.
Nearly every dermatologist has a story about a patient who, in response to the request “Show me what you’re using on your skin,” drags in a suitcase full of products. There’s no need to spend extreme amounts of time or money on your skin. If you have three good products—a polisher (exfoliant), a cleanser, and a nourisher (a topical cream, lotion, serum, oil, or mist with anti-aging ingredients)—plus a sunscreen, and take the time to perform three steps, once in the morning and once before bed, you’ll be on the path to younger acting and younger looking skin.
Skin care is relatively uncomplicated. Choosing products, unfortunately, isn’t as simple. The sheer number of anti-aging products on drugstore shelves is staggering. Add to that products sold in department stores, spas, and doctors’ offices and the choices become mind-boggling. Despite the vast array of options, I often had trouble finding exactly what I was looking for. Products either didn’t deliver on their promises, didn’t work for all of my patients, or required an elaborate regimen. What was missing was combined simplicity and efficacy, so I set out to fill the gap by creating my own line of products, LANCERx (lancerskincare.com). The products were years in the making, and incorporate some ideas of my own, such as pairing reparative ingredients with oxygenating ingredients that increase their effectiveness. I put a lot of time and effort into them, and I didn’t skimp on anything: The ingredients are of the highest quality, in therapeutic amounts, in first-rate formulations. My patients get great results from the products—I see the evidence in my office every day.
The LANCERx line is not inexpensive (although compared to advanced procedures or plastic surgery, it’s reasonable!), so it may not be for everyone. However, you may find it’s worth the investment, especially when you consider that so many of the products in drug stores and department stores are what you’d call “glorified moisturizers.” LANCERx products have a true therapeutic benefit.
Keep in mind that though products are important, just the sequencing of this anti-aging method is going to do a lot for your skin. Nighttime steps 1 and 2 increase circulation and promote cell turnover as well as clear the path for step 3: delivery of beneficial nutrients. These are the three critical steps. It’s not necessary (or recommended for most people) to polish twice a day, so in the morning your third step is applying sunscreen. Sunscreen doesn’t change the behavior of the skin the way the other steps do, but it prevents damage, which is just as important as repairing damage.
While these steps target aging and are great for treating acne as well, I’ve frequently seen them repair skin that once seemed irrevocably damaged. About a year ago, a patient of mixed ancestry came to see me. She was part Hawaiian and part Middle Eastern. I was taken aback when I first saw her: she had big black circles around her eyes like a raccoon. “Okay, you’ve got my attention,” I said. “What’s the story?”
The patient, who was only thirty-two, had noticed a few sun spots on her face and went to see her aesthetician. She gave her some lightening cream, which caused a terrible red and prickly rash that, when it finally went away, left more spots. She went to another facial spa (a so-called medispa), where something called a “soft light” laser treatment was used over her entire face with the aim of remedying the situation. That’s when the raccoon circles surfaced. When I heard that part of the story, I wasn’t surprised. Her type of skin is vulnerable to damage from lasers and other therapeutic light sources, a topic I’ll talk about in more depth beginning here. The inflammation caused by the “soft light” laser created scarring, which gave my patient the rings around her eyes. It took about seven months, but we were able to reverse it—strictly with the three basic steps I’m recommending to you.
These steps, which I outline below, are important to do every day. Don’t slack off! Consistency is key. No matter how tired you are, don’t fall into bed without performing your skin care routine first. Your skin repairs itself while you sleep; just imagine it trying to do so with all kinds of pollutants, dead cells, and oil in its way.
Most people call this step exfoliation, but I like to call it polishing because the word gives you a good visual image of what you’re going to accomplish: removing the sludge (dead skin cells) to reveal fresher, smoother skin. Think of it as taking the tarnish off silver. There are two types of polishers: mechanical exfoliants, which can be anything from a loofah or rough washcloth to a scrub with tiny grains or crystals that rub off dead cells, and chemical exfoliants made of enzyme-based ingredients from plants such as pineapple and papaya that dissolve dead cells. I happen to think that a combination of both tiny scrubbers and enzymes works best. Loofahs and washcloths aren’t as efficient, and they can harbor bacteria unless you wash them thoroughly after every use.
When you remove the top layer of dead skin cells, you’re not removing all of the stratum corneum (which you’ll remember is made up entirely of tightly knit dead cells), but you are removing the dysfunctional cells that have lingered on top too long, causing the skin to look dull and flaky. As those cells are swept away, the layers below get the message to create new skin cells, helping to accelerate cell turnover and bring forth fresh cells. Remember, too, that removing those cells also makes way for the nourishing topical ingredients you’re going to add in step 3. Polishing has a few other benefits as well. As you exfoliate, you’ll be both increasing the circulation to the skin, giving it an instant glow, and helping to oxygenate the cells, which will increase the effectiveness of reparative proteins and antioxidants.
WHAT TO LOOK FOR: In my own polishing products, I use a combination of mechanical and chemical exfoliants. Most products tend to be one or the other, so faced with a choice, go for the mechanical kind, preferably one made with sea minerals, birch bark, walnut shell, or apricot kernels. Choose a product that will polish your skin without abrading it. The “scrubbers” should be superfine and the product emollient enough to feel comfortable on your skin—that’s the mark of high-quality chemistry.
If you prefer to use the type of exfoliant that dissolves dead cells, look for one with natural exfoliating enzymes such as bromelain (derived from pineapple) or papain (from papaya). A good polisher is worth paying extra for.
If polishing is a little like going into a mine and blowing up the rocks surrounding the gems, cleansing is like bringing in a cart to carry all the debris away—it helps you get rid of everything that you’ve loosened up by exfoliating. The gems are now exposed. That metaphor aside, you’re not going for strip-mining here. The removal process shouldn’t leave your skin too dry or irritated. A good cleanser will gently remove makeup, sunscreen, dirt, excess yeast, and bacteria and be oil-dissolving enough to remove sebum and other gunk caught in the pores without leaving a film behind. Yet a cleanser shouldn’t be so harsh that it leaves your skin feeling very taut or itchy—which is what soap is likely to do.
