Rejuvenate
Your Skin
A healthy body, mind, and spirit creates an inner balance that results in radiant, healthy skin on the outside. This is the reason, as an osteopathic dermatologist, that I’ve focused on developing your spiritual self, managing stress, eating healthy, exercising, and getting enough sleep before discussing how you can better care for your skin on the outside. I know that when you’re healthy and feeling good, you have a radiance about you that comes from a body and soul that’s nourished. I also know that doing so gives you more confidence in yourself and improves your overall outlook on life.
There’s a reason all these healthy living tweaks affect how you look on the outside: the skin is your body’s largest organ. Whatever you do to your body affects your skin. Nutrients from whole foods like fruits, vegetables, whole grains, legumes, proteins, and healthy fats help to feed skin cells, build collagen that makes skin look and feel youthful, and protect the skin from the environment around you. Getting regular exercise boosts circulation to the skin, bathing skin cells in a fresh dose of oxygen and nutrients and boosting healthy radiance in the process. And de-stressing and getting enough sleep can regulate levels of hormones in the body, which can calm the body and the skin, helping to prevent skin conditions like acne and psoriasis. Everything is linked. But first, let’s talk more about the skin. It covers an average of twenty square feet and weighs about six percent of our total weight. It’s made up of three layers.
The epidermis is the topmost layer of the skin that’s thickest on the soles of the feet and thinnest around the eyes and on the eyelids. Overall, this layer is extremely thin (only about a tenth of a millimeter in thickness or about the thickness of one sheet of paper) and is the layer of skin that you see. The outermost layer of the epidermis is called the stratum corneum. It helps protect the body from the environment and from bacteria, viruses, chemicals, and ultraviolet light. It also traps water in the skin, keeping it hydrated. Without the proper nutrients, the skin’s barrier (which is made up of layers of flattened cells) can break down, making it more prone to skin problems like infections, dry skin, and more.
In fact, it’s in the epidermis that new skin cells are created. This constant regeneration of cells is one reason it’s important to keep this layer exfoliated. Manually removing dry, dead skin cells allows for the healthy, new, radiant cells to showcase themselves. A thickened stratum corneum can feel rough and dry and gives skin a dull appearance.
It’s also in the epidermis that melanin, the pigment that gives your skin and hair color, is produced. Melanin is critical to the skin’s protection against the sun’s ultraviolet rays. When the skin tans, this is melanin in action. It’s the body’s way of protecting itself.
The dermis is the second layer of skin that gives the skin its flexibility and strength. It’s thinnest on the eyelids and thickest on the back (the dermis on the back is about thirty times as thick as the dermis on the eyelids). The dermis produces sweat, helps you feel (as a result of the nerves present in this layer), grows hair, makes sebum or oil thanks to sebaceous glands that secrete sebum into hair follicles, and brings blood to the skin through blood vessels.
It’s in the dermis that the structural proteins, collagen and elastin, are found. These proteins are what keep the skin firm and elastic. (When you pull on your skin and it snaps back into place, this is a sign of elasticity.) It’s also in the dermis that hyaluronic acid is found. This substance helps the skin hold on to water and stay hydrated. This is also what helps our faces retain youthful fullness.
Lymph vessels are also located in the dermis. These are your body’s drainage system and work to cleanse, detox, and maintain proper fluid levels in the skin. They transport lymph fluid throughout the body. It’s this lymph fluid that contains white blood cells, which are key to fighting bacteria and viruses. One of the best things you can do to keep your lymph fluid pumping throughout the skin is regular daily movement. Another good way to keep lymph flowing properly and doing its job is through dry brushing. To dry brush, simply take a natural bristled dry brush (available from most bath and beauty stores) and, starting from your feet, firmly but gently brush your skin in circular motions moving in the direction of the heart. Be sure to do your feet, legs, belly, chest, arms, neck, and even your face. It should take about five to ten minutes and can be done in the morning before your shower. You’ll notice your skin has a rosier glow afterward. This is an outward sign that you’ve boosted the circulation and lymph flow in your skin.
The subcutaneous layer (or hypodermis) is the bottommost layer of skin. It’s where fat and connective tissue (which connects the skin to the muscles and the bones) is found. It’s also where larger blood vessels and nerves are located. It’s this layer that controls the temperature of the body.
This layer is thickest on the buttocks and abdomen, providing caloric reserves, insulation, and cushioning. It also gives skin its youthful volume. With age, this layer thins and shifts.
Why Do We Age?
As we get older, all the processes in our body start to slow down. This is dictated by our genes, but it’s also affected by the environment around us and our daily habits. In fact, there are two types of aging: intrinsic and extrinsic. Intrinsic (which means “from the inside”) aging has to do with your genes or characteristics of aging that you got from your parents, your grandparents, your great-grandparents, and so on down the line.
