Fashion & Beauty

COMPLEXION, Part II: Retinoids, “Wrinkle-Fillers,” Exfoliating, and More

Recently, Women’s Voices for Change asked New York–based dermatologist/dermatologic surgeon Anetta Reszko, M.D., Ph.D., a member of our Medical Advisory Board, to develop a three-part series on skin care for women over 40. Dr. Reszko has published more than 20 scientific research articles, reviews, and book chapters—as well as posts for us on laser surgery and skin-cancer detection.

Dr. Reszko’s article COMPLEXION, PART I (October 13) covered skin-care basics: how to determine skin type and the proper way to cleanse, tone, and moisturize, including references to specific commercial products.

But she has more to suggest on good skin care. Here’s COMPLEXION, Part II.

RETINOIDS
Topical retinoids are the cornerstone of skin care for women over 40.

The retinoids are a class of chemical compounds derived from vitamin A. Clinically, retinoids reduce the appearance of fine lines and deep wrinkles, reduce pore size, and are helpful in evening pigmentary changes (brown spots).*

The over-the-counter form of retinoid is called retinol. Retinols (RéVive Intensité Crème Luster, Ren Bio-Retinoid Anti-Aging Concentrate, RoC® MULTI CORREXION® 5 in 1) are available without prescription in pharmacies and at cosmetics counters.*

To obtain the much-stronger version, retinoic acid, you would need a doctor’s prescription. The biological strength and activity of retinoic acid (tretinoin, Differin, Retin-A Micro, Atralin) is 100 times that of retinol.*

Here are my tips on introducing a retinoid product with minimal side effects.

  • Use retinoids at night.
  • Wash the skin with cool or lukewarm water. Do not use hot water.
  • Cleanse skin with a non-detergent gentle cleanser (Neocutis Neo-Cleanse Gentle Skin Cleanser, Cetaphil, CeraVe Hydrating Cleanser). Pat skin dry.
  • Wait 20 minutes before applying a topical retinoid.
  • Apply a pea-sized amount of medication to the entire face by dotting around the face and then gently connecting the dots with your fingertips. Only a very thin layer of retinoid is needed.
  • Avoid application near the eyes and lips, as this can cause irritation and scaling. Do not rub the retinoid preparation in vigorously.
  • Apply moisturizer with sunscreen that’s SPF 30 or higher anytime you are in the sun even for a short amount of time. Retinoid may make you more susceptible to sunburn.
  • When you first start using retinoid, apply it every other night or every third night. Increase frequency to every night as tolerated.
  • If you are experiencing mild irritation or dryness, you may try the following strategies to minimize irritation:
    • Decrease frequency of use
    • Wash the medication off after 1 hour of application
    • Apply a non-comedogenic (not clogging pores) moisturizer after 1 hour of retinoid application.
    • Avoid astringents and abrasive products.
    • If you experience severe irritation, discontinue retinoid use and wait until irritation completely resolves before restarting retinoid.

Dr. Reszko’s tip: Regular use of retinoids at least 2 to 3 times a week can lead to noticeable improvement over a period of 2 to 6 months. On average, it takes at least 6 months to see a noticeable difference in the appearance of fine lines and wrinkles. The best benefit is seen if retinoid therapy is used for at least a year.

 
ADDITIONAL PRODUCTS FOR SPECIFIC SKIN CONCERNS

Wrinkle-Fillers”
For optimal moisture and “wrinkle filling,” use products containing microspheres of hyaluronic acid and collagen. Hyaluronic acid (the same material as used in cosmetic fillers like Restylane, Juvéderm Voluma), fills and reduces the depth of wrinkles almost immediately post application (Neocutis Hyalis 1 % Hyaluronate Refining Serum, Sesderma Fillderma line). Because of its affinity to draw in water, it hydrates and increases the elasticity and firmness.

Expression-Line Minimizers
For Botox-like effects to minimize the appearance of expression lines, look for products containing peptide mimetics (acetyl hexapeptide, Argireline, palmitoyl tripeptide-5, Matrixyl 3000) (Caudalie Premier Cru La Crème Riche, SkinMedicaTNS Essenstial Serum) or DMAE (dimethylaminoethanol) (NuFace Smoother Powerhouse Peptide Serum).