WHAT TO LOOK FOR: I’ve had some patients ask me if you need a different cleanser for your eyelids and the answer is no. You should be able to safely use the same product on your entire face, neck, and chest. What you should be looking for in a cleanser is a product that strikes a balance between clearing the skin of dead cells and debris and leaving some of the skin’s natural oils intact. Many companies that make cleansers are afraid of creating a product that is overly drying, so they add humectants (substances that promote water retention) and other moisture-gathering compounds to their formulas, and as a result the products leave a film on the skin. It’s a bit like the concept of a combination shampoo and conditioner, cleaning and moisturizing in one fell swoop. It may be convenient, but it isn’t ideal.
The moisturizing benefit of this type of cleanser may be fine for people who are acne prone or have rosacea, but for anti-aging purposes, choose a stronger cleanser. Most cosmetic cleansers these days employ synthetic cleansers called syndets, which are pH neutral and don’t leave a film on the skin. Soaps, on the other hand, drive fats out of the skin and can leave a residue. Your goal should be to find a cleanser that is pleasant to use, non-irritating, non-inflammatory, and soothing—but thorough. Try it out on the soft, non-sun-exposed skin on the inside of your arm; if the cleanser doesn’t cause any redness or irritation, chances are it will be okay for your face, neck, and chest. One surprisingly good option is simple baby shampoo, a gentle but thorough cleanser that you can use on your face as well as on the skin on your body.
Some cleansers have added exfoliating ingredients such as salicylic acid, papaya, pomegranate, or alpha hydroxy acids (see here). This can help further refine the stratum corneum and prep the skin for nourishment. Many products will give you information about extras such as exfoliating ingredients on their labels. If you don’t find what you’re looking for, go on to drugstore or beauty product websites and survey the options. You can often read about product details, including active ingredients.
Although I recommend that you nourish the skin from the inside out—eating right and taking the supplements recommended in chapter 3 will help increase your collagen production and replenish your skin with antioxidants—there is only so much you can influence the skin through diet. Eating all the oranges in the world won’t give you the therapeutic amounts of vitamin C you need to restore the health of your skin. Plus, there are compounds we know can improve the skin that you can’t get through diet at all. That’s where topical nourishment comes in.
Nourishing products shouldn’t be confused with moisturizers. Though most of them do help the skin retain moisture, nourishers’ main role is to deliver antioxidants, vitamins, and other anti-aging ingredients to the stratum corneum. They can come in many forms, including lotion, cream, or serum formulations. As a general rule, be sure to choose a product that feels and smells good to you. It has to be pleasant to use or you’re going to conveniently “forget” to put it on, which will ensure that you get no benefit at all. Just as with exercise, you have to be consistent with skin care, and that means complying with all three steps on a regular basis.
WHAT TO LOOK FOR: Some nourishers may be labeled as reparative lotions, some as anti-aging creams, others as anti-wrinkle treatments. What’s most important is that a) they have active ingredients (and enough of them) to make the skin behave younger, and b) you like the formulation.
Through research, we’ve been able to determine that many compounds change the skin. But it’s still a somewhat inexact science. We know a lot about retinoids—derivatives of vitamin A that I’ll discuss shortly—but the benefits of other ingredients are still somewhat poorly defined. Still, we know that if you open up the doors on the skin, which you effectively do by polishing and cleansing, and allow these ingredients in, they will effect positive changes in your skin, provided they’re in sufficient amounts and well formulated.
A beneficial day and nighttime nourisher will contain several therapeutic ingredients, among them antioxidants. There are many antioxidants used in skin care products, and one is not necessarily better than the next; they just use different metabolic pathways to protect the skin. The following are some that you should look for.
Vitamin C—Vitamin C helps stop free radicals caused by sun exposure from doing damage and may even provide a barrier to the sun’s rays. C also protects the collagen you already have and goads the fibroblasts into producing more. Many products now feature vitamin C as an active ingredient. However, not all C is created equal; some forms are very unstable. Be wary of products that have turned brown; this indicates that the C has oxidized and lost potency. Look for C in the form of L-ascorbic acid, the form the body most easily recognizes and gets the best anti-aging results.
Vitamin E—You’ll usually see vitamin E on the ingredients list as alpha tocopherol. Vitamin E, an effective free radical scavenger, is especially good at helping to fight inflammation and keeping the skin moisturized. Bear in mind that vitamin E is also a preservative, used to keep cosmetics from spoiling, so if you see it on the ingredients listing, it doesn’t necessarily mean it’s there in the amount necessary to make your skin younger. Look for E close to the top of the ingredients list.
CoenzymeQ-10 (CoQ-10)—This antioxidant can regenerate the skin, and its small size makes it easy to absorb. This is one of the ingredients in my Tri-Defense CoQ-10 (which also contains green tea and sodium hyaluronate). Newer to the market is idebenone, which works similarly to CoQ-10.
Coffeeberry, Green Tea Polyphenols, Resveratrol—These antioxidants are increasingly cropping up in skin care products, and they may have some benefits. Here’s the caveat. On a microscopic level and in the lab, these and other antioxidants such as pomegranate, grapeseed extract, licorice, and soy, cause some activity within skin cells. When they’re applied to the skin on a real, living being, it’s difficult to say if they have much effect. I think they can be helpful if they’re used in large enough concentrations, but concentrations in most over-the-counter products are probably too low. Expect minimal benefits.
Besides antioxidants, a good nourishing product may also include peptides/pentapeptides. This group of amino acids has a range of anti-aging effects. Some of them, such as palmitoyl pentapeptide-4, help repair broken capillaries and stimulate GAG synthesis and collagen production. When collagen breaks down, it forms peptides, and the peptides signal the skin to make new collagen. Topical peptides have been shown to do the same. Other peptide ingredients work a little like neurotoxins to relax wrinkles on the skin.
Whichever type of nourisher you choose, keep in mind that it’s one of the most important products that you’ll use. Don’t skimp when it comes to nourishers; it’s where you should put your money.
Polish—Using an exfoliant, polish the damp skin on your face, neck, and chest area for 60 to 90 seconds or according to the product instructions. Rinse thoroughly with lukewarm water. (Note: If you’re wearing foundation, cleanse first, polish, then cleanse again. There’s no need to use a makeup remover—if your cleanser can get rid of sebum and pollution, it should be able to get rid of all your makeup, even mascara.)
Cleanse—Massage your face (including your eyelids), neck, and chest with a non-irritating cleanser for one minute. Rinse thoroughly with lukewarm water and pat dry.
