Facts on saving your skin!!!
Moisturizers cannot prevent or really get rid of wrinkles. They coat the skin with a very thin layer of oil or silicone, which prevents it drying out. If skin is dry, wrinkles are more noticeable, so by keeping the skin moist and plump they help to blank out smaller wrinkles. It is best to apply a moisturizer after washing in the morning, while your skin is slightly damp.
Retinoids, such as tretinoin and isotretinoin, are chemicals that are related to vitamin A. They make the skin produce new cells more quickly, so it becomes thicker and more compact. The skin also produces more collagen but less pigment (melanin). According to research published in the New England Journal of Medicine (N Engl J Med 1997; 337:1419-28), retinoin also helps protect collagen against such sun damage. After a month or two of using retinoids, the skin becomes smoother, fine wrinkles are repaired, age spots fade and the skin colour becomes more even, but it doesn't produce totally wrinkle-free skin. If you carry on using the cream, the skin continues to improve for a few more months, but after 6 months of use there is no further change. If you stop using it, the skin gradually goes back to how it was before. Retinoids do not have any effect on very noticeable wrinkles, such as the deep lines that appear between the nose and mouth, or on thread veins.
Some anti-ageing creams contain retinoids ('retinol') but for the most effective concentrations, you need a doctor's prescription. However, doctors cannot prescribe tretinoin for sun-damaged skin under the NHS in the UK, so you will have to ask your doctor for a private prescription, which means you will have to pay for it. For the first 2 weeks you apply it every other night; for the next few weeks you apply it every night; after a few weeks, 2 or 3 nights a week is enough. If there is no improvement after 6 months, there is no point in continuing.
Retinoids do irritate the skin, so that there may be dryness and flakiness, sometimes with itching, soreness, redness and a tight feeling. You have to avoid the sun. Some specialists think that retinoids work simply because they irritate the skin, and that the normal skin repair processes then smooth out wrinkles. Other specialists worry that retinoids could increase the risk of skin cancer.
How effective is tretinoin cream?
In a study of 251 people with sun-damaged skin aged 29-50, tretinoin cream used once a day for 6 months:
produced some type of improvement in 79% (however, 48% of people who used only sunscreen and moisturizers also showed improvement)
made the skin 29.3% less rough
faded age spots by 37%
improved wrinkles by 27.1% (measured by taking silicone impressions of the skin) (Source: Archives of Dermatology 1991;127(5):659-65)
Verdict: in spite of the hype, tretinoin will not change your skin radically, but it may produce some improvement Alpha hydroxy acids (AHAs) are chemicals found in fruit juices (hence their name 'fruit acids'), wine, sugar cane and milk. They may be the magic ingredient of skin recipes containing milk, lemons or wine. AHAs improve the appearance of skin by speeding up the shedding of old, dead cells from the skin surface. AHAs have very little effect on wrinkles, though some researchers claim that they make the skin thicker, help it to hold moisture and improve the elastin.
Many face creams now include AHAs. When buying, check their concentration. Anything less than 5% is not very effective, but the safest to use. A 5-10% cream is probably more effective, but scientists worry that, long-term, this concentration might damage your skin, and you might end up with more wrinkles rather than less. For the first few weeks of use, AHAs may make the skin slightly flaky. If the cream is very acid it may cause more irritation, so look for a pH of 3.5 or higher (the higher the pH, the lower the acidity).
So are AHAs safe? The US Food and Drug Administration is concerned about them and is doing more research (see Useful Contacts) and the European Commission is looking into the matter. So at the moment, we simply do not know.
One concern is that they damage the skin by penetrating its defensive barrier. If you find that products containing AHAs cause irritation, stinging, burning, redness or swelling round the eyes, stop using them immediately. The other concern is that because they make the skin sensitive to sunlight, they could increase the risk of further skin damage and of skin cancer. So if you use an AHA product, use a SPF 15 sunscreen as well, every day, even if the weather is overcast, and choose a cream with a low AHA concentration.
Beta hydroxy acids (BHAs) are similar to AHAs, but may be less likely to irritate the skin. The most common is salicylic acid.
