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Anti-Aging Skin Care: Ask the Dermatologist

Dermatologist Doris Day, MD answers your questions about anti-aging skin care.

Question:
Any woman can look younger if you have the money to pay for the expensive treatments. What does one do if they can't afford the expensive lotions and creams?
Answer:

I am a big fan of drugstore products. The single most important way to keep your skin looking its best over time is to use sun protection every day all year round and to protect against excess sun exposure. In products, look for ingredients such as retinoids (retinol, retinyl palmitate, retinyl propionate, and others), peptides, vitamin C, niacinamide, caffeine, grape seed extract, marine extract, and other antioxidants.

Question:
What is the best routine to prevent aging?
Answer:

Use sun protection every day all year round, protect against excess sun exposure, and exfoliate on a regular -- but not daily -- basis. Look for gentle products that do not strip away the outer layers, just gently remove the excess dead skin cells ready to slough off. The outer layers of skin cells are called the stratum corneum and studies show that this layer helps protect against sun damage and against excess water loss from the skin. When it is an even smooth layer, the skin looks more radiant and younger. Retinoids, emollients and gentle exfoliants help achieve this goal.

Question:
What can I do to improve the appearance of wrinkles on my hands?
Answer:

Sun protection and regular moisturizing. Don't overwash and be sure to moisturize after each wash. Also, you can apply facial anti-aging moisturizers on the back of your hands at night when you won't be constantly washing your hands.

Question:
My skin under my eyes is wrinkled and loose. How can I tighten under my eyes? I had under-eye surgery 14 years ago. Now my eyes are puffy and the skin is loose. What can I do to tighten under my eyes? I am 54 years old.
Answer:

Look for under-eye creams that contain retinoids, niacinamide, peptides, and caffeine. The next step is to see your dermatologist for an evaluation for a fractional CO2 procedure, which can tighten and smooth the skin very nicely. Be careful to also manage your salt intake, get enough sleep, and try not to rub the area around your eyes. If you have allergies/sinusitis, be sure to keep them under control as much as possible since that can also contribute to the puffiness in this area. The under-eye area is also one place where stress shows very quickly, so managing your stressors is helpful as well.

Question:
I am 47 and have sensitive and acne-prone skin. I have noticed that I also break out when I use any sunscreen -- separately or in a moisturizer. It is so hard to find the right products that will help with wrinkles because of this. Any suggestions?
Answer:

Look for powder or gel sunscreens. Make sure to wash off every night with a foaming cleanser to avoid buildup of the product.

Question:
I'm 51 years old and notice that my skin has changed. It looks like reptile skin and the color is uneven. What do I do?
Answer:

Start by using sun protection every day, all year-round and re-applying every two hours if you are outdoors. This will allow your skin to repair itself as much as possible. I would also start with an over-the-counter regimen of moisturizers, retinoids, and antioxidants. The next level of treatment would be to see your dermatologist about in-office evaluation, first to make sure that your skin is otherwise healthy -- no skin cancer or precancer -- and to review possible treatments such as chemical peels or laser peels.

My favorite treatment for the right candidate is an in-office fractional CO2 peel. This has about one week of “downtime” where your skin is red and you really need to be home. After that you can typically wear makeup and go back to your normal routine. The result is smoother, younger, healthier skin that with proper care will continue to look great for years.

Question:
I am 44 years old but I look like 50+. I tried many products and I even have done the Cutera Pearl Laser Treatment a year ago, but I do not see any improvement in my skin. Is there a product or treatment that really works?
Answer:

There are several factors that cause the face to age. Genetics account for 20%-30% and the rest is environmental factors -- sun, smoking, stress, diet, and other lifestyle factors. There are many procedures that can help rejuvenate the skin. The best approach is a combination of Botox, soft tissue fillers, and laser as appropriate. It is important to use appropriate topical products/treatments to even out the skin tone, Botox helps soften and even eliminate certain wrinkles and can even lift the brows. Soft tissue fillers add volume in a very natural way when done correctly and are so important in the rejuvenation process. These treatments are typically done over several visits and the results can last for years.

