There are photos indicating wrinkles, pores and texture, but as the aesthetician pointed out, it’s the sun damage view that most people dread. Given my decades of sun worship, long before most folks really understood how deadly those lovely rays could be, I shouldn’t be surprised that the image looks ravaged.
Of course, it’s not just the sun that causes the dark spots, sagging, wrinkles and overall aging. But physicians say cumulative sun exposure certainly speeds up the process.
The good news? With the right treatments, some of those negatives can disappear.
But consumers beware.
Americans spend billions of dollars on anti-aging creams, lotions, serums and more. Flip through any lifestyle magazine and there are oodles of ads for products with fancy ingredients promising dramatic results.
Skin doctors say most are a waste of money.
“There’s a lot of information out there that can lead people astray,” said Dr. Evelyn Vanderveen, who has been practicing dermatology in Grand Rapids since 1985.
“Back when I was finishing my residency at the University of Michigan, I went to a makeup counter in a department store to see what they would suggest for around my eyes, a very delicate area.”
She purchased a pricey cream and applied it religiously. Later she was describing the product to a research chemist at the university. “He told me, ‘Evelyn, it won’t do a thing for you.’ That experience instilled in me a goal to help my patients be savvy consumers.”
While dermatologists and plastic surgeons have an arsenal of treatments — from peels and microdermabrasion to lasers and facelifts — most say there’s one thing everyone should do on a daily basis: apply sunscreen.
It’s the No. 1 defense against ultraviolet sun rays that can cause everything from skin cancer to premature aging. What’s more, it’s easy and inexpensive. Yet most people either don’t apply it at all or don’t apply enough.
“People in Michigan tend to think they only get damage when the sun is out,” said Bengtson, who heads up the Bengtson Center for Aesthetics and Plastic Surgery. “That’s simply not the case. The UV rays that damage skin can penetrate clouds, so it’s important to wear sunscreen every day all year round.”
Physicians say it’s the chronic and repetitive exposure to UV rays that adds up over time — with most damage occurring before the age of 18.
“It just doesn’t show up until later in life,” said Dr. Robert Lamberts at Dermatology Associates of West Michigan. “Just walking to your car every day adds up. It’s all cumulative.”
An excuse he often hears from patients — especially men — is that they always wear a shirt and hat at the beach so they don’t need sunscreen.
Dr. Bradley Bengtson, at the Bengtson Center for Aesthetics and Plastic Surgery, discusses the results of a VISIA complexion analysis with Macy Durry. The machine identifies skin conditions topically and subsurface.
“Unless it’s a very tight weave, a shirt doesn’t block the UV rays,” Lamberts said. “Wearing a hat doesn’t help because you’re still getting reflection from the sand and water, and that’s just as bad.”
Parents need to be diligent about applying sun block to their children and making it a daily routine, like brushing teeth.
“Back in the ’80s when I started researching sun damage, sunscreens weren’t very elegant,” Vanderveen said. “They were heavy and fragrant.”
Today the choices are numerous, from tinted moisturizers and oil-free options to heavy-duty waterproof lotions. Look for a product labeled as broad spectrum, meaning it protects against both UVB and UVA rays.
UVB are the ones that cause sunburn and reddening and once were thought to be the most dangerous. Researchers now believe UVA — the dominant tanning rays — penetrate skin more deeply and are the ones that cause aging, wrinkling and lead to the development of skin cancers.
Also key is using a sunscreen with at least a 15 SPF, preferably 30, the experts say.
“Since most people don’t reapply sunscreen, the higher number offers more protection,” Vanderveen said.
For those folks who spend a lot of time in the sun, whether working in the garden or playing on the beach, it’s essential to keep applying sun block every few hours.
“Another misconception I hear is that if you wear a sun block, you can’t tan at all,” Bengtson said. “Not true. Sunscreen simply blocks the harmful UV rays.”
Dermatologists say they also hear concerns about getting enough vitamin D.
Since the body only makes vitamin D when the skin is exposed to UVB rays and few foods supply enough, patients worry that wearing sun block will leave them deficient.
“It’s an understandable concern, especially in Michigan,” Vanderveen said. “The best thing to do is have your doctor test your blood levels to determine if you have enough vitamin D. If you’re low, oral supplements are safe.”
