This document discusses ways to achieve healthier, younger looking skin. It describes the three main causes of skin aging as photoaging from UV exposure, gravitational aging from tissue stretching, and volumetric aging from fat and muscle loss. The number one culprit for skin aging is identified as UV light. Ways to slow aging discussed include regular sunscreen use, antioxidants, retinoids, and the three R's - relax with botulinum toxin, refill with dermal fillers, and resurface with various laser and chemical peel procedures. Specific product recommendations and before/after photos are provided.
4. How do we age?
Photoaging
UV-induced
Gravitational aging
Stretching
Sagging of soft tissue
Volumetric aging
Fat and muscle atrophy (loss)
Bone loss http://www.seattleface.com/html/fat_injection.php
Unknown cause
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5. How do we age?
No.1 culprit for skin
UVA (aging) – penetrates deeper, though windows
UVB (burning) — most effective UV promoter of skin cancer
Both UVA and UVB cause DNA damage
Chronic sun exposure causes:
Wrinkles, brown spots, blood vessels, loss of elasticity,
discoloration, leathery skin, facial volume (fat) loss, skin cancer
Much slower and later in darker skinned people (melanin)
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6. How do we age?
Bolognia JL, Jorrizo JL, Rapini RP. (Ed.). (2008). Dermatology, Edition 2. Elsevier.
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7. How do I slow aging down?
Sun protection (most cost effective)
Sunscreen
Sun avoidance
Sun protective clothing
Antioxidants
Retinoids
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8. Slowing aging: Sunscreen
Sunscreen1,2
Multiple studies show both clinical and microscopic evidence of
sunscreen prevention of photoaging
Can reduce damage (solar elastosis) that has already occurred
Also prevents skin cancer and pre-skin cancer
Organic (chemical) — absorb UV and convert it to heat
Common allergies
Some forms are unstable (easily breakdown = less effective)
Inorganic (physical) — block UV
Zinc oxide, titanium dioxide combined = broad spectrum (UVA, UVB)
1. Stenberg C, Larko O. Sunscreen application and its importance for the sun protection factor. Arch Dermatol 1985;121:1400-1402.
2. Sambandan DR, Ratner D.Sunscreens: an overview and update. J Am Acad Dermatol. 2011 Apr;64(4):748-58. Epub 2011 Feb 3.
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9. My favorite sunscreen
No. 1: SkinCeuticals Physical Fusion
SPF 50
physical blocker, thin, tinted
No. 2: Neutrogena with Helioplex
SPF 30+
photostabilized chemical blocker
No. 3: L’Oreal Anthelios with Mexoryl
SPF 30+
photostabilized chemical blocker
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10. Slowing aging: Antioxidants
Can prevent and/or reverse photoaging due to
free radicals1
Vitamin C (must be in stable, penetrating form)
Phloretin
Ferulic acid
Vitamin E
Green tea polyphenols, oral soy isoflavones,
coenzyme Q10 and many more …
Growth factors and peptides can improve photoaging by
reducing lines/wrinkles and supporting skin function
1. Rabe JH, Mamelak AJ, McElgunn PJ. Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.
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11. Slowing aging: Retinoids
Vitamin A and its natural and synthetic derivatives:
Retinol
Tretinoin
Adapalene
Tazarotene
Prevent and treat photoaging1, 2
Reduce fine lines, wrinkles, discoloration
Boost collagen formation
Often causes irritation, redness, peeling
Minimize side effects with gradual increase in use, using moisturizer
1. Rabe JH, Mamelak AJ, McElgunn PJ, Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.
2. Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term treatment of photoaged human skin with topical retinoic acid improves epidermal cell atypia and
thickens the collagen band in papillary dermis. J Am Acad Dermatol. 2005 Nov;53(5):769-74.
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12. How do I turn back the clock?
The three Rs
Relax
Refill
Resurface
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13. Relax
BOTOX® and Dysport ®
Botulinum toxin type A
Block nerve impulses to treated
muscles thereby inhibiting
muscle activity that leads to
wrinkles
Effective in two to seven days
Lasts three to four months
Can be used in many areas
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20. Relax
Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010 Dec;63(6):1042-51.
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21. Refill
Fillers
Many types: hyaluronic acid, calcium
hydroxylapatite, poly-L-lactic acid, fat, silicone,
collagen, etc.
In general, hyaluronic acid (e.g., JUVEDERM®,
Restylane®, Perlane®) are safest
Reversible
Allergic reactions are rare
Can be used virtually anywhere on face to minimize
wrinkles and replenish volume
Also used on hands, earlobes, depressed scars
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25. Resurface
Superficial (epidermis only)
Microdermabrasion
Superficial chemical peels
Microlaser peel
Medium to deep (epidermis and dermis)
Dermabrasion
Medium and deep chemical peels
Fractional laser resurfacing
Deep laser resurfacing
Nonablative (no downtime)
Broadband light (a.k.a., intense pulse light)
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New technology helps rejuvenate skin and enhance appearance. The environment, the aging process and a lack of effort when it comes to caring for your skin can all take a toll, adding years to your appearance. Nothing gives away your age faster than wrinkles, age spots and leathery skin. Even worse, looking weather-beaten or older than you are can impact your self-esteem and the way you approach life. Join Kesha Buster, MD FAAD, a dermatologist and expert in aesthetic treatments, at the November Women’s Connection. She will discuss ways to maintain healthier skin as well present new techniques and procedures to rejuvenate the skin and help maximize your aesthetic.
Full face, even tone, http://webdesignlists.com/beautiful-baby-photos.html/
Symmetry, even tone, appropriate distribution of hairFemale: wide set eyes, full lips, prominent cheekbones, arched eyebrows, heart shaped lower face (lower face smaller than upper),
Gravitational-SMAS saggingBone-recession of mandible and maxillahttp://www.seattleface.com/html/fat_injection.php
DON’T forget tanning bedsRemember to say UVB causes photoaging tooCyclobutane–pyrimidine dimers (CPDs)6-4 photoproducts—usus T-C
e.g., avobenzone-t is highly photolabile; 1 hour of sun exposure decreases its photoprotective properties by 50%to 60%. Several patents to make stable have been developed: helipplex (NTG) and mexoryl (L’Oreal’s anthelios)
Vit C-short half life so often put in more stable form. Problem is some of these more stable forms do not penetrate the skin as readilyAll of above neutralize free radicals (Phloretin CF)Vitamin C (must be in stable, penetrating form)Promotes collagen synthesisPhloretinIncreases cell turnover, decreases production of pigmentFerulic acidInhibits UV-induced creation of pigment