Nourish—Apply a nourishing product with free radical–scavenging antioxidants on your face, neck, and chest.
Cleanse—Massage your face (including your eyelids), neck, and chest with a non-irritating cleanser for one minute. Rinse thoroughly with lukewarm water and pat dry.
Nourish—Apply a nourishing product with free radical–scavenging antioxidants on your face, neck, and chest.
Protect—Follow with an SPF 30 sunscreen, preferably one that also contains antioxidants.
The question most people have about skin care products is “How do you know if you’re getting what you’re paying for?” Nobody wants to shell out hard-earned cash for anything that doesn’t deliver. The truth is it’s difficult to know if an expensive product will work better than a less expensive one. I know from my own experience developing LANCERx that the raw components you purchase to put into an anti-aging product can be expensive. When, say, an anti-aging serum is priced at one hundred dollars, it may have a high concentration of antioxidants, peptides, or other ingredients that have been shown to make skin look more youthful. The greater the volume of these ingredients in a product, the more costly it is to produce and, of course, the more expensive the retail price is going to be. But how do you know for sure that there are therapeutic levels of active ingredients in a hundred-dollar serum? Therein lies the problem. Whether it’s a vitamin C cream from a high-end line or a vitamin C cream sold at chain drugstores for one-tenth the price, there really isn’t any way to tell exactly what you’re getting.
There are, though, some clues. If the product has an ingredients list either on the label or within the packaging, look to see where anti-aging components such as vitamins and antioxidants fall. The farther down the list they are, the weaker the concentration of those ingredients. For the most part, you should not expect low-priced products to contain more than low amounts of active ingredients. There is no way a cosmetics company can pump up the volume of active ingredients and keep prices very low. It’s also important to realize that a product’s effectiveness depends on more than just the potency of the active ingredients. In order for these ingredients to reach the areas of the epidermis and dermis where they do their work, they require “vehicles”—molecules that encapsulate or otherwise capture the ingredients and deliver them into the skin. Delivery ingredients, too, can be costly.
None of this means that low-priced products aren’t helpful—many of them are—but it means you shouldn’t expect the parting of the Red Sea (or, more to the point, the return of your face to its high school luster). The bottom line is this: A high-priced product from a reputable company may indicate the presence of beneficial concentrations of helpful ingredients and efficient delivery systems, but it’s no guarantee. Lower-priced products tend to have lower concentrations of the anti-aging components you need, but can still turn back the clock a little bit—especially if you use the polishing-cleansing-nourishing method of skin care. If you’re willing to pay for one or two higher-priced items, spend your money on a good nourisher first, a good polisher second. Those are the most important products.
Which brings me to another point about skin care products. There is no one magic ingredient destined to be your personal fountain of youth. Attaining beautiful, youthful skin requires a system, and all the pieces need to be in place. You can’t just slap on a cream with coffeeberry or green tea and call it a day. Don’t be lulled into the concept that one superduper ingredient is the Holy Grail.
Since my practice is in sunny Southern California, there’s nothing I hear more than the lament “I shouldn’t have spent so much time in the sun.” Well, yes, that’s true. A lot of my patients, such as Bob, grew up when the only sunscreen available was the zinc oxide lifeguards used to coat their noses. But what’s past is past. Let’s talk about now, because we know for sure that UV rays are incredibly damaging, and that they not only accelerate the aging of the skin but also put us at risk for skin cancer. The figures are startling: one in five Americans will develop skin cancer in a lifetime. Not all skin cancers are deadly (though even the milder ones can be disfiguring), but sun exposure also increases the risk of the most serious form of skin cancer, melanoma. According to the Skin Cancer Foundation, melanoma rates are rising, and although melanoma has a good survival rate if you catch it early, the rate of survival falls to 15 percent if the disease advances.
Everyone needs sun protection: people with white skin, people with brown skin, people with black skin. For instance, in a 2010 study, black women living in Florida had a 60 percent higher rate of melanoma than black women living elsewhere. I think the message of this study is clear: no matter what color your skin, you can’t afford to shrug off sun protection.
If you haven’t yet begun using a sunscreen every day, start now. Here are some sun protection guidelines to go by.
Start with sun avoidance. The best way to avoid sun damage is to stay out of the sun. Seek shade whenever possible, and if you have to be out, try to avoid the hours when the sun is strongest, ten a.m. to four p.m. Wear protective clothing, too. The darker and more tightly woven the clothes, the more protection they’ll afford. (Save gauzy whites for summer nights—a white T-shirt only has an SPF of 5.) You can also buy clothing with a built-in SPF, or wash it with a laundry aid such as Sun Guard, which gives clothes a higher SPF.
Be smart about SPFs. A product’s SPF refers to how long you can stay out in the sun without burning. For instance, if you typically burn in ten minutes without protection, wearing an SPF 15, you can probably stay in the sun for 150 minutes without burning. But that presupposes a few things. One is that the sunscreen you’re wearing is absolutely as intact as it was when you first applied it. Sunscreen degrades and gets rubbed off easily; in fact, after two hours, an SPF 30 drops down to an SPF 15, if not lower.
For ultimate protection, you need to reapply sunscreen every two hours. And what is ultimate protection? With sunscreen it’s never 100 percent, no matter how high an SPF you choose, so sun avoidance is really your best defense against UV rays. Always wear an SPF 15 or higher, but also be aware that the numbers top out. An SPF 15 blocks 94 percent of rays; an SPF 30 blocks 97 percent. Thus, an SPF 30 doesn’t offer twice the protection of an SPF 15; it just has more active ingredients so more of them may stay on as the sunscreen starts to degrade and rub off. That’s helpful, but again, you don’t want to be lulled into thinking you can stay in the sun longer than you should.
Choose effective ingredients. The active ingredients in sunscreens fall into two categories. As their name suggests, chemical absorbers—aminobenzoic acid (PABA), avobenzone, ecamsule, and oxybenzone, to name a few—work by absorbing radiation. Physical blockers—the minerals titanium dioxide and zinc oxide—work by reflecting and scattering rays. Because chemical absorbers penetrate the skin, they’re more commonly linked to skin irritation. Physical blockers aren’t absorbed, which is why they often leave a white sheen (and why they’re considered the safest choice for kids). My LANCERx contains a mix of both types of active ingredients, and some other sunscreens do as well.
