A trip to the cosmetics counter says it all: Skin care is an ever-changing business. Last year's big news is this year's snooze as fresh products hit the shelves, promising to tone, tighten, and smooth better than anything that's come before. Here, the pros address your biggest aging concerns, tell us what's hot and what's not, and offer a glimpse of what the future might bring.
Old Think: We learned early on that squinting, frowning, even smiling can lead to expression lines. The first fix, Wrinkle Eradicators, arrived in 1889: What was merely tape to train muscles to stay relaxed quickly became a Hollywood secret and was later renamed Frownies. The self-adhesive pads are still sold today ($20 for 144 pads).
New Think: At home: Topical muscle-relaxing creams help reduce muscular contractions, leading to a subtle smoothing, says New York- and Miami-based cosmetic dermatologist Fredric Brandt. Look for GABA, found in 24.7 Skincare Smoothing Anti-Aging Moisturizer, $30; Argireline, in Therapy Systems Line Tox for Lips, $68; and Ameliox, in KaplanMD Perfecting Serum, $295.
At the Doctor's Office: So far, nothing beats Botox. Botulinum toxin is injected into the muscle to prevent it from contracting so wrinkles can't be etched into the skin. The smooth results last up to four months.
Future Think: A new way to relax! Dysport, approved by the FDA in May 2009, works similarly to Botox but is said to kick in a little faster (Botox takes a week to work its magic) and lasts a little longer. Bonus: "A little Botox competition might lead to a decrease in price," says dermatologist David E. Bank, M.D., director of the Center for Dermatology, Cosmetic and Laser Surgery in Mount Kisco, NY.
Old Think: For decades, going under the knife was just about your only option for sagging skin. "We tried heavy peels for a while," says Brandt. They would slightly tighten the skin but required two weeks downtime and caused hyperpigmentation, an uneven darkening of the skin.
New Think: At home: You know excess sugar is bad for your waistline, but we're now learning that it's bad for your skin too. Glycation — when glucose (sugar) attaches itself to collagen and other molecules, causing them to break down — contributes to sagging. Topical products that target glycation, such as Patricia Wexler M.D. Intensive 3-in-1 Day Cream SPF 30, $42.50, can help prevent sagging skin. Also, peptides that increase collagen production can help maintain firmness. Try Esteé Lauder Perfectionist [CP+] Wrinkle Lifting Serum, $80.
At the Doctor's Office: "If you look at young faces, they're not tight and pulled; they're round and full," says Bank. So dermatologists are plumping up skin by injecting fillers like Radiesse, made of calcium-based microspheres, into cheeks and between the nose and mouth. Also making waves: radio-frequency technology such as Thermage, which stimulates collagen production head to toe, creating a tightening effect on skin's surface. Good news: Thermage is a onetime treatment with zero downtime. You won't see results until four to six months later, but those results can last two or three years.
Future Think: Uplifting news: Dermatologists say we'll see fillers with thicker consistencies, better for creating volume. Coming soon to the United States: Restylane SubQ and Voluma, two thicker fillers currently used in Europe.
Old Think: Out, out, damned spot! Hydroquinone (HQ), a topical skin whitener, has been center stage for the last 50 years. But it's not without controversy: Some women with darker skin tones find that the ingredient actually darkens their skin, and most recently, the FDA listed HQ as a possible carcinogen.
New Think: At home: The search is on for a gentler, safer alternative to HQ. Botanicals such as mushroom extracts, kojic acid, mulberry root extract, and arbutin (found in cranberry leaf) are less effective than HQ, but they will lighten spots over time. Try Dr. Andrew Weil for Origins Plantidote Mega-Mushroom Treatment Lotion (with mushroom extract), $30; Lumecin Overnight Brightening Gluco-Protein Treatment (with mulberry root extract), $45; and Euoko W-00 Active Starch White Masque (with arbutin), $70.
At the Doctor's Office: Lasers target the pigment within the spot, making it scab up and eventually disappear (scarring is uncommon).
