4 THE AGE-FIX ROUTINE
So far, we’ve talked about how skin ages and some of the things you can do to treat specific aging features on your skin. However, the real foundation of ways to combat aging is in your daily routine. How you treat your skin every morning and every evening will affect your skin quality and youthfulness in a way that provides a solid base for the wrinkle treatments, fine line attacks, and even procedures like Botox.
Skin care is confusing. Department stores are filled with so many brands and so many products that it can make even the most educated, savvy consumer feel a little bit bewildered. In fact, one report estimated that in 2013, over $55 billion was spent on cosmetics, much of this on products to look younger.10 I once had a patient ask me for advice on which products were best for her skin. I requested that she bring her products with her to her next appointment so we could determine together which ones to use and which ones to discard. A week later, she carted in a huge garbage bag filled with half-empty bottles and tubes of lotions, potions, and cleansers! Unfortunately, I don’t think she’s alone. Most women have dozens of partially used beauty products filling their bathroom cabinets, shelves, and drawers. This chapter is going to tell you what to do with them. Most of them are unnecessary and should go in the garbage (or recycle bin). A handful can really make your skin look better.
This chapter will help you separate the necessary products from the products that are simply a waste of your money. I’ll also help you establish that all-important routine so you can stop contributing to aging and start reversing the aging process today. In fact, I like to think of it as an Age-Fix routine, rather than merely a skin-care routine, because that’s exactly what we are doing—optimizing your skin quality specifically so you look as ageless as possible.
THE AGE-FIX SCHEDULE
Your basic Age-Fix routine really is relatively simple. All it takes is three steps: cleansing, treating, and protecting, each practiced twice per day. These three simple steps (with the right products for you) can go a very long way toward keeping you looking younger longer. The younger you are when you start, the better this Age-Fix routine will preserve the good skin you’ve already got, but it’s never too late to turn back the clock. You can start at any age and look younger almost immediately. Let’s start today! More specifically, here’s what you will be doing:
EVERY MORNING:
1. You will cleanse your skin with a cleanser that is appropriate for your skin type.
2. You will treat your skin with the appropriate serum.
3. Finally, you will protect your skin with moisturizer and sunscreen.
EVERY EVENING:
1. You will cleanse your skin, removing makeup with a product we will tailor to your skin type. You will also cleanse away the day’s debris, oil, and pollution. In the evening a few times a week we will also include exfoliation, which is a preparatory step for treatment.
2. You will treat your skin with the appropriate serum, which is particularly essential before sleep.
3. Finally, you will protect your skin, but this time it won’t be with sunscreen. It will be with the night cream that is best for you.
Let’s look at each part separately so you can pick out some products.
CLEANSING
Cleansing is the foundation for effective skin care, because clean skin can maintain itself with the least interference, and it can best absorb products that combat aging. Cleansing is particularly important at night. Like the rest of the body, skin restores itself at night. Having its pores clogged with oil and makeup and its crevices filled with dust, grime, germs, and pollution can prevent this from happening, in addition to increasing the risk of breakouts.
Cleansing your skin in both the morning and the evening will get rid of external dirt and internally produced oil that can give skin a dull look. Cleansing, and particularly exfoliating, also helps to sweep away that very top layer of dead skin, revealing fresher, younger-looking skin.
However, many women cleanse their skin incorrectly, either not cleaning it thoroughly enough or cleaning it too harshly. Cleansing should leave your face feeling clean and comfortably tight. It should never make your face red or sting, or cause the skin to feel dry and look flaky.
Apply cleanser in a circular motion using clean hands. The circular motion gently massages your face and stimulates blood flow and oxygenation of the skin. Rinse with warm water, and then pat dry with a clean towel.
How do you know what kind of cleanser to use? Before you can determine this, you must first know what your skin type is.
Find Your Skin Type
You may already know what kind of skin you have—oily, dry, combination. Maybe you know how your skin used to be as a teenager or a young adult, but you aren’t sure what’s happening lately. Or maybe you have no idea. You just wash your face and move on with your life.
Knowing your skin type is actually quite useful, because it allows you to tailor products to your exact skin type, which means you will get better results from the products you use. Skin type can change as you age, too. A teenager with oily skin can grow into a woman with dry skin, and a young woman with normal skin can develop oily or dry or especially combination skin as she gets older. To find what your skin type is today, here’s a simple test:
1. Wash your face with a gentle facial cleanser, rinse, and pat dry with a soft towel.
2. Wait sixty minutes.
3. Blot your face with a tissue. Look at your skin and the tissue.
Dry skin: If your skin is dry, then sixty minutes after washing, it will look a bit flaky and feel tight. No oil will be on the tissue.
Sensitive skin: If you have sensitive skin, you may notice redness, itching, or even a rash after cleansing.