What’s critical is that you select a product that protects against both UVA and UVB rays. As you might remember, short-wave UVBs cause sunburn, which is of course very damaging to the skin. But although long-wave UVAs don’t cause a burn, they reach way down to the dermis and wreak havoc on cell DNA. SPF numbers refer only to protection against UVB rays, so it’s difficult to tell if a product also deflects UVAs based solely on its SPF (the FDA has long been promising to come out with a rating scale for UVAs, but it’s yet to materialize). But there are clues. Look for the words “broad spectrum” on the label or check the ingredients list; avobenzone, ecamsule, and zinc oxide give the most extensive UVA coverage.
Consider children’s sunscreen. Most sunscreens formulated for young children and babies have just about everything you’d want: they’re reasonably priced, have a high SPF, have zinc oxide or other blockers that effectively protect against both UVA and UVB rays, and have fewer chemicals that get into the bloodstream (there’s no evidence that the chemicals do harm once they’re in there, but we do know that the body absorbs them).
Here are some other tips for choosing and using sunscreen:
The brand or ingredients in a sunscreen are important, but not quite as important as whether you use it, and you’re only going to use it if you like it. If it’s not easily applied, or if it feels slimy or smears, toss it and buy another one. Some of the higher-priced sunscreens are also higher-quality sunscreens, meaning that they’re formulated not just for protection but for comfort as well. And in the long run they’ll save you money. I tell my patients that they’ll save themselves a lot of money on lasers and fillers if they just stay out of the sun and protect themselves whenever they are exposed.
Apply sunscreen every day of the year, all over your body. UV rays penetrate clouds and some of them even penetrate glass, including car windows—the left sides of the faces in this car-centric country are usually five to ten years more aged in appearance than the right (it’s the opposite in England). In a perfect world, you’ll reapply every two hours. Always reapply after swimming, even if the label says your sunscreen is waterproof.
Slather on your sunscreen thirty minutes before you go out. That will give the active ingredients time to bind with the skin so they can do their work.
Don’t worry about getting your vitamin D from the sun. You may know that the skin, when exposed to sunlight, manufactures the all-important nutrient vitamin D. There has been some concern that sunscreen prevents the production of vitamin D and, indeed, many people don’t get enough D—there seems to be an epidemic of vitamin D deficiencies in this country and it’s now been linked to everything from cancer to autoimmune diseases like rheumatoid arthritis and Crohn’s disease. It doesn’t make sense to expose yourself to cancer-causing rays to increase your body’s production of vitamin D so, if you’re deficient, look to your diet or a vitamin D supplement to make up the difference. See here for more information on vitamin D.
Be advised that indoor tanning isn’t safer than outdoor sun exposure. You can still get a burn, and studies have shown that people who use tanning beds are at higher risk for melanoma than nonusers.
If, for whatever reason—maybe you don’t have genetics on your side or were a sun worshipper in your earlier years, or a smoker—you have deep lines and wrinkles, you may need to add an extra step or two to your routine to get the results you want. You can benefit from going the extra mile, but not necessarily the extra ten miles. In most cases, simple is always better. Slapping fifteen different products on your skin every day won’t make it superior—it will only take you more time (not to mention cost you more money).
The best way to take your skin care routine to the next level is to add either an alpha hydroxy acid (AHA) or a retinoid product—or both—to your arsenal. There are lots of anti-aging ingredients out there, but these two types of interventions have the best track record.
Alpha hydroxy acids. AHAs, as they’re commonly known, have exfoliating capabilities. They dissolve the lipids (the “mortar,” as you’ll remember from my earlier anatomy lesson) that hold together the dead cells in the stratum corneum. As they exfoliate, AHAs also get skin cell turnover back on track. For some people, polishing alone doesn’t clear the skin well enough to stimulate accelerated cell turnover.
Among the AHAs, glycolic acid (made from sugar cane) has the smallest molecules, so it penetrates quickest and deepest; however, other AHAs can be effective, too. Lactic acid (from milk), malic acid (from apples), and tartaric acid (from grapes) are AHAs that you will likely also find in reparative creams, cleansers, and other skin care products. AHAs are also used in high concentrations in in-office face peels.
The results you’ll get from using an AHA product depend on the concentration of the acid. Most over-the-counter products have fairly low concentrations—about .5 to 1 or 2 percent—but they smooth the skin somewhat. You can also buy products that have 5 to 10 percent concentrations of AHAs, and they do more, helping to lighten age spots and get rid of fine lines. (I have an over-the-counter 10 percent glycolic acid product at lancerskincare.com.) Higher concentrations of AHAs are generally used in peels that need to be supervised by a physician (see here).
What’s critical to an AHA product’s effectiveness is the way it’s been formulated. AHAs can be hard on the skin—they sting—so they must be buffered or toned down with other ingredients. Too much buffering negates the power of the AHA, so it’s a delicate balance. How well the manufacturer walked that line, though, is hard to judge from the label. Choose a product from a reputable company and give it a month or so to see if it works. You will undoubtedly have some stinging or tingling at first (that tells you that the AHAs are having some effect), but it will likely go away as your skin becomes accustomed to the product. While it’s okay for your complexion to turn a light pink, if there is real redness and swelling along with the stinging, it’s a sign that the product is too irritating to your skin and you may need to try another.
Alpha hydroxy acids can be used either in the morning or at night. If you use an AHA product in the morning, apply it before your sunscreen and nourisher. If you use it at night, apply after cleansing.
Retinoids. Retinoids, synthetic versions of vitamin A, are one of the greatest discoveries of cosmetic science. They really work to reverse years of sun and environmental damage to the skin. In some ways, they’re similar to alpha hydroxy acids—they help slough off dead cells. But retinoids go further, signaling the skin to produce new collagen and hyaluronic acid. Depending on the strength and type of the retinoid you’re using, the skin responds fairly quickly: lines and wrinkles smooth out and the skin tone becomes brighter and more uniform. Retinoids are an effective treatment for acne, too.
Retinoids come in different forms. There are several prescription-only creams—tretinoin (Retin A), taxarotene, and adapalene among them—of varying strengths. These are generally prescribed when the problem affecting the skin originates from the lower sections of the dermis, and are sometimes recommended to treat acne, rosacea, and discoloration of the skin. A clinical exam by your dermatologist will tell you if you need a prescription retinoid. He or she can also help you decide which one is right for you and give you samples to try.
