En español | When you go to a dermatologist now, you'll probably find brochures on products and procedures that will "turn back the clock." But how do they work, and are they worth the money and effort?
Some of the most popular products for reducing fine lines are prescription-strength retinoids, which are vitamin A derivatives, marketed under the brand names Retin-A or Renova. Their active ingredient is tretinoin or the milder retinoid called retinol.
"Anytime I talk to people about skin care, basically I tell them to get the prescription drug Renova," says Linda Rhein, a biochemist with Bayer Healthcare Pharmaceuticals and editor of the 2009 book Aging Skin: Current and Future Therapeutic Strategies. "At least with Renova you know there were valid clinical trials conducted to prove that it works."
But one of those clinical trials on retinoids also showed that it may pose a cancer risk. When researchers tested tretinoin on a group of older male veterans, the study was halted because of a higher death rate, including from lung cancer, among men assigned to use tretinoin. The research was spurred by earlier evidence that retinoids may lower the risk of skin cancer. Researchers disagree over whether the tretinoin was to blame, but other studies have linked vitamin A products to lung cancer, writes dermatologist Kenneth Katz in an editorial about the study in a 2009 issue of the Archives of Dermatology.
"This is an inconvenient truth," Katz says. "Tretinoin is a great medicine — it's very effective — but this trial showed us there might be some big risks in using it."
Dermatology nurse Barbara McKeehen, a member of the Dermatology Nurses' Association, disagrees. "There have been no previous similar adverse events associated with tretinoin in all the years it has been available," she says. She also notes that the study participants were "typically elderly men who have been smokers."
Recent animal tests by the National Toxicology Program (NTP) also suggest that some retinoids may pose a cancer risk. John Bailey, a biochemist and now chief scientist at the industry-funded Personal Care Products Council, called for the testing when he worked for the Food and Drug Administration's cosmetics office. However, he now says that the NTP study was "very flawed" and should have been thrown out.
An FDA spokesperson said the FDA continues to believe that tretinoin "is a safe and effective product when used as labeled."
Dermatologists not only have prescription lotions and creams, they also offer products and procedures that they say abrade the skin so it grows back smoother and without as many of its old wrinkles and brown spots.
Peeling back time
In a chemical peel, the doctor or an assistant puts an acid on your skin that causes the top layer or layers to peel off. Daihung Do, a dermatologist at Beth Israel Deaconess Medical Center, recommends peels every two to three weeks for a few months, and then a few peels a year to maintain the skin's appearance. Peels come in varying strengths, but he avoids the harsh ones. "We like to keep it so the patient doesn't look like a molting insect," he says.
Some chemical peels are very strong and will, intentionally, cause a second-degree burn, says James Zins, head of plastic surgery at the Cleveland Clinic in Ohio. It takes two weeks before you can even wear makeup to cover the redness, warns Zins, who performs the procedure. (Check out the Cleveland Clinic website for detailed information on many cosmetic skin treatments.)
Although these peels are very effective in erasing fine lines and discoloration, they must be done with surgical-like caution, says Bailey, of the Personal Care Product Council.
Cost: From $150 to $300 for a superficial chemical peel to $2,500 to $6,000 for a deep chemical peel.
Frequency: Every two to three weeks for a few months, then several times a year to maintain.
Recovery time: At least two weeks of redness.
Heads up: Make sure your dermatologist or aesthetician is licensed and experienced. Every year unlicensed or untrained people performing cosmetic procedures cause severe burns, infection and permanent scarring, federal authorities warn.
Abrading those wrinkles
Dermatologists will combine chemical peels with a procedure called microdermabrasion, so the chemical penetrates better.
By essentially roughing up the skin, microdermabrasion "takes away the dull finish and gives you a shinier look — it's harmless," says dermatology nurse McKeehen. Dermatologists' take on microdermabrasion is that it is a good exfoliant and it also may boost effectiveness of chemical peels. Lawrence Samuels, chief of dermatology at St. Luke's Hospital in St. Louis, explains that microdermabrasions "chemically exfoliate dead skin cells, whereas most chemical peels actually stimulate cells down in the lower levels of the skin to begin to grow and repair themselves."
Often, aestheticians will combine a microdermabrasion with a peel, he says. A cautionary note: Like other skin procedures, it could spread a wart or cold sore virus from one part of your face to another.
Cost: $70 to $250 per treatment.
Frequency: Weekly for five to 12 weeks or monthly.
Recovery time: A few hours of redness, swelling; occasional bruising.
Next: Laser treatments >>
For a wide variety of repair jobs, dermatologists use lasers that zap the skin with light or heat. Lasers can remove dark (but not light-colored) hairs from the chin or upper lip, "liver" or age spots, and broken capillaries or spider veins and rosacea.
Most laser procedures involve multiple treatments over a period of weeks, and then touch-ups after a year or more. Lasers can scar or permanently darken or lighten your skin, and people with dark skin are at greater risk of unwanted color changes, warns McKeehen.
There are different types of lasers, big and small, and they differ considerably in how much downtime they require after the procedure.
A dermatologist may use a photosensitizer — a chemical that makes your skin more sensitive to light — to enhance the laser's effectiveness. If so, you must be very (very) good about staying indoors and away from all sunlight for a couple of days after the procedure, or you will risk a serious burn, says Jeffrey Orringer, associate professor of dermatology at the University of Michigan School of Medicine. Also, some illnesses and medications make you sensitive to light and would prohibit you from getting laser treatments.
Cost: Between $1,000 and $3,000, but the costs can be much lower for less-involved treatments.
Frequency: Three to five times over several weeks; touch-ups after a year.
Recovery time: Varies depending on treatment, but up to two weeks of redness; skin can have a severe sunburn reaction.
To decrease wrinkles without surgery, dermatologists are applying heat, in the form of "radio frequency." One technique, Thermage CPT, "truly tightens the skin," says Debra Jaliman, a dermatologist in New York City. "It's like shrink-wrapping," she says.
The original Thermage didn't work, Jaliman concedes, which gave the procedure a bad name. With the new version, you get about 10 percent tightening initially, and additional tightening over the next six months. Just how much more varies from person to person. The older you are, the more-limited results you will get, Jaliman says. She adds that smokers don't do as well as nonsmokers, "and the more sun damage, the less dramatic results will be."
Cost: $960 to $3,500.
Frequency: Once is usually enough.
Recovery time: Full activity may be resumed immediately.
Tina Adler writes about health, science and the environment.
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