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The Message On the Bottle 

Learn to decipher the language on the label and find the anti-aging product that's right for you.

With the overwhelming number of anti-aging creams and cosmeceuticals on the market today, consumers are daily inundated with a dizzying array of ingredients and buzz words that promise to deliver youth in the prettiest of teeny tiny bottles, jars and tubes. Powerful marketing strategies and article after article in beauty magazines imply that clinical research and testing have somehow decoded the secrets to anti-aging Ñ granting you, the consumer, access to privileged information and scientific breakthroughs, while baffling you with everything from herbal extracts, botanicals and fruit enzymes to minerals, proteins, antioxidants and antibiotics. So how do you separate fact from fiction and make sense of the often confounding list of ingredients on the label? Local dermatologists Nia Terezakis and Sharon Meyer and clinical researcher Don Owen weigh in on four of the most popular anti-aging ingredients on the market today and offer some advice for decoding the message on the bottle.

First of all, when reading a product label, the active ingredients should be listed first or separate from the filler ingredients, says Terezakis. Because the FDA does not allow pharmaceutical and cosmetic companies to list the concentration percentage of some ingredients such as retinol, she says the way one can generally tell is to look at its place on the ingredient list — the lower it is on the list, the lower the concentration.

Moreover, what you can get from a doctor is often going to be much more concentrated than what you can get over the counter. In addition to the concentration percentage, a product's delivery system can also change the efficacy of the anti-aging ingredient. For example, a gel with the same percentage of retinol as a cream may be much stronger than the cream, because retinols happen to be more soluble in gel form.

"All retinols are not the same," Terezakis explains. "Because of the way they're mixed up, the vehicle that they're in affects the solubility, the stability and potency of it. Think of this: you can go to a cooking contest and there will be five people making gumbo. But the flavor of one of them is so much better than all the rest because of all the other ingredients. It's not to say that some retinols are better than others, it's just that some skin types react better to one than they do another, as they do with cosmetic choices. Some people just like one better than the other."

Products are often marketed by their filler ingredients as much as the active ingredients. Filler ingredients are those added to soothe and moisturize the skin, enhancing the overall effects of a product but not contributing to the work of the active ingredient itself. These would include natural ingredients such as aloe or other fruit and botanical extracts that can function as important anti-inflammatories or soothing, moisturizing agents that add to the way the product feels and the way you apply it, but do not combat aging as active ingredients do. Regarding active ingredients for anti-aging, Meyer and Terezakis are very specific in what they recommend, noting that a lot of the newer products on the market today just don't have the years of research to back up their claims the way that retinols - and alpha hydroxy acids (AHAs) to some extent - do. Owen agrees.

"What you have is hundreds of ingredients from raw materials suppliers that claim efficacy, that claim that they work," says Owen. "In reality, we've only got two or three ingredient categories that we know work [for anti-aging]. We have basically the big three, retinoids which include retinoic acid and retinols, the alpha hydroxy acids that cause mild exfoliation, and the final category which is kind of new, the peptides."

Beyond these categories, if you're looking for something new, Meyer and Terezakis recommend doing a little research. They suggest looking at articles and studies in dermatological journals and health publications that back up product claims with specific research and double-blind, unbiased trials. Likewise, they suggest mixing up your skin care routine. If you alternate a retinol with another new product like a peptide or an antioxidant, once you finish a bottle, try out another new one to see what brings you the best results.

As always, using daily sunscreen is essential, as many products can make skin more sensitive to UV rays. Likewise, pregnant women should always check with their doctor before using a new skin care product.

1. RETINOIDS

Derivatives of vitamin A, retinoids (prescription strength) and retinols (over the counter) - terms often used interchangeably -- shrink pores and increase cell turnover by causing the skin to exfoliate faster than normal, which helps smooth fine lines and wrinkles in addition to improving discoloration. There also is research that suggests retinoids help control collagenase, the enzyme that breaks down collagen after skin is exposed to UV rays.

As Terezakis explains, when skin is exposed to the sun "it's like X ray or radiation. It's like bombarding your exposed skin with the atom bomb. So for the next 20 to 50 years, every time your skin exfoliates it's going to be older and older. What a retinoid does is to make you shed fast the way a sunburn does, but it's doing something different. It's actually repairing the DNA."

She says that retinols can be used to treat all signs of aging from lines and wrinkles, to discoloration, clogged pores, rosacea, acne, scars, and even abnormal, pre-cancerous cells.