You should know, though, that there is a downside to retinoids. While your skin will generally adjust to them, they can be very irritating, so it’s imperative to work with your dermatologist to figure out the best formulation for you. You may need to start with a lower-strength product. Retinoids also make the skin more sensitive to the sun and to environmental factors such as altitude; this is the reason they are best applied before bed (though you still need to avoid sun exposure as much as possible). When you’re using a prescription retinoid, be careful about the other products you’re using. A cleanser or toner that never irritated before may suddenly make your skin red and flaky. If you’re also using an alpha hydroxy acid, use the AHA in the morning and the retinoid product at night. If for some reason you can’t apply the AHA in the morning, apply the AHA Monday, Wednesday, and Friday nights and the retinoid Tuesday, Thursday, and Saturday nights. It’s important to get a group of products that all work well together so that you can continue to have a good skin hygiene program.
Many over-the-counter products now contain retinol, retinal, and other forms of retinoids. I, for instance, use retinol in my AM/PM Nourishing Treatment and Fortified Moisturizer. Over-the-counter retinoids are alternative versions of the prescription-strength retinoids, and they can still make a difference in your skin when used regularly. They are much less irritating, too, so it’s something to consider if you have particularly sensitive skin. But even if you don’t have sensitive skin, OTC versions are a good place to start. Look for retinol/retinal products that also contain anti-inflammatory ingredients such as green tea polyphenols.
If you’re using an over-the-counter product for twenty-one days and don’t see improvement, talk to your dermatologist about the possibility of a prescription retinoid. Prescription retinoids are considerably stronger than the OTC counterparts, and they significantly smooth and brighten skin while also making it more even in tone. Whether you’re using a prescription or over-the-counter retinoid, check with your doctor before taking any supplements that contain vitamin A, which can be harmful at high levels.
Here are two problems that can be addressed by supplementing your regular routine with alpha hydroxy acids or a retinoid (or both), along with a few other therapeutic products.
At night, after cleansing as you normally would, use a nourisher or separate product containing coenzymeQ-10 (see here for more on coenzymeQ-10). If you use a separate coenzymeQ-10 product, use that first, then apply your nourisher, and finally smooth on a 10 percent glycolic acid cream.
In the morning, put on a collagen-boosting vitamin C–rich product after cleansing (if you’re using a toner to deal with acne, apply it after the toner). Vitamin C creams can sting a bit, particularly under certain conditions (such as high altitude). If the stinging is too intense, cut back to every other day until your skin adapts.
In the evening, apply a retinol cream before you put on your nourishing product. Sun damage puts you at risk for skin cancer, so make certain that you see your dermatologist every four to six months for checkups. Practice sun avoidance and use a sunscreen daily without fail.
Sometimes the polish-cleanse-nourish method isn’t enough or needs to be altered if you have a particular skin problem. Here are additional steps to take for special needs.
Use a cleanser made specifically for acne, such as LANCERx Exfoliating Blemish Cleanser (cleansers for acne usually contain benzoyl peroxide or salicylic acid), followed by a nondrying toner. If you have sensitive skin, some cleansers made for acne sufferers may be too harsh. Some people with acne believe that the drier the skin, the better. If you dry out your stratum corneum too much, it sends a signal below to produce more oil. Watch your results: if the product isn’t working, move on.
Follow with a redness relief product with soothing ingredients such as licorice root, bisbolol (made from chamomile), and sodium hyaluronate. My Rapid Redness Relief contains chamomile, cucumber, resveratrol, and evoida, a traditional Asian herbal therapy.
Twice daily, use a soothing, nondrying toner (see above) after cleansing, but only if you have oily, red, inflamed rosacea. Skip the toner if you have the dry form of rosacea.
After cleansing (if you have the dry type of rosacea) or toning (if you have the oily kind), use a redness relief product (see above).
In the evening, use a rosewater spray to hydrate and calm inflammation, followed by a nighttime moisturizer fortified with vitamins and proteins after applying your nourisher. Grapeseed oil (the kind you can buy in the grocery store) is a good inexpensive moisturizer. A costlier, but extremely effective moisturizer is Bulgarian rose oil (see lancerskincare.com).
Put on an eye cream after your nighttime nourishing step. The product should have everything your nourishing cream has, but be lightweight, have lower concentrations, and be formulated specifically for the eyes. Grapeseed oil, the kind traditionally used for cooking, also works as an eye cream. Apply the cream from just under your eyebrow down along the top eyelid, then under the eye all the way up to where the bottom lashes begin. My new Eye Bright Illuminator Rx contains a comprehensive formula of peptides, chealators, and antioxidants to reduce the appearance of under-eye dark circles and puffiness as well as fine lines and wrinkles.
At night, before you nourish, use a product specifically designed to lighten pigment and that contains properly formulated hydroquinone. The most common causes of skin discoloration are sun damage, inflammation from some kind of injury, and medication. Other ingredients such as niacinamide, malic, pyruvic, and lactic acids can contribute to partial improvement, but hydroquinone works best. Even though hydroquinone is sold over the counter, it’s controversial, so talk to your dermatologist about it before you give it a try.
Say you’ve never done much more to your skin than wash it with soap and water and use a moisturizer. Now you’re going to be not only giving it a deep cleaning, but also introducing topical ingredients that are going get your skin back in gear. Your new routine shouldn’t cause pain, but your skin might suddenly become drier and more sensitive.
In a few days, all the junk skin on top will be gone. Those layers of dead cells may have made your complexion look dull but they also kept out a lot of things—irritants as well as any potentially helpful ingredients in products you may have been using. Now that those layers are gone, you’ve got delicate, newly minted skin; fresh dollar bills that haven’t been crinkled up yet.
Here’s where patience and a little practicality is a virtue. If your skin becomes tight and dry, polish once every third night or only once or twice a week until your skin recovers. After about twenty-one to twenty-eight days, you should be able to go back to polishing more often. See how much your skin will tolerate as you gradually up the frequency.