Future Think: "My wish is that everyone would wear sunscreen religiously so they wouldn't get brown spots to begin with," says Bank. As for those existing spots: "I'm hoping for a laser that works instantaneously, so you won't have to go through any scabbing," he says.
Fine Lines and Wrinkles
Old Think: When acne medication Retin-A hit the market in the 1980s, doctors started noticing an unexpected side effect: fewer wrinkles. Since then, retinoids (derivatives of vitamin A) have been a top choice in fighting lines and wrinkles. Unfortunately, accompanying irritation and dryness makes it a tough topical to stick with.
New Think: At home: Topical creams made with silicone and mica particles fill in wrinkles like spackle — at least until you wash them off. Try Olay Regenerist Filling + Sealing Wrinkle Treatment, $20. For long-term smoothing, retinol, an over-the-counter retinoid, is more potent than most topical creams yet less irritating than prescription retinoids, thanks to amped-up formulas that keep the molecule stable and provide a slow time-release function, explains Bank. Try L'Oréal Paris Advanced Revitalift Anti-Wrinkle Concentrate Clinical Action, $17, and Neutrogena Healthy Skin Anti-Wrinkle Intensive Night Cream, $17. Another new approach: combining ingredients that stimulate skin-supporting collagen, such as peptides, with antioxidants that protect the skin from wrinkle-inducing environmental damage. "Until recently, products didn't prevent new damage while the repair was taking place," says Bank. Try iS Clinical Super Serum Advanced, $130, with antioxidant vitamin C and collagen-stimulating copper; and SkinCeuticals Phloretin CF, $150, with vitamin C, ferulic acid, and collagen-boosting phloretin, a root-bark ingredient.
At the Doctor's Office: Injectable fillers literally fill in wrinkles. The most popular are hyaluronic acid fillers (HAs) such as Restylane, Perlane, and Juvéderm. HAs bind with water in the skin to create volume that lasts for six to 12 months.
Future Think: Combining powerhouse topical ingredients to work synergistically is a trend that Stuart Kaplan, M.D., a Beverly Hills-based dermatologist, thinks we'll see more of. "Your skin cream will become like a multivitamin," he explains. Up next in fillers? HAs that also contain lidocaine or novocaine, to limit the ouch factor — a common complaint of those injectable fillers.
Old Think: We've tried every trick, from going on anticellulite diets to applying Preparation H, but those dimples are tough to treat. Even liposuction couldn't nix those pesky fat cells trapped between the fiber bands that connect the skin's tissue. Mechanical massage treatments such as Endermologie work but require regular maintenance.
New Think: At home: Circulation-boosting ingredients such as caffeine can temporarily reduce water retention, making cellulite less prominent. "Ingredients that plump and firm the top layer of the skin can decrease the appearance of cellulite too," says Kaplan. Try Orlane Slimming Contouring System, $150, or Bliss fatgirlslim, $29.
At the Doctor's Office: New treatments such as VelaShape and SmoothShapes combine radio-frequency technology and lasers to tighten skin and break down fat, reducing the appearance of cellulite.
Future Think: Turns out, cellulite smoothing is an unexpected side effect of the skin-tightening procedure Thermage, so a cellulite-specific version could be next. Bank also says that ultrasound technology, available only in Europe, looks promising.
Old Think: Prescription drugs Retin-A and Accutane were the early heroes in serious acne care. But at-home products were designed for teenage skin — too harsh and drying for adults.
New Think: At home: Salicylic acid is still the best, says Brandt. But add retinol and you're getting some antiaging help too. There are also treatments targeted for adult skin, with moisturizers and natural anti-inflammatories. Try Murad Moisturizing Acne Treatment Gel, $43, with salicylic acid, retinol, and chamomile extract.
