Cosmetic antiaging treatments

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VOL 114 / NO 1 / JULY 2003 / POSTGRADUATE MEDICINE

Over a lifetime, skin gets damaged by the sun and normal aging. For some people, the wrinkles and discoloration are hard to take. If you feel this way, you may be tempted to try some of the cosmetic antiaging treatments now being marketed to help you look younger.

What cosmetic antiaging treatments are available?
Various chemical treatments and procedures are available to ease the signs of age on the face, neck, arms, and hands.

Creams and lotions: Products with hydroquinone, a bleaching ingredient, can tone down blotchiness or blemishes. Some hydroquinone products also contain vitamins, herbs, or other chemicals, but it isn't clear whether these additional ingredients make the product more effective.

Products containing alpha-hydroxy acids, salicylic acid, ascorbic acid (vitamin C), alpha-tocopherol (vitamin E), or copper may improve skin texture, but they haven't been proved to work. Retinoic acid, which has undergone extensive testing, has been shown to modestly improve skin texture. However, neither of its relatives, retinol and retinaldehyde, appears to provide the same results. In fact, the makers of the retinoid treatments tretinoin emollient cream and tazorotene cream (Avage, Tazorac) must state in bold print on the packaging that these medications "do not remove or prevent wrinkles, repair sun-damaged skin, reverse aging due to the sun, or restore more youthful skin."

Creams with ingredients such as kojic acid, lavender, olive leaf, bearberry, thyme, ubiquinone (formerly called coenzyme Q), or peppermint are billed as improving the appearance of skin on the face. However, these claims have not been proved.

Microdermabrasion: A procedure called microdermabrasion uses tiny crystals to buff the skin's surface. A special tool hurls the crystals at the skin and at almost the same time vacuums them and dead surface skin cells away. Microdermabrasion offers a fast and relatively inexpensive method to improve the skin's texture and reduce blemishes. It is painless, typically produces only mild redness, and allows a patient to return to work right away. Multiple treatments usually are needed.

Chemical peel: This procedure consists of applying a mild acid, such as glycolic acid, salicylic acid, or lactic acid, to the skin, then allowing it to soak in before wiping it off. Results vary depending on the type and strength of the acid used. After a typical superficial peel, a mild sunburn-like reaction occurs and the skin peels within days. Regular treatments are necessary to maintain the benefit. Peels of any type that do not redden or inflame the skin generally don't have a lasting effect.

Botulinum toxin: Botulinum toxin type A (Botox Cosmetic) and the shorter-acting type B toxin (Myobloc) make some wrinkles and expression lines less visible. The toxin is injected into muscles in the forehead and between the eyebrows as well as into the skin at the outer corners of the eyes ("crow's feet"). This treatment provides obvious improvement within days, requires little recovery time, and lasts 3 to 4 months.

Dermal fillers: Injected collagen from cows (Zyderm, Zyplast) can help "fill in" wrinkles and creases. A single series of injections lasts about 3 or 4 months. A supposedly longer-lasting material combines bovine collagen with tiny beads of a substance called polymethylmethacrylate. This combination is sold under the trade name Artecoll. Dermal fillers are often used in combination with botulinum toxin.

Intense pulsed light: Methods that use intense pulsed light, which is often incorrectly referred to as a laser, can help clear up red blood vessels on the skin surface and even out blotchiness and blemishes. In general, three to five sessions are needed. Redness after the procedure usually lasts less than 24 hours. This treatment is often used with botulinum toxin injections and microdermabrasion.

How much do these treatments cost?
Costs for treatments differ. For example, it is not uncommon to spend $100 to $200 for a botulinum toxin treatment or $75 to $250 for microdermabrasion. Generally, these costs are not covered by insurance.

Do antiaging treatments really work?
The results of these treatments vary. Make sure the doctor who provides or supervises the treatment is skilled and comfortable with the mate-
rial or treatment you choose. The best advice about antiaging products remains "let the buyer beware." Plain, old-fashioned petrolatum (Vaseline) has withstood the test of time, is inexpensive, and may be just as good as or better than more expensive products.

It's never too late to start protecting your skin

No matter what your age, there are a number of practical ways to help keep skin looking young.

• Stay out of the sun, especially between 10 AM and 3 PM, when the sun's damaging rays are strongest.
• Wear a daily moisturizing lotion with a sun protection factor (SPF) of at least 15 and preferably 30.
• If you have to spend time in the sun, use a sunblock with an SPF
  of at least 30, and reapply it often.
• When in the sun, wear dark-colored clothing, which absorbs the sun's ultraviolet rays better than light-colored clothing.
• Don't smoke.
• Eat a healthful diet and drink lots of water.

This information is not a substitute for medical treatment.

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