Also bear in mind that you may have to adjust your polishing according to hormonal shifts or travel. If you find your skin is oilier, polish more frequently. If you travel to a high altitude or desert where the air is very dry, scale back. If you’re in the humid tropics, you might even need to polish twice a day. One of my goals is to see you get into a regular skin care routine, but don’t set yourself on automatic. It’s important to really pay attention to your skin so you can give it what it needs when it needs it.
Collagen repair begins immediately when you “injure” the skin, which is what, in a sense, good skin care does. The results come from this repair process, but it can take anywhere from six to eight weeks to see those results. So don’t expect to see your skin change overnight. Just hang in there and consistently stick to the polish-cleanse-nourish routine.
When was the last time you looked at your whole, unclothed body in the mirror? I thought so. Rarely do we give a glance to parts of our body other than the face. I’ve already talked about the importance of caring for your skin from the hairline to the breast line. But we’re living in a world where more and more people are revealing parts of their bodies. Shorts, sleeveless dresses, short-sleeve shirts, shorter skirts with no stockings, sandals, and slingback shoes (even in winter). More exposure means the need for more comprehensive skin care. Even if you’re relatively modest, you don’t want to have the face of someone twenty years younger but the hands and feet of someone past his or her prime.
But perhaps even more than that, I find that people want the skin on their body, and particularly the hands and arms, to feel better. They want it to feel softer, smoother, and silkier. That’s all possible with some easy skin care steps.
The anatomy of the skin on your body from the collarbone down, including the hands and feet, is dramatically different from the skin on your face. The stratum corneum, epidermis, and dermis are much thicker, and the subcutaneous fat takes on a life of its own depending on how much stored body fat you have. The skin on the body also has a slower metabolism, a more leisurely paced skin cell turnover, and it sheds dead cells at a more measured rate. Oil gland production and hair growth is unhurried, too, and the oil and wax secretions are different. Because everything is in slow motion relative to the behavior of the skin on the face, skin on the body doesn’t need the same degree of maintenance—but it still needs maintenance.
When you ask people how they care for the skin on their body, most say, “Oh, soap and some lotion that smells nice.” They don’t realize that they can do better while still keeping skin care very simple. It’s generally a two-step process. You need a mild, non-detergent body cleanser and a hydrating lotion. Something as basic as Cetaphil’s Body Wash and Moisturizing Lotion can do the job. Moisturizing lotions are mostly a matter of taste and need. You may want to use a light one in the summer, a heavier one in the cooler, drier months. What matters most is that you apply it daily after showering while your skin is still slightly damp.
If you have more intense sun damage, excessive dryness, discoloration, tiny bumps on the upper arms (called keratosis pilaris), rough elbows, loose, crepe-y skin on the front of the arms, or other problems, I recommend you take body skin care to the next level. Here are the steps to add:
Polish. Use an exfoliating body scrub in the shower on an as-needed basis. You may, for instance, use it on the backs of your arms, elbows, knees, and lower legs two times a week but use it on the rest of your body only once a week. Look for a scrub with tiny scrubbers that also contains anti-inflammatory antioxidants (I like green tea and use it in the LANCERx Body Buff product).
Step up moisturizing. Swap your regular lotion for an alpha hydroxy acid moisturizer that contains glycolic or lactic acid, especially if you have very dry skin.
Because they’re exposed more than other parts of the body (sometimes even more than the face and neck), the hands can get considerable environmental and sun damage. Over the years, that results in a depreciation of color and texture and the appearance of fine lines, sun spots, and crepe-y skin. Intrinsic changes alter the hands, too. Just like the face, the hands lose fat and the deficit of volume makes them look old and scrawny.
Hand repair does have its limits, but you can do a lot to restore the supple nature of the skin on your hands by decreasing dryness and the fissures that make them feel rough. You can also improve the color of the hands and soften sun spots. It takes these two steps:
Polish. Use an exfoliating body scrub on your hands two times a week.
Moisturize. Once a day, use an alpha hydroxy acid moisturizer that contains glycolic or lactic acid.
If you have significant sun damage on your hands, I’m afraid that even a good skin care routine won’t repair it. You need to look into peels and lasers. Likewise, skin care can’t repair volume loss. For that you may want to talk to your dermatologist about fillers.
The soles of the feet, like the palms of the hands, have a very thick stratum corneum. They develop a callused covering for protection, which isn’t much of a problem on the palms, but it can get very dry and cracked on the feet, especially as you get older. The way to deal with it is fairly simple. Apply a glycolic acid foot cream daily for two or three days, then once or twice a week after that as needed. Alpha hydroxy acid creams for the feet are different from the ones you use on your face. The AHA percentages are sometimes lower than those that might be used in a cosmetic peel, yet because they have a different pH, they’re able to deeply exfoliate the callused skin on the feet.
Use the glycolic cream after showering. Pat your feet dry, then massage a light layer of the cream all over the bottom of the foot, including in between the toes and anywhere else that is cracked and callused. A good cream will work well without any additional help from a pumice stone or other scrubber.
As the nails age, they grow more slowly and can become dull and brittle. Eventually, they can become very thick and more curved, too. So you can see why good manicures and pedicures are an important anti-aging strategy. Good is the key word. The risk of infection from unclean nail care facilities is high—I have one patient who still hasn’t recovered from a life-threatening infection he got from a manicure—so you have to use caution.
Conservative trimming of the nails will keep them clean and smooth, and keeping the cuticles gently pushed back can help prevent infection. The Rolls Royce approach to nail care is to buy your own instruments (such as clippers, cuticle pushers, nail brushes, and emery boards) and have a manicurist come to your home. That way you avoid any potential bacterial outbreaks in a salon. The more affordable and cost-effective approach is to bring your own tools to the salon and ask the manicurist to use them. That way, you’re in charge of keeping things clean (up to a point). Whenever you get home from a manicure and pedicure, take a shower and wash your hands and feet thoroughly. That will reduce the potential of anything you picked up at the salon causing an infection.
When you care for your skin properly and it begins looking refreshed and radiant, any thought you might have once had about plastic surgery or dermatologist office touch-ups may disappear. Some people, of course, want more, and some people need more. When they do, and after I’ve had them try alpha hydroxy acids or retinoids, I offer them a conservative, progressive approach to smoothing out lines and wrinkles, replacing volume, improving skin texture, and doing away with sun and age spots.
