This document discusses ways to achieve healthier, younger looking skin. It describes the three main causes of skin aging as photoaging from UV exposure, gravitational aging from tissue stretching, and volumetric aging from fat and muscle loss. The number one culprit for skin aging is identified as UV light. Ways to slow aging discussed include regular sunscreen use, antioxidants, retinoids, and the three R's - relax with botulinum toxin, refill with dermal fillers, and resurface with various laser and chemical peel procedures. Specific product recommendations and before/after photos are provided.

1. Healthier, Younger Looking Skin …
A New You!
Kesha Buster, MD FAAD
Dermatology
Advanced Aesthetics & Plastic Surgery

2. What is healthy, youthful skin?
http://webdesignlists.com/beautiful-baby-photos.html/
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3. What is beauty?
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4. How do we age?
Photoaging
 UV-induced
Gravitational aging
 Stretching
 Sagging of soft tissue
Volumetric aging
 Fat and muscle atrophy (loss)
 Bone loss http://www.seattleface.com/html/fat_injection.php
 Unknown cause
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5. How do we age?
No.1 culprit for skin
 UVA (aging) – penetrates deeper, though windows
 UVB (burning) — most effective UV promoter of skin cancer
Both UVA and UVB cause DNA damage
Chronic sun exposure causes:
 Wrinkles, brown spots, blood vessels, loss of elasticity,
discoloration, leathery skin, facial volume (fat) loss, skin cancer
 Much slower and later in darker skinned people (melanin)
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6. How do we age?
Bolognia JL, Jorrizo JL, Rapini RP. (Ed.). (2008). Dermatology, Edition 2. Elsevier.
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7. How do I slow aging down?
Sun protection (most cost effective)
 Sunscreen
 Sun avoidance
 Sun protective clothing
Antioxidants
Retinoids
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8. Slowing aging: Sunscreen
Sunscreen1,2
 Multiple studies show both clinical and microscopic evidence of
sunscreen prevention of photoaging
 Can reduce damage (solar elastosis) that has already occurred
 Also prevents skin cancer and pre-skin cancer
Organic (chemical) — absorb UV and convert it to heat
 Common allergies
 Some forms are unstable (easily breakdown = less effective)
Inorganic (physical) — block UV
 Zinc oxide, titanium dioxide combined = broad spectrum (UVA, UVB)
1. Stenberg C, Larko O. Sunscreen application and its importance for the sun protection factor. Arch Dermatol 1985;121:1400-1402.
2. Sambandan DR, Ratner D.Sunscreens: an overview and update. J Am Acad Dermatol. 2011 Apr;64(4):748-58. Epub 2011 Feb 3.
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9. My favorite sunscreen
No. 1: SkinCeuticals Physical Fusion
 SPF 50
 physical blocker, thin, tinted
No. 2: Neutrogena with Helioplex
 SPF 30+
 photostabilized chemical blocker
No. 3: L’Oreal Anthelios with Mexoryl
 SPF 30+
 photostabilized chemical blocker
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10. Slowing aging: Antioxidants
Can prevent and/or reverse photoaging due to
free radicals1
 Vitamin C (must be in stable, penetrating form)
 Phloretin
 Ferulic acid
 Vitamin E
 Green tea polyphenols, oral soy isoflavones,
coenzyme Q10 and many more …
Growth factors and peptides can improve photoaging by
reducing lines/wrinkles and supporting skin function
1. Rabe JH, Mamelak AJ, McElgunn PJ. Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.
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11. Slowing aging: Retinoids
Vitamin A and its natural and synthetic derivatives:
 Retinol
 Tretinoin
 Adapalene
 Tazarotene
Prevent and treat photoaging1, 2
 Reduce fine lines, wrinkles, discoloration
 Boost collagen formation
Often causes irritation, redness, peeling
Minimize side effects with gradual increase in use, using moisturizer
1. Rabe JH, Mamelak AJ, McElgunn PJ, Morison WL, Sauder DN. Photoaging: mechanism and repair. J Am Acad Dermatol. 2006 Jul;55(1):1-19.
2. Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term treatment of photoaged human skin with topical retinoic acid improves epidermal cell atypia and
thickens the collagen band in papillary dermis. J Am Acad Dermatol. 2005 Nov;53(5):769-74.
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12. How do I turn back the clock?
The three Rs
 Relax
 Refill
 Resurface
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13. Relax
BOTOX® and Dysport ®
 Botulinum toxin type A
 Block nerve impulses to treated
muscles thereby inhibiting
muscle activity that leads to
wrinkles
 Effective in two to seven days
 Lasts three to four months
 Can be used in many areas
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14. Relax
http://cosmeticlasermd.com/wp-content/uploads/2012/05/botox-brow-lift-b-a1.jpg
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15. Relax
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/botox-cosmetic.aspx
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16. Relax
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/botox-cosmetic.aspx
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17. Relax
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/botox-cosmetic.aspx
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18. Relax
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/botox-cosmetic.aspx
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19. Relax
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/botox-cosmetic.aspx
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20. Relax
Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010 Dec;63(6):1042-51.
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21. Refill
Fillers
 Many types: hyaluronic acid, calcium
hydroxylapatite, poly-L-lactic acid, fat, silicone,
collagen, etc.
In general, hyaluronic acid (e.g., JUVEDERM®,
Restylane®, Perlane®) are safest
 Reversible
 Allergic reactions are rare
Can be used virtually anywhere on face to minimize
wrinkles and replenish volume
Also used on hands, earlobes, depressed scars
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22. Refill
http://www.juvederm.com/views/before-and-after/
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23. Refill
http://www.ringpfeildermatology.com/images/baa/hand-rejuvenation-with-fillers-before-and-after.jpg
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24. Refill
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25. Resurface
Superficial (epidermis only)
 Microdermabrasion
 Superficial chemical peels
 Microlaser peel
Medium to deep (epidermis and dermis)
 Dermabrasion
 Medium and deep chemical peels
 Fractional laser resurfacing
 Deep laser resurfacing
Nonablative (no downtime)
 Broadband light (a.k.a., intense pulse light)
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26. Resurface
Profractional
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27. Resurface
Microlaser peel
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28. Resurface
Broad band light
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29. Questions?
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