In the latter 1800s, Scarlett O’Hara and her kindred Southern belles wouldn’t dream of stepping outside without a bonnet to shield their "magnolia white skin" from the sun. By the time Malibu Barbie came along in the 1970s, a pale complexion was gone with the wind. Tans were seen as a sign of health and even wealth (as in time spent in St. Tropez).
But that "glow" came at a price: damaged skin. According to the American Academy of Dermatology, at the current rate of diagnoses, one in five Americans will develop skin cancer in their lifetime. And the Skin Cancer Foundation reports that 90 percent of all skin cancers are caused by sun exposure.
"Sun damage has become more prevalent in the last 20 years because the ozone has disappeared," says Rancho Mirage cosmetic surgeon Mark Sofonio. With that loss of protection against UV rays comes a loss in collagen, the protein that provides structure to our skin. "Once you have sun damage, the UV light gets into basal cells and mutates them," Sofonio says. "If you get more and more sun damage until there is no collagen left, all you have is an empty platform of skin that cannot regenerate."
Fortunately, with some collagen on the platform, it’s possible to repair deterioration caused by UV exposure.
THE LIGHT TOUCH
"Your skin has the natural ability to repair itself, and that is the exciting part of good skincare," says Pat Riley, founder and president of Florida-based Clientele. "Give your skin what it needs and the skin’s own stem cells and natural repair mechanisms will help it renew and rebuild."
Riley recommends looking for the following ingredients in skincare products: palmitoyl oligopeptide, palmitoyl tripeptide-5, palmitoyl pentapeptide-4, palmitoyl tetrapeptide-7, hexapeptide-9, acetyl hexapeptide-8, rice peptides, coenzyme Q10, carnosine, superoxide dismutase, thiotaine, and resveratrol. Avoid synthetic fragrance, synthetic hormones, and synthetic dyes. She bases her line of skincare products on natural ingredients (i.e., extracts of grape seed, algae, tomato, rice, goji, alfalfa, ginger root) and patented the use of lotus seed extract in Clientele formulations. Most recently, she introduced a Gravity Control System that combines LED light therapy with a peptide serum to activate the sirtuin (protein) gene for cell longevity and help prevent collagen breakdown.
"Extensive sun damage can be difficult to repair, but the new FirmaLight LED light therapy can boost collagen and elastin and even skin tone," Riley says. "For more dramatic repair of damage, dermatologists and skincare professionals are using lasers to achieve success."
They’ve proven valuable as weapons in sci-fi flicks, to enhance Pink Floyd concerts, to scan barcodes, and for PowerPoint presentations. But as Riley notes, lasers have become an important tool in the arsenal of aestheticians, dermatologists, and cosmetic surgeons. As Sofonio explains, "injuring" the skin forces it to regenerate.
"The traditional way of injuring skin was dermabrasion, sanding off the top layers," he says. "The problem is it’s hard to sand a table and get it where you want it, within micrometers; it’s harder to do with skin.
"In the 1960s and ’70s, peels came out, but they were hard to control. Skin is deeper in some areas than others: 1,000 microns around the mouth and 200 around the eyes," he explains. "When the CO2 laser came out [as a skin resurfacing tool], it was totally revolutionary. Technology caught up with what we needed."
According to Sofonio, the latest technology is the Fraxel (fractional skin resurfacing) CO2 laser, which vaporizes the top layer of skin. But it is far from the only option. There’s also intense pulsed light, which superheats the skin. As for topical products, those with retinols, alpha hydroxy acids, and antioxidants that stimulate the skin to make new collagen can be found in over-the-counter and prescriptionstrength formulas. You can even use them in conjunction with each other, for example Retin-A (a high concentration of retinol) in the evening and an AHA product during the day.
"The most important thing if you are interested in skincare is to meet with some kind of skincare professional and stick with it," Sofonio advises.
BY THE LETTERS
Dr. Ronald Moy, a dermatologist and cosmetic surgeon in Beverly Hills and president of the American Academy of Dermatology, has developed a line of products with DNA repair enzymes engineered from marine and botanical sources and epidermal growth factors synthesized from barley grown in Icelandic waters and volcanic pumice soil.