Many patients talk with me about the genes they inherited from their parents or grandparents. But, in reality, our genes and how we age goes back much further in our lineage. Our genes date back to our ancestors. Though it’s hard to know how your ancestors aged, a good place to start is seeing how your mom or dad or grandparents aged, as this will be a starting point to assess how you’ll age too. Keep in mind, your lifestyle and habits may be much different from your parents or grandparents, which may make a difference in how you age.
Then there’s extrinsic aging (which means “from the outside”). This has everything to do with the environmental factors (like UV light and pollution) that surround you, as well as your diet, your stress levels and how you manage them, how much sleep you get, whether or not you smoke, and what things your skin is exposed to on a daily basis. When discussing healthy habits, it’s the extrinsic aging that we’ve addressed in the first part of this book. In this chapter, we’ll be talking about other extrinsic factors, such as sun exposure and the products that you use on your skin.
Antioxidants: Why They Make a Difference
Free radicals are highly destructive molecules in our bodies, including in our skin, that can destroy cells, and over time, trigger diseases like cancer. These molecules are highly destructive because they’re missing something called an electron, which is necessary to keep them stable. They’re most stable when they’re in pairs. When they’re not, they attack other cells in an effort to steal an electron and create a pair with their own odd electron. But, in stealing an electron, they leave another molecule without an electron, thereby making it unstable and creating even more destructive free radicals in the process.
Free radicals trigger a process in the body called oxidation. This is just a scientific word to describe what happens when an apple turns brown after you cut it. A similar “browning” process occurs inside our bodies as a result of free radicals. This oxidation, as well as the normal aging process, shortens the telomeres in our cells. As I mentioned earlier, these are the “plastic tips” on the “shoelaces” at each end of our chromosomes or DNA in each of our cells. They protect the end of the chromosome from deteriorating so cells can continue to divide and tissue can regenerate.
Antioxidants provide free radicals with the extra electron they need, stabilizing the free radical, neutralizing it, and rendering it harmless. Antioxidants work because they stop free radicals in their tracks, preventing a cascade of negative effects in the body and on the skin. Simply put, antioxidants are nature’s great neutralizers.
With antioxidants being so critical to balance in our body, it makes perfect sense that nature has provided our bodies with their own free-radical-fighting antioxidants like vitamin C, vitamin E, and co-enzyme Q 10. These are common supplements today, but the body manufactures its own supply as well. All of these antioxidants are designed to neutralize free radicals that our body is exposed to, but in a modern society with plenty of pollution and pesticides, our bodies’ systems can easily get overwhelmed. When this happens, it creates a state of oxidative stress in the body that, over time, can trigger premature aging, of both the body and the skin, and lead to disease.
Eating a diet rich in brightly colored fruits and veggies is one of the best ways to shore up our body’s supply of antioxidants. Minerals like selenium, manganese, copper, and zinc, as well as vitamins like A, C, and E, are all antioxidants found in healthy foods. Other sources of antioxidants include coffee beans; green, white, and black tea; and cocoa. (Rhodes et al, 2014; Lobo et al, 2010)
When applied topically, antioxidants help calm redness and decrease skin inflammation. When ingested, antioxidants help protect against damage from the sun’s ultraviolet (UV) rays. One study, published in the British Journal of Nutrition, found that drinking two cups of green tea every day, along with taking the antioxidant vitamin C, can reduce the effects of the sun’s ultraviolet (UV) radiation on the skin. According to the researchers, the antioxidants in green tea make the skin more resilient to the effects of the sun’s UV rays, thereby helping to prevent premature aging of the skin and possibly even skin cancer. But this doesn’t mean you can drink green tea, along with your vitamin C supplement, and skip the sunscreen. The antioxidants just offer additional protection to keep your skin at its healthy, radiant best.