Chemical Exfoliation
Aging skin with lines and uneven tone may benefit from chemical exfoliation with mild alpha hydroxyacids such as lactic, glycolic, or mandelic acid (listed in the order of increasing potency). Alpha-hydroxy acids normalize and unify skin color and stimulate new collagen synthesis (Bliss That’s Incredi-peel, SkinMedica AHA/BHA Cream, Dr. Gross Alpha Beta Peel Extra Strength, Glytone Mini Peel Gel).

Re Sensitive Skin
Sensitive skin requires gentle care with formulations containing oatmeal and soy proteins, chamomile, gentian extract, allantoin, algae and plankton extracts (Aveeno Positively Radiant Daily Moisturizer, La Mer The Moisturizing Soft Cream, Dr. Denese HydroShield Ultra Moisturizing Face Serum, SkinMedica TNS Ceramide Treatment Cream™). For acne-prone skin, use only non-comedogenic moisturizers (Origins Zero Oil Oil-Free Lotion with Saw Palmetto, Peter Thomas Roth Ultra-Lite Oil-Free Moisturizer).

For Evening Out Skin Tone
For uneven skin tone with dark sun spots and other hyperpigmentation, consider products with natural brighteners such as vitamin C, soy extract, kojic acid, licorice, and azelaic acid (Borghese Cura-C Face Treatment, SkinCeuticals Pigment Regulator, Caudalie Vinoperfect Radiance Serum, Lytera® Skin Brightening Complex, Neocutis PERLE). Use of the topical retnoids is the key (see above). Prescription hydroquinone may be helpful in resistant cases, although prolonged use might results in skin irritation and paradoxical skin darkening.

Blemish Fighters/Acne-Prone Skin

Acne
For acne-prone skin with occasional blemishes, use benzoyl peroxide and salicylic acid that impart gentle antibacterial effects (La Roche-Posay Effaclar Duo Acne Treatment, Murad Transforming Powder).

Dr. Reszko’s general tips for moisturizer use:

  • When the toner is dried, apply a pea sized amount of moisturizer, gently massaging in an upward circular motion from the outside towards the center of your face and neck.
  • If you haven’t applied enough moisturizer and your skin still feels a little tight, then apply a bit more. If you apply too much and it feels too oily, then gently blot with some tissue.
  • Some people also like to use a separate moisturizer that is designed for the eye area to prevent aging or swelling.

Rosacea
Rosacea-prone skin requires more in-depth discussion. The principles of skin care for rosacea-prone skin are centered on two main goals:

  •  First, limit skin inflammation. Look for sulfa-based washes, products containing green tea extract, caffeine, feverfew, niacinamide, ruscus (vasoconstriction), a bioflavinoid hesperidin methyl chalcone and ambophenol (anti-oxidants and strengthen blood vessel walls), (Neocutis Peche Redness Control, Avene Antirougeurs Redness Relief Dermo-Cleansing Milk, Avene Antirougeurs CALM Soothing Mask, La Roche Posay Rosaliac AR Intense).
  • Second, repair the skin’s natural lipid barrier function. Consider products with glycerin, hyaluronic acid, ceramides, niacinamide (Teoxane RHA Deep Repair Balm, SkinMedica Redness Relief CalmPlex).

You should always avoid any products that cause irritation, stinging, and/or burning of the skin. Avoid cosmetics with these commonly recognized triggers of rosacea: alcohol, witch hazel, fragrance, menthol, peppermint and eucalyptus oil. Avoid toners, astringents, and exfoliating agents. Cosmetics, especially those with a green or yellow tint, may be effective in reducing the appearance of redness (La Roche Posay Rosaliac).

Dr. Reszko’s tip: Rosacea and acne are not the same condition! In some cases there is overlap between the two conditions, but the vast majority of patients with rosacea do not have acne, and acne treatments might actually exacerbate rosacea.

If you have rosacea, blot, but do not rub, the face dry with a soft towel and wait up to 15 to 30 minutes for the face to completely dry before applying topical medication or other products.

 

Exfoliation

Do NOT-over-exfoliate
Gentle exfoliation is essential to remove accumulated dead skin cells, dirt, and oils and make your skin appear smoother thanks to uniform light reflection. Consider gentle manual exfoliation with a washcloth, a makeup remover cleansing towelette, or Clarisonic cleansing brush daily. In addition, consider an exfoliating peel once a week. Choose a glycolic acid peel for normal skin, salicylic acid for oily/acne prone skin, and mild lactic acid for dry, sensitive skin.

Make sure that you do not over-exfoliate or use chemicals that are too harsh. Exfoliant should not feel like sandpaper to be effective. Over-exfoliation might end up disturbing the delicate homeostasis of the skin, leading to over-drying that in turn might result in increased oil production, clogging of the pores, and skin inflammation.

