The largest organ of your body is – your skin!  In view of that, much less attention and care are given to it than one might think.  There are many ways to influence and optimize the appearance of your skin.  The following is a general outline.

There are three general principles to Skin Care:  1) Maintenance of the desirable qualities you currently have, 2) Repair of any damage (caused by the sun, environmental factors, etc.), and 3) Prevention of future damage.  Fortunately, currently available skin regimens can address one or more of these principles concurrently.

Optimizing the appearance of your skin starts early – when you are born.  Sun exposure is the best-known negative factor:  early use of sunscreen and limiting sun exposure is arguably the single most important thing that can be done…although for anyone reading this now it’s probably a little late to get the maximum effect!  But it is never too late to start.  Ongoing sun protection includes the avoidance of peak sun strength and UV radiation (generally about 11 am – 3 pm), and active use of a good sunscreen (ideally spf of at least 50, applied early, often, and in sufficient quantities).  Beyond that, environmental influences such as smoking, exposure to strong wind, alcohol and many other factors can contribute to the suboptimal appearance of the skin.

What then – aside from the Sun Protection guidelines noted above – can be done for your skin?  [Injectable treatments such as Botox/Dysport and Fillers are discussed separately.]

The simplest regimen is the daily application of a series of preparations that exfoliate the skin and produce, in effect, a very light peel.  This results in skin that is softer and smoother.  The treatments can also be used to improve a number of different skin conditions, including fine wrinkling, sun damage, blotchy pigmentation and dark patches, superficial acne scarring, and age spots.

The first approach is with topical skin care products; i.e., products that are applied directly onto the skin.  There are many different types and lines of products and treatments available; they accomplish both the optimization of the existing appearance of the skin and the repair of existing sun damage.  The bases for these treatments are any of a number of light acids such as Retin-A or alpha-hydroxy acids (e.g., glycolic acid and lactic acid). The preparations are applied to the face every night for several weeks, until improvement is achieved, and about twice a week thereafter. Other areas of the body, such as the hands, arms and shoulders, can also be treated. Dry, flaky skin can be expected during the first phase of treatment; this is, in fact, the "light peel". A moisturizer should be used and, as with other forms of exfoliations and peels, a sunblock. 

Conditions involving deeper layers of the skin, such as wrinkling (particularly around the upper lip, mouth and eyes), and acne scarring, often are treated most effectively with resurfacing procedures, such as laser and other light source therapies, chemical peels or dermabrasion, since the exfoliation described above is not adequate. All three modalities diminish wrinkling and produce a more youthful appearance by removing superficial layers of the skin.

Resurfacing, whether through laser, chemical peels or dermabrasion can be light, medium or deep. The use of different techniques and chemicals is responsible for this variation in depth. Deep resurfacing procedures produce more dramatic improvement than light ones, but also have a longer recovery time, and have increased risks. For this reason, a series of light to moderate procedures is often recommended in place of a single deep one. The skin is generally extra sensitive to sunlight after resurfacing, and a sunblock must be used daily. Not all skin types are equally good candidates for these procedures. In general, lighter-colored skin is considered better since darker skin may have an increased risk of pigmentary (color) changes and scarring with these procedures.

The best-known resurfacing devices are carbon dioxide and erbium lasers.  Fractionated procedures, in which the energy of the lasers is administered to only a portion of the treatment area at one time, have gained popularity.  Still, the depth and coverage of the treated area remain the keys to the effectiveness of any resurfacing procedure.  The also are the main factors in determining the downtime and risks of the procedures.  Many different “lighter” treatments are available.

The first step is a consultation, during which you can explain what you would like to accomplish, you will be examined, and then a treatment plan will be formulated. There are many different topical products, sunscreen and rejuvenating procedures available.  These may include Skin Care, Botox/Dysport, Injectable Fillers, and/or Laser and Other Light Treatments.  This field is rapidly changing and ever-evolving; there’s almost always something new.  However, the core principles of Sun Protection, Maintenance, and Repair, remain the hallmarks of any Skin Care regimen.


Alan M. Engler, MD, FACS - Board Certified Plastic Surgeon
122 East 64th Street New York, NY 10065 USA
(212) 308-7000

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