Normal skin: If you have normal skin, then your skin will feel slightly tight but comfortable without flaking and without oil on the tissue.
Oily skin: If you have oily skin, there will be oil on the tissue from most or all of the areas of your face.
Combination skin: If you have combination skin, you could have a combination of oil in areas like the T-zone, flaky skin in areas like the cheeks, and normal skin in areas like the chin.
Cleanser Matchup
The first thing to do, now that you know your skin type, is to find the best cleanser for you. There are a slew of them out there, but don’t just grab the first one you see (or the one you’ve been using since you were seventeen). Cleansers should leave your face feeling clean and tight but not too tight, never greasy but also never red, stinging, dry, flaky, or irritated. Some cleansers come with gentle exfoliating particles. Other cleansers aren’t even meant to be washed off with water, and should be gently wiped off with a tissue.
Is your cleanser still right for you? Maybe not. Here are the best cleanser types for your skin. You’ll notice I’ve included some subcategories, such as “very dry” and “slightly dry,” as well as conflating some categories, like “normal to oily.” This allows you to customize further. Try a few different things before settling on the one that makes your skin look and feel fantastic after using it. Also keep in mind that the cleanser that works for you this year might not work so well a few years from now. Always pay attention to how your skin reacts to your Age-Fix routine, and always be willing to try new things when something isn’t working as well anymore.
For very dry, very sensitive skin: Use a surfactant-free cleanser that doesn’t require rinsing. Just the act of rinsing the skin with tap water can worsen the driest, most sensitive skin. If that sounds like you, there are a handful of “no-rinse” cleansers that are very mild, preserve as much moisture as possible, and don’t require you to rinse them off. Pond’s Cold Cream Cleanser is a very affordable old standby that many people still use to clean the skin while still maintaining hydration. My favorite in this category is Avène Extremely Gentle Cleansing Lotion. It’s a little pricier but is devoid of fragrances and parabens. Add a spray of thermal spring water (such as Avène Thermal Spring Water spray) after you’ve wiped it off with a tissue for best results.
For slightly sensitive, slightly dry skin: Try a creamy cleanser that will leave your skin feeling slightly moisturized. An inexpensive choice is CeraVe Hydrating Cleanser, with ceramides and hyaluronic acid to moisturize the skin. Philosophy Purity Made Simple Cleanser costs more but is fragrance free and contains natural oils that can leave your skin feeling lightly moisturized. Both of these should be gently rinsed off with tap water.
For normal to oily skin: Try a foaming cleanser. This will clean skin more aggressively and is particularly effective at removing makeup. However, because of the more aggressive cleansing, foaming cleansers can be drying and irritating to sensitive skin. An inexpensive choice is Neutrogena Fresh Foaming Cleanser. A splurge is Epionce Gentle Foaming Cleanser, which retains the natural oils of the skin better than most foaming cleansers.
All About Exfoliation
Exfoliation is an important and often overlooked way to expose younger skin and even regenerate skin cells. It can be part of cleansing, or it can be separate from cleansing. A large portion of the upper layers of our skin is composed of dead or dying skin cells. These dead skin cells can cause a flat or dull look to our skin. Exfoliating will help remove the upper layers of dead skin and speed up cellular turnover, which starts to slow down in the twenties and thirties.
Basically, exfoliation causes the cells to send signals to produce new skin cells. It also stimulates the production of new collagen fibers, replacing the damaged, irregular, and aged collagen fibers. Exfoliation can reverse the thinning of the collagen in the dermis that occurs with aging, and it also enhances the work of treatment creams and serums. This is why I prefer evening for exfoliation. Removing the top layers of dead skin will make it easier for your night cream to penetrate into the deeper layers of skin. For best results, always exfoliate after you cleanse, so you are exfoliating a fresh, clean face.
There are really three ways to exfoliate, and you may find that one or two of these work for you but not all three. Or you may find (especially if you have very sensitive skin) that you don’t need to exfoliate much at all. Here are the types and levels:
1. Physically: Some cleansers or other topical products contain tiny microbeads meant to gently abrade the top layers of skin. This is considered to be the gentlest kind of exfoliation. However, I really don’t think these beads do much of anything, and one study even suggests that these beads can be hazardous to the environment.11 For these reasons, I recommend you steer clear of cleansers with microbeads. Instead, two better ways to physically exfoliate your skin are to use a handheld cleansing and exfoliating device (like the Clarisonic) or to use a gritty skin polisher. Currently, my favorite physical exfoliating polish is the ZO Skin Health Offects Exfoliating Polish. It combines ultrafine magnesium crystals with antioxidants for an effective, gentle exfoliation. Another great option, Epicuren Micro-Derm Ultra-Refining Scrub, contains ecofriendly bamboo microcrystals that can gently exfoliate your skin.
