Skin Through the Ages
I was treating a patient the other day who is in her mid 30’s with very healthy skin. She is regular about her skin care treatments and religious about her home care. She is seemingly doing great but asked me if she should be doing peels. In her case I advised against it and asked why she felt like it was something she should explore. She said she simply didn’t know what comes next. That sat with me for the remainder of the day, and I realized that probably many of my patients were wondering the same thing. So, what comes next? The short answer is that if you need something other than what we are currently doing, I will let you know, and we will put a plan together. The long answer comes with some explanation of how skin ages, and since I am rarely at a loss for words on this particular matter…the long answer it is!
Understanding How Skin Ages
No matter what your chronological age, I begin all treatments and consultations by categorizing your individual needs as either corrective or maintenance. Once I figure out what we need to do, I can determine which tools will be needed to get the work under way. To be clear, the tools themselves can be either corrective or for maintenance depending on how we utilize them. As I run through the basics of the chronological degradation and stages of skin aging, I encourage you to remember that you are the expert. You know which tools are in your toolbox. I also encourage you to show your patient that here is no replacement for personalized consultation with a professional by showcasing your education. You need your patients to trust that you are the best source of information, so they don’t turn to less desirable sources.
Skincare Throughout Life: From Childhood through Adulthood
Childhood and Teen Skin Care
In a perfect world, proper preventative skin care would be learned during childhood. I taught my kids at a young age that they need to care for the largest organ they have so that it stays healthy throughout their lifetime. Like dental care, good dermal health requires a combination of in-office and home care. I even wrote a blog post about this subject years ago called “Where Are All My Mommas.” In it, I talk about the importance of teaching kids the basics of good skin care to establish healthy habits early. Unfortunately, we don’t live in a perfect world and skin care doesn’t become a concern until it’s a concern. What I mean, is that hormonal teen and tween years wreak havoc on skin prompting the maiden voyage into skin care exploration. This means that we are starting with a goal of correction instead of teaching preventative care…not ideal.
Teen skin can be pretty volatile. Acne is one of the biggest teen skin struggles we see, but there are also excessive hair growth and hyperpigmentation issues that sometimes need intervention. I firmly believe that hormones found in meat and dairy products are to blame for the increased number of teens that present with the latter two issues, but I digress. Acne comes in many forms and there are lots of treatment options available. Check out the post “Acne Is a 4-Letter Word” for more detailed treatment information. Hirsutism, or excessive hair growth can be the result of too much testosterone. I’ve seen girls as young as 10 years old with full on mustache and beard growth! As a mom of two kids entering this period of awkward changes, I would move mountains to keep my precious babies from being the school bully’s next target. If a child is growing hair in unexpected places or they are growing abnormally thick and dark hair the first stop should be the pediatrician’s office to rule out any medical issues. If no medical treatment is recommended, then a skin and laser professional should be able to help. Waxing, Laser hair reduction, or electrology could be viable options. For more information about Laser hair reduction, check out “Hair Today…Gone Tomorrow.” Pigment, while more of an issue later in life, can begin during teen years. Sometimes it’s a result of past injury or physical trauma, it could also be lack of proper sun protection or introduction of oral contraceptives. The pill is used during puberty for all sorts of reasons including but not limited to period regulation and acne mitigation, but it can come with some undesirable side effects. If a person is genetically predisposed, birth control pills can stimulate hormonal pigment called melasma. Melasma is notoriously tough to treat, and it can not be cured, but there are some fantastic treatment options which I detail in the post “Unmasking Melasma.” These formative years are replete with emotionally charged moments, and even the most confident kid can become vulnerable when faced with hormonal skin changes, so be sure to tell them how amazing they are, then offer them a professional treatment to help correct the issue(s).
Adult Skin Care (20’s, 30’s, 40’s)
For the ladies who escaped teen acne, do not be surprised if you experience some adult acne instead. As humans evolve and are having babies later in life, the systems of our body also evolve and timelines for hormonal changes that prepare the body for childbirth can happen later for some. Adult acne is usually not quite as severe as teen acne and can be treated any number of ways. Whenever possible, try to get acne under control prior to pregnancy because most of the treatment products, medications and devices can not be used when expecting. If patients do become pregnant and are genetically predisposed, they may experience melasma often referred to as “mask of pregnancy.” Pregnancy is one of the most common causes of hormonal pigment and like adult acne, most of the treatments for melasma are contraindicated during pregnancy and breast-feeding. That means that your patients will likely have to wait until after they finish nursing to treat. We talk about skin maladies during pregnancy within the 20’s, but they all apply to pregnancy at any age.
The 30’s and 40’s will bring some architectural changes to the face and body including laxity and the early signs of jowl formation. Patients will begin noticing more fine lines around the eyes and forehead area, and an increase in sunspots and redness. They may become aware of other new growths as well. I lovingly refer to these lesions as barnacles. This is the time to buckle down and get a solid plan for anti-aging products and treatments in place for your patients. I highly recommend writing out a plan for the year. This may seem like a bit much, but a personalized plan will keep patients on track so they don’t wind up doing aggressive treatments that could’ve been avoided. A year-long plan will provide you the opportunity to set realistic timelines and expectations, present a workable budget so costs don’t get out of hand, and it will ensure that your patient never has to wonder “what comes next?”
Skincare in Your 50’s and Beyond
In your 50’s and beyond, your patients may be considering surgical interventions like face lift, neck lift or blepharoplasty (removal of fat pads and excess skin folds around the eyes). As their trusted provider, you should counsel your patient’s that if their skin is in good shape prior to your surgery, they will have a better more natural looking outcome. This is your cue to fast-track a plan for superior dermal health for them. In my practice, we offer a package called The Quad that utilizes BBL photofacial to target and eliminate unwanted brown and red in the skin, Scarlet SRF microneedling with radio frequency for global tightening of skin laxity, AGNES RF for targeted correction of individual lines, and erbium resurfacing for improvement of overall tone and texture. BBL, Scarlet and AGNES are performed in-office prior to surgery and erbium resurfacing takes place in the operating room immediately following the scheduled surgery and while the patient is still under general anesthesia. If your patient has decided that they are never ever ever having surgery no matter what, that’s perfectly okay too. The Quad or a similar multi-modality plan can be part of a non-surgical intervention too. The biggest adjustment is that the resurfacing portion of the package is performed in the office with local anesthetic (topical numbing creams in combination with nerve blocks). These types of tools are amazing because they not only improve appearance, but they also improve the quality of the skin by redensifying elastin tissues, stimulating collagen, and altering the gene expression to that of chronologically younger skin!
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