Medical skin care is a frequent topic coming up in consultations with clients, who are interested in cosmetic surgery of the face and measures that can be taken before and after a procedure to improve the appearance of the skin in the face.
For most medical skin care is a confusing world. Thousands of products exist in a multi billion dollar market. Advertisements for cosmoceuticals and skin care products are virtually limitless in unproven and unprovable assertions. Cosmoceuticals and over the counter skin care products are not approved pharmaceuticals and contain no pharmacologically active ingredients. “White mud” is most often the only correct label for these high priced and ineffective products. How do you as a patient and consumer now find a way through the maze of medical skin care ?
Like everywhere else in medicine and surgery the first step is diagnosis so that your skin problems can at least be given a name. Medical skin care is no exception. Without a diagnosis it does not make sense to start thinking about treatment or the skin care products required. Diagnosis also defines serious skin conditions like acne, rosacea, dermatitis or skin tumors, requiring dedicated medical or surgical treatment. Once diagnosis ascertains that your skin problems are “cosmetic” (e. g. only affect the appearance) such as enlarged pores, irregular pigmentation, loss of elasticity and so forth, photographic documentation is performed and one can proceed to the next stage – treatment.
From the standpoint of treatment in medical skin care and the necessary products there are exactly five things you can do for your skin. All rational and effective skin care products as well as more intense treatments such as resurfacing by dermabrasion or chemical peeling aim to influence one or more of these five factors. There is nothing more that can be done with topical (externally applied) products. These five pillars of rational medical skin care are cleansing, protection, hydration, exfoliation and stimulation.
A medical skin care program designed to take all five factors into account will achieve the best results with smoother, tighter and rejuvenated skin. Less is not more and failure to take all five factors into account results in suboptimal appearance.
Cleansing can be done using an arbitrary over the counter product designed for that purpose and that purpose only. Whether prescribing a medical skin care program or medications for our surgical patients, we strongly oppose so called combination preparations containing more than one pharmacologically active ingredient. To keep things simple it is one product, one active ingredient, one effect. As far as cleansing is concerned, its function is really only the removal of debris collecting on the skin surface in the course of the day or night. Cleansing is performed mornings and evenings and prepares the skin for the next step.
Hydration with moisturizers is of benefit only in dry skin or in individuals with certain medical skin problems. While marketed aggressively to the point that women worldwide unquestioningly accept their necessity, they are by and large superfluous in medical skin care once the skin is conditioned, stimulated and functions properly. Skin that functions properly does not feel dry. Children and most men have skin which functions properly at the cellular level, they never use moisturizers and never complain their skin is feeling dry. Perceived dryness is a sign of improper functioning of the skin at a cellular level. It is treated by restoring skin function, not with moisturizers. Overuse of moisturizers on the other hand is very problematic in dark skin in the Caribbean with its high prevalence of oiliness, acne and seborrhea, which may all worsen with moisturizers.
Protection on the other hand is of paramount importance. Skin protection is sun protection, not much else. We recommend at least sun protection factor 35 to be applied at least daily and better more often, not matter if the sun shines, it is raining or overcast. UV rays, the harmful agent, are present continually. UV rays damage the DNA of skin cells and thus the cells itself, resulting in improper functioning of skin at a cellular level. Dryness, aged appearance, loss of elasticity, pigment abnormalities ensue, eventually underlining the marketing claim that such and such cream (containing a potent enough sun screen) actually, really and convincingly prevents aging, dry skin, dullness and what not. Sun protection is also indispensable to prevent side effects from products used for stimulation and exfoliation. You may think as a person with dark skin in the Caribbean you are immune to the harmful effects of sun light on the skin? Well, think twice and ask anyone making a living off their looks why they only go to the beach when paid to do so, pedantically avoid any unnecessary sun exposure and more or less religiously apply sun screen to their faces. To keep it simple, just use a day cream with potent sun protection in the morning, it is protective and will at the same time provide all the moisturizer you will ever need.
The more difficult part in medical skin care is the selection of the products for exfoliation and stimulation. These products are essential to restore normal skin function. Due to the color changes possible if exposed to UV rays they are usually part of the evening routine and must be used in conjunction with potent sun protection. Exfoliation can be performed with low strength alphahydroxyacids and retin-A at concentration of 0.05% or higher (requiring a prescription), stimulation with vitamin C serum (which also has a protective effect as an antioxidant), (copper) peptides, retin-A and 2% or 4% hydroquinone (with koijc acid and glycolic acid as possible alternatives or enhancers). If there is one miracle drug in medical skin care it is retin-A which predictably and reliably reprograms skin cells to function normally. In individuals with dark skin hydroquinone or its alternatives are essential to reprogram the pigment producing cells and ensure even skin tone. Our preference is hydroquinone due to its long standing track record. Its application requires supervision and sun protection is a must.
It follows logically from the above that five to seven products should be sufficient for effective medical skin care. The key to success now are persistence and patience. These products only work if applied regularly as directed. Reprogramming skin to function normally at a cellular level takes about six weeks to yield visible effects. This is the time it takes until on average all cells of the top layer of skin are changed out once and the skin has completed a so called cell cycle.
Pharmacologically active and effective medical skin care products requiring a prescription and application under medical supervision a rarely more expensive than a couple of jars of hope purchased at some department store from a sales clerk who in 99.9% of cases has no idea at all about comprehensive skin care. None of the products you see on these long lines of shelves is better than the other and with the exception of cleansing and sun protection have no positive effect at all on your skin. Do not be fooled by commercials and high gloss brochures either. After all, the manufacturer’s marketing departments have to do something to distinguish their variation of “white mud” from the one five steps down the aisle.
Today medical skin care more and more means simplification and focusing strategy on essentials. The individual components of you skin care series should all have a clear focus – cleansing, hydration, protection, exfoliation, stimulation. If you cannot recognize the purpose of a product in the five pillars of skin care you are likely wasting your money on “white mud”. The effects and possible side effects of a medical skin care program require ongoing supervision. Combine medical skin care with superficial or medium depth chemical peels, botox for the inevitable crow’s feet and hyaluronic acid fillers for deeper wrinkles and you are on your best way to rejuvenated, more vital and healthier skin !
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Trinidad Institute of Plastic Surgery – the superior choice for medical skin care in the Caribbean, Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Bermuda, British Virgin Islands, Cayman Islands, Turks and Caicos Islands, Miami, New York, Toronto, London