2. Chemically: Cleansers or other topical products can contain alpha- or beta-hydroxy acids, which remove the top layers of skin through chemical action. I’ll talk more about these in the treatment section, but this is a more aggressive exfoliation that can unveil younger skin but may be too harsh for very sensitive skin.
3. Enzymatically: Cleansers or other topical products can contain botanical extracts to exfoliate the skin through their enzymatic action. I’ll also talk more about these in the treatment section, but this kind of exfoliation can range from aggressive to gentle, depending on the product.
Exfoliation is effective, but you can also overdo it. If you have sensitive skin, exfoliate one or two times per week at most. If you have normal skin, you can exfoliate every other day. If your skin gets red and irritated, that’s a sign that you are exfoliating too often. Slow it down and find a level of exfoliation that doesn’t irritate you but still keeps your skin looking fresh and smooth.
DIY BAKING SODA CLEANSER/EXFOLIATOR
I’m not a huge fan of making your own cleanser, since cleansers are, in general, pretty inexpensive to purchase and there really aren’t a lot of benefits to DIY cleansers, compared to some of the other DIY recipes in this book. Unless you really want to save money and be as natural as possible with what you put on your skin, it’s probably best to just buy a good, inexpensive cleanser like Neutrogena Fresh Foaming Cleanser if you can’t afford a nicer, pricier one, like the Clinique Rinse-Off Foaming Cleanser.
However, I do like this one, because baking soda is a natural exfoliator and can even have a subtle, gentle lightening effect. Your skin will feel clean and fresh after you use this. Make this fresh each time you want to use it, and use the whole thing—it does not keep well due to the milk.
1 tablespoon baking soda
½ teaspoon honey
¼ cup reduced-fat milk
1. Gently warm the milk on the stove or briefly in the microwave, just until it starts to steam, but not so long that it bubbles or scalds. Watch it closely!
2. Stir all the ingredients together in a bowl.
3. Rinse your face with warm water, put the cleanser on a washcloth, and gently clean your skin with it. Rinse off with warm water.
TREATMENT
Clean, exfoliated skin is prepared for treatment, and there are many excellent ways to treat your skin, depending on what your issues are. Check out these various treatments and what they do so you can choose the ones that will tackle the specific issues you have now.
Retinoids
No matter your issue, unless your skin is very sensitive, retinoids just may be your new best friend. Retinoids are really just various types of vitamin A, which is the vitamin contained (in the form of beta-carotene) in orange fruits and vegetables like carrots, pumpkins, peaches, and apricots. Sounds pretty ho-hum, right? Wrong! If I could choose one type of topical treatment for the skin, no question it would be a retinoid. Retinoids do it all. They exfoliate the skin, gradually lighten dark spots, act as anti-inflammatory agents, tighten the skin, reduce fine lines, and even increase the thickness of the skin, which is especially important for the thin skin of the eyelids (more on that later). Retinoids can effectively treat both pimples and wrinkles, and they are one of the most effective products for either issue—and an Age-Fix lifesaver if you suffer from both at the same time, as so many perimenopausal women do. Even more impressive, some studies have shown that prescription-strength retinoids can actually reverse early pre-skin-cancer changes in the skin and actual pre-skin-cancer lesions like actinic keratoses.12 Impressive, right?
There are two types of retinoids: prescription-strength tretinoin and the milder, over-the-counter retinol. These products are best applied at bedtime, allowing them six to eight hours to penetrate and affect the skin while you sleep.
RETIN-A
Retin-A is the brand name for tretinoin, and with daily use you may see acne clearing up within two weeks, and wrinkles smoothing and skin tightening within a month or two. It comes in three prescription strengths: 0.1%, 0.05%, and 0.025%. Use a pea-sized amount on your skin every other night to every night, as directed by your doctor. Apply it only at night, because light will deactivate it. You may develop irritation of the skin, dryness, flaking, or a dermatitis within a few days of starting tretinoin. It is also possible that you will experience an initial, temporary period of increased acne. These symptoms typically resolve with continued use, but if you develop these types of symptoms, consult with your doctor. He or she may recommend that you decrease the frequency of use until your skin gets used to it, or prescribe a lesser strength.
The first time I tried Retin-A, I was in medical school. My family physician, who didn’t have much experience in prescribing it, started my wife and me on 0.1% every night and instructed us to slather it on. Three days later, both our faces were beet-red, swollen, painful, and peeling. Our faces felt as if they were on fire, and we looked like a pair of lobsters.
Unless you have the skin of an elephant, it may be best to ask your doctor to start you on a lower strength of tretinoin until you know your skin can tolerate it. This can be frustrating, because the higher the strength of tretinoin, the sooner you will see the positive effects. Slowing down use because of irritation can also slow down results, but be patient and stick with it! Let your skin adjust. You will see results from this 
. Tretinoin is quite effective as long as you stick with the program. Although some patients just can’t tolerate tretinoin, most of us can as long as we allow our skin to gradually get used to it.