These anti-aging upgrades, I might add, can all be done without plastic surgery, a message that seems to be getting across. In the last few years, the number of plastic surgery procedures has dropped while the number of nonsurgical treatments has increased—and I don’t think it’s completely due to the economy. For one thing, the innovations in injectables and laser procedures have made these treatments the top choice of men and women seeking to look more naturally youthful. Erase for a moment the picture in your mind of expressionless faces and freakishly inflated lips. When you see a skilled board-certified dermatologist, those aren’t likely to be your results. Instead, peels, injectables, and laser procedures—coupled with good skin care—can simply make you look healthy and refreshed.
Plastic surgery has its place, and in my opinion it’s best used to repair something that has been damaged or is misshapen. Obviously, the shape of someone’s nose or asymmetric breasts will not respond to topical treatments. The downside of relying on dramatic aesthetic measures such as face-lifts, brow-lifts, and eyelid surgery is that no matter how well done the procedure is, your face won’t match the rest of you. That’s another reason I believe that more people are pursuing less invasive interventions. When you opt for the surgical blade, it’s often like remodeling the kitchen but leaving the rest of the house looking outdated. But the head-to-toe extreme makeover is not what most people want (or should have).
The menu of anti-aging touch-ups available continues to grow, with some options falling out of fashion as other, more sophisticated treatments take their place. When laser treatments and peels first became popular, they were quite severe—a controlled burn that required major recovery time. But few dermatologists use those drastic procedures anymore. Whereas those treatments worked by triggering a major healing response, many of the treatments we use now are more like tickling: They trigger a natural restoration of the skin that results in an increase in volume and firmness and a healthier tone. These procedures wake up the machinery. Instead of walking out of your doctor’s office looking like you were in a house fire, you might be a little pink (there can also be some very mild bruising), but you can go out to dinner that night with minimal makeup.
Each type of treatment has many variations. There are, for instance, dozens of different types of lasers. You’ll need to discuss the specifics with your dermatologist—your, I stress, board-certified dermatologist. I am a board-certified dermatologist, which means that along with my regular medical training, I completed a three-year residency in dermatology and passed a test administered by the American Board of Dermatology. Of course I’m going to recommend that you see a board-certified dermatologist for injections, laser procedures, and anything else involving diagnosis and treatment of medical, surgical, and cosmetic concerns of the skin, hair, and nails. This is not just me being territorial. Every day in my office I see what happens when patients receive treatments from people who are not qualified or experienced in giving them. Not only do people get overfilled or treated with the wrong kind of laser, but the person treating them often misses more serious problems. Do your homework. The American Academy of Dermatology can help you find a board-certified dermatologist in your area (www.aad.org/findaderm). For more on who should and shouldn’t treat you, you can also go to my website www.lancerskincare.com.
When someone needs more than skin care to address aging, I have him or her try the least invasive procedure first, and then we go from there. Here’s what I believe is a good progression.
Microdermabrasion is a technique that “sands” the superficial layers of the skin. Dermabrasion is a similar technique, but it causes much greater wounding and has a longer healing process. In most cases, I don’t recommend it and certainly not as a first stop. Microdermabrasion, which is gentler, uses an abrasive wand and a vacuum suction to remove the dead skin cells. It’s good for sun-damaged skin, age spots, superficial pigmentation, fine lines and wrinkles, clogged pores, blackheads and whiteheads, and some mild acne scars. The neck and chest can also be treated to blend the skin and remove any sun damage found in that area. The procedure takes only about a half hour, and there’s little or no healing time.
Before a patient tries lasers or injectables, I almost always recommend a chemical peel first. Peels are like an extra-effective polish and cleanse session: they deeply exfoliate the stratum corneum to refresh the skin, smooth lines, and lighten brown spots. They can also be used to remove precancerous lesions. Peels involve the application of a liquid or paste. They can be of varying strengths; some use alpha hydroxy acid solutions, some a mix of acids. The skin generally responds by peeling, the same way it does after a sunburn, and it may take a week or ten days to heal. Some peels—phenol peels, for example—strip the skin so thoroughly that they can be painful and require weeks of healing time. These typically aren’t done anymore.
The effects of peels can last from one to several months. You can have them done solely on your eyelids, or section by section, all over your body. If you’re having a peel on your face, it’s usually a good idea to do your neck and chest, too, so there isn’t a disconnect between what’s above and what’s below the chin.
While not all skin care treatments are recommended for every color skin, all skin colors can handle some form of chemical peel. Your dermatologist can advise you on what type of anti-aging peel will remedy your particular concern. Some are best for acne, some vanquish blotchiness, and others can minimize wrinkles. In my office we typically combine peels with microdermabrasion. Polishing the skin first lets us apply the peel to a primed canvas (so to speak), setting the stage for a clean, smooth, and more predictable response.
The next step along the touch-up continuum is laser resurfacing. Einstein laid the groundwork for the invention of lasers (light amplification by the stimulated emission of radiation)—that’s how far back they go. In 1963, they became medical grade, and I’ve been using them myself since the 1970s. But today’s lasers are nothing like the ones we used back then, when there were only two suitable for dermatological use, both of which burned the skin and required major recovery time. Today’s lasers are highly refined, and the skin heals quickly after most treatments if properly done on well-primed skin. (I can’t overemphasize the need for skin conditioning before a procedure!)
Lasers and other energy-based treatments generally work by triggering a healing response that leaves skin softer, smoother, and tighter. But that’s really a generalization, because there are so many energy-based treatments available now and they all have their unique means of reaching a particular end. There are, for instance, treatments for brown, blotchy discolorations on the skin. Some lasers are used for correcting fine lines, scars, or pore enlargement. Some tone or tighten skin. Others remove hair or broken blood vessels. There are lasers that specialize in removing tattoos as well as permanent eyebrow and lip lines. There are even liposculpting lasers that work from the inside (this is an invasive procedure) to tighten and contract the skin. And not all energy-based treatments use lasers. Other technologies include infrared light, which uses heat (versus light) to tighten loose skin; intense pulsed light (IPL), a tool effective for redness, rosacea, and excess melanin, and for improving color and pore size; radiofrequency, which helps produce new collagen; and light-emitting diode (LED), which helps with acne, wrinkling, and pigmentation.
