The Dos and Don’ts when Caring for Aging Skin

Featured image
Rembrandt's An Old Woman Reading, 1655. The National Gallery, London; © The Buccleuch Collection.

My Apple News feed bombards me with articles about anti-aging products and procedures. The algorithms know me so well.  Never mind that those pieces feature photos of dewy 20-something skin and never mind that I find the term “anti-aging” somewhat offensive.  If the past year has brought anything into sharp focus, it’s that getting older is a privilege.  May I suggest “pro-aging” instead?

Board Certified plastic surgeon, Dr. Jackie Yee.

Fashion designer, Norma Kamali, in her new book, I am Invincible, prefers to think of it as aging with power, asserting that “each decade in a woman’s life teaches and informs her ability to reach her potential.”  I’m going with that. For purposes of this article, though, I will stick to the conventional terminology.

Of course, strength and self-esteem are universally attractive attributes.  But still, what if the mirror doesn’t reflect your inner youth and energy?

Menopause, stress and the passage of time, after all, are not kind to the complexion.  Fortunately, there is no shortage of products and procedures as the beauty industry is waking up to the superior spending power of the 50+ generation.  Below, a plastic surgeon, a dermatologist and an esthetician proffer their advice on how to put your best face forward not just in mid-life, but at any age.

“Because I’m 50, how about I talk about the things that I do?” begins plastic surgeon Dr. Jackie Yee.  From a topical standpoint, adequate sunscreen and exfoliation are a must.  The latter can begin simply with a glycolic or salicylic acid, eventually graduating to a stronger retinol and ultimately, a prescription-strength retinoid.  “A retinoid will always be helpful,” says Dr. Yee, “regardless of all the new products that come in and out of the market.”

The award-winning Alastin skincare line contains a blend of peptides and active botanicals which work to clear out damaged elastin and collagen while supporting the skin’s natural ability to restart the collagen and elastin-building process. “So, it’s going to help you with luminosity. It’s going to help you with brown spots. It’s going to help you with texture,” says Dr. Yee.

Also tried and true is hydroquinone, according to Dr. Yee, citing it as the enduring standard of care in treating spots, melasma and “mitigating all the discolorations.” When it comes to newer products, there’s the Alastin skin care line.  Greatly favored by the plastic surgeon (and many of her patients), the line’s creams and serums encourage the renewal of elastin and collagen on the face and body.  There’s a lot of science and a lot of active ingredients behind it, according to Dr. Yee, who uses its products on her neck and under her eyes.

As for devices, “what I am in love with and absolutely swear by and use on a monthly basis is a laser called Clear + Brilliant,” reveals the plastic surgeon. This gentle re-surfacing treatment targets early signs of facial aging and sun damage by creating microscopic treatment zones in the upper layer of skin which in turn, stimulates collagen production and removes dead cells. It also minimizes pores. “Plus,” adds the plastic surgeon, “it’s great for darker skin types such as mine and for those who have to deal with melasmaand are always concerned about getting hyperpigmentation from too strong a setting or heat on the skin.”  An additional benefit is the lack of downtime.

Before Clear + Brilliant.
One week post six treatments of Clear + Brilliant. Photos:

And that’s not all. Dr. Yee is also excited about a brand new upgrade to the device. Capable of utilizing multiple wavelengths, the Clear + Brilliant Touch uses different settings to address a host of issues.  “So in addition to treating the melasma on my face, I can also use a different setting for my pores, my fine lines, that I couldn’t previously,” explains Dr. Yee. “You can really tailor the treatment by adding on the neck, the hands and things like that.”

What about below the neck?  What weapons are there in the beauty arsenal to combat signs of aging on the body?  Staying moisturized and hydrated tops the list for Dr. Yee who also lists radiofrequency and ultrasound collagen-stimulating treatments like Thermage and Ulthera.  Additionally, there are dermal fillers.

Before and After photos of a 55-year-old patient whose hands Dr. Yee injected with Radiesse.

Usually associated with the face, injectables like Sculptra and Radiesse are used off-label on the body to render the skin denser, thicker and more elastic.  That’s because they are bio-stimulatory, meaning that they work by creating new collagen.  The “filler” is the fresh collagen that forms in response to the injectable.  The product itself is quickly metabolized by the body.

Board Certified dermatologist, Dr. Mark Nestor.

By contrast, other types of filler like Juvederm, plump tissue by remaining under the skin. “You don’t want your knees to get fuller,” points out Dr. Yee.  “You want your knees to get less crepey.” In addition to the area above the knees, these formulas are also used on the upper arms, chest, buttocks and hands.  While results are not instant, they are relatively long-lasting — upwards of 24 months for Sculptra and a minimum of a year for Radiesse.