There are also some other versions of tretinoin, or Retin-A. Retin-A Micro contains the same amount of the active ingredient but is a less irritating formulation, and Renova (or its similar competitor, ReFissa) is a more moisturizing form of Retin-A. While your prescription medication insurance may cover generic tretinoin or Retin-A Micro to treat acne, it never covers Renova or ReFissa. These two are considered cosmetic products for the sole purpose of reversing aging.
RETINOL
Retinol is a weaker, over-the-counter form of retinoid that is not as fast acting as tretinoin but may be more appropriate for those who find prescription-strength tretinoin to be too strong. Studies have shown that although retinol is not as potent as tretinoin, it can have similar antiaging effects.
Most major skin-care manufacturers with antiaging lines carry retinol-based products. They don’t typically give you an exact percentage of retinol in their product, so unfortunately the best way to determine which retinol cream is best for you is through trial and error. Two of my favorites are SkinCeuticals Retinol 1.0 and Revision Retinol Facial Repair. For a less expensive option, you can check out the retinol-based serums and creams at your local drugstore, such as Neutrogena’s Rapid Wrinkle Repair and RoC Retinol Correxion.
DIY APRICOT FACE MASK
Retinoids are an active form of vitamin A, and apricots are chock-full of vitamin A, which is why many face products contain apricot ingredients. You can take advantage of this by creating your own face mask full of vitamin A. Your face will feel softer, smoother, and more moisturized afterward, like a baby’s butt! It will also smell great. The smell of this mask reminds me of the high-end skin-care line called Epicuren. They have a number of products that smell like apricots.
Warning: This mask can be a bit messy, especially if you apply it yourself. If you have another person apply it with an inexpensive makeup brush, it may go on better (and feel more like a spa experience). Also, rinse this off in your kitchen sink, as tiny pieces of apricot could clog your bathroom drain.
½ cup dried apricots
½ cup warm water
1 tablespoon raw honey
Blend all the ingredients in a blender or Magic Bullet until the mixture is pureed and smooth. Spread the mask on your face and let it sit for twenty minutes. Discard any extra. Rinse your face with warm water and apply a facial moisturizer.
ANTIOXIDANTS
Antioxidants are in many of the foods we eat, especially colorful fruits and vegetables. They include things like vitamin C, vitamin E, and even the vitamin A that makes up retinoids. They also include other antioxidants such as coenzyme Q10 and manganese. What makes a substance an antioxidant is its ability to repair and prevent damage from free radicals in the body by neutralizing them.
I like antioxidants for antiaging used both internally (in the diet and in supplements) and externally, on the skin. They fight aging, sagging, wrinkles, and even skin cancer. They provide a protective effect, and while they don’t reverse previous damage, they can do a lot to prevent future damage.
I recommend using an antioxidant cream in the morning so it can protect your skin during the day. Ingredients in many skin-care products that signify antioxidant content include:
Vitamin C
Vitamin E
Green tea
Black tea
Coenzyme Q10
Pomegranate
Soy
Vitamin C is one of the most common and effective antioxidant ingredients in skin-care products, and it is often included in serums. Look for at least 10% L-ascorbic acid in the ingredients if you want the vitamin C to have an effect. Also, vitamin C is relatively unstable and must be packed correctly or it will degrade. A vitamin C product should always be in a dark container, because light will oxidize it, causing it to lose effectiveness. If your vitamin C serum turns dark yellow or brown, throw it away. It has oxidized. ZO Medical Products has a great moisturizing 10% vitamin C serum called C-Bright.
Vitamin C’s best friend and partner is vitamin E. A study in the Journal of the American Academy of Dermatology found that the effects of topical vitamin C are enhanced when combined with vitamin E, another potent antioxidant.13 Combining antioxidants can actually be synergistic! SkinCeuticals has a fantastic combo product called CE Ferulic, an with 15% L-ascorbic acid and 1% alpha-tocopherol, a type of vitamin E. Its effects can last seventy-two hours after the application.
DIY Pineapple Scrub
Vitamin C treatments are easy to make at home with fresh fruit. One of the most potent sources is pineapple, which works hard for you in this great, gritty scrub that uses cornmeal as an exfoliator. The exfoliation effect will help the vitamin C to penetrate more effectively, making your skin feel smooth and rejuvenated. Repeat twice per week, as long as this treatment doesn’t irritate your skin. (Discontinue if you notice any redness or irritation. This treatment should feel good, but it may not agree with all skin types.)
