14 May 2014
Posted by: Administrator Catagory: Skin
The Art of Skin Rejuvenation
By DR. VIVEK SHRIVASTVA
Does your skin appear healthy?
There are many components that create healthy skin. Some of the most important characteristics
are even colour, uniform pigmentation and clarity as typified by a child’s skin. With the pasage of
time, blotchiness, hyper- and hypopigmentation occur, dark spots appear (e.g. solar lentigines)
and dark circles become resident under the eyes. Healthy skin also looks and feels smooth. If
looked at closely it is ‘regularly irregular’ with tiny peaks amidst the pores and follicles and troughs
in between. Unhealthy looking skin might be laden with comedones (blackheads and whiteheads),
blemishes, fine lines and wrinkles which remove uniformity. Health resplendent skin is also plump
and toned -a reflection of and hydration, but also underlying collagen support, fat pads and
skeletal structure. Without support, nutrition and hydration, the skin appears dull due to a buildup
of dead skin cells. This slowing of the epidermal cell cycle is enhanced with chronological age, sun
exposure and free radical damage. The remnant dead skin cells on the surface scatter light
causing the skin to appear dull and lifeless.
How is young skin really that different to ageing skin?
Typical ageing skin is affected by the intrinsic (natural) ageing process (namely genetics,) as well
as extrinsic factors like sun exposure and free radical damage. As we grow older, several
changes take place in our skin:
- Our melanocytes (the cells that give our skin its pigment) decrease in number
- Sebaceous glands no longer produce so much oil as younger skin.
- Within the skin, elastin, the substance that enables skin to snap back into shape, has a bit
less spring and collagen production slows. In fact we start to lose collagen at the same
rate in our mid twenties as our early forties.
- Bone resorbtion and loss of supportive fat pads occur with age.
Thus aged skin often appears more wrinkled, pale, dry, thin and transparent than it did in youth.
The loss of bone, fat and collagen causes hollowed cheeks and eye sockets, sagging skin as well
as noticeable loss of firmness on the hands and neck.
How can I look as good as I can for my age?
There are thousands of potions, creams and vitamins marketed to enhance your beauty with the
promise of eternal youth. There is however no one modality or unilateral approach that will
restore this; but rather a combination of processes tailored to your skin type, texture and volume
In fact the ageing process is so complex involving intrinsic genetics, (cellular changes, DNA
damage, effects of enzymes and free radicals) and extrinsic factors (photodamage, smoking,
alcohol, exercise, diet) that a far more comprehensive approach is required. The results can be
There are a handful of trade secrets to give you that beautiful dewy skin you always craved.
Some treatments provide fast results and target the physical appearance of skin whereas other
processes target the physiology and metabolic processes within the skin itself to maintain youth
and skin nutrition. These latter treatments concentrate on hydration, exfoliation, antioxidant
therapy and sunprotection. These are synergistic with the likes of Botox and dermal fillers, and
one approach is no use without the other. Diet and lifestyle aside, here are my top products and
For fast results
1. Chemical Peels
The most common peels performed in clinic are alpha-hydroxy acids (AHAs), beta-hydroxy acid
(BHA), Jessner’s soloution and Trichlorocetic acid (TCA). All of theses agents cause
desquamation of the skin surface leading to a hastened cell cycle and collagen induction. They
improve the texture and clarity of the skin, fine lines and are also useful in the treatment of acne,
rosacea and pigmentation.
2. Hyaluronic acid
When considering anti-ageing products, the buzz word on everyone’s lips is Hyaluronic acid,
otherwise known as dermal fillers. Hyaluronic acid has now become the gold standard for nonsurgical
correction of volume loss. This is a naturally occurring sugar molecule (polysaccharide)
that can bind water many times its mass, giving the skin lubrication and pliability. With age we
lose volume in the face (beneath the eyes, cheeks, mouth area), and so surgical interventions –
i.e. facelifts do not always produce the desired results as volume is not always replaced.
Synthetically made Hyaluronic acid (e.g. the Juvederm Range from Allergan) stimulates collagen
production and is naturally broken down in the body. It is most effective when used in the face,
lips, neck, chest and hand area where the first signs of ageing occur. Subtle and careful
placement of this product by an expert can produce beautiful and more importantly, natural
results. Be cautious of department store products and moisturizers displaying hyaluronic acid –
this is a large molecule and cannot penetrate the epidermis (outer layer) of the skin. It will
temporarily plump up the skin but the end result is needing to over-moisturize which is
detrimental to the skin’s physiology in the long run.
3. Botulinum Toxin
There are several different types of Botulinum toxin, but the most well known is probably “Botox”
made by Allergan. There are a growing number of indications for it’s use, but the best results in
the facial area are lines in both the upper and lower face (crow’s feet, frown lines, gummy
smiles, neck lifts, peri-oral wrinkles) to provide subtle and beautiful results.
Longer term – essentials for enduring youthful skin and a must for all those concerned with signs
4. Vitamin C
With it’s strong antioxidant properties it can improve fine lines, skin texture and clarity.This strengthens
collagen and elastin damaged by free radicals, and is also anti-inflammatory. It’s important to buy a
bioavailable and stabilized Vitamin C (e.g. Obagi/Skinceuticals) so that the body can actually use it. Most
of the products in department stores do not contain a stable or bioavailable Vitamin C so you’re not getting
any bang for your buck.The most bio-available form is L-Ascorbic acid, and a stable form delivers more to
the skin than the diet. This is a must for every lady’s beauty bag. If I had to choose only one product to
use on the face daily, this would be it.
Vitamin E is a term for the group of tocol and tocotrienol derivatives. These are used in topical creams and
lotions. This vitamin improves surface moisture content, promotes healing, and also provides some sun
protection and anti-inflammatory properties.
We should all be wearing sunscreen daily, even in cloudy weather. Find a sunscreen with good UV
protection (UVA -aging, UVB – burning). The most preferred and cosmetically acceptable ingredient to
combat ageing is a product containing Microionized Zinc Oxide, This powerful mineral is known for its sundeflecting
ability as well as its nonirritating and nonallergenic properties– look for this on the labelling.
One can immediately tell if someone is using a retinoid – their skin is glowing and smooth. Retinoids are
vitamin A derivatives that have been proven to boost collagen, reduce fine lines, and to speed cell
turnover, which evens out discoloration. Retinoids are available over-the-counter (as retinol) or with a
prescription (as tretinoin, adapalene, and tazarotene). This is the only drug that increases collagen
synthesis and also reverses sundamage. In fact UVB exposure upregulates several enzymes that
breakdown collagen and tretinoin inhibits this process. This is a common product used by dermatologists
and surgeons alike.
Mesotherapy involves microinjections of different pharmaceutical, homeopathic and plant extracts,
vitamins and microelements into the dermis of the skin. Administration of antioxidant vitamins (Vitmins C
and E), Co-enzymes (e.g. Q-10), trace elements (copper, zinc and magnesium), and injection of amino
acids or synthetic peptides are used to stimulate the elastin and glycoproteins responsible for the
biomechanical property of skin. Increased firmness is achieved by injection of organic silica, and Centella
Asiatica, whereas hydration is given with hyaluronic acid. Organic silica in particular has diverse actions
including antioxidant properties and binding moisture in the epidermis. Centella Asiatica stimulates type 1
collagen and helps with scars, dermatitis, ulcers and hair loss. DMAE (Dimethylaminoethanol) is
commonly applied due to its stimulatory effects on collagen production resulting in a firming and lifting of