Botox

Some of your facial wrinkles are caused by the pull of underlying facial muscles. The are the expression lines, most notable around the eyes, on the forehead, and the fine lines above the lip. We have used Botox since 1995 to erase these lines with fabulous results! A simple injection aimed at the underlying muscle can eliminate these lines completely.

Botox is a trade name of botulinum toxin A, made by Allergan Pharmaceuticals. Produced from Clostridium botulinum bacterial cultures developed in a fermenter, the material is purified and processed into a protein for medical use. Clostridium Botulinum A exotoxin produces temporary paralysis of striated muscles. The toxin weakens the targeted muscles and thereby lessens the wrinkles produced by common muscular contraction.

Side effects have been very rare and short-lived. The toxin takes three to five days to produce the desired effect and you may need a second touchup injection. Botox injections need to be repeated anywhere from 4-18 months in order to retain results.

Chemical Peels:

Chemical peeling is also referred to as chemexfoliation or dermapeeling. A chemical solution is applied to your skin, which causes it to “blister” and eventually peel off. Your new, regenerated skin is usually smoother and less wrinkled than the old skin.

Generally, if you are fair-skinned and light haired you are an ideal candidate for chemical peels. Darker skin types may also experience good results, depending on the specific problem.

Light Peels:

Alpha Hydroxy Acids (AHA’s) are a group of naturally occurring acids derived from certain plants and fruits. The most commonly used form is glycolic acid, which comes from sugar cane. Alpha Hydroxy Acids work by

stimulating new growth of skin and collagen by decreasing the “glue” that holds dead skin cells on the skin surface. This allows dead cells to slough off, leaving behind a layer of smoother, softer skin. AHA’s also help to unclog pores and thus decrease the tendency for acne to develop.

During Alpha Hydroxy Acid peels a solution of glycolic acid is applied to your skin for a brief period of time and is then washed off. This solution causes several of the top layers of skin to dry up and to peel off over a period of several days. When the older layers of skin have peeled off, it exposes a new layer of undamaged skin, which has a softer, smoother texture and more even color.

Beta Hydroxy acids are also used for light peeling. These peels are excellent to brighten the skin, improve texture and the blotchy pigmentation, which results from sun damage. We have also seen improvements in pore size with these peels.

Both AHA and BHA peels are superficial and are often called “lunchtime peels,” since most can be performed without having to miss any time from work or your regular schedule. Both of these light peels need to be done in a series to achieve optimum results.

Medium Peels:

TCA is a non-toxic chemical, which has been used to perform skin peels for over 30 years. Unlike some other peels, TCA peels have the additional advantage of creating a fresh natural-appearing complexion, while preserving the normal skin color. TCA peels can improve many conditions, such as dull, weathered skin, freckling, blotchy pigmentation, fine wrinkles, shallow acne scars, and sun damage, including some precancerous lesions.

The application of the solution containing TCA is usually associated with a burning and stinging sensation. This burning is so brief that most patients choose not to use any sedation or anesthesia.

Most people take 5-7 days to heal from an average TCA peel. During the healing process there is no pain, but the skin looks as if it has had severe sunburn. Anyone who has had a TCA peel is more sensitive to sunlight for at least 6-8 weeks after their peel. During this time it is very important to protect the new skin with sunscreens, hats and the avoidance of strong sunlight. Unlike Alpha Hydroxy Acid peels, excellent results can usually be obtained with one peel; although a second TCA peel may be necessary for some skin problems.

Over the past 25 years, a transformation in dermatology has occurred. Previous generations of dermatologists were limited in their abilities to treat disorders associated with abnormal development of the stratum corneum. Whether intrinsic, such as acne or the icthyosiform dermatoses or extrinsic, resulting from ultraviolet radiation, topical compounds that could restore normal differentiation of the epidermis were lacking.

This transformation began with the development of commercially available alpha hydroxy acids and retinoids. The investigations of Kligman & Layden at the University of Pennsylvania, and John Vorhees at Michigan laid a solid scientific foundation for the evolution of retinoid therapy. VanScott & Yu were two of the most notable pioneers in AHA therapies with numerous publications supporting their efficacy and safety.