Resveratrol is an antioxidant that can be found in many plants and has been found to protect them from the sun’s UV damage and from other environmental stressors. Food sources include grape juice, peanuts, and ripe berries. Resveratrol has also been found to help prevent diseases like type 2 diabetes and cardiovascular disease. What’s more, when used topically, resveratrol was shown in one study—published in the Journal of Cosmetic Dermatology—to work synergistically with vitamin E to help prevent the domino effect of skin cell changes that result from the natural aging process and exposure to the ultraviolet light and pollution in the environment around us. (Ernst, 2015; Wein, 2019; Farris, 2015)
Other antioxidants that seem to help the skin when applied topically include coffee fruit (the berry of the coffee plant), green tea, vitamin C, vitamin E, coenzyme Q 10, and azelaic acid. It’s been demonstrated, for example, by Duke University researchers that topical use of antioxidants vitamin C and E can provide additional protection from oxidative damage, slow skin aging, and improve the appearance of the skin. (Quevedo et al, 2000; Lin et al, 2003)
Sun Exposure and Your Skin
Just fifteen minutes of sun exposure can age you. That’s what an Australian study found, which is why I advise all my patients to be careful when out in the sun and to apply sun protection whenever they’re exposed to the sun’s UV rays. It doesn’t matter how great your genes are; if you’re exposed to the sun, your skin will age faster than normal and you’ll have a higher risk of skin cancer. In fact, the sun is responsible for the majority (80 percent) of skin aging, according to research published in the journal Clinical, Cosmetic, and Investigational Dermatology. The researchers explained that sun exposure causes hyperpigmentation, reduced skin elasticity, and changes in skin texture—along with fine lines and wrinkles. Plus, the effect of exposure to the sun’s ultraviolet rays increases with age. After the age of fifty, people who are exposed to the sun look older than their actual age. (Hughes et al, 2013)
What does this mean for you? Does it mean you should never go out in the sun? No. Knowing what the sun can do to your skin can help you to make better choices, specifically avoiding deliberately trying to get a tan. Most people don’t realize that a tan results from injury to the skin’s DNA. The skin darkens in an attempt to prevent further DNA damage. Over time, this continued injury to the skin triggers mutations that can lead to skin cancer, the most frequently diagnosed cancer in the United States, with one in five Americans developing it in their lifetime. In fact, the incidence of melanoma (the most dangerous form of skin cancer) is increasing faster than any other cancer.
With all the information circulating about the benefits of vitamin D, many of my patients are telling me that being out in the sun is actually good for them. While exposure to sunlight does help the body make vitamin D, the American Academy of Dermatology doesn’t recommend getting your vitamin D from the sun because of the risks of sunlight exposure. Instead, get vitamin D from your diet or a supplement, if necessary. (Sivamani et al, 2009)
Why exactly does the sun trigger so much damage in the skin? One reason is that the sun’s ultraviolet (UV) radiation suppresses the immune system, which is why people with herpes break out in cold sores after exposure to the sun. The other reason is that the sun’s rays penetrate deep into the skin, triggering damage to the cells and to the skin-firming proteins collagen and elastin. What’s more, exposure to UV radiation reduces collagen production in the skin. The sun not only damages the collagen that you have, it also reduces its production. When you understand it like this, you begin to understand why many years of exposure to the sun results in skin that looks older than it actually is. (Hughes et al, 2013)
Understanding the sun’s rays, however, and how and why they penetrate the skin, is helpful to understanding how all this damage is done when you’re out in the sun. Here’s a quick primer:
The sun’s ultraviolet or UV rays are divided into UVA rays, UVB rays, and UVC rays. All are invisible to the human eye and all UV radiation can damage the skin’s cellular DNA, triggering genetic mutations, which can cause cancer. For years, it was thought that UVB rays were the most damaging to the skin, but it’s only been in recent years that scientists have discovered that UVA rays, and even infrared rays, are even more harmful. (Flament et al, 2013)
UVA light or ultraviolet A radiation is not filtered by the earth’s ozone layer, meaning as much as 95 percent of UVA reaches the earth’s surface. This light penetrates deep in the skin into the mid-dermis and is responsible for tanning and also for skin cancer; eye damage, including cataracts; and the breakdown of collagen, the main structural protein responsible for supporting the skin. What’s more, these UV rays are present year-round, at all times of the day, and can penetrate through clouds and glass. A good way to remember what UVA rays do to the skin is the A in UVA is for aging. (Quan et al, 2004)
Tanning beds are particularly bad for your skin because they emit only UVA rays. In fact, tanning beds emit doses of UVA as much as twelve times that of the sun, according to the Skin Cancer Foundation. (Sarnoff, 2011; Peeples, 2010)
UVB light or ultraviolet B radiation is somewhat filtered by the earth’s ozone layer, but it only makes up about 4 to 5 percent of UV light (UVA makes up the rest). This UV light does not penetrate as deep as UVA rays. It penetrates to the basal, or bottom, layer of the epidermis, where melanocytes, the cells responsible for pigment, are found. This is the type of light that can cause burning of the skin as well as tanning, skin cancer, and eye damage like cataracts. While UVA rays are present at all times of the day, year-round, UVB radiation is most prevalent between 10 a.m. and 3 p.m. and it doesn’t penetrate glass. A good way to remember what UVB rays do to the skin is the B in UVB is for burning.
UVC light or ultraviolet C radiation is completely filtered out by the ozone layer, so zero percent of it reaches the earth’s surface.