Dr. Reszko’s tips:

  • Remove makeup first, then gently massage the exfoliator in outward circular motions for half a minute. Don’t scrub too hard. Be gentle.
  • If using an exfoliating washcloth, soak the washcloth in warm water and rub the washcloth in small circles on your face.
  • Make sure that you focus on the creases by your nose, which often get clogged up and develop blackheads.
  • For chemical exfoliation with alpha hydroxyacids (glycolic, lactic) consider individually wrapped peel pads, since the pH of the acid and its clinical effectiveness may change when exposed to air.

Applying a Face Mask

Apply a face mask regularly. In general, peel-off masks are best for oily and acne-prone/blemished skin, whereas rich, moisturizing masks are best for dry skin. Sheet masks are great moisturizers, since they drive active ingredients into deep layers of the skin far more effectively than creams.

Dr. Reszko’s tips:

  • Use a gentle, preferably natural face mask once a week
  • Apply the facial mask according to the manufacturer’s instructions on clean, warm skin for best results, and rinse with cool water. Don’t leave it on for longer than suggested (normally about 15 minutes).

Sunscreen
ALWAYS wear it!
Stay tuned for my in-depth discussion of sunscreens in the coming weeks.

Establish your skin care routine and stick to it!
Proper daily skin care is the cornerstone of long-term skin health. Your skin’s particular needs will vary with age and season changes. Tweak your daily routine to accommodate these changes.  

Part III of this series will cover professional treatments, facials, lasers, chemical peels, and skin-tightening technologies. But note that the procedures recommended should be viewed as supplemental to your daily regimen. Your skin needs daily pampering—be kind to it!!!

 

*This additional material added on October 27.

Join the conversation

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  • Izabela November 11, 2014 at 9:29 pm

    Thank you so much for your expert advice Dr. Reszko!

    Reply
  • Dr. Anetta Reszko October 28, 2014 at 9:32 pm

    Great point Leslie!
    Thank you for your comments! I absolutely agree. Aging is not a disease, should not be treated as such and does not require treatment.
    That said, whether we personally agree with it or not, women, and increasingly men, are looking for treatments that would preserve youthful and healthy appearance of their skin.
    My job as a dermatologist is to guide my patients and provide them with the most comprehensive overview based on the best available scientific research. In the blog I have used commonly used terminology including the term “anti-aging” as opposed to more appropriate terms like “collagen stimulators, epidermal turnover modifiers,” so the readers of various backgrounds and educational levels could follow the content.
    Again thank you for your input.
    Best,
    Anetta

    Reply
  • Leslie in Oregon October 28, 2014 at 5:52 pm

    Thank you for your reply, Dr. Pat. I certainly did not mean to cast any judgment on women who use products to try to prevent, or reverse, the signs of aging. I just thought it ironic that by publishing the portions of this article advising the use of products that are said to fight signs of aging, this group, called Women’s Voices for Change, is in effect reinforcing the age-old cultural norm that women should focus time, energy and resources on looking younger than we are. That is the purpose, beyond improving skin quality, for which these products are touted and for which we are supposed to want to purchase and use them.

    Reply
  • Patricia Yarberry Allen, M.D. October 28, 2014 at 8:57 am

    Dear Leslie,

    Many of use these products that are well described by Dr. Reszko.

    It is unfortunate that products developed to improve the quality of the skin of “mature women” are currently referred to as “anti-aging”. I wish someone had the energy and time to take on this battle and would force the marketing people in this industry to choose a more acceptable term.

    In the meantime, we support women’s choices to improve their complexion at any age without judgement.

    Dr. Pat

    Reply
  • Leslie in Oregon October 27, 2014 at 6:28 pm

    Thank you for skin the information and advice except that relating to anti-aging efforts. As to the latter…isn’t this Women’s Voices for Change (with emphasis on the last word)?

    Reply
  • Deborah Harkins October 27, 2014 at 6:19 pm

    Good questions, Cathy. So good that they called for answers. Look for three new paragraphs, marked with asterisks, at the top of the Retinoid section.

    Thanks for asking! Really!

    Deborah Harkins
    WVFC

    Reply
  • Cathy Chester October 27, 2014 at 8:02 am

    Thank you for this article. But when you say retinoids, what do you use? Where do we get them? Are they prescription only? Which ones do you recommend?

    Thank you.

    Reply