If you’ve tried a chemical peel and want to go to the next step, start with a nonablative laser treatment. Also called nonwounding lasers, these are best at making minor corrections on the skin, firming and improving tone and texture. They work beneath the top layers of the skin to trigger collagen production and other repair mechanisms. Another option is fractional resurfacing, which delivers a series of microscopic, closely spaced laser spots to the skin while simultaneously preserving the normal healthy skin between those spots. This is a good option for improving fine lines, wrinkles, brown pigmentation, sun spots, age spots, and acne scarring. And because the laser preserves the healthy skin, the healing is rapid. The entire face can be treated in about forty-five minutes with very little discomfort; there’s no need for pain medication and no significant downtime. Both types of laser techniques require several sessions spaced three to four weeks apart.
The most invasive type of lasers are called ablative. Because they go deep and effectively vaporize the top layer of the skin, they create dramatic results in only one treatment—you get more bang for your buck. However, these lasers require significant finesse and there’s more healing time (seven to ten weeks).
Laser treatments are not without risk. Some can cause loss of pigment, scarring, or an unattractive change in skin texture. If you have black or brown skin, be sure to go to a dermatologist who is well versed in treating darker ethnicities. And no matter how your skin looks to the naked eye, be certain your doctor also knows your ethnic heritage, especially if it’s mixed. In 1998 I introduced a scale that dermatologists can use to predict whether their patients are appropriate candidates for laser treatments. The scale assigns a number, 1 through 5, to each grandparent of the patient. Grandparents who were African get a 5; grandparents from Nordic areas get a 1. The total is then divided by 4 to get the patient’s LES (Lancer Ethnicity Scale) score. The lower the score, the lower the risk of scarring and uneven pigmentation after laser treatments. Here are a few other suggestions. Remember: Procedure means risk!
Don’t get lasered at the mall. Every day I see scars from laser treatments performed by people who shouldn’t be operating the equipment even if there is no law against it. Lasers can be damaging if they’re not used properly. Go to a board-certified dermatologist who will perform the treatment him- or herself, preferably one with years of experience and many different lasers (that way there’s a greater chance that he or she will use the absolute best tool for the job).
Be prepared for the cost. Laser treatments can run into the thousands of dollars.
Know the likelihood of success. Do lasers work for everybody? No, although they have a very good record. Patients tend to fare better if their skin has good elasticity and they are relatively thin. Talk to your doctor about what you can reasonably expect from the treatment. Realistic expectations are a must.
Injections of compounds that plump up or freeze wrinkles and firm slack skin should be last on your list of interventions. The concept of injecting something into the body to increase volume seems relatively new, but even a hundred years ago, fat fillers were used to help in recovery from battle wounds. There are also reports in the medical literature going way back of people injecting themselves with oil and waxes.
The first big commercially used dermatologic filler was silicon, and some doctors are still using it today. There’s no law against it, but there probably should be. Unlike other injectables, silicon doesn’t dissolve, so even if the initial injection doesn’t trigger an inflammatory immune response, eventually the immune system will wake up and the body will start to wall off the silicon, creating rock-hard tissue and other problems. Don’t go there—it’s not worth it.
Modern fillers and wrinkle-freezers eventually dissolve. Fillers not only fill the space where collagen and fat used to be, but also stimulate a controlled response in the skin (not an unpredictable one as happens with silicone) that triggers collagen production, creates volume, and attracts water to the skin. Depending on which type of injectable you choose, they’re good for improving fine lines and wrinkles, making lips fuller, filling hollow cheeks, and plumping up deep folds. Injectables tend to be used around the mouth, eyes, cheek, jaw, brow, and bridge of the nose. But they can be used anywhere there is tissue volume loss (hands, breast, buttocks, for instance).
Wrinkle-freezers, also known as neurotoxins, work by blocking the nerve receptors on the muscle to inhibit wrinkle formation. Think of it this way. Water in a cup ripples when you tap it; frozen water doesn’t. It sounds like it will feel weird, but there’s no odd sensation. After treatment, patients can still frown and smile normally, but when they do, the crinkles around their eyes and forehead are greatly diminished. The effects last about four months.
Most patients get neurotoxin injections to address crow’s feet and forehead lines, but you don’t want a total elimination of lines and faults in the skin. You want a reduction; otherwise you’ll look so altered that it will be obvious from a hundred yards away that you’ve had Botox. You want to look fresh and radiant, not “fixed.”
Your dermatologist can help you decide which brand-name filler or freezer best meets your needs. Some fillers are made from compounds natural to the body like collagen and hyaluronic acid, while others are made from synthetics. Botox is the most famous neurotoxin, but there are others on the market, too.
Injectables are relatively reasonable in price—they start at a few hundred dollars—but they require somewhat of a commitment on your part. While it varies from person to person, you’ll probably need filler injections about twice a year, sometimes more often depending on what’s used. That’s not only because the fillers don’t last, but also because the clock keeps ticking, meaning you’ll lose more volume and have more to fill as time goes on. Most people are pleased when they see their faces looking twenty years younger, but some people get a little too pleased. They want more and they begin to get a distorted idea of what looks attractive. That’s when you start seeing frozen foreheads and platypus lips, a sign that both the patient and the physician have lost their sense of proportion and artistry. It’s also a sign that injections have become an unhealthy addiction.
It’s a dangerous addiction, because even though most fillers and wrinkle-freezers eventually dissipate, there’s still a chance of permanent damage. Think about a balloon. If you keep filling it up, it begins to lose its original shape when the air is gone. That’s what happens to the face or any part of the body if you’re not conservative with fillers. In the case of injectables, less is more. Before you embark on treatment, make sure that you and your dermatologist agree on appropriate goals.
The beauty buffet is wide, but I encourage you to use restraint. You’ll hear a lot about all the different procedures that can make you look younger, but there’s no need to jump on the bandwagon at every turn. When you take good care of your skin, you may not need to spend a lot of money or take risks to turn back the clock. Remember you’re not just going for the illusion of youth; you want your skin to act younger.
Think, too, about how a skin care regimen can keep your complexion youthful and vibrant for life. It’s something you can always do by yourself—you don’t have to worry about a procedure wearing off and going through the whole thing again… and again… and again. Skin care is easy, it’s quick, it’s relatively inexpensive, and you are in the driver’s seat.