RADIANT, HEAD TURNING SKIN

by Leslie Forrester RN. BS.
Leon Forrester Tcheupdjian, M.D.

Few freckles may have their charm, but spots, dullness, sun damage and wrinkles do not. New treatments can even your complexion, clear inflammation, reduce wrinkles, brighten your face and definitely take off years off your appearance.

Radiant skin is what we all crave. The most radiant skin is homogeneous in color and texture, free of pimples, zits and discolorations. This simple skin quality can make a person look 10 to 20 years younger. Fashion photographers tell us that “Blotchy faces do not turn heads. If a model has great features but has blotchy, mottled skin, we often turn them away.” Radiant skin has the ability to reflect light. Dead cells, sun damage, discolorations and heaps and valleys do not reflect light evenly.

“Photo-aging,” as I call it, results from years of free radicals, hormonal ups and downs, stress and poor eating habits. You may have great features but overall look older. This affects women of all ethnicities. People with a fair complexion have sun sensitivity, which aids in the development of freckles, lentigines, actinic keratoses and rosacea.
Asian women and men develop skin hyper-pigmentation, dyschromia, melasma and vitiligo. African and Native Americans may have a tendency to develop unwanted discolorations after pimples, ingrown hairs or even a simple scratch or mosquito bite.

To remedy the problem women and men turn to false promises of TV ads, internet magic treatments or over the counter quick fixes including potential cancer causing drugs like hydroquinone. Moreover, these treatments never target the “source” of the problem. Believe me, if you follow my simple instructions you will achieve radiant, younger, fresher skin.

Successful rejuvenation of the face requires a thorough and systematic understanding of the cause/source and diligent treatment plan.

As I start an analysis of the face, I look for everything, but I will simplify it for you into five elements, which are as follows:

1. Contour related changes: Loss of volume, wrinkles, deep smile lines, loss of cheeks and sagginess, loss of volume of the lips or hard to find lip definition, jowls and pre-jowl dents. It’s all in the volume of the face. You can't have enough cheeks or chin.
2. Texture related changes: Superficial or deep wrinkles, loss of skin elasticity, pores, oiliness, dullness, excessive dead cells, dryness, spider veins and acne scars.
3. Color related changes: discolorations, melasma, photo-aging (excessive Ultra-violet UVA and UVB exposure).
4. Inflammation related changes: Active acne, White heads, black heads, bumps and dumps moles, pimples, rosacea, syringomas (obstructed sweat ducts appear as light colored bumps primarily in the lower eyelid region but can be anywhere). Actinic keratosis, which are dry pink scaly rough textured patches on the skin (AKs) left untreated may progress to squamous cell carcinoma, a type of skin cancer that can be fatal.
5. Gravity related changes. Jowls, platysma (neck) bands, horizontal neck lines.

Next I will discuss the “Art & Science” of an individualized treatment plan. I will give you a sample, although in practice it is much more involved.

For the category 1 patient who has loss of contour & loss of volume in the form of deep wrinkles, I recommend FILLERS. The most popular type of fillers are the Hyaluronic acid based fillers. Present options are Restylane™ and Juvéderm ULTRA™. (And their longer lasting counterparts, Perlane™ and Juvéderm Ultra PLUS™.) They are excellent for lips and smile lines. They last up to 1 year (depends how much you move your face).

The next type of fillers are the liquified Calcium gel, as in Radiesse™. It lasts perhaps slightly longer than the longer lasting hyaluronic acid products but cannot be injected in the lips because it may cause unwanted lumpiness. The third type is the natural collagen builders, such as Sculptra™. They are amazing. The main ingredient is Poly-lactic acid, which has been used as dissolvable sutures for many years and is very safe.

Sculptra takes a few monthly injections to achieve correction. It lasts about 2 years but cannot be injected in the lips.

The last choice is the permanent filler Artefill™. This product is made out of bovine (cow) Collagen mixed with acrylic beads that stimulates the skin to make its own collagen. Results are permanent, but so are the tiny beads, which could show through thin skin.

Artefill™ is best used for acne scars. However, it cannot be injected in the lips because it may cause unwanted lumpiness. This is my least favorite due to potential permanent lumps.