"Retinols were invented for acne. With acne you have an abnormal oil gland -your pore is your oil gland- so if a retinol is going to shrink an oil gland and make it go back to normal, guess what? It's going to shrink pores. They're a very important compound, and they're probably the one cosmetic that truly works for most of the things you dislike about aging," she says.

There are a variety of retinoids and retinols available in different strengths, but their efficacy can vary according to a person's skin type and the ingredient's delivery system (such as a gel or cream form), she says. Ideally, retinoid use should be integrated into a patient's skin care routine at a very gradual pace, as it can cause peeling and irritation until skin gets used to the treatment.

Terezakis and Meyer both agree that while it is difficult to convince some patients to use retinoids because of the initial degree of flaking and sensitivity, Retinoids and retinols are nevertheless the tried and true gold standard of anti-aging ingredients. They have been on the market since the 1970s and have had numerous studies and reports written documenting their effects.

2. ALPHA AND BETA HYDROXY ACIDS

Some of the most common acids listed in product information belong to this category, such as salicylic acid, lactic acid, glycolic acid and other fruit acids. The primary purpose of these ingredients is to exfoliate. "They all basically slough away skin cells, and they're better for exfoliating which helps with lines and wrinkles," says Meyer. "A lot of times, people using a retinol on alternate nights might also use a lactic acid product," which helps to soften, smooth and exfoliate skin, augmenting the effects of a retinol, she says.

Owen explains that AHAs work to soften the surface of the skin and stimulate epidermal cell turnover, which in turn helps other materials like retinols or peptides penetrate the skin.

This "make(s) your shedding layer of skin more compact so that the outer layer of the epidermis actually ends up sealing in moisture," says Terezakis. But while this can produce a healthy glow, she says that it does not do what a retinol does in overall effects.

Meyer also confirms that while exfoliation from these ingredients improves acne and the appearance of wrinkles, these products alone don't do anything for cancer prevention, nor do they combat damage from free radicals.

3. PEPTIDES

Also on the market today are peptides, another major bioactive ingredient category used to combat aging, also are known to researchers as lipopeptides or oligopeptides. Owen conducts research for Therapeutic Peptides, a company that manufactures lipopeptides for use in products he says are "profoundly effective against wrinkles but also suppress pigmentation." He also emphasizes that peptides, like most other skin care products, are best used in combination with other treatments. "Often if you've got a lot of sun damage, you would use a stronger alpha hydroxy acid followed by a peptide, or some people use a combination of all three [retinol, peptide and AHA]." He adds that those with sensitivities to retinols "wouldn't have that sensitivity, in all probability, to one of the peptide products."

Protein is like a pearl necklace, in which there are 20 different kinds of pearls (amino acids) that can be strung on the string, Owen explains. Oligopeptides are fragments of the strand, usually about 3 to 10 amino acids long. Because these fragments have an electrical charge, they aren't able to penetrate the top layer of the epidermis (the stratum corneum) entirely on their own, so a lipid tail is attached to form a lipopeptide.

Lipopeptides work by stimulating cells near the epidermis to promote collagen production, and during that stimulation they also can produce growth factors and enzymes that help skin repair itself. He says that the use of an AHA to soften the stratum corneum and can help the lipopeptides penetrate the surface of the skin and be more effective.

4. ANTIOXIDANTS AND VITAMINS

There's another buzz-worthy category popping up in everything from tea to foot cream. Antioxidants are ingredients that help prevent oxidative damage to cells caused by free radicals. Idebenone and glutathione are two popular antioxidants currently on the market, while vitamins A, C and E are the only known antioxidant vitamins.

"Free radicals are naturally put off by our bodies as we age and are increased by exposure to UV light (and other environmental factors). Free radicals cause cellular damage and activate collagen-degrading enzymes that break down collagen. Antioxidants sort of work to get rid of those," says Meyer.

However, most dermatologists still are skeptical of the benefits antioxidants provide as anti-aging treatments. "When retinoids first came out, they knew it was good for acne, and there was some speculation that it was good for anti-aging. But no one really believed that for a while. It had to really prove itself over a decade. I think that's where we are with a lot of these antioxidants. There's a lot of data out there that says they're helpful, but we're skeptical of some of the data because it's industry-sponsored or the clinical studies might not be double blind or placebo-controlled. We want to believe it, but we're not willing to bet the farm on it the way we are with retinoids," she says.

Likewise, the benefits of topical creams with antioxidants and antioxidant vitamins should not be confused with those gained from dietary supplements, as there has been little research done to prove how much of the antioxidants from a supplement really reach the skin. "While [the vitamins and antioxidants] are important and we use them in skin, we still don't have any real way of telling whether these vitamins and antioxidants added to a skin care product work any better than when you take them internally," says Owen.

