Patient Information

Basic Skin care Routine

Basic skin care routine usually includes the following steps: cleansing/wash, toning, skin moisturizer and UV protection.  In general, for most people, routine skin care is usually twice daily.  However, for those with dry or sensitive skin, it may be better to cleanse/wash once a day and moisturizing two or more times a day.  Skin exfoliation should also be a part of your basic skin care routine.  However, daily exfoliation may be more than what your skin needs which then may lead to skin irritation.  So, exfoliation once to twice a week is usually sufficient.

UVA and UVB protection is very important for any skin care routine.  Sunscreen should be applied lastly, on top of moisturizer or other skin treatment as the final step of the skin care routine.  Apply sunscreen to sun exposed areas.  Some skin care products have added UV blockers.  Fair skin people are more prone to sun damage.  Be more careful to minimize sun exposure, and remember to apply sunscreen more consistently & frequently.

Basic skin care routine should fit to your skin care type.  For maximum benefit, first determine your skin type which includes, dry/sensitive, dry to normal, or normal to oily skin.  As a reminder, your skin type may change with age, diet, and season.  In the summer, the skin tends to be oilier as opposed to winter.  As we age, our skin can change to drier.  A change in our diet such as low fat diet can alter the skin from dry to normal.

Chose scientifically proven active ingredients is important to your skin care routine.   in order to obtain maximum benefits.  The result of your skin care can be improved if you properly integrated the skin care products to your basic routine.  If you apply products to the skin that has not been cleansed, the active ingredients in the skin product are more difficult to penetrated deep into the skin surface.  If you cleansed, and moisturize before you apply the advanced skin care product, then the active ingredients in the advance skin product may not be absorbed through the skin because the moisturizer block the entryways.  The best time to apply active ingredients product is right after you have washed or cleansed, rinsed, dried your skin.  Apply the active product and allow for it to dry underneath your skin before applying moisturizer.

Choosing the right sunscreen

Choosing the right sunscreen is important part in your overall skin health.  Sunscreen should be able to block by absorption or reflection of UV light.  Physical blockers deflect UV rays by utilizing minerals zinc oxide and titanium dioxide.  Because the mineral zinc oxide and titanium dioxide are minimally absorbed in the skin, then are easily rubbed off from skin surface.  Therefore, you should reapply for frequently.  There are three subtypes of UV light: UVA (320-400nm wavelength) UVB (280-320 nm wavelengths), UVC (100-280 nm wavelengths).  UVA is subdivided to UVA-1 (350-400nm) and UVA2 (320-350nm) which penetrates deep to skin and is play major contributor in skin damage and wrinkles.  UVB usually cause sunburn on skin surface only.  UVC never reach the earth surface because it has been absorbed by the ozone layers. Typically, most sunscreens combine two or more sun blocking agents.

How to apply sunscreen can improve the effectiveness of the sunscreen.

Apply about 15-30 minutes before exposing to sun light.  Apply to skin in sufficient amount.  Reapply regularly, more if you are exposed to water. Reapply sunscreen every two hours.  If swimming or sweating, apply even more often.  Use water resistant sunscreen if you are actively involved in water.  According to FDA guidelines, water resistant sunscreen maintains SPF level only after 40 minutes of water immersion.  Very Water Resistant sunscreen maintains SPF level after 80 minutes of water immersion.  Reapply after sweating or swimming.  Sunscreen may vary in ways to apply them.  Read instruction on the label for best result.  Remember to cover face and neck if possible.  Wear hat when possible.  Cover your hands and arms with long sleeve clothes.

Skin Composition

Our skin is made up of three layers: epidermis, dermis, and subcutaneous tissue.

The epidermis is the outermost layer of the skin which is a protective barrier against infection and drying.  It made up of keratinocytes, melanocytes, and Langerhans cells. The maturation of the skin cells move from the innermost to outermost surface of the skin.   The outermost layer of skin is the stratum corneum which continuously sloughs off and replaced by the new one from below.  Usually it renews itself every 4-5 weeks.  Most chemical peels work by removing the outer stratum corneum layer and accentuate the skin renewal process. The melanocytes of the epidermis are responsible for skin pigmentation.  The middle layer of skin is the dermis which comprises of collagen and elastin.  The protein collagen and elastin give skin the structural integrity, elasticity, and resiliency.  The dermal layer also contains sebaceous glands, sweat glands, and hair follicles.  The sebaceous glands surround the hair follicle and produces sebum which lubricates skin and hair.  As we grow older, the sebaceous glands produce less sebum which makes our skin drier and therefore our skin are more prone to wrinkling.  In contrast, some adolescents have overproduction of sebum which could leads to acne.

The subcutaneous layer of skin in the deepest layer of epidermis consists mainly of subcutaneous fat.  This subcutaneous fat layer is a heat insulator protecting our body from the cold.  As we age, the loss of subcutaneous tissue leads to skin sagging/slackening which makes wrinkles more apparent.  Some skin cream/formula that fills in wrinkles and restore skin firmness, and skin texture.