Check for these words on skin cream labels; they mean alpha or beta hydroxy acids
Mixed fruit acids
Triple fruit acids
Tri-alpha hydroxy fruit acids
L-alpha hydroxy acids
Malic acid
Citric acid
Glycolic acid
Lactic acid
Hydroxycaprylic acid or alpha-hydroxycaprylic acid
Glycolic acid + ammonium glycolate
Alpha-hydroxyoctanoic acid
Sugar cane extract
Salicylic acid
Vitamin C is essential for the production of collagen. It also encourages the renewal of skin cells and is an antioxidant, which means that it mops up free radicals. Free radicals are molecules produced by our body's metabolism, particularly when it has to deal with pollution in the environment. Free radicals can be harmful and may contribute to skin ageing. Vitamin C is a very unstable vitamin that is broken down by light and does not penetrate the skin readily, so cosmetic companies have had great difficulty making a skin preparation containing it. They seem to have cracked the problem, and skin preparations containing vitamin C are now available. Whether they really do reduce ageing changes in the skin remains to be seen.
Botulinum toxin injections have become a well-known anti-wrinkle treatment. Botulinum toxin is actually a powerful poison that blocks the action of nerve fibres. This causes a mini-paralysis of the facial expression muscles that crease the skin. By pinpointing a specific area, such as crows feet and frown lines, the specialist can smooth out the skin - you do not have frown lines because you cannot frown. The effect is not immediate (it may take a week or two to show), but it lasts for several months.
Like any other procedure, it has some risks. If it is not done properly you could end up looking rather expressionless, or one side of your face could look different from the other. As with any cosmetic procedure, it is important to find a good doctor - see our section on Cosmetic surgery for general advice.
Fillers, such as collagen, injected into the skin fill in hollows and can help smooth out lines, including deep wrinkles such as nose-to-mouth grooves and frown lines. Collagen is absorbed by the body, so the effect doesn't last and the treatment has to be repeated every 3-6 months. It can be painful, and may cause bruising; there is often some redness and swelling on the day of the injection, which fades by the following day. Some people develop hard, red blotches as a result of an allergic reaction. The collagen comes from cattle, and there have been concerns that it could trigger an autoimmune reaction (in which the body attacks its own cells), but there is no evidence this has ever happened to anyone.
Collagen is not the only type of filler - many other substances are used.
Silicone injections are usually given as a course of about five sessions, each a month apart. It is not yet known if these have any long-term side-effects.
Chemical peeling with AHAs (glycolic peel) is another treatment given at some private clinics. It went out of fashion for a while (when laser resurfacing seemed more promising), but is now regaining popularity. Chemical peeling works by producing a chemical burn on the surface of the skin. As the skin heals, some of the smaller wrinkles and irregularities are smoothed out and there is some improvement in the appearance.
Laser resurfacing of the skin removes part of the outer layer of the skin (the epidermis). This regrows in 3-6 weeks from the remnants left in the hair follicles and sweat glands (see Baldness). During this time, you will look as if you have severe sunburn, as your skin will be red and there may be some weeping. The repair process alters the skin collagen, 'lifting' mini-wrinkles from the skin during the subsequent 4 months. Afterwards, you must always use sunscreen to protect your skin.
There may be side effects, such as lightening or darkening of the skin. In people whose skin tends to form keloid scars, laser treatment is risky. There is also a risk of reactivating herpes (cold sores).
Because these skin techniques are so new, discoveries are still being made about the best methods, and what they can and cannot do, and their long-term effects. As with all cosmetic operations and procedures, try to choose a reputable clinic and a well-known doctor; your family doctor may be able to advise you (see Cosmetic surgery). Ask to see 'before and after' photos, and check that the procedures were carried out by the person you are talking to, and are not simply promotional material supplied by the laser manufacturer.
Plastic surgery was the only option before retinoids. It can produce a big improvement in lines at the sides of the eyes and sagging skin (which retinoids won't help), but will not improve the overall texture of the skin. As with all plastic surgery, make sure you choose a reputable clinic.
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