So what can you do to keep skin looking good and stave off the inevitable wrinkling, brown spots and more? Local physicians were unanimous in recommending Retin-A or other brands of tretinoin, the acid form of vitamin A, also known as retinoic acid. Applying it nightly helps increase cell turnover, meaning it does some serious exfoliation and allows new cells to come to the surface. This prevents clogged pores and fine lines, and it even fades dark spots.
At less than $50 for a tube, it sounds like a miracle.
Alas, there’s a catch.
Many people experience redness, irritation and dryness when they start using topical vitamin A. Some can’t tolerate it at all.
“In many cases, the problem is that it’s not used correctly,” Lamberts said. “You only need a pea-size portion to spread on the entire face. And people with sensitive skin should only apply it every other night.”
Those who survive the first two to three weeks of adjustment will often see a turnaround in the skin’s appearance.
“The payoff is a soft, glowing complexion,” Vanderveen said. “When Retin-A first came out in 1972, it was used for acne. Researchers soon discovered it also resulted in a wonderful, softening appearance to the skin.” Later, it was approved for anti-aging.
Retin-A and similar tretinoin products come in cream and gel forms in a variety of strengths but they are only available with a prescription. Many over-the-counter products contain retinol, a weaker form.
“For the best results, you really want medical grade products,” Bengtson said. “Those sold over the counter can’t have the high concentration of ingredients because of the risk of improper use.”
Clarisonic, the original sonic tool for cleansing, is recommended by local skin doctors for gentle exfoliation.
Physicians also suggest antioxidants, such as vitamin C in a serum form, to even out dark areas and improve the skin’s texture. Dr. John Renucci of Plastic Surgery Associates touts products with green tea extracts to help prevent the damaging effects of free radicals.
Vanderveen, who says she tests all products on her own skin before recommending to patients, is a fan of the Revaléskin line, made with coffee berry.
“It’s important to have your skin analyzed by a trained aesthetician who can tell you what’s appropriate for your skin type before using anything,” Renucci said.
Also important: exfoliation.
While grainy scrubs and chemicals once dominated the market, the gizmo most skin care experts prefer is Clarisonic, a handheld device that uses oscillating brushes to cleanse and invigorate the skin. There are similar products on the market but Clarisonic is the original and the brand Renucci uses in his office.
“At night, after you’ve applied sun blocks and moisturizers all day, the Clarisonic, used in conjunction with a mild cleaner, removes all that dry waxy residue, and that allows Retin-A and antioxidants to penetrate the skin.”
The Big Guns
Twenty years ago, plastic surgeons typically saw women in their upper 50s and older looking for a face lift.
“Now we’re doing more mini-lifts for men and women in their 40s,” Bengtson said. “We also have more clients who’d rather invest in multiple smaller procedures. We’ve shifted away from surgery to preserving youth.”
Botox, the popular treatment for softening grooves between brows, is now requested by younger clients, doctors say.
“There’s interesting research that shows if people in their 20s and 30s use Botox, it helps prevent wrinkles from forming,” Bengtson said.
Lamberts sees several women in their 30s who are forgoing regular pampering facials or mild peels and instead getting pricey fractional laser treatments once a year.
While the laser treatments require three to four days of down time, he said, they also stimulate collagen growth — and that’s an investment clients are willing to make.
Before signing up for anything, the experts say patients should talk to a trained, certified physician to determine what’s best for skin type, lifestyle and budget.
And avoid anything that sounds too good to be true.
“My father once told me if someone is trying to sell you a diamond ring for 10 cents, it’s probably worth a dime,” Bengtson said with a chuckle. “When it comes to anti-aging procedures, for the more dramatic results, you have to expect more down time and more expense.”
There are numerous types of procedures, including lasers, ultrasounds and fillers, designed to tighten skin, improve pigmentation, reduce wrinkles, plump sagging areas and more. Prices range from a few hundred dollars to several thousand.
Vanderveen warns that many popular procedures are temporary at best.
“If you’re inducing changes, what are the long-term effects? We do have lasers that do wonderful things for broken blood vessels. But lasers for improving pigmentation aren’t always effective because dark patches often return unless the person is diligent about using sunscreen and Retin-A.”
For those seeking the fountain of youth, the face lift is still considered the gold standard. But the goals have changed through the years.
“The best cosmetic surgery is when you can’t tell if a patient has had anything done,” Bengtson said. “No one wants to look over-tightened.”
As for me? After that imaging nightmare, sun blocks and retinoids have become my new best friends. GR