½ cup cubed or chopped pineapple, preferably fresh
¼ cup warm water
3 tablespoons cornmeal
Puree the pineapple with the water. Add the cornmeal and blend just until combined. Gently apply the scrub to your face and massage. After a few minutes, wash off with warm water. Store any extra in an airtight container in the refrigerator. It should last for two to three days.
ALPHA-HYDROXY ACIDS (AHAs)
Alpha-hydroxy acids (AHAs) include three kinds of acids that naturally occur in common foods: fruit acids, glycolic acids, and lactic acids. These light acids exfoliate the skin, removing the upper layer of dead skin cells and exposing the younger, smoother layer underneath. This stimulates new cell growth.
The most effective of the AHAs is glycolic acid, which comes from sugarcane. The small size of the glycolic acid particles allows for better penetration into the skin. However, glycolic acid is also the most likely to cause irritation, so if you have sensitive skin, glycolic acid may not be the best choice for you.
Lactic acid comes from milk and acts as a good moisturizer as well as a gentle exfoliator. Women in ancient Egypt, including (according to legend) Cleopatra, used to bathe in milk for its beautifying effects. Somehow, they knew about the antiaging properties of lactic acid.
Fruit acids include citric acid from citrus fruits.
AHAs can be used as stand-alone peels or serums, or incorporated into exfoliating cleansers. Look for products with 7% or higher content of AHA for the best results. (Doctors often prescribe AHAs in a strength of 20–30%.) Everyone’s skin has a different tolerance for AHAs. Some people tolerate them well and benefit from a stronger percentage in order to see results. Ideally, pick a strength that gives some initial flaking of the skin that resolves quickly and doesn’t cause extended redness or irritation.
Many over-the-counter products do not list their AHA percentages, and this is probably on purpose, because many of them don’t contain enough to make a difference. However, there are some I like because I’ve seen noticeable effects with their use. La Roche-Posay has a nice AHA serum called Effaclar Pore Refining Anti-Wrinkle Serum that boasts 7.5% AHA-glycolic complex.
Because AHA Ingredients Are So Common in Foods, It’s Easy to Make Effective DIY Products at Home.
DIY AHA Mask
This mask uses fruit acids from the orange juice and lemon juice and lactic acid from the yogurt. It also contains a nice dose of vitamin C.
3 tablespoons orange juice
2 tablespoons lemon juice
¾ cup plain (unsweetened, unflavored) yogurt
Mix these ingredients together with a fork until combined and apply to your face. Let the mixture sit for twenty minutes, or until dry. Rinse it off with warm water. Your skin will feel softer and smoother afterward.
Growth Factors
Growth factors are a little more complex, but they can have a dramatic effect on your skin. They are chemical messengers that can signal the skin cells to increase the production of new collagen. Growth factors have been effectively used for many years in wound healing, and they now have become an essential ingredient in the antiaging creams and serums of many skin-care products. They can be a good replacement for retinoids if your skin cannot tolerate those, because they cause much less irritation, flaking, and drying. If I had to choose between a retinol-based cream and a growth factor–based cream, I’d go with the retinol, since the science to support its antiaging effects on the skin is clearer and retinols are, in general, less expensive. However, if these just don’t work for you, consider growth factors.
Neocutis and SkinMedica are two examples of skin-care companies that reportedly use growth factors in their products. I’ve had many, many patients who swear by SkinMedica’s TNS Essential Serum as an integral part of their skin-care regimen. I first encountered this product many years ago but was immediately turned off by its strong smell. Since then, the scent has been greatly improved, and for most it’s no longer an issue. If you’d like to see how growth factors may improve your skin, then SkinMedica’s TNS Essential Serum or TNS Recovery Complex are considered by many dermatologists and plastic surgeons to be the gold standard.
Neocutis’s products aren’t as talked about as SkinMedica’s. Still, its line of Bio-Restorative skin creams is worth a look, especially its Bio-Restorative Serum. Both SkinMedica and Neocutis products are sold in doctors’ offices. My main issue with growth factor–based skin products is the price. They can cost over $200 for as little as one ounce of product! It’s like liquid gold! Therefore, again, I recommend that you try retinoids first.
PEPTIDES
Peptides are another common antiaging ingredient in skin-care products. They come in three forms, each with its own specific benefits.
The first type of peptide improves the skin by prompting the cells to increase collagen production. As the collagen in our skin degrades with age, it releases small proteins. These proteins signal the skin to create new collagen to take the place of the degraded collagen. Peptides, such as Matrixyl, Dermaxyl, and oligopeptides, are small chains of proteins that can potentially do this as well, signaling the dermis to create more collagen and rejuvenate aged skin.14 Peptide-based products are, in general, less expensive than growth factor–based products. You can find these types of collagen-enhancing peptides in the Oil of Olay Regenerist line and StriVectin’s Advanced Intensive Concentrate for Wrinkles and Stretch Marks. Both can be found in your local drugstore or online.