The most important anti-aging measure for dermatologist Dr. Mark Nestor is sun protection. In Florida, where he is based, Dr. Nestor recommends an SPF of 100 “because the sun is so strong and it’s impossible for individuals to reapply sunblock the way they’re supposed to.  The highest SPF allows you to apply it less often,” explains the dermatologist.

When it comes to the types of sunscreen — mineral vs. chemical — Dr. Nestor recommends the former which acts like a shield, deflecting the sun’s rays, rather than the latter which gets absorbed by the body.

It is important to note, however, that photoaging is not only caused by the sun’s UVA and UVB rays, but also by visible, i.e. colored light.  Visible light, like the blue light emitted by computer screens, tablets and smartphones, breaks down collagen and affects pigmentation exacerbating conditions like brown spots and melasma.

Emerging studies show that blue light can damage skin cells, resulting in faster breakdown of collagen and elastin. It can also cause changes in pigmentation.

Mineral sunblock in and of itself, doesn’t always block blue light, warns the dermatologist.  “Oftentimes, you need a pigment in there.”  That is why he recommends a tinted sunblock.

La Roche Posay Anthelios Ultra-Light Tinted Mineral Sunscreen SPF 50 is one of several tinted mineral sunscreens on the market.  Dr. Nestor advocates using a tinted sunscreen to combat the skin damage caused by blue light from computer and phone screens.

Left: La Roche Posay Anthelios Ultra-Light Tinted Mineral Sunscreen SPF 50 is one of several tinted mineral sunscreens on the market. Dr. Nestor advocates using a tinted sunscreen to combat the skin damage caused by blue light from computer and phone screens.
Right: Dermend Moisturizing Bruise Formula.

Another consideration is the skin quality of many older individuals.  “A lot of them are on blood thinners, on aspirin, and they get a lot of purpura [bruising under the skin],” says Dr. Nestor.  And for this, “there are some over-the-counter topicals like Dermend that can help with bruising and some of the sun damage on the arms and legs.”

Sun protection can also be effectuated internally, with anti-oxidant supplements like Heliocare playing an important role.  Available both over the counter and by prescription for a more potent version, “Heliocare is the one I recommend because it has the most data associated with it,” reveals Dr. Nestor who takes it every day for its “very strong anti-skin aging, anti-oxidant and cancer-fighting properties.  Taken regularly, it does prevent sun-associated damage.”

Heliocare skincare dietary supplement.

After sun protection, moisturizing is the second most important step in skin care, according to Dr. Nestor.  To that end, he advocates using a very mild soap, like Dove for sensitive skin.  Make up removal too should be carried out with products that are as gentle as possible.

When it comes to topicals for the face, as with Dr. Yee, Dr. Nestor is a proponent of retinoids.  Retinoids like Tretinoin and Differin “have been tested and looked at the most for their long-term benefits.”  Of the different brands available, it is a relatively new over-the-counter retinoid which Dr. Nestor favors. “One of the big things that has changed is Adapalene which is Differin that went over-the-counter at 0.1% a couple of years ago,” reveals Dr. Nestor.  “It’s inexpensive and I very often recommend it to my patients who have been using tretinoin and the like, to switch to Adapalene or Differin.  You can use it once a day.  It’s an active medicine which definitely has really good efficacy as anti-aging.”

Adapalene Gel topical retinoid.

And what about crepey skin on the arms and legs?  There are multiple treatment options to tighten the skin, according to Dr. Nestor.  There are fractional CO2 and erbium lasers and microneedling with radio frequency.  “It won’t give you perfect skin, but it’s certainly something that can improve the appearance.”

A treatment that Dr. Nestor greatly favors both for the body and the face is IPL or Intense Pulsed Light.  IPL therapy uses intense wavelengths of light to penetrate the skin, activating the body to begin a natural healing process, thereby triggering collagen production.  It can improve the appearance of sun damage, acne scars, spider veins, lines and wrinkles.  Approximately five treatments are needed in order to experience optimum results.

Photo rejuvenation with IPL: “For a lot of people who have discoloration from the sun, have blood vessels, but don’t have a lot of deep lines, photo rejuvenation or IPL works incredibly well. The results in long-term studies are probably better for IPL than anything else,” says Dr. Nestor. “There’s a good study published that showed individuals who have a series of treatments and then have one to two treatments a year, if you look back after 15 years, virtually all of them, their skin looks better 15 years later than 15 years before because it’s constantly building collagen. It’s a great anti-aging treatment and it’s easy and patients don’t have a lot of downtime. It’s a mainstay of one of the treatments we do.”