2. Texture related changes are divided into 4 subtypes:
a) Superficial or deep wrinkles, sun-damage, loss of Collagen, loss of skin elasticity, dullness, excessive dead cells and dryness. The best method of treatment here is to provoke Collagen synthesis in the deep layers of the skin (the Dermis). I usually suggest beginning with Microdermabrasion. Six sessions combined with Dermagenesis skin care home treatment is the preferred treatment plan. Chemical peels such as Tri-Chloracetic Acid TCA, Glycolic acid, Mandelic acid, lactic acid or Salicylic acid are often used in conjunction to facilitate a faster peeling process. I suggest adding a few sessions of Fractional Lasers: Sciton's Profactional or Fraxel® Laser combined with Erbium Micro laser peels as a finishing touch to bring the skin to a smooth, tight, even glow.
b) Pores: congested oily skin. IPL is the best treatment here (Intense Pulse Light)
c) Spider veins. Lasers are best suited to eliminate these nuisances.
d) Acne scars. Depending on the depth of the scars Fractional Lasers such as Sciton's Pro-factional® Laser combined with Erbium Micro laser peels will do wonders. Other lasers are used as well such as Ultra pulse CO2 or Erbium Lasers.

3. Color related changes: These can be simple discolorations. Discolorations can be either brown hyper-pigmentation or loss of color referred to as hypo-pigmented skin. Hyper-pigmentation is treated with Q switch lasers like the Versapulse-C® or IPL.

If the problem is hypo-pigmentation, loss of color as a result of Stretch marks, I use Relume® to promote color return.
Another tough condition to treat is Melasma, also called pregnancy mask. We have had great success using a Forrester Peel, followed by twice a day application of a special melanin stabilizer Dermalan™ or Cosmelan.

Sun-damage or "Photo aging" is a result of excessive Ultra-violet UVA and UVB exposure. The best treatment here is daily application of Solaris™ (UVA & UVB blockers) Plus IPL combined with Fractional Lasers as Sciton's Pro-factional® Laser or Erbium Micro laser peels. Newer technology, such as Plasma Lasers also appear promising.

4. Inflammation related changes take the form of active acne. The one and only treatment that is clinically effective is PDT Photo Dynamic therapy. In a nutshell, PDT is a five session series of a monthly application of DUSA (LEVULAN KERASTICK (aminolevulinic acid HCl 20%Topical Solution). The DUSA remains on the skin for 30 to 40 minutes, allowing the medication to penetrate into the deep layers of the skin. Following eight minutes, a special DUSA-Clear Blue Light is used to activate porphyrins in your skin to kill P-acnes bacteria in your bacteria infested skin. An additional home therapy of Benaqua™ wash, a topical drying agent, with an anti-oxidant Gen-X Toner™ and daily treatment of Gen-X pads™ is used to keep the skins bacterial levels low and prevent scarring.

Rosacea is known as the "Celtic curse.” Blue-eyed, light color complexion individuals suffer from dilated capillaries on the nose and cheeks, which makes then look like they are blushing. The cause is unknown but inflammatory in nature. Syringomas (obstructed sweat ducts appear as light colored bumps primarily in the lower eyelid region but can be anywhere).

Actinic keratosis, which are dry, pink, scaly, rough, textured patches on the skin (AKs), if left untreated may progress to squamous cell carcinoma, a type of skin cancer that can be fatal.

The fifth category is Gravity related changes. Jowls, platysma (neck) bands, horizontal neck lines. Here we need to tighten the collagen of the dermis and the sub-dermis. My favorite is Radio-frequency (RF). There are many manufacturers but they are all the same, Refirm®, Accent®, Skin Tight® by Sciton. The radio frequency restores healthier collagen. It tightens, lifts, smoothes and renews facial contours. It is a non-invasive procedure and has no down time. You can treat all skin types safely. The effects are amazing. The initial effect is immediate collagen contraction/shrinkage resulting in tightened skin and renewed facial contour. As we age, collagen stretches like a slinky. RF tightens and resets this “slinky” back to its tighter state. The second effect is referred to as the “ongoing effect.” New collagen growth prompts continual tightening and contouring of the skin up with lasting effects up to six months post treatment.