The second type of peptide acts as a carrier for copper, allowing the combination to penetrate the skin and affect its structure. Copper has been used for decades to improve wound healing and has been incorporated into skin-care products since 1997. Copper peptides are believed to have many beneficial effects on aging skin, including increasing the production of hyaluronic acid (a moisturizing component of the skin) and collagen, and acting as an antioxidant. If you’d like to see how copper peptides improve your skin, check out the Progressive Nourishing Lotion or Crème de la Copper by NEOVA. These can be purchased online or through a physician’s office.
The third type of peptide is collectively called neuropeptides. These include gamma-amino-butyric acid (GABA) and dimethylaminoethanol (DMAE). Studies show that GABA can act as a smooth muscle relaxer.15 Smooth muscles are also called involuntary muscles, like the muscles of the GI tract, blood vessels, and uterus. If GABA can relax smooth muscles, can it also relax voluntary muscles like the ones that cause facial wrinkles? In other words, can it be like Botox in a cream form? Although rigorous scientific studies haven’t proven that GABA in creams can penetrate the skin and relax the underlying facial muscles, it hasn’t stopped some skin-care companies from claiming that it can and producing products that promise just that.
So what do I think of peptides? Should you look for creams and serums with peptides in them? Not necessarily. If you are a skin-care novice and want to maximize your dollars on your skin-care products, then hold off on buying peptide-based products. The science to support their benefits isn’t very strong, and there are other, proven, less expensive ways to make your skin look better. However, if you are a seasoned veteran of skin-care products or a skin-care enthusiast, and you want to try something different, peptide-based creams and serums may be worth a try. Just don’t believe all the hype.
SKIN LIGHTENERS
If you have dark spots, age spots, freckles, or melasma (all of which I discussed in the last chapter), you may want to try a skin-lightening treatment for the treatment step of your Age-Fix routine. You have a few options:
Hydroquinone: The gold standard for skin lightening is an ingredient called hydroquinone. This is a chemical compound that inhibits tyrosinase, a key enzyme essential in producing melanin (the pigment in the skin). The standard strength for hydroquinone in an over-the-counter product is 2%. Prescription strength is 4%. Hydroquinone works best when combined with retinoids and/or an AHA to get better penetration and quicker results (such as with the Ultimate 3-in-1 Antiaging Face Cream I told you about in chapter 3). For even better penetration, visit a plastic surgeon’s or dermatologist’s office and combine this with microdermabrasion. The microdermabrasion will gently exfoliate the skin and work with the hydroquinone to clear the dark spots faster.
Hands down, the best system for reducing pigmentation, in my humble opinion, is the ZO Multi-Therapy Hydroquinone System, my . While I do believe the 3-in-1 cream I recommended in the last chapter is the best single cream for pigmentation, it should not be used long-term. The ZO Medical system takes more steps but it is excellent for both short-term and longer-term use, and in that regard, I think it works even better for pigmentation than the 3-in-1 cream. This system combines 4% hydroquinone with tretinoin and AHAs for the most aggressive but well-tolerated skin-lightening regimen I’ve ever seen. I’ve witnessed amazing results with this system, but ideally you have to buy into the whole thing: cleanser, toner, exfoliator, lightener, blender, and sunscreen, which, taken together, appear to be synergistic with each other. If you have a lot of pigmentation problems that you need cleared up and cost isn’t a barrier for you, then don’t bother with the milder treatments. Go straight to ZO and see those spots lift within weeks. ZO Medical products can be purchased only through a physician’s office.
Kojic Acid: This is an alternate skin lightener that also works by inhibiting tyrosinase. It can be slightly more irritating than hydroquinone, but it is less expensive. Unlike hydroquinone, kojic acid doesn’t come with the risk of ochronosis, but it also doesn’t work quite as well. A recent study in the Indian Journal of Dermatology found that hydroquinone was more effective than kojic acid for the treatment of melasma. Because kojic acid is less effective than hydroquinone, it’s best combined with an exfoliating agent for better penetration, such as an AHA or a retinoid. Otherwise, the results may be very mild and unsatisfactory.
Elure: Elure is a relatively new, nonhydroquinone, skin-lightening product marketed by Syneron, a prominent laser company. It has a patented natural enzyme formulation called Melanozyme, which can improve dark spots within twenty-eight days.
Niacinamide: Some over-the-counter skin-lightening products contain niacinamide, a very mild and gradual skin lightener. The good thing about niacinamide is that it’s very safe, well tolerated, and inexpensive. The bad thing about it is that it works pretty slowly. L’Oréal has a nice, inexpensive skin lightener called Youth Code Dark Spot Corrector, which utilizes niacinamide. I mentioned this in the last chapter, so this is just a reminder.
