"There are too many things to choose from," says Covington plastic surgeon Dr. Elizabeth Kinsley. "Most of the over-the-counter products will actually improve your skin for a couple of weeks, but the results aren't very long-lasting. What you need is a regimen that will get your skin healthy from the inside out. What you want is to have healthy skin without having to use moisturizers and have it balanced and toned."
The quest for healthy -- or at least younger-looking -- skin is one Americans are undertaking with tremendous zeal. Business experts say cosmetics and skin care is a $6 billion-a-year industry, and the American Society for Aesthetic Plastic Surgery reports that nearly 8.5 million Americans visited doctors for surgical and nonsurgical cosmetic procedures last year alone, a 48 percent jump from 2000. Technology and scientific knowledge also have experienced great advances and breakthroughs over the past couple of decades, adding even more treatments and products to the mix. The problem is, even savvy consumers who read and compare labels and have learned to recognize beneficial skin elements -- such as Retin-A, vitamin C and vitamin E -- still don't know exactly what they're getting. In addition, some of the common components consumers have seen on the labels of trusted products for years are, in reality, detrimental to skin.
"I have a degree in chemistry and I couldn't figure out the labels," says Dr. Penelope Treece, a surgeon and medical director at Southern Aesthetics in Metairie and Mandeville. "I started really reading the labels, which is a really scary thing. Most of our over-the-counter makeups are pigmented with coal tar, the same thing as in cigarettes, and almost every product on the market contains sodium lauryl sulfate." That is a cleansing agent that research published in the American Journal of Toxicology indicates has a degenerative effect on cell membranes. Talc, also a common ingredient of everything from makeup to powder, actually clogs the pores and irritates the skin, she says.
To make the complex even less manageable, Treece points out that even labels that appear to have "good" ingredients -- vitamins, enzymes, alpha hydroxy and beta hydroxy acids -- can be deceiving, because of something called a "chiral." Chemical molecules, such as vitamin C, for instance, are composed of mirror-image components, which are exact opposites of each other. Oversimplified, one part of the molecule does good work in the body, while the other -- the evil twin, or chiral -- wreaks harm. "Everything in nature appears in opposition to each other," the doctor explains. "It's the same with every chemical compound. You have to purify out the bad chemicals that cause harm, and keep the good ones. People need to look for chiral-free products."
Many consumers are sidestepping all the confusion and one-size-fits-all products by seeking help from professionals they trust, and plastic surgeons and dermatologists are increasingly employing licensed aestheticians to help analyze individuals' skin and custom-tailor skin-care regimens.
"The best place to start is with a medically supervised aesthetician," says Kinsley. "There are so many people out hawking skin-care products, from the beauty salons to doctors offices, without really analyzing each person's skin and lifestyle. Consumers commonly don't know their skin type or what solutions they need.
"I recommend that they have a facial to start with," says Tamara Piazza, an aesthetician at Southern Aesthetics. "That way I can analyze their skin. I use a magnifying lamp and a wood's lamp that actually will show orange and pink in oily areas, for instance. I also have them fill out a very thorough consultation form." There's more to recommending a care program, however, than just knowing their skin type and condition. "I go with what they're trying to accomplish," Piazza says. "I ask what would they want to improve about their skin the most -- if they're trying to improve the fine lines, texture, tone. That and what I find in the analysis would determine what products would be best suited to them."
Identifying appropriate products still isn't enough, Kinsley adds. Doctors also have to consider the human factor: how much of a regimen will the patients actually do on a regular basis. "Some systems have four to five steps every night and not everyone has time for that or wants to do it," the Covington doctor says. "Or they may do it for two weeks then stop. My advice to people would be to get a program that fits their skin and their lifestyle. You may want to get something that is a once-a-day thing or twice-a-week thing, whatever regimen you will do that will get your skin healthy."
One of Kinsley's favorite product lines is Obagi, which is a complete skin-care system that includes everything from chemical peels to toner. The ideal Obagi program starts with a chemical peel that eradicates the dead top layer (or layers) of skin, then you follow with products to heal and rejuvenate the skin through the first six-week "skin cycle" -- the time it takes a whole new healthy layer of skin to form -- then maintain it for a lifetime. Patients don't have to undertake the complete, intense regimen to reap benefits of the products, however.
"What's good about the Obagi system is that even if you wash with the cleanser and put on toner and stop there, your skin is better off than if you didn't do anything," Kinsley says. "We sit down and find out what steps we can get them to do to get the results they want. (If they don't want to do an intense treatment or regiment) it might just take longer to get the results we want." She also uses Obagi products as an adjunct for patients who come into her office for cosmetic surgery. "When they come in for other procedures, we always try to improve their skin as well, because it just adds to the positive outcome. If you just do a facelift and the skin is tight but not toned, it's not going to look as good as it does for someone whose skin is radiant."
Treece's products of choice are Jane Iredale cosmetics, developed by Emmy Award-winning makeup artist Kevin Bennett, and Cosmedix skin care line, with products that contained only purified (chiral-free) active ingredients that are good for the skin. She chose Cosmedix as an alternative to developing her own line of products because it fit her patients' needs and is as affordable as most over-the-counter brands.
"There is no makeup that rejuvenates your skin," Treece says. "(Jane Iredale makeup) is antibacterial, anti-inflammatory, what it does is give great coverage without clogging your pores. It also soothes the skin."
People who want more dramatic, quick results turn to everything from microdermabrasion or laser resurfacing of the face, which is usually reserved for correction of acne scars and severe sun damage, to chemical peels of varying strengths. What they choose depends on what results they want, whether their skin can handle taking off several layers of skin at a time, and how much recovery time they can afford. Microdermabrasion and laser resurfacing can mean two weeks down time, while some peels will require a week or several days recovery time. Milder peels can make your face red for a couple of days but heal quickly.
"I think deep peels are going out in favor of multiple peels that can essentially achieve the same results (in a longer period of time) without the down time and the damage to the skin," Treece says. "But without peeling away the top layers and the fine lines and wrinkles, you can't get rid of the wrinkles. You just have to decide how you want to do that."
Kinsley agrees that deep-skin peels aren't a solution for everyone. "The problem is that not everyone can tolerate it, so for those people we have to have alternatives." Lighter peels and microdermabrasion are options. "Microdermabrasion is great for getting your skin looking a little healthier, more radiant; to do a course of four-to-six treatments does improve the quality of skin. But unless you maintain (your skin) with something, it's going to start looking the same again."
Skin care isn't just a subject for the face. Chemical peels are now being developed for different parts of the body: the arms, legs, etc., and science is still seeking new therapies to smooth and remove dimpled cellulite patches. Southern Aesthetics uses a non-invasive suction and message system called dermatherapy to reduce cellulite. "It's the only form of therapy that the FDA has approved for the reduction of cellulite," Southern Aesthetics Piazza says. "It's a treatment that combines suction and massage and uses deep penetrating seaweed gel. It improves the skin tone and contours the body, increases circulation and lymphatic drainage, which helps you get rid of toxins."
People can't depend on topical, surgical or massage to give them the healthy look they want, though. Treece says you still have to adhere to some basics, such as exercising, drinking water, eating a balanced diet and getting rid of bad habits such as smoking, drinking caffeine and bulking up on carbohydrates instead of protein.
"It's like anything else," she says. "You don't look in shape if you're not on a good exercise program. You're skin doesn't look in shape if you don't take care of it."