Aguirre Specialty Care

Posted on Tue, Nov 13, 2012

Glance in the mirror after a certain age and it seems each day brings another of Father Time’s subtle footprints: First the fine lines around the eyes and mouth. Then the freckle-like age spots and faint shadows beneath the eyes. And for women, it’s hard to ignore those widening pores and occasional wiry facial hairs. The good news about these nagging harbingers of age: “There are a ton of things we can do to fend them off,” says Dr. James DeVito, MD, of Dermatology Associates of Colorado. Better yet: there’s no need to go under the knife.

Here’s a look:


Why they happen: Time and sun are the enemies of a smooth face. “As we get older our skin loses its ability to hold water and it slows down its cell turnover rate,” explains DeVito. Ultraviolet rays (particularly UVA rays which penetrate deeper than UVB) hasten the process by breaking down skin-strengthening collagen and impairing elastin, the protein that allows skin fibers to snap back into shape after we smile or wince. Some small studies also suggest that endurance sports fuel oxidative stress in the skin. “We tend to see really significant lines in long-distance athletes like runners and cyclists,” says Dr. Joel Cohen, of AboutSkin Dermatology and DermSurgery.

To prevent them: Look for a sunscreen that is SPF 15 to 30 (no need to go higher), free of chemicals like oxybenzone (which some believe can actually damage skin cells), and protects against UVA as well as UVB, says DeVito. Titanium dioxide and zinc oxide are a good bet. If you’re an athlete, wear wrap-around sunglasses to ward off lines around the eyes. And load your plate with carotenoid-rich veggies (like tomatoes, squash, and carrots). These powerful antioxidants build up in the skin and, studies show, can boost your internal SPF by as much as 3 points.

To address them: For fine lines around the eyes and forehead, Cohen recommends injectable neurotoxins like Botox and Dysport, which relax the muscles beneath the skin. For deep lines and wrinkles around the lower half of your face – which you don’t want to relax too much – consider a plumping filler like Juvaderm, says De Vito. He also recommends a new product, LaViv, which uses tissue taken from behind the ear to create new tissue from your own cells. It is then re-injected to fill in wrinkles: “Clinical trials are showing it lasts 3 to five years or more, versus a year, and you don’t have to worry about a reaction because it is your own tissue.”

If you’re needle-phobic or can’t afford a procedure, consider a topical Vitamin A derivative like tretinoin, a.k.a. Retin-A (prescription only and not recommended for pregnant women) or its milder over-the-counter cousin retinol. It helps remodel the skin and bolster production of skin-healthy proteins. “If you could take only one tube of cream with you to a desert island, it should be tretinoin,” says DeVito. “It is one of the only compounds out there with years of scientific data showing it reverses sun damage.”


Why they happen: Hormone changes related to pregnancy, oral contraception, and menopause can all prompt the skin cells called melanocytes to produce more pigment, which tends to accumulate in spotty clusters on the hands, chest, and face. Sun exposure makes it worse.

To prevent them: Again, sunscreen is key. Once you see a brown spot forming, exfoliating products like glycolic acid can help break up the pigment and keep it from getting worse, and Retin A and its over-the-counter derivatives “actually help prevent transmission of pigment from lower levels of the skin to upper levels,” says DeVito.

To address them: For mild skin discoloration, Cohen recommends over-the-counter low concentration hydroquinone. For more serious cases, the prescription cream Triluma – a blend of tretinoin, hydroquinone, and a topical steroid – can help. Lasers and chemical peels also work well to break up pigment.


Why they happen: “Dark circle are often associated with not getting a good night’s sleep, but it’s actually a lot more complicated than that,” says Cohen. For some, it’s a result of allergies to dairy, gluten or even eye make-up. Others are just born with blood vessels closer to the surface of the skin. And as we get older the skin under the eyes tends to get thinner, allowing the purple hue of our underlying muscles to show through, says DeVito.

To prevent them: Try propping your head up slightly with a pillow at night, so you aren’t lying flat on your back – which can make the blood vessels under the eyes swell. Try placing two cool teabags over your eyes. Cold can constrict dilated vessels.

To address them: Topical products containing caffeine can also constrict vessels under the eyes, fading shadows. Best-sellers include Elastiderm by Obagi and Neocutis Lumier. For more serious dark circles, Cohen recommends specialized lasers to diminish under-eye vessels, and skin-plumping injectables to restore volume around hollowed eyes.


Why it happens: As women enter the peri-menopause/menopause years their estrogen levels drop, prompting a dominance of testosterone, which can fuel hair growth.

To prevent it: Cut back on refined carbohydrates like white pasta and sugar, and steer toward slow-burning carbohydrates like whole grains instead, says Boulder nutritionist Sue Van Raes. “When you spike your blood sugar regularly, your body produces more insulin, which in turn can prompt more testosterone production,” she says. “I often see excess facial hair in women who are pre-diabetic.”

To address it: For milder cases, shaving or waxing will do. For troublesome cases, DeVito prescribes the oral testosterone blocker spironolactone, or the prescription cream Vaniqa – which blocks hair growth within the follicle.


Why they happen: As collagen and elastin break down, the skin grows attenuated, expanding pores. Accumulation of dead skin and oil can also stretch them out.

How to prevent them: Don’t smoke and keep your drinking to a minimum. “People who smoke and big drinkers tend to have very prominent pores,” says Cohen. Also, keep your pores free of oil and accumulating debris via regular exfoliation.

To address them: Cohen recommends mattifying gels like OC 8, which soak up oil and make pores appear less prominent. To reduce the size of pores, he recommends an in-office treatment called photodynamic therapy, in which a topical treatment like Levulan or Allumera is applied to the skin and activated with a blue-light.

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