Infrared light or infrared (IR) radiation can trigger inflammation and is also responsible for changes in the skin that can lead to premature aging. It’s divided into IR-A, IR-B, and IR-C radiation, thermal heat, and visible light. New evidence demonstrates that solar aging is a combination of UVA and UVB ultraviolet photoaging (which constitutes about 6 percent of total solar radiation), visible light aging (which makes up almost 40 percent of total solar radiation), infrared aging (which represents about 54 percent of total solar radiation), and thermal or heat aging. Thermal aging occurs from visible light and infrared radiation.
Free radicals are activated by the different parts of solar radiation and heat. The negative effects of solar light on the skin, in the past, were attributed to wavelengths in the UVA and UVB range. But we now know that IR and visible light can also play a part in extrinsic skin aging as well as skin cancer. Infrared radiation also transmits heat energy, which contributes to premature skin aging, as seen on baker’s hands and on the faces of glass blowers.
The issue with infrared light is that current broad-spectrum sunscreens don’t protect the skin against it. This is why it’s so important to layer an antioxidant under the current sunscreens to help protect against it and to minimize skin inflammation. Antioxidants have been shown to protect skin cells’ DNA, mitochondria, proteins, and membranes, and can help defend the skin from radiation that gets through the sunscreen barrier. Topical antioxidants and sunscreens work together synergistically to protect the skin.
To protect yourself from any of the sun’s UV rays, consider these tips:
• Wear a broad-spectrum sunscreen that protects against both UVA and UVB rays whenever you’re outdoors, whether it’s seven in the morning or three in the afternoon. And do so, too, whether it’s sunny or cloudy, as the sun’s rays can penetrate through clouds. You can add extra layers of protection for the skin by applying topical antioxidants under your sunscreen. Antioxidants have been shown to neutralize free radical production and protect the skin from ultraviolet damage. Topical antioxidants and sunscreens work synergistically to protect the skin.
Ultraviolet rays can also reflect off sand, snow, water, and concrete, so just because you’re under an umbrella or covering doesn’t mean you don’t need sunscreen. And know, too, that if you’re in high altitude areas, there’s less atmosphere to absorb the harmful ultraviolet rays, so you’re getting more radiation, another reason to apply (and reapply) sunscreen.
• Use enough sunscreen. You need a golf-ball-size amount of sunscreen (about one ounce or enough to fill a shot glass, though this should be adjusted based on body size) for the entire body every two hours. Most people don’t use enough.
• Do your best to avoid the sun between 10 a.m. and 3 p.m., when the sun’s UVB rays are most prevalent. And seek shade whenever possible. If you have to be out in the sun during this time, be sure to apply and reapply SPF, wear a hat, and wear sunglasses.
• Avoid tanning beds. People who use a tanning bed are 2.5 times more likely to develop a type of skin cancer called squamous cell carcinoma, and 1.5 times more likely to develop a type of skin cancer called basal cell carcinoma. In fact, according to research from the University of Minnesota, when teens use tanning beds, they increase their risk of melanoma (the deadliest kind of skin cancer) by almost 75 percent.
• Consider adding UV-protective film to your car’s side and rear windows if you drive a lot. Only front windshields typically have it. The sun’s UV rays shine through car windows, and research from the Journal of the American Academy of Dermatology shows that the left side of the face in US drivers is more aged in appearance and more skin cancer prone than the right side. Being sure to apply sunscreen before driving can help too. (Butler, 2010)
• Cover up. Clothing is UV protective. Thicker shirts have more SPF than thinner ones, and darker colors give you more SPF protection than lighter colors. Clothing labeled UPF (ultraviolet protection factor) is also specifically protective against the sun’s ultraviolet rays.
• Wear UV-protective sunglasses whenever you’re outdoors to shield your eyes from the sun’s damaging UV rays. Most sunglasses are UV-protective, but to be sure, look for the “100% UV protection” sticker on the lenses.