At the Doctor's Office: Isolaz combines a suction-like device to deep clean pores and an intense pulsed light laser to kill acne-causing bacteria. Atralin Gel, a new topical retinol, is less irritating thanks to the addition of moisturizers and humectants. And Solodyn Extended Release Tablets, a new oral medication, has none of the nauseating side effects of previously used antibiotics
Future Think: Brandt speculates that we'll see new antibacterial lasers and continue to see less irritating forms of topical retinoic acids.
Old Think: Making lips look bigger with lip liner was our only hope until the early '80s, when bovine collagen injections hit the scene. But results lasted two to three months at best — and many people were allergic to it. Around 2002, human collagen injections were introduced (thanks to bioengineering). No more allergic reactions, but longevity was still a problem. We also saw a ton of topical lip plumpers that temporarily swelled lips with irritating ingredients — ouch!
New Think: At home: A new reason to smile? Topical treatments are moving away from painful plumping and toward an antiaging approach. Peptide technology, antioxidants, and topical hyaluronic acids can help smooth lip wrinkles and plump slightly over time. Try Blistex Deep Renewal, $3, and Nivea A Kiss of Rejuvenation Anti-Aging Lip Care, $4, both with antioxidant CoQ10. Also try Peter Thomas Roth Un-Wrinkle Lip, $30, with peptides.
At the Doctor's Office: HAs picked up where collagen fell short — lasting six to 12 months with no risk of allergic reactions. Studies even suggest HAs might encourage your own collagen to grow over the long haul.
Old Think: Concealer was your best bet for years. Under-eye creams that contained vitamin K showed promise by constricting dilated blood vessels (which cause the shadowing effect), but the vitamin was found to be unstable and tough to deliver topically.
New Think: At home: The first line of defense is to re-plump the skin around the eyes. As we age, we lose the fat under the eyes, which makes dilated blood vessels look more prominent. Retinol and other peptides thicken the skin. Brandt adds that creams with caffeine can help temporarily shrink dilated blood vessels. Try Dr. Brandt Skincare r3p Eye, $80, or Lancôme High Résolution Collaser-5X Eye Serum, $59. Another bright idea: More stable forms of vitamin K are being paired with new delivery systems to help it penetrate better. Try Auriderm Illume Eye Creme, $50. At the doctor's office: Once again, it's fillers to the rescue. HAs such as Perlane and Restylane fill in the hollow under the eye. The blood vessels can also be sealed with lasers such as the Vbeam. Finally, Thermage recently introduced a handheld device to tone, tighten, and stimulate collagen around the eyes, which will plump the area.
Future Think: Bank suspects we'll see one machine that would do the work of lasers and radio frequency — zapping blood vessels, tightening skin, and stimulating collagen — in a single treatment.
Old Think: We learned that pore size was genetically determined. (Darn!) However, dirt, debris, and even sun damage can stretch pores. For decades, dermatologists have turned to chemical peels (glycolic and salicylic acids) to unclog pores. They've also prescribed the antiacne medication Accutane, which shrinks pores by reducing oil glands, but controversy about the drug's safety (it's been linked to birth defects, depression, and suicide) has made that a less popular option today.
New Think: At home: New delivery systems for salicylic acid help it penetrate deeper into the pores. Try AvonAnew Rejuvenate Night Revitalizing Cream, $32. Products with peptide technology strengthen skin around pores so they won't be permanently stretched. Try DDF Wrinkle Resist Plus Pore Minimizer, $85, a serum that also contains vitamin B3, said to increase cell renewal, and light-reflecting microparticles for an immediate fix.
At the Doctor's Office: Chemical peels are still number one. But Bank has also seen a reduction in pore size from Photodynamic Therapy, an acne treatment during which an antibiotic ointment is applied to the skin and accelerated with a light source. Brandt also uses non-ablative lasers (lasers that don't visibly disrupt the surface of the skin) to tighten the skin surrounding the pores.
Future Think: Doctors hope for a safer oral medication. "If there were some way to modify Accutane to get benefits without the questionable side effects, that would be phenomenal," says Bank.
Originally published on September 18, 2008