In fact, large amounts of vitamin A taken orally can actually be toxic, and can cause headaches and liver damage, says Terezakis. "We just don't have the years of follow-up and research (for antioxidants) that we do with the retinols. Retinols are vitamin A derivatives [but] vitamin C is new." Concerning vitamin E, she says that while there are plenty of anecdotal stories regarding the ways it can improve the appearance of scars, there is in fact little to no data from controlled, double-blind studies to support them.

She says that part of the difficulty with developing antioxidant vitamin creams lies in the fact that the compounds are very unstable, meaning they are easily inactivated by light and other ingredients with which they may come into contact.

"The best thing to do is to check in the cosmetology and pharmaceutical journals and see who did studies confirming their claims-and you want it to be a company that's not selling [the product]," says Terezakis.

She recommends using antioxidants and vitamin-based products in combination with retinols: "Definitely use a copper peptide or idebenone or AHA. They don't do as much as retinols do, but they are important."

Meyer also recommends putting an antioxidant on in the morning under sunscreen in rotation with a retinol.

to age. This is just one part of the whole advice we give to the patients — they've got to use sunscreen regularly, avoid tanning booths and use topical creams with alpha hydroxy acids or anti-oxidants daily." Regarding active ingredients for anti-aging, Meyer and Terezakis are very specific in what they recommend, noting that a lot of the newer products on the market today just don't have the years of research to back up their claims the way that retinols — and alpha hydroxy acids (AHAs) to some extent — do. Owen agrees.

"What you have is hundreds of ingredients from raw materials suppliers that claim efficacy, that claim that they work," says Owen. "In reality, we've only got two or three ingredient categories that we know work [for anti-aging]. We have basically the big three: retinoids, which include retinoic acid and retinols, the alpha hydroxy acids that cause mild exfoliation, and the final category, which is kind of new, the peptides."

Beyond these categories, if you're looking for something new, Meyer and Terezakis recommend doing a little research. They suggest looking at articles and studies in dermatological journals and health publications that back up product claims with specific research and double-blind, unbiased trials. Likewise, they suggest mixing up your skin-care routine. If you alternate a retinol with another new product like a peptide or an antioxidant, once you finish a bottle, try out another new one to see what brings you the best results.

As always, using daily sunscreen is essential, as many products can make skin more sensitive to UV rays. Likewise, pregnant women should always check with their doctor before using a new skin care product. 1 Retinoids Derivatives of vitamin A, retinoids (prescription strength) and retinols (over the counter) — terms often used interchangeably — shrink pores and increase cell turnover by causing the skin to exfoliate faster than normal, which helps smooth fine lines and wrinkles in addition to improving discoloration. There also is research that suggests retinoids help control collagenase, the enzyme that breaks down collagen after skin is exposed to UV rays.

As Terezakis explains, when skin is exposed to the sun, "It's like X-ray or radiation. It's like bombarding your exposed skin with the atom bomb. So for the next 20 to 50 years, every time your skin exfoliates it's going to be older and older. What a retinoid does is to make you shed fast the way a sunburn does, but it's doing something different. It's actually repairing the DNA."

She says that retinols can be used to treat all signs of aging from lines and wrinkles, to discoloration, clogged pores, rosacea, acne, scars and even abnormal, pre-cancerous cells.

"Retinols were invented for acne. With acne, you have an abnormal oil gland — your pore is your oil gland — so if a retinol is going to shrink an oil gland and make it go back to normal, guess what? It's going to shrink pores. They're a very important compound, and they're probably the one cosmetic that truly works for most of the things you dislike about aging," she says.

There are a variety of retinoids and retinols available in different strengths, but their efficacy can vary according to a person's skin type and the ingredient's delivery system (such as a gel or cream form), she says. Ideally, retinoid use should be integrated into a patient's skin-care routine at a very gradual pace, as it can cause peeling and irritation until skin gets used to the treatment.

Terezakis and Meyer both agree that while it is difficult to convince some patients to use retinoids because of the initial degree of flaking and sensitivity, retinoids and retinols are nevertheless the tried and true gold standard of anti-aging ingredients. They have been on the market since the 1970s and have had numerous studies and reports written documenting their effects. 2 ALPHA AND BETA HYDROXY ACIDS Some of the most common acids listed in product information belong to this category, such as salicylic acid, lactic acid, glycolic acid and other fruit acids. The primary purpose of these ingredients is to exfoliate. "They all basically slough away skin cells, and they're better for exfoliating, which helps with lines and wrinkles," says Meyer. "A lot of times, people using a retinol on alternate nights might also use a lactic acid product," which helps to soften, smooth and exfoliate skin, augmenting the effects of a retinol, she says. Owen explains that AHAs work to soften the surface of the skin and stimulate epidermal cell turnover, which in turn helps other materials like retinols or peptides penetrate the skin.