• Live a healthy lifestyle. It’s long been known that exposure to the sun’s ultraviolet rays has been linked to the skin cancer melanoma. But now German researchers have discovered that lifestyle factors play a role as well. The researchers, at the University of Osnabrück, discovered that something in the skin called MicroRNA’s (or MiRs), which are regulators of genes, become overwhelmed from exposure to things like smoking, air pollution, chronic inflammation, chemicals, a high-fat/high-sugar diet, and a sedentary lifestyle. When these MiRs become overwhelmed from this exposure, benign melanocytes (pigment cells) can easily transition into melanoma skin cancer. This is just another reason why a healthy lifestyle is important to not just a healthy body, but to healthy skin too. (Jancin, 2016)
And just a note about smoking. If you smoke, I know you’re already aware of its health risks. But it also affects how you look, which many smokers don’t realize. Research from Case Western Reserve University in Ohio has shown that the nicotine in tobacco causes blood vessels in our skin to narrow, limiting the oxygen and nutrients it needs and the removal of waste products it doesn’t need. The result: delayed wound healing and the production of free radicals that break down the skin-firming proteins collagen and elastin, as well as DNA. E-cigarettes need to be used with caution too. Nevada-based researchers have found that the vapor from these e-cigarettes still contains chemicals that have similar effects. (Okada, 2013; Rivas, 2013; ScienceDaily, 2018)
• Get enough probiotics. Another reason to eat them is more youthful looking skin. Research from Japan shows that ingesting probiotics seems to also protect against photo-aging from the sun’s ultraviolet B rays. The signs of photo-aging include hyperpigmentation, rough skin, fine lines and wrinkles, and sagging skin. Probiotics seem to work by suppressing water loss from the skin and preventing UVB-triggered changes in the skin like skin thickening and overall damage. You don’t necessarily need to take a supplement. You can get probiotics from yogurt and fermented foods like sauerkraut and kefir. (Rupani, 2015; Satoh et al, 2015)
The Visible Signs of Aging
An inverted pyramid (also called the triangle of youth) is often used to represent a youthful face. This includes healthy, full, vibrant cheeks and fullness in the area around the eyes. As we age, the effects of gravity play a role as everything starts to move downward and we become more of an upright pyramid. We lose volume in our upper face from our forehead and cheeks. The eyebrows start to drop and we develop eyelid wrinkles. Fine lines and wrinkles appear around the mouth, too, along with a thinning of the lips. There’s also a dimpling of the chin. Some of the visible signs of skin aging include:
• Dull skin appearance due to slower turnover of radiant new skin cells
• Facial expression lines (how wrinkled you become depends largely on how much sun you have been exposed to in your lifetime)
• Telangiectasias or small, superficial blood vessels on the surface of the skin
• Dry, rough skin and uneven texture
• Laxity or sagging
• Irregular brown pigmentation
• Purpura or bruising
• DNA mutations and precancerous and/or cancerous changes in the skin
Your Home Skincare Routine
Many first-time patients come into my office interested in age-erasing cosmetic procedures, but they don’t take care of their skin at home. They don’t have a dedicated skincare regimen or use sunscreen daily. A simple at-home regimen can do wonders for the skin. This includes cleansing and exfoliating, replenishing the skin with key nutrients/ingredients, protecting it, and moisturizing it. This is the foundation of care that addresses all three layers of the skin. It helps repair damage that’s already occurred and prevents future damage.
Keep in mind that it’s important to maintain your skin all over, not just on your face, which is the area most people are most concerned about. I often advise my patients not to forget the areas that surround the face—the neck, chest, shoulders, and upper back—as well as the lower legs, arms, and the back of the hands. The skin on the body has a much slower cell turnover rate than the face, so daily maintenance is needed. This is why you should treat all of the areas of the skin with the same maintenance routine and rejuvenation methods. Remember, environmental damage occurs all over the body, though this damage to the face is the most visible.
Here are the key steps that I recommend to all of my patients:
• Gently cleanse your skin. Washing your face, morning and night, helps to remove makeup and/or sunscreen, daytime grime that’s collected on your face and in your pores, bacteria, dead skin cells, and skin oil. It also preps your skin for any products you’re applying afterward, helping them to be better absorbed. Leaving makeup or sunscreen on at night can inhibit the skin’s natural exfoliating process.
When you’re washing your face or applying any products to the skin, do so gently from the neck upward to the forehead. Applying products in a downward motion tugs down on the skin, which can contribute to sagging over time. Rubbing or tugging at the skin, particularly in the delicate area around the eyes, can also have this effect.
Be sure to always use a gentle cleanser that’s free from chemicals like parabens, the antibacterial triclosan, perfumes, and dyes, all of which can irritate sensitive skin. If a cleanser is too harsh, it can strip the skin of natural oils, irritating the skin. And it’s also a good idea to use lukewarm, not hot or cold, water. Extreme temperatures strip skin’s oils and trigger broken capillaries, the tiny blood vessels on skin’s surface. Water that’s too hot or too cold can also irritate sensitive and rosacea-prone skin.
You may also need to use a gentle makeup remover before cleansing, particularly around your eyes if you use waterproof makeup. Not properly removing eye makeup is a sure way to trigger eye irritations. One of my favorite makeup removers is coconut oil on a cotton ball. It’s gentle enough for all skin types, and effective. When cleansing around the eyes, gently dab (don’t rub) the remover. Since the skin around the eyes is the thinnest anywhere on the body, it’s easy to rub and tug and damage this delicate skin, triggering fine lines and deeper wrinkles called “crow’s feet” around the eyes.