PROTECTION
There is one thing you can do to protect your skin that far outweighs anything else. It is an essential practice for maintaining younger-looking skin, and it can even save your life. It’s called sun protection.
I see you rolling your eyes at me! I know, people have been telling you to wear sunscreen ever since you were a sun-worshipping teenager, but you want your tan (or your vitamin D dose). Unfortunately, not everybody believes that sunscreen and sunblock are necessary unless, perhaps, you are at risk for burning, such as during a day at the beach. Many of these people claim that we need vitamin D from the sun and that sun is “natural” and that daily sunscreen use will lead to chronically low vitamin D levels. However, the aging effects of the sun are profound. Even if you don’t burn, you will prematurely age if you get frequent sun exposure without protection. Is premature aging worth a temporary golden glow during the summer months? If you have darker skin, then the melanin in your skin can protect you from getting burned, but melanin will not protect you from getting wrinkles, pigmentary blotches, and skin cancer like melanoma. Sun protection is essential. My professional advice to you is to take a vitamin D supplement and embrace the sunscreen. Let’s talk about how to use it.
Sunblock
I cannot overstate the importance of protecting young skin from the sun. It is always better to prevent skin damage than to treat it. This is especially important for children, so apply sunblock on your kids every day. Believe it or not, as much as 60 percent of the sun’s damaging radiation penetrates the clouds, even on really cloudy days. You always need sunblock. Always. You need protection from both types of solar radiation that can damage and age your skin and cause cancer: UVA rays and UVB rays.
UVA rays: UVA rays cause aging, discoloration, and wrinkles, effects that can progress to skin cancer. These rays have a longer wavelength than UVB rays, so they penetrate deeper into the skin, at the molecular and cellular levels. Melanoma is caused by UVA rays, which react with the skin cells to produce free radicals. Free radicals caused by UVA rays can destroy DNA, sicken healthy cells, and damage collagen and elastin in your skin. This is what causes premature aging and sun damage. This damage can be even worse when combined with environmental free radicals like pollution and a poor diet.
A study conducted on twins by researchers from Case Western Reserve University showed an extra thirty hours a week of sun exposure made the subjects look 2 years older by age forty, and 3.5 years older by age seventy.16 It can take ten years or more for the aging effects of the sun to surface on the skin, so your teenager’s days at the pool without sunblock will affect her or him later, no matter what.
UVA vs. UVB RAYS
UVB rays: UVB rays are the ones that cause you to tan and also to burn. Long-term exposure to UVB rays is linked to basal cell and squamous cell carcinoma. UVB rays are most intense between 10 a.m. and 3 p.m., so try to limit your sun exposure at this time. Also keep in mind that the sun’s rays are more intense near the equator and at higher altitudes. Also, being surrounded by snow, which reflects the sun’s rays, can make it much easier for you to get burned. You may be surprised that higher altitudes make a difference, but they do. As a college student, I once took a ski trip to the Matterhorn in Switzerland. I’d never worn sunscreen while skiing before, but I slapped a little bit on my cheeks, just in case. When I finished skiing that day, my entire face was burned to a crisp, except for those two hand marks on each cheek and around my eyes where I wore my glasses. I looked like Free Willy. The other students made fun of me for weeks afterward, but I learned a valuable lesson. Even if it’s cold, the sun’s rays can still burn your skin. Apply sunblock every day to uncovered skin!
For all these reasons, always wear sunglasses whenever you are in the sun. It helps if you have a pair stowed in your car for whenever you drive on a sunny day. Also start your children using sunglasses early to help get them in the habit as well. You’re never too early to block the rays of the sun and prevent future wrinkles!
ABOUT SPF
Every bottle of sunscreen and sunblock tells you its SPF number. SPF stands for sun protection factor, and it applies to protection against only UVB rays, not UVA rays. For that reason, high-SPF sunscreen may prevent tanning and burning, but it may not protect you against premature aging, age spots, and wrinkles.
Look for sunblocks or sunscreens labeled “broad spectrum,” because then you know they also block out UVA. The FDA recently implemented a rule that a warning now be placed on sunscreens that lack adequate UVA protection. I also recommend an SPF of at least 30, which absorbs 97 percent of the sun’s rays. The American Academy of Dermatology recommends a minimum SPF of 30, so they agree with me.
Q: How much do you apply?
SPF is based on the assumption that you are applying a good amount of sunblock on your skin. Most people don’t apply nearly enough sunblock to be as effective as the SPF indicates. It’s estimated that we apply only 25 percent of the recommended amount. Ideally, one ounce (or two tablespoons) of sunblock should be enough to cover the exposed parts of your body. This is the amount recommended by the American Academy of Dermatology. If you are bigger or have more area exposed (nudists, listen up!), then be more liberal—you’ll need more than an ounce. Your face alone, including your ears and neck, should get at least a teaspoon. If you have short hair, apply sunscreen to your scalp, too, or look for a sunscreen spray made for hair.