Question:
Is collagen IV an effective anti-aging product? Is Gluthathione IV effective for skin whitening? What about a collagen pill and collagen powders?
Answer:

There is no collagen product that when applied to the skin will penetrate and remain as intact collagen. The molecule is simply too large. However, topical collagen can be a really good moisturizer. There are ingredients such as peptides and other antioxidants that can help stimulate collagen production. The effect won't be the same as having a soft tissue filler, such as collagen or hyaluronic acid injected into the skin, but they can help soften fine lines and wrinkles. The gold standard best product for brightening the skin is hydroquinone. Other ingredients such as glutathione, sepi-white, n-acetyl glucosamine, licorice root extract, mulberry root extract, and azeleic acid can also be helpful.

There is no collagen pill that has been shown in proper studies to grow collagen. I do recommend a multivitamin daily, omega-3 and vitamin D supplements, always under the guidance of your physician.

Question:
I have a very sensitive system, my skin included. I use only water, occasionally Cetaphil cleanser, then olive oil, and a little Mary Kay foundation. Anything else seems to cause my sinuses to hurt. Do you have any suggestions? I'm 55 and getting too many wrinkles.
Answer:

I would recommend an evaluation by an otolaryngologist (ear, nose and throat specialist) regarding the sinuses. I would make sure to add sun protection daily since most wrinkles are caused by sun exposure over years. If you are sensitive to sunscreen, look for chemical free sunscreens. These are not absorbed into the skin and should not have an effect on your sinuses. Otherwise, I would see your dermatologist about possible in-office procedures to help treat the wrinkles and determine the best approach for you.

Question:
What is best for dark circles under the eyes and chin firming?
Answer:

Under-eye circles are due to a combination of factors -- genetics, allergies, rubbing, stress, lack of sleep, dehydration, leftover makeup. Look for products that contain peptides, sepi-white, caffeine, niacinamide, mulberry root extract, or retinoids.

Chin firming creams should contain retinoids, peptides, hyaluronic acid, growth factors. Speak with your dermatologist or plastic surgeon to see if a radio frequency procedure such as Thermage is appropriate for you. The results in the chin area can be dramatic.

Question:
What is the best moisturizer for older skin?
Answer:

Look for products that contain shea butter. This is very hydrating to the skin and is great for older, dry skin. As we age, our skin barrier can become more delicate. If not properly moisturized, our skin can enter into a dry skin cycle. To avoid this and to best care for and moisturize older skin it is recommended to use products that contain ingredients such as glycerin and niacinamide which can help to hydrate skin, renew the outer layers of skin, replenish the Natural Moisturizing Factors and help to repair the moisture barrier.

Question:
What kind of eye cream should I use for dry skin at the age of 30?
Answer:

Any age really. It is helpful to use an antioxidant under your sunscreen, and again at night to help prevent wrinkles. The most important anti-aging cream you can use is sunscreen, every day all year-round, even if it is cloudy. Damage from sun exposure is cumulative. It is so much easier to prevent wrinkles than it is to fix them afterwards.

Question:
How does retinyl propionate compare to prescription retinoic acid and nonprescription retinaldehyde (supposedly the closest to retinoic acid) and retinol (two steps away from retinoic acid) in successfully treating deep wrinkles and skin sagging?
Answer:

In a six-month clinical study, a new three-product skin care regimen containing a deep wrinkle treatment with retinyl propionate was professionally tested and clinically proven to be as effective as the leading anti-aging prescription brand indicated for reducing the appearance of fine lines and wrinkles (0.02% tretinoin in an emollient base). Others studies have shown that retinyl propionate may be less irritating to skin than the prescription retinoic acid, retinaldehyde, and retinol. It could provide a good alternative for women who cannot tolerate these retinoids.

Question:
During wintertime I use Retin-A products during the night. What do I have to use in summer during nighttime?
Answer:

You can continue using your Retin-A product, just be sure to be diligent about applying sunscreen during the day and reapplying every two hours or more often as needed.