"All other EGF is made from bacteria, making it less stable in creams," he says. His DNAEGF Renewal lotion also includes extracts of rosemary, rice, wheat, lavender, and hibiscus. According to Moy, the lotions can repair sunburned skin, as well as sun damage accumulated over time.
"DNA repair research is the newest area of research in anti-aging and prevention of cancer, replacing the antioxidant, free-radical research," Moy says. "Nanotechnology will allow particles to go deep into the bloodstream instead of staying within the skin."
Sun damage is basically oxidated stress, says Richard Foxx, founder and medical director of The Medical and Skin Spa at Agua Serena in Indian Wells. "It creates free radicals in the cells and breaks them down."
Topical application of vitamins C and E protects against oxidated stress, but can’t repair already damaged skin. And though exfoliation stimulates the production of new collagen, Foxx says, "it can get to the point where collagen is so damaged that it can’t repair itself."
While snakes shed dead skin cells in one continuous sheet, leaving behind a papery shell, humans shed skin cells continuously in small quantities. People in their 20s and 30s get a new face, so to speak, every two to three weeks, Foxx says, while the natural exfoliation cycle for people in their 50s and 60s is in the seven- to eight-week range. The Medical and Skin Spa offers dermal planning (scraping dead cells, bacteria, and oils), typically done every two months to maintain the improvements made to the skin after other procedures.
Those procedures include intense pulsed light, which "explodes" pigment cells and brings them to the surface, where they can be brushed away. Like Sofonio, Foxx points to Fraxel as the best new laser technology. "It vaporizes dots of tissue, 20 percent of the skin, on each treatment, typically three to four weeks apart," he says.
At the end of 2010, Foxx introduced a spectrum of organic products developed over the past two years with David Parker, owner of The Body Deli in Palm Desert. Additionally, he says, "Retin-A products should be an integral part of all skincare. But apply it in the evening, because UV light inactivates Retin-A."
Foxx notes that lasers significantly change the texture and color of skin in eight weeks; products typically take 12 weeks for similar results.
"You can go into a store and find a lot of products that are OK and won’t hurt you," Foxx says. "To really individualize procedures for your face, you should sit down with a professional in an aesthetic medical office."
NO QUICK FIX
"A lot of sun damage can be repaired. The question is how aggressive you want to be," says Palm Springs plastic surgeon Scott Aaronson. "Creams and lotions very, very gradually take off the top layer of dead skin. To go faster, you have to do it with some means of scraping, burning, or chemically treating the skin. With lasers, you are going deeper by vaporizing the superficial layer." Faster processes require recuperation time, are more expensive, and cause more alteration in skin color.
While Aaronson questions the claims of many face creams that they stimulate collagen, he does agree that glycolic acids (AHAs) aid in getting rid of superficial sun damage and that Retin-A is among the most effective ingredients. He combines Retin-A and hydroquinone, which bleaches hyperpigmentation (brown spots) caused by sun exposure. "The Retin-A irritates the skin and allows hydroquinone to get in deeper," he says. "If you use Retin-A by itself, it makes the brown spots worse, because it leaves your skin more susceptible to the sun."
"A significant amount of clinical sun damage (brown spots, wrinkles, sallow complexion) can be repaired. However, some of the molecular damage may not be reversed, and this damage tends to accumulate over time, resulting in skin cancers later on," says Dr. Pamela Broska of West Dermatology in Rancho Mirage. Treatments include topical treatments, cryotherapy using liquid nitrogen, photodynamic therapy in which a solution is applied to the skin and then activated by blue light, chemical peels, laser resurfacing, and mirodermabrasion. Some procedures require a series of treatments to achieve the desired final results, and some have longer healing times.
Broska offers products that include glycolic acid, retinoic acid, vitamin C, and antioxidants. She also offers sunscreens for sensitive skin, acne-prone skin, and in combination with skin-rejuvenation products.
Statistics show that approximately 80 percent of all sun damage occurs before the age of 18," says Rancho Mirage plastic surgeon Dr. David Morrow. "This damage does not become apparent in the form of lines, wrinkles, poor texture, and brown spots until years later. But rest assured, the damage is there. Unfortunately, not every patient who delays treating sun-damaged skin will escape with just one skin cancer. Fifty percent of people who develop a basal-cell carcinoma will develop another basal-cell skin cancer within five years."