Q: When and how often to apply?
If using a chemical sunscreen, apply it fifteen to thirty minutes prior to heading outdoors, to allow it to be absorbed by your skin. Reapply every two hours until you go indoors, more often if you are sweating or in the water. No sunscreen is truly waterproof! You need to reapply it after being in the water. Don’t forget.
Also don’t forget to apply sunscreen to your lips. Lips don’t tan, so they are completely exposed to the effects of the sun. Use a lip balm with SPF 30 or higher, then apply your lip gloss or lipstick.
Q: Which one to use?
The best sunscreen or sunblock for you depends on your skin type. Follow this guide:
For sensitive skin: Apply a physical sunblock and/or one that is fragrance free and hypoallergenic. Zinc oxide can soothe irritation and reduce redness in people who have sensitive skin or rosacea. The white color is worth it for you!
For acne-prone skin: Use a gel-based, oil-free, or spray-on formula. Avoid heavy physical blockers. Avobenzone and oxybenzone (Neutrogena makes a combination of avobenzone and oxybenzone that provides broad-spectrum UVA/UVB protection called Helioplex) are preferred for you.
For oily skin: Avoid products with mineral oil. You may respond well to oil-free and spray-on products, just like people with acne-prone skin.
For dry skin: Use lotion or cream formulas. These can contain aloe or other moisturizers. Avoid spray-on products that may contain drying alcohol.
Moisturizer
Sun protection is essential if you want to prevent premature aging, but the other big area that is important for protection of the skin is moisturizer. There are several kinds of moisturizers that can be used for various purposes, but in general, moisture makes skin more pliable, plump, young-looking, and resilient to damage like wrinkling. Moisturizer should be an important part of your skin-care routine, no matter what your skin type. Good moisturizers are most important in the winter, when the humidity drops in cooler climates and skin gets drier.
Most people need two different moisturizers: one that you apply in the morning that contains sunblock and possibly antioxidants to protect your skin during the day; and one that you apply at night that can renew and refresh your skin, such as Renova, or one with alpha-hydroxy acids to treat your skin. Let’s look at some of the types:
OCCLUSIVES
Occlusive moisturizers prevent the loss of water from the skin. They provide a barrier so water doesn’t seep out and evaporate. This keeps in the moisture you already have. Examples of occlusives are petroleum jelly, mineral oil, dimethicone, lanolin, shea butter, and beeswax. The problem with occlusives is that they can clog pores, leading to breakouts.
HUMECTANTS
Humectant moisturizers attract water from the air and from deep in the skin to the visible layer of skin. These moisturizers aren’t as thick and heavy on the skin as occlusives, and they are less likely to clog pores, so they are better for people with acne issues. They plump the skin and reduce wrinkles, acting as instant wrinkle fillers. Some examples of humectants include hyaluronic acid, glycerin, lactic acid, propylene glycol, and urea.
In addition to these two types, moisturizers come in three forms:
1. Lotions are mostly water and the lightest (good for all skin types).
2. Creams are heavier and oilier than lotions (good for dry skin).
3. Ointments are the heaviest and oiliest (good for people with extremely dry skin).
Moisturizers may also contain many of the treatment elements we’ve already talked about in this chapter, such as antioxidants like vitamins C and E or green tea, retinoids, peptides, or growth factors, as well as SPF for protection. Use antioxidant moisturizers and moisturizers with an SPF during the day. It’s best to apply moisturizers to the skin right after a shower and when your skin is still damp, in order to lock the moisture into your skin.
At night, a more powerful moisturizer can help restore moisture to your skin and rejuvenate it. In addition to the moisturizing component, there are other ingredients to look for in a complete moisturizing night cream. Look for a retinoid to reverse aging while you sleep, such as retinol or Retin-A. Peptides and antioxidants can also fight off the aging process. Currently, my favorite night cream is ZO Skin Health’s Ommerse Overnight Recovery Cream. Not only does it moisturize with a combination of occlusives and humectants, but it’s also chock-full of other goodies like retinol and antioxidants.
YOUR AGE-FIX ROUTINE WRAP-UP
Find the products that work for you, and then stick with them—practicing your Age-Fix regimen on most days will make a real difference over time. Cleanse, treat, and protect every morning and every night, and in a month you’ll be looking younger. If you want more guidance, I’ve put together individual Age-Fix routines for each skin type:
Applies to All Skin Types:
During the day, protect your lips with a good lip balm that provides sun protection.
In the evening, exfoliate your skin two to three times per week, right after cleansing.
Morning and evening, apply a good eye cream.