Question:
Is Retin-A Micro used for reducing fine lines and wrinkles?
Answer:

Yes, and it is very effective for this purpose. Just be sure to be careful about using sunscreen during the day.

Question:
I have been noticing my skin starting to look a little dry even wrinkled. I am 36 and I was wondering if there is something happening or maybe I am not getting the stuff I need for my skin. Can you help me?
Answer:

Cutting-edge genomics research shows that as we age and particularly if we are exposed to sun, our natural moisture barrier becomes more fragile and difficult to repair. At the same time skin's natural renewal cycle starts to slow down. Moisturizers containing niacinamide have been clinically proven to strengthen skin's moisture barrier, holding in natural moisture and to decrease the appearance of fine lines and wrinkles in as quickly as four weeks.

Question:
Which product is better, collagen or retinol?
Answer:

There is no collagen product that when applied to the skin will penetrate and remain as intact collagen. The molecule is simply too large. However topical collagen can be a really good moisturizer. Products with retinoids like retinol or retinyl propionate can affect deeper layers of skin by stimulating collagen production.

Question:
What is the best over-the-counter skin treatment to combat aging neck skin?
Answer:

You can use products developed for use on the face. Look for ingredients such as retinoids (retinol, retinyl propionate, and others), peptides, vitamin C, niacinamide, caffeine, grape seed extract, marine extract, and other antioxidants.

Question:
What can I use to tighten my skin? I am 66 and so far my skin only has a few wrinkles but I do not like the sag.
Answer:

You can try using drugstore products that contain ingredients like niacinamide, peptides, hyaluronic acid, and hexamidine that provide skin firming. If you would like additional firming benefits you could procedures such as Thermage or aluma which use radiofrequency energy for tissue tightening.

Question:
What are the best antioxidants to use? What products are the best for an anti-aging regimen?
Answer:

Vitamins C and E, acai berry, grape seed extract, marine extracts, among others. Products containing these antioxidants and ingredients like retinol, retinyl propionate, peptides, niacinamide, hexamidine and caffeine

Question:
I am 26 and I have started developing some wrinkles. I want to get rid of them, can you please help?
Answer:

The single most important treatment for your age group is proper sun protection. The majority of wrinkles, up to 90%, are caused by sun exposure. If you simply moisturize and use proper sun smart behavior, some wrinkles will naturally soften or disappear. The next step would be to look for products that contain retinol, retinyl propionate, tretinoin, retinoic acid.

Question:
What should I do to get rid of "brown spots" or "age spots"?
Answer:

Wear sunscreen of at least SPF 15 daily as UV exposure causes age spots. Products with ingredients like retinol, retinyl propionate, niacinamide, sepi-white, and n-acetyl glucosamine have been clinically proven to reduce the appearance of age spots. There are also excellent in-office chemical peels and laser treatments that your dermatologist can provide to dramatically improve the appearance of sun spots.

Question:
What type of lotion can I use to decrease my facial wrinkles?
Answer:

Look for ingredients such as retinoids (retinol, retinyl propionate, and others), peptides, vitamin C, niacinamide, caffeine, grape seed extract, marine extract, and other antioxidants.

Question:
I am in my mid-40s and would like to get rid of my wrinkles near the eyes. Which product do you suggest to be the best to get rid of them?
Answer:

I like products that contain retinol, niacinamide, peptides, and caffeine.

Question:
Is there a prescription that will remove wrinkles and age spots?
Answer:

The only prescription product available for wrinkles is renova. Retin A and Tazorac also work well and are stronger than renova, but they are FDA approved for the treatment of acne. The prescription product that works for wrinkles and age spots is Triluma. It contains tretinoin, 4% hydroquinone, and a gentle cortisone to minimize irritation. There are other prescription hydroquinone products available for age spots as well.

Thank you for joining us for WebMD Ask the Dermatologist. Be sure to come back on Dec. 9 at 11a.m. ET when we will discuss "The Truth About Sun Exposure." Sign up if you'd like an email reminder the day before our next event.

WebMD Ask the Specialist Transcript

Reviewed by Doris Day, MD on November 11, 2009

The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. 

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