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Introduction to Skin Care

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    "One of the most important things that we do for our patients before or after surgery, or even during our process of doing procedures with injectable and other non-invasive technologies is to inform them and educate them about skin care.

    Skin care is the single biggest return on investment type of activity that any of our patients can do, and that even includes surgery. If they do it for their lifetime it assures good quality skin, the reduction of wrinkles and spots that are associated with the aging process, and most importantly, it keeps the skin healthy and much less chance of skin cancers and other types of neoplasm, or growths of the skin that none of us want.

    We can break skin care down simply into four basic kind of categories. The first one is cleansing and exfoliating and I'll put them together because they often work together. When we do cleansing or exfoliating, we can do that depending on your skin condition, from a very gentle cleanser to cleansers that help to start the exfoliation process with light acid types of washes. When I say light, I mean very light, no peeling or weeping of the skin is done with that.

    In many cases, I'll ask my patients or encourage them to use something like a Buf Puf or a clarisonic brush, something that will actually mechanically help dislodge some of the dead skin cell layer which there are 50 to 100 layers of just dead skin cells on the surface of most people's skin, and we want to stimulate new generation of skin from the deeper basal layers of the skin to the surface, and make the skin smoother feeling and appearing by doing this cleansing and exfoliation.

    The second area is "treatment," and this is the area that I think has been really hyped with lots of different commercial and corporate interests, but when it comes down to it, they're is really only a handful of molecules that we know actually can treat the skin and change the appearance of the skin and actually physiology of the skin that's associated with aging and sun damage, a condition we call solar elastosis.

    One of the main ingredients is Tretinoin, which is a vitamin A based molecule. The trade name was originally Retin A, it's off patent now, so it comes in many forms. The Tretinoin is a molecule, a vitamin A derivative, that does many things in the skin cells themselves, in particular, the basal layer of skin, that improves the quality of the skin, division or replication, it improves the contours of the anatomy of the skin. If you look at the basal layer all the way to the skin surface, the epidermis and the skin really has two layers, the dermis and the epidermis, the Tretinoin molecule has an impact all the way through those skin cell layers including helping with the remodeling and reorganization of collagen, which we lose, or lose the integrity of as we age. So, using Tretinoin in addition to a handful of other things that we think help are good and important parts of the skin care program.

    So I make sure that patients are doing the cleansing exfoliation part and then treating the skin with some type of a retinoid so it’s a broad category Tretinoin or Retin A is one of them. If people can't tolerate that, and there are some people who have some irritation when using Retin A or Tretinoin, we can use a Retinol type of product, which is a little more gentle on the skin but still has many of the same benefits.

    It's interesting that our skin cell nuclei even have receptors for this molecule which, really again helps to improve the organizational structure of the skin, it improves fines lines and wrinkles, it helps to regularize skin cell pigment and the production of pigment within the skin cells themsleves, so there's just a myriad of things that this particular molecule does. All of this data is very well established in excellent studies that were done initially at the University of Michigan and onward have been proven by multiple others.

    The other molecule that we found to be very helpful with the skin is an anti-inflammatory and anti-oxidant, is topical vitamin C. It’s got to be the estorized version of l ascorbic acid when its applied so it’s important that you look for that, but by using tretinoin, retinoids, the retinol type of products in the evening, along with cleansing and exfoliation, we're beginning a process of treatment that for most patients will make a substantial impact and they're skin quality and appearance over time.

    In the morning, I have people use the vitamin C based product, vitamin C the l ascorbic acid that I mentioned is in an ester form, it's really important that's it’s the ester vitamin c product applied topically now, we're not taking these as vitamin pills or other supplements, but applied topically as a cream onto the skin surface, it’s a very powerful antioxidant, and it also has anti-inflammatory and protective effects to the skin. I think if we're using those two molecules, we're doing about 90% of what we know actually can improve the skin surface.

    There are dozens of other molecules that are being studied and written about including the polyphenols, copper peptides, there's a dozen or more that have a growing amount of scientific data behind them, but those two core molecules I think should make up the basis of the treatments of the skin what we're talking about skin care.

    Then there's hydration. Most of the things that we see purchased over the counter at most of the skin care studios and salons like Nordstrom's or Neiman Marcus are very good hydrators of the skin, very good moisturizers and there's nothing wrong with excellent moisturization.

    Moisturization of the skin creates plumping, when the skin cells are plump, they're very well hydrated that makes the skin look smoother and feels smoother and gives it a better appearance overall. It’s not actually treating the skin per say, but it is making the skin look better and replenishing that surface hydration that improves overall skin quality and tone, and I think that's an important component of it, I just don’t like the idea that people are spending hundreds or even in some cases, thousands of dollars for good moisturizers.

    The last component of skin care, if we keep this really simple, is protecting the skin, and sunscreens are becoming much better known now. I see these crazy SPF factors of 50 and 100 and 200, and in practice SPF is a way of measuring how your skin would perform without the sun screen versus how it would do with the sunscreen. It's frankly a ratio, anytime you get above 30 or 40 SPF it probably makes no sense because it’s the equivalent of your being in the sun for 40 consecutive hours with the product versus one hour without.

    So in practice, no one's really out in the sun for 40 consecutive hours, and in fact most sun screens even the best of them, wash off in outdoor conditions or sweat off in outdoor conditions within about 4 hours, even the water-proof ones. There's really no such thing as a truly waterproof sunscreen, so re-application of sunscreens is very important but even the best of them contain physical blocking agents either micronizing oxide or titanium oxide, along with the newer molecule which been approve avobenzone, which all block the UVA, the long wave link rays, which we used to called "tanning rays," which we now know cause the most wrinkles and are also associated with the dangerous skin cancer melanoma, and the burning rays are the UVB rays.

    So the sunscreen that you use should have a physical blocking agents zinc, and/or titanium oxide, it should have avobenzone in it, and it can be oil free if you're acne prone, because some sunscreens do plug the skin so customizing the sunscreen or sunblock, as it used to be called, to your skin and the condition of your skin is very important also.

    So in summary, I just would say that sunscreens are very important parts of the overall skin care program but they're not the only part of the skin care program, we can cleanse the skin and exfoliate it, we can treat the skin with the retinoids and with estorized vitamin C, and then we can hydrate the skin with very good moisturizers, none of which have to be very expensive, and I think a lot of people are paying way more money than they should on a good skin care program.

    Four components again, exfoliation and cleansing, treating the skin which we've mentioned the molecules, hydrating, and then protecting the skin with sunscreens are the key to long term success and quality skin, whether you have surgical procedures or small interventions like injectable or some of the non-invasive technologies that are offered here at The Maas Clinic and elsewhere.

    If you have other questions about skin care programs I encourage you to visit our website at, you can write me or send me an image of your skin at our video blog, and as always, we welcome live consultations here at the Maas Clinic and Appearance Care Center.

    This is Dr. Corey Maas on "Looking Your Best"