Gently dab (never rub) skin with a towel to dry. Harsh rubbing with a towel or washcloth during the cleansing process can irritate skin and, over time, the trauma can contribute to fine lines and wrinkles.
You may want to finish with a toner, which can help remove any dirt or makeup left behind after cleansing. I’m a big advocate of alcohol-free toners. Alcohol can strip the skin of natural oils, leaving the complexion tight, dry, and in desperate need of moisture. It can also trigger excess oil production, which can aggravate already oily skin. Keep in mind that a toner is not essential to a skincare regimen, but I’ve found that many of my patients like the clean feeling a toner can give their skin. Some of my patients even like to use it throughout the day to help reduce shine and freshen skin. If you want to try a toner, look for ones that feed the skin with gentle, natural ingredients like witch hazel, green tea, rosemary, grapeseed, and/or chamomile. Toners can also contain exfoliating ingredients like glycolic, salicylic, and/or azelaic acid, which can help slough off dead skin cells, keeping pores clear and the complexion radiant.
• Exfoliate regularly. The skin is continually renewing itself, shedding dull, old skin cells to make way for newer, more radiant skin cells. This is a process that takes place in the skin every twenty-eight days, though as we get older this process slows down. This is one reason skin looks duller as you get older, particularly if you don’t exfoliate regularly.
The dead skin cells, along with sun exposure, pollution, dirt and grime, makeup, and the skin’s oils all work their way into the skin’s pores, making these pores look larger and potentially clogging them too. Exfoliating daily gets rid of this debris on the skin, making skin smoother and less likely to break out. Exfoliating has also been shown to help the absorption of the serums, lotions, and/or creams, particularly those containing the antioxidant vitamin C, that you apply to your skin.
When we exfoliate, the cells in the outermost layer of the skin send signals to the layers of cells below to increase new cell production. This speeds up cell renewal and transforms dull skin almost immediately, adding radiance. Exfoliating can also even out skin tone and pigmentation.
There are two ways to exfoliate: manual and chemical. Physical scrubs, electronic cleansing brushes, and even cleansing sponges or washcloths are all ways to physically exfoliate the skin. A word of caution, however: scrubs that contain crushed seeds or nut shells are too rough for the face and may cause microscopic tears, along with resulting irritation and inflammation in your skin. Chemical exfoliation, on the other hand, sounds unnatural, but it’s actually not. There are plenty of natural “chemical” exfoliators, in the form of foaming cleansers, home peels, serums, and stronger in-office peels. These work by “ungluing” the dead cells from your skin so they can be washed away.
The most common chemical exfoliators include:
Alpha hydroxy acids (AHAs) are acids found naturally in the sugars of plants or milk. There are five AHAs: citric (from citrus fruits), tartaric (from grapes), malic (from apples), glycolic (from sugar cane), and lactic (from milk). They’re all water soluble, which means they can’t penetrate the skin’s sebum, which is why these acids are not ideal for oily skin or skin prone to breakouts. Like other chemical exfoliators, AHAs can increase sensitivity to the sun, which is why you need to wear SPF daily.
Beta hydroxy acids (BHAs) are essentially salicylic acid, derived from acetylsalicylic acid or aspirin. These differ from alpha hydroxy acids in that they’re lipid or oil soluble, meaning they’re able to penetrate through sebum into pores, exfoliating and getting rid of the debris that can clog pores and contribute to breakouts.
Beta hydroxy acids have been shown to improve the signs of aging, namely fine lines and wrinkles, rough skin, and hyperpigmentation, after at least six months of daily application. But they can also increase sun sensitivity by 50 percent, which means you have to use daily sun protection when you use beta hydroxy acids. (Brannon, 2019)
Azelaic acid, which is derived from wheat, barley, and rye, is a jack-of-all-trades, so to speak. It exfoliates the skin and it’s an antibacterial and anti-inflammatory, making it a good option for acne-prone skin. Not to mention it also prevents hyperpigmentation by regulating the production of melanin. Like beta hydroxy acids, it can make skin sun sensitive, so use a daily sunscreen when using products that contain this chemical exfoliant.
Retinoids vary in strength from prescription-strength—which go by names like tretinoin (a.k.a. Retin-A or Renova) and tazarotene (or Tazorac)—to weaker over-the-counter versions like retinyl palmitate, retinol, and retinaldehyde. All retinoids are derivatives of vitamin A; these work by sloughing off dead skin cells to prevent pores from clogging, even out skin tone, and help prevent premature aging of the skin. They can also stimulate the production of collagen and hyaluronic acid. These are best used on the skin at night, as retinoids can make the skin extremely sensitive to the sun and they can break down in sunlight, making them less effective. This is why applying daily sun protection when using these products is an absolute must.