Science Behind Anti-aging

In order to understand science behind anti-aging products, we need to know what the causes of aging process are.  First of all, free radicals/unpaired electrons are very reactive.  Free radicals cause damages to whatever cellular structure they encounter.  Free radicals are in integral part of life on Earth.  Most living organisms utilize energy by breaking down carbohydrates and fat from our diet into biological energy form in mitochondria and produces energy form in ATP (adenosine triphosphate).  This stored energy ATP breaks down for cellular needs which in term produce free radicals as by-products.  Free radicals  are also in form of X-rays, UV lights, ozone, etc...Free radicals react to any cellular structure as they come in contact and cause cellular DNA damage which alter the gene function and can even lead to cancer.  Fortunately, living organisms have developed protective mechanism that neutralizes free radical using protein/enzymes that inactivate the free radicals.  Also, cells can be protected by antioxidants which are free radical scavengers including vitamin C, E, selenium, and others. Topical antioxidants provide some protection against environmental damage by slowing the skin aging. Other things that we do such as a reasonable amount of exercise which helps to stimulate antioxidant defense.  High fruits and vegetables diet also have antioxidant protection. Avoid environmental damage such as smoking and exposure to sunlight

Anti-Aging Treatment

Alpha hydroxy acids are organic acids that have been use in skin care product lines for several decades.  How it works depends on the concentration of the AHA.  The high strength AHA is used in-office chemical peels.  Chemical peels have demonstrated that it can reverse some signs of aging by improving the quality of elastic fibers, increase density of protein collagen, and some reversal sign of photo aging.  Peels with 8-15% AHA have been shown improvement in skin wrinkles and skin smoothness.  AHA at a higher concentration would be more effective but also are more likely to cause irritation.

Beta Hydroxy Acids are simple organic acids with slightly different structure and mechanism of action as the alpha hydroxyl acids.  Salicylic acid is one BHA that has been use for acne treatment.  It has some exfoliation action and may be use as alternative to alpha hydroxyl.

Kinetin/Kinerase is trade name for chemical Furfuryladenine which is a plant-derived growth factor.  It has claimed to reduce wrinkles, fine lines and improve skin appearance without causing skin irritation.  Furfuryladenine has been comparable to a non-irritating alternative to Retin A.  One such study has showed topical furfuryladenine at 0.1% concentration may be equivalent in its effectiveness to Retin A without the side effect of Retin A.  At this time, more studies are needed for better designed study to confirm its effectiveness.

Vitamin C is widely use in skin care product.  Vitamin C is an important factor for collagen production which is an important in skin cellular structure/matrix.  Also Vitamin C is an antioxidant which helps to minimize the damage caused by free radicals.  In general, if vitamin C is absorbed via skin, it would have a good effect in reducing wrinkles and improving skin texture.  Well preparation of the compound is important because vitamin C is easily get oxidized.  In oxidized form, vitamin C has little anti-aging effect.  Also, manufacture of vitamin C skin cream has to prepare them in ways that would stabilize in its active form for it to work.  Also, high concentration vitamin C (10% or more) is needed to be effective topical agent.

Vitamin C is one of the most widely used skin care ingredients. The variety of skin rejuvenation / anti-wrinkle products with vitamin C is staggering. Do these products work? Do their claims have any substance? The situation is a little complicated. On one hand, vitamin C does possess definite, scientifically validated merits for wrinkle reduction and skin rejuvenation. On the other hand, many vitamin C products do not work.

Potentially, vitamin C can benefit skin in two important ways. Firstly, vitamin C is essential for the synthesis of collagen, a key structural protein of the skin. Adding vitamin C to a culture of skin cells (fibroblasts) dramatically increases the synthesis of collagen. Secondly, vitamin C is an antioxidant and can help reduce skin damage caused by free radicals. So, when vitamin C is properly delivered into skin cells, there is a good chance to reduce wrinkles and improve skin texture.

There are, however, some complicating circumstances often disregarded by manufacturers. First, vitamin C is relatively unstable (unless it is in a dry form). In the presence of air or other oxidizing agents, vitamin C is easily converted to oxidized forms. The oxidized vitamin C is not only incapable of boosting collagen synthesis or scavenging free radicals but may actually promote free radical formation causing damage to vital molecules such as proteins and DNA. In poorly prepared or poorly stored skin care products, vitamin C may already be oxidized by the time you apply it to your skin. Second, only highly concentrated preparations (10% or more) deliver enough vitamin C to the cells to be topically effective.  In an optimal use, about 50% of the patient will see noticeable results.  Therefore, selecting a vitamin C product/manufacturer is important.

Hyaluronic Acid is a natural biopolymer in the skin.  It is often used in topical skin care to enhanced skin matrix and skin hydration.  Beside the moisturizing effect of Hyaluronic acid, some suggested that HA may help to reduce skin irritation and inflammation.

Retinoid/tretinoin is a vitamin A derivatives.  The active ingredients tretinoin increase cellular growth and differentiation, but also inhibit break down of collagen and elastin. As a result, skin cellular turn over or rejuvenation process is enhanced which result in reduction of fine lines/wrinkles, skin roughness, and sagging.  Typical strength topical tretinoin is 0.025 to 0.1%.  Some studies show that 0.025% may just be as effective as 0.05 or 0.1% but has less skin irritation, dryness, peeling, and sun sensitivity.  The product may be use up to one year of continuous use.   Presently all topical retinoin products are sold by prescription only. 

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