This "make(s) your shedding layer of skin more compact so that the outer layer of the epidermis actually ends up sealing in moisture," says Terezakis. But while this can produce a healthy glow, she says that it does not do what a retinol does in overall effects.

Meyer also confirms that while exfoliation from these ingredients improves acne and the appearance of wrinkles, these products alone don't do anything for cancer prevention, nor do they combat damage from free radicals.

3. PEPTIDES Also on the market today are peptides, another major bioactive ingredient category used to combat aging, also known to researchers as lipopeptides or oligopeptides. Owen conducts research for Therapeutic Peptides, a company that manufactures lipopeptides for use in products he says are "profoundly effective against wrinkles but also suppress pigmentation." He also emphasizes that peptides, like most other skin-care products, are best used in combination with other treatments. "Often if you've got a lot of sun damage, you would use a stronger alpha hydroxy acid followed by a peptide, or some people use a combination of all three [retinol, peptide and AHA]." He adds that those with sensitivities to retinols "wouldn't have that sensitivity, in all probability, to one of the peptide products."

Protein is like a pearl necklace in which there are 20 different kinds of pearls (amino acids) that can be strung on the string, Owen explains. Oligopeptides are fragments of the strand, usually about three to 10 amino acids long. Because these fragments have an electrical charge, they aren't able to penetrate the top layer of the epidermis (the stratum corneum) entirely on their own, so a lipid tail is attached to form a lipopeptide.

Lipopeptides work by stimulating cells near the epidermis to promote collagen production, and during that stimulation they also can produce growth factors and enzymes that help skin repair itself. He says that the use of an AHA to soften the stratum corneum can help the lipopeptides penetrate the surface of the skin and be more effective. 4. ANTIOXIDANTS AND VITAMINS There's another buzz-worthy category popping up in everything from tea to foot cream. Antioxidants are ingredients that help prevent oxidative damage to cells caused by free radicals. Idebenone and glutathione are two popular antioxidants currently on the market, while vitamins A, C and E are the only known antioxidant vitamins.

"Free radicals are naturally put off by our bodies as we age and are increased by exposure to UV light (and other environmental factors). Free radicals cause cellular damage and activate collagen-degrading enzymes that break down collagen. Antioxidants sort of work to get rid of those," says Meyer.

However, most dermatologists still are skeptical of the benefits antioxidants provide as anti-aging treatments. "When retinoids first came out, they knew it was good for acne, and there was some speculation that it was good for anti-aging. But no one really believed that for a while. It had to really prove itself over a decade. I think that's where we are with a lot of these antioxidants. There's a lot of data out there that says they're helpful, but we're skeptical of some of the data because it's industry-sponsored or the clinical studies might not be double-blind or placebo-controlled. We want to believe it, but we're not willing to bet the farm on it the way we are with retinoids," she says.

Likewise, the benefits of topical creams with antioxidants and antioxidant vitamins should not be confused with those gained from dietary supplements, as there has been little research done to prove how much of the antioxidants from a supplement really reach the skin. "While [the vitamins and antioxidants] are important and we use them in skin, we still don't have any real way of telling whether these vitamins and antioxidants added to a skin-care product work any better than when you take them internally," says Owen.

In fact, large amounts of vitamin A taken orally can actually be toxic, and can cause headaches and liver damage, says Terezakis. "We just don't have the years of follow up and research (for antioxidants) that we do with the retinols. Retinols are vitamin A derivatives, [but] vitamin C is new." Concerning vitamin E, she says that while there are plenty of anecdotal stories regarding the ways it can improve the appearance of scars, there is in fact little to no data from controlled, double-blind studies to support them.

She says that part of the difficulty with developing antioxidant vitamin creams lies in the fact that the compounds are very unstable, meaning they are easily inactivated by light and other ingredients with which they may come into contact.

"The best thing to do is to check in the cosmetology and pharmaceutical journals and see who did studies confirming their claims — and you want it to be a company that's not selling [the product]," says Terezakis.

She recommends using antioxidants and vitamin-based products in combination with retinols: "Definitely use a copper peptide or idebenone or AHA. They don't do as much as retinols do, but they are important."

Meyer also recommends putting an antioxidant on in the morning under sunscreen in rotation with a retinol.

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