When it comes to exfoliating, more is definitely not better. Too much exfoliating (i.e., using a manual exfoliator followed by a chemical one, while you’re applying retinoids at night) can leave skin irritated. I recommend daily exfoliation to my patients. If this makes skin irritated, then switch to every other day or every third or fourth day. If your skin can tolerate daily exfoliation, then you can work up to twice-daily exfoliation.
• Replenish the skin with antioxidants. The skin’s natural antioxidants include vitamin C, found naturally in high levels in both the epidermis and the dermis where it’s critical to the production of the skin-firming proteins collagen and elastin. But the skin’s antioxidants are depleted by daily exposure to the sun’s UV rays and to environmental pollution from car exhaust and smoke, including secondhand cigarette smoke.
What can help? A diet rich in antioxidants and topical antioxidants. One study, in the American Journal of Clinical Nutrition, found that eating a diet high in vitamin C-rich foods can actually keep your skin healthier and more youthful looking. Topical antioxidants, on the other hand, replenish the skin’s stores from the outside in, thereby helping to neutralize the effects of free radical damage. They also fight inflammation and, in many cases, they help the skin stay moisturized. What’s more, antioxidants like vitamins C and E have been shown to help prevent UV-induced damage to the skin, keeping the skin youthful looking longer. In doing so, they protect the collagen that you already have and stimulate cells in the skin called fibroblasts (found in the dermis) to produce even more collagen. (Cosgrove et al, 2007: Quevedo et al, 2000)
Placing antioxidants like vitamin C directly on the skin can offer great benefits by directly targeting the desired areas of improvement. This is why I recommend that all my patients apply topical antioxidants and, when used during the day, layer these antioxidants under a sunscreen. Research presented at the World Congress of Dermatology showed that pre-treating the skin with vitamin C under a sunscreen prior to going out in the sun or being exposed to pollution seems to prevent significant free radical damage. It’s because of studies like this that I recommend layering a concentrated antioxidant product under sunscreen. (Lin et al, 2003; SkinInc., 2015)
When choosing an antioxidant product, look for airless containers that preserve the potency of the antioxidants inside. These containers also keep skincare products free from bacterial, viral, or fungal contamination. Think about what happens to that apple that’s been left out on the counter. The same “rusting” happens to the antioxidants in products, so to speak. Oxygen causes antioxidants to lose their potency. Every time you open your jar or bottle of antioxidants, you’re exposing the product to air and decreasing its potency. (Duarte et al, 2009)
• Apply sunscreen. Sun is the number one cause of premature aging. That’s why I recommend to all my patients that they apply SPF (sun protection factor), be it in a sunscreen, a foundation, a bronzer, whatever, every single day, rain or shine. And if you’re out in the sun, you need to reapply every two hours, or more frequently if you’re in and out of the water, sweating, and/or drying off, which can rub off your protection. Your SPF should offer broad-spectrum protection. This means it protects against both the sun’s aging and cancer-causing UVA rays and burning and cancer-causing UVB rays.
Sunscreens are divided into two categories: physical and chemical. Each offers protection from the sun, but does so in a different way.
Chemical sunscreens work by absorbing ultraviolet radiation. Since they’re absorbed into the skin, these sunscreens are more commonly associated with skin irritation. The key to the effectiveness of these products, though, is you need to apply them at least thirty minutes before sun exposure to give them time to work. One of the most common chemical sunscreen ingredients is oxybenzone.
Physical sunscreens are my favorite. These include titanium dioxide, zinc oxide, and magnesium oxide. They work by reflecting and scattering the sun’s ultraviolet radiation. Look for these ingredients in non-nano formulations that are designed to not be absorbed by the skin. Instead, they sit on the skin and act as a physical block and are well tolerated by people of all skin types, including sensitive skin and rosacea-prone skin. They work immediately upon application, so you don’t have to wait before being exposed to the sun.
• Moisturize as needed. While the skin produces its own oil, called sebum, every skin type still needs to add extra hydration. Frequent skin washing and daily environmental damage can all strip the skin of its natural oils. It’s best to apply moisturizer within about three minutes of washing and gently patting your skin dry. This helps keep any water present in the skin from evaporating. Look for moisturizers that add nutrients, such as antioxidants, back into the skin.
I always recommend that my patients use a moisturizer day and night for optimum hydration. When your skin is properly hydrated, it’s even-toned and even-textured and fine lines and wrinkles are much less noticeable. Nighttime is especially important, as that’s when the body undergoes most of its repair, including repair and rejuvenation of the skin. Skin temperature actually rises at night, which can lead to water loss, another reason why moisturizing at night is key. (Rising skin temperature also allows for key ingredients to better penetrate.)