Morrow urges using a broad-spectrum sunscreen every day and using products with Retinol, which accelerates cell turnover; Lascorbic acid (vitamin C), which inhibits the release of free radicals and promotes collagen production; glycolic acid, which reduces the thickness of the outer layer of dead skin and promotes cell turnover; and CoQ10, which generates energy in the skin cell and neutralizes free radicals. Aesthetician treatments can enhance the effectiveness of topically applied skin preparations and stimulate blood flow to the skin and the turnover of skin cells.
Morrow’s first choice for reversing photo aging for most patients is a skin peel. "A well-designed and executed skin peel will accomplish in a few days what might take weeks and months to accomplish with several different lasers and at a fraction of the cost, with virtually no pain and no scarring," he says. The down side is a longer recovery period.
"The single-most effective prescription skin product to reverse photo aging is tretinoin [Retin-A and Renova]. When looking under the microscope at skin samples before and after the use of tretinoin, the results are truly remarkable," Morrow says. "Hydroquinone is at its best for bleaching brown spots when combined with tretinoin, L-ascorbic acid, and another active ingredient called kojic acid."
The Morrow Institute sells is own line of skincare products, Skin ReSource, that incorporates botanicals, homeopathic remedies, and L-ascorbic acid and this fall will launch MorrowMD, which includes an at-home skin peel system, as well as a glycolic cleanser, skin renewal serum, and broad-spectrum sunscreen.
No one technique addresses all sun damage, Morrow says, adding that each form of damage needs to be addressed according to an individual’s skin type and color and the extent of damage. "Surprisingly, just using a broadspectrum sunscreen every day helps to reverse sun damage," Morrow says. "When skin is not busy trying to defend and protect itself from exposure to UV light, it can turn its energy into renewing itself."
According to the American Academy of Dermatology, indoor tanning increases a person’s risk of melanoma by 75 percent.
"I have had patients — young women with a history using tanning beds — who have died from melanoma," reports academy President Ronald Moy. In a 2011 AAD survey among teen girls and young women, 32 percent of respondents had used a tanning bed in the past year and 25 percent used one at least weekly on average.
More than 30 states have enacted legislation prohibiting or requiring parental consent for indoor tanning by minors. California’s Filante Tanning Facility Act of 1988 prohibits anyone younger than 14 from using ultraviolet tanning devices and requires parental consent for those between 14 and 18 years of age. Senate Bill 746 (placed on the Appropriations Suspense file in May) would remove the consent option, raising the age prohibition to 18.
The American Academy of Dermatology reports that melanoma rates have been increasing for at least 30 years and is the most common form of cancer for those 25 to 29 years old and the secondmost common form of cancer for those 15 to 29 years old.
A WORD TO THE WISE
Listen to aestheticians, dermatologists, and cosmetic surgeons and you’ll swear their word-a-day calendars bear the same nine letters on each page: sunscreen.
"Do not start [using skin-resurfacing products] unless you are willing to protect your skin from more damage," says Dr. Mark Sofonio.
Make sunscreen part of your daily routine," says Dr. Pamela Broska. "Use an SPF of 30 or higher, and apply a generous amount. Don’t forget to wear lip balm with sunscreen."
Look for both UVA and UVB protection in a sunscreen. As Broska explains, UVB rays penetrate the outer layer of skin, damaging skin cells, and are the primary cause of sunburn. UVA rays can pass through windows and penetrate deep into the layers of skin, contributing to premature signs of aging. Both play a part in the formation of skin cancer.
A product that claims UVA and UVB protection and does not specify "broad spectrum" may provide as little as 5 percent protection from UVA light.
According to Broska, sunscreens that block UVB rays are composed of some or all of the following chemicals: octyl methocinnamate, padimate O, octyl salicylate, homosalate, benzophenone, phenylbenzimidazole sulfonic acid, and octocrylene. Broad-spectrum sunscreens add oxybenzone or avobenzone (Parsol 1789) to block UVA rays. Mexoryl, helioplex, and ecamosule also block UVA rays. Titanium dioxide and zinc oxide are physical blocks that reflect the sun’s rays and protect against UVA and UVB.
"No matter what you do to help your skin look and feel better, it won’t last or even work if you do not practice ‘safe sun,’" says Dr. David Morrow. "That means using sunscreen every day. That means no tanning booth."