Surprisingly for me, one product which neither doctor endorses is Vitamin C, oft-touted for its anti-oxidant, skin brightening effects. “I personally have issues with Vitamin C.  All versions that I’ve used, I developed acne.  So, I don’t speak highly of them,”  says Dr. Yee.  Dr. Nestor’s lack of enthusiasm rests on the fact that there haven’t been many good comparative clinical studies showing efficacy.  “The bottom line is that there are a lot of variations and there just isn’t the data for me to recommend Vitamin C.,” says the dermatologist.  “There are other things that work better like retinoids.”

Chrissy Nucci, esthetician at Eternal Hair & Esthetics medical spa: “We are not just skin. We are human beings. To have good skin, your body needs to be in balance because your skin is a reflection of everything you put inside your body.”

“When I think about rejuvenation, I think about integrative health,” says esthetician, Chrissy Nucci.  “In other words, everything depends on your health and your lifestyle.  If you want to slow down the aging process, you have to eat healthy, supplement your body with vitamins, drink water, sleep well, stress less, avoid sugar, use sunblock, exercise and use good cosmetics on a daily basis.”

Beauty starts from within for the esthetician and for this reason she is a proponent of nutraceuticals.  A broad umbrella term, nutraceuticals is used to describe any product derived from food sources with extra health benefits in addition to the basic nutritional value found in foods.  This includes a wide array of agents such as dietary supplements, herbal supplements, vitamins and fortified foods.  Hydrolized collagen, which has been broken down into smaller, easy-to-process particles is best, says Ms. Nucci, especially a type of patented collagen peptide called Verisol.

trunature Verisol hydrolized collagen powder — one of several collagen brands containing Verisol.

But, ingesting collagen isn’t enough to optimize its production by the body, cautions the esthetician.  “You have to make sure that the minerals in your body — like zinc, magnesium and selenium are in balance — because they are the basis for building collagen.  If you don’t have adequate amounts, your body won’t produce collagen.”

Procedure-wise, Ms Nucci recommends chemical peels.  They generate cell turnover, resulting in a glowing complexion.  But, there’s no need to overdo it, she says, explaining that today’s peels have a pH balance that is close to your own skin’s, so they don’t cause inflammation but still deliver results. “A lot of patients, if you don’t peel off the skin, they will feel the treatment isn’t effective,” says Ms. Nucci.  “But that’s not true.  You don’t have to be home for seven days.  There’s no down time and you still get the benefits.  That’s our approach here and that’s my approach.”

In the end, despite the myriad procedures and products, whether you’re 25 or 65, perhaps self-acceptance is the best beauty tool of all.  “If you look in the mirror and you like what you see, you will give off a different energy,” counsels Ms. Nucci.  The most important thing, she says, is to embrace the way your skin changes as you grow older.  “So, maintain realistic expectations and love yourself.” Aging with power indeed.

Beauty tips

Dr. Jackie Yee:  Let’s not forget surgery.  There are some cases where people are either doing too much for their skin, getting too many injectables and really, ultimately, surgery may be the thing.  And the reason I say all this of course, is because I’m a plastic surgeon.  I think it’s a spectrum.  You can spend a ton of money on surgery, but if you have bad skin, it doesn’t look good and vice versa.  You can spend a ton of money on your skin, but if you really need surgery, that’s not going to look good.  It depends on everyone’s anatomy and what would make them look their best.

Dr. Mark Nestor:  For the body, what I tell my patients here in Florida and what I use, is sun protective clothing.  There are garments like fishing shirts made by the sportswear company, Columbia.  If you wear it, you don’t need any SPF and it also keeps you cool.  That’s something that I think people don’t look at enough and it really makes a big difference.

Chrissy Nucci:  If you’re under 40, I don’t recommend that you take collagen.  The reason is that your body will recognize it and stop producing it.  Also, take collagen supplements at night because your body will metabolize it better when it is resting.  In the morning, you’re going to waste it on something else – energy, etc.  Night time is ideal.

Dr. Jackie Yee:  On menopause — the effects range from subtle to severe.  The worst aspects that I most commonly see or treat are thinning of the skin resulting in increased crepiness, acne formation, and dryness.  Some patients opt for oral hormone replacement.  But the options that I recommend are topical Retin-A, Sculptra injections, Thermage and increasing the emollience of their moisturizers.

Dr. Mark Nestor: Movement-associated lines are also something that occurs with age and obviously, a botulinum toxin like Botox, Dysport or Xiomin can help prevent deeper lines and can also have some very interesting additional benefits.

“I just published a review of studies about something called emotional anatomy.  What that means is that when you use a toxin to treat the frown lines and you don’t frown, you feel happier.  It’s been shown very clearly that depression goes down, in fact they’re using it to treat depression, as well as other negative attributes, and people feel happier.

“But, if you treat the crow’s feet area — the smile lines — it actually cancels that out and you don’t feel as happy.”

For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn.

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