There are two forms of moisturizers: humectants and emollients. Humectants draw water into the outer layer of the skin from the environment and from the deeper dermal layer. These enhance your skin’s ability to hold on to water and make your skin feel soft and smooth. Hyaluronic acid and glycerin are two types of humectants. Emollients provide a protective film on skin to prevent water loss. These can be oil- or water-based. Some types of emollients include natural oils like avocado or safflower oil.
Here’s a guide to what moisturizers you should be using for your skin type:
• Normal/combination skin: Use a lighter, water-based moisturizer
• Oily skin: Apply a lighter, water-based or non-comedogenic moisturizer (lotions and gels are lighter than creams). Moisturizers with exfoliating ingredients like salicylic or azelaic acid can help keep skin clear.
• Dry skin: Use an oil-based cream moisturizer, particularly during cold weather months.
• Sensitive skin: Use soothing ingredients that won’t irritate skin. Also steer clear of synthetic dyes, synthetic fragrances, and chemicals like phthalates, parabens, and sulfates.
• Mature skin: Use an oil-based moisturizer to help add moisture to the skin and hold on to hydration already in the skin.
And whatever you do, don’t forget your feet. A common problem I hear about from patients as they age is thickened or callused yellow skin on the feet. The issue is that most people don’t care for their feet like they do their face and the rest of their body. But our feet need attention too. Here’s my two-step daily foot solution: after showering, massage the feet with a pumice stone or other foot exfoliator. Then apply a cream or lotion with a chemical exfoliant like glycolic acid. Be sure to rub all over your feet, including around your toes. If you can put on a pair of socks afterward to help the cream absorb, do so. You’ll see a difference in your feet almost immediately.
Oils: Good for Your Skin and Your Scalp
Hair is technically dead, but the skin on the scalp is very much alive and needs regular care. The right oils massaged into the scalp before washing can strengthen the scalp and the hair. After applying oils, cover hair with a shower cap or towel and leave on for thirty to forty-five minutes before washing. The following is a guide to the best hair oils.
• Almond oil is rich in key nutrients like polyunsaturated and mono fatty acids, as well as vitamins A, B, and E. It’s an emollient, which means it softens the hair, giving it a silky, lustrous texture (as well as softening the skin, when rubbed into it and onto the scalp). It can also nourish and strengthen the hair and boost shine.
• Argan oil is an oil extracted from the argan tree, which is native to the Mediterranean region. It’s high in fatty acids and antioxidants like vitamins A and E, which is why it’s been used for thousands of years to make hair silkier, softer, and shinier. It also shows some benefit as a de-frizzer. It’s not greasy, which makes it an effective leave-in conditioner.
• Avocado oil is packed with nutrients like vitamins A, B, and E, super-hydrating essential fatty acids, protein, and amino acids, which are compounds critical to hair growth and strength. All can help feed the hair follicles. Since avocado oil is a humectant, locking in moisture, it makes an effective deep conditioner. The essential fatty acids also help to add shine.
• Coconut oil has been shown to have antibacterial, antifungal, and antiviral properties, thanks to fatty acids called lauric acid and capric acid. It’s also rich in antioxidants and nutrients like vitamins E and K. It penetrates deep into the hair shaft, helping to retain moisture, strengthening strands, and keeping hair soft and hydrated.
• Extra virgin olive oil, which is chock-full of healthy fats and antioxidants, is an emollient, meaning it can get down deep into the hair shaft, hydrating and adding softness, body, and shine. There’s even some evidence that using olive oil as a topical solution on the hair can also help prevent, or at least stem the tide of hair loss by obstructing production of a hormone called DHT (dihydrotestosterone) that’s linked to some types of hair loss.
• Jojoba oil, which comes from the seeds/nuts of the jojoba plant, is actually a wax, despite its name, that’s very close in composition to human skin oil. It’s also packed with antioxidant nutrients like vitamin E, zinc, and selenium. Plus, it’s an emollient, which makes it an effective moisturizer. Jojoba oil is also good for smoothing strands and adding shine.
Where Do You Go from Here?
Remember that skin is the largest organ of the body. By balancing out what’s going on inside the body, you can achieve healthier, more youthful looking skin. I know that patients who put into practice my healthy skin program look and feel at least ten years younger. And know that it’s not about being perfect every day. Sure, we all eat chips, cookies, and other processed foods once in a while or sleep in and skip our exercise routine. Don’t beat yourself up about it. What matters is that you get right back on track and continue the good habits I talk about in this book. I can’t stress enough: the difference you’ll feel (more energy, better sleep, more creativity, and more happiness and inner peace) and the difference you’ll see firsthand (healthier, younger-looking skin) will be quite dramatic.