Skin Care

Published on July 3, 2013 by

Baby boomers, who range in age from early 30’s to early 50’s, obviously cannot remain forever young. However, with cosmetic innovations through scientific research progressing so rapidly in Dallas and abroad, patients may be able to significantly delay the visible aging process by practicing preventive skin care and taking advantage of chemical treatments for facial rejuvenation.

Causative Factors

Multiple factors affect the way skin ages: Heredity, sun exposure, chronological age, emotional stress, repeated weight gain and loss, diet/nutritional supplements and exercise. As we age chronologically the outermost layers of the skin thin due to a decrease in collagen production and the elastin fiber degeneration–this is documented microscopically. Also the skin becomes drier due a decrease in glandular secretions. These “progressions” in skin aging can be aggravated/accelerated when combined with sun and other environmental exposure. For example, with habitual exposure to sun the photo-aging process exhibits itself by skin thickening (a leathery appearance) and the collagen is replaced with a misaligned “tangle” of elastin fibers which also is visible microscopically. The underlying tissues become thinner and eventually skin laxity and wrinkles can be seen. Of course, some facial wrinkles may be caused from animation–the underlying muscles which are used to smile, frown, etc…. exerting action on the skin, which over time creases the surface.

Anti-aging Agents

Many skin care protocols from specialists are available to help slow, halt and reverse, to some degree, the negative effects of skin aging. The two primary ingredients to improve texture and appearance are Alpha-hydroxy acids and Retin-A.

Retin-A increases collagen production and increases the amount of capillaries (small blood vessels) in the skin. This new capillary ingrowth allows more oxygen and nutrients to feed the skin. Retin-A is supplied in varying strengths, depending on your skin type and the goal in mind, through the plastic surgeon’s office and to be used at home nightly. Use of Retin-A may cause flaking or peeling of the skin, increased sensitivity to the sun and a reddish hue to the skin.

Alpha-hydroxy acid (AHA) is beneficial in slowing skin aging and helps to minimize fine wrinkles, promotes the skin’s cell turnover (shedding dead skin layers more often), lightens “age spots” and unclogs pores (which improves acne). This acid has several sources: Fruit, sugar cane and dairy. We have found the sugar cane derived AHA to be the most moisturizing as it effects change in the surface of the skin. Skin irritation is minimal with AHAs. Over-the-counter products containing these AHAs are required to have low concentrations of the active ingredients whereas products supervised by physicians may contain higher and more effective concentrations. Alpha hydroxy acids are packaged for at-home maintenance use in varying concentrations up to 12% and in various forms (solutions, lotions and creams). The AHAs may also be applied through the physicians office at concentrations between 20% and 70% on a weekly schedule for 6 weeks. This peel allows for a patient to be treated and be back in makeup within 2-3 hours. The resulting skin is overall more radiant.

Another recent “breakthrough” has been the stabilization of Vitamin-C so that it may be applied topically and be absorbed by the skin. It is widely known and accepted that Vitamin C is an antioxidant (which inhibits oxidative reactions, is necessary for collagen production and removes free radicals from the body) when taken internally through diet or supplemental form. It is fairly well established that little of this dietary Vitamin C is used for skin repair by the body even when blood levels are high. For years researchers have sought to stabilize topically used Vitamin C to heal damaged skin and now that has been achieved. Presently only one formulation of Vitamin C is absorbed so be wary of large-scale, over-the-counter claims. Cellex-C is the brand name associated with the largest amount of absorption at the present time. The benefits of Vitamin C are: increased collagen production, repair of sun-damaged skin, some sunscreen properties, total absorption into the skin (it will not wash off for 2-3 days). This topical solution of Vitamin C actually works from the inside layers of the skin outwards. Moisturizers that contain Vitamin E aid the action of Vitamin C in the skin.

Incorporating the above ingredients into your normal skin care regimen is usually not time-consuming. Many patients are actually able to reduce cost and time of their present skin care regimens and see more benefit very quickly. We recommend that if patients want to see the most benefit possible in their skin they should use other products (cleansers, moisturizers, sun blocks–SPF greater than 17) that are plant-based rather than those containing animal or petroleum products. Using botanically-based products helps keep the skin’s pH at a level that allows Retin-A, AHAs and Vitamin C to work more effectively. Retin-A and AHAs should be used in conjunction with a SPF 17 or higher sun block as they do increase the skins susceptibility to sun damage. These products are environmentally safe and utilize no animal testing. The AHA and Vitamin C is metabolized on the surface of the skin and is safe even for pregnant and nursing mothers. Retin-A products are metabolized by the liver and should not be used by the above mentioned patient group.

Phenol and Trichloroacetic acid (TCA) are chemical peeling treatments for major sun damage, wrinkles and acne. TCA gives surgeons flexibility in adjusting the strength of the peel solution to individual patient’s skin type. Each of these treatments requires pre-treatments of Retin-A and/or AHAs. Phenol is less popular today and we have abandoned this modality in our practice due to the many associated negatives with this agent and the now available CO 2 laser, which in qualified hands, is an excellent tool for treating patients that may have at one time had only the phenol peel as an option for treatment.

Hyperpigmentation is possible following TCA peel or aggressive treatment with Retin-A or AHAs so many skin care protocols may also incorporate the use of a skin bleaching agent, hydroquinone.

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    Dr. Steve Byrd

    Board-Certified Plastic Surgeon

    To visit our office use address:
    9101 N Central Expy #560
    Dallas, TX 75231



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    9101 N Central Expy #600
    Dallas, TX 75231
    Tel (214) 821-9662
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    The American Society for Aesthetic Plastic SurgeryAmerican Society of Plastic Surgeons