Lachydrin and Retin-A were the first two compounds in these classes available to the dermatologist. Once widely in use, it became evident that these drugs had effects beyond treating their approved conditions. Textural changes and overall improvement in the appearance of skin were observed by many clinical investigators and the idea of reversing skin aging through the use of topical compounds was no longer fanciful talk heard only at cosmetic counters.

Over the past decade, a seemingly endless number of companies have entered the anti- aging arena. Cosmeceutical is now a well established term, and hundreds of compounds are being marketed as ‘anti aging.’ Unfortunately, in the rush to literally cash in on this arena, the science to establish efficacy for many of these compounds is often lacking.

Despite this, there are a number of interesting compounds that may enhance the physiologic processes involved in maintaining the structural integrity of the skin or act as physiologically protective, minimizing environmental damage to the skin. The end result of such actions may be a more youthful appearance. The following discussions will focus on a few of the compounds that are finding their way into the spotlight of cosmeceuticals.

Shea Butter – Despite a plethorplethora of moisturizers readily available and the recent popularity of body shampoos, xerosis remains a common problem seen by dermatologists. Severely dry skin generally looks worn and older than it should. It’s often quite symptomatic as well. Shea butter, derived from the Karite plant is gaining popularity in skin care though it has been used for many centuries. It is described as a natural or physiologic moisturizer as its lipid content has high amounts of lineolic and palmitic acids, two of the fatty acids found within the stratum corneum. Shea butter is not unique in this regard. Many oils mimic the lipid content of skin and can temporally keep oil depleted skin from feeling dry and uncomfortable. Recent studies suggest that the duration of action for some shea butter compounds can be quite prolonged. Lipikar and Ceralip are two shea butter based products from LaRoche-Posay. Studies to date have demonstrated restoration normal barrier function for up to four days after one weeks application of Lipikar. Ceralip has been studied in Accutane induced chelities. I have found Lipikar to be an outstanding product for senile xerosis, PUVA and Accutane induced xerosis as well. Ceralip has become a mainstay in Accutane induced chelitis prophylaxis. These are two cosmeceuticals worth considering.

Green Tea - Green tea is produced by steaming the leaves of the Camellia plant, and drying them at high temperatures to avoid oxidation of the polyphenolic compounds contained within the leaves. These polyphenols have been well described and include epicatechin, epigaliocatechin, epicatechin 3-gallate, and epigaliocatechin – 3 gallate. These compounds exert significant anti inflammatory effects in animal models and have been studied extensively by Hasan Mukhtar, Phd at Case Western University. A recent review of his work was published in the Archives of Dermatology. Over the past ten years published studies have demonstrated photoprotective benefits with both topically applied and systemically administered green tea in animal models. Reduction in UV induced skin cancers have been dramatic. In humans, attenuation of delayed contact hypersensitivity, and UV induced erythema have also been shown.

Neova, manufactured by Procyte, was the first cosmeceutical green tea product in distribution to dermatologists. Replenix is also in distribution from Topix. To assess the photoprotective properties of Neova, my nurses applied this product to the right side of my back bid for five days. Thirty minutes after the 6th day AM application, MED testing was performed. On the untreated side, erythema was noted at all six test doses, and all were symptomatic. No symptoms were noted on the Neova treated side, and slight erythema was noted at the highest energy site only. In this case a doubling of the MED was noted. Green tea polyphenols have become a cornerstone in my photoprotection armamentarium. They are quite useful in controlling the erythema and photosensitivity seen in rosacea sufferers. Hopefully further studies will be performed to better evaluate the photoprotective and anti-inflammatory characteristics of the polyphenols.

Advances in topical therapies in the cosmeceutical arena will continue to play an important role in skin care. Objective evaluation by the practicing dermatologist must be an important factor in determining which of the myriad of choices available are efficacious, and communication within forums such as this needs to continue to maintain integrity for the dispensing cosmetic dermatologist.