(July 24, 2009 - Insidermedicine) In this video, Dr. Gerald Goldberg, MD, discusses what he would if he had excessive skin aging. Dr. Goldberg is Associate Clinical Professor of Dermatology and Pediatrics at University of Arizona Health Sciences Center. He also practices privately at Pima Dermatology, in Tucson, Arizona.
At the American Academy of Dermatology's annual meeting in San Francisco, we had a chance to Dr. Gerald Goldberg, Associate Clinical Professor of Dermatology and Pediatrics at University of Arizona Health Sciences Center. Dr. Goldberg also practices privately at Pima Dermatology in Tucson, Arizona.
How and why does skin age?
Dr. Goldberg: Hopefully, we will all age, and age gracefully. As they say, the only things that are certain in this world are death and taxes, and aging, actually, if we're all lucky enough to reach a ripe old age. What that involves has a lot to do with aging skin. Aging skin has to do with loss of its elasticity, so there's less 'springiness' to the skin, and more sagging and loss of collagen in the supportive structures of the skin.
That's because of two or three main factors: one is heredity, two is environmental (sun and other environmental factors). Skin aging manifests in a non-uniform color, where you get a mixture of reds from blood vessels, browns from sun (depending on your skin type) and wrinkles and textural issues. Those are the key things that we see in skin aging.
What constitutes excessive skin aging?
Dr. Goldberg: Excessive skin aging involves deep wrinkles, abnormal skin texture, and non-uniform color in the skin, such that some people have very splotchy, non-homogeneous or irregularly-colored skin.
How is excessive skin aging treated?
Dr. Goldberg: Certainly, if we just step back and say, "What are the options for skin rejuvenation?" there are many. Skin rejuvenation involves different types of wrinkles, so that if we have wrinkles that are caused by facial movement (such as on the upper face), Botox can be used to actually decrease the activity of certain muscle-related wrinkles.
There are some deep wrinkles and folds that we're not going to get rid of with any procedure, so certain fillers can be put in in those cases. There are also some home products, like vitamin A, glycolic acid, antioxidants, vitamin C, etc. We can use these products in conjunction with whatever procedure we may be looking at for the patient.
In terms of laser skin rejuvenation, we have a wide array of options, from very gentle procedures which require no down-time for the patient post-treatment, to a modest or even significant down-time. We try to match the sort of procedure that someone may want to what his or her needs are.
For example, in the case of a 30- or 40-year-old woman with very mild skin irregularity in terms of color would necessitate a different approach than would a 70-year-old with deep wrinkles or sagging skin who needs more skin tightening. For the younger person, we might recommend a series of very mild, no down-time treatments using infrared laser. Those are very gentle, and the patient will only be swollen for 24-48 hours and can go about his or her life normally. This may be done three or four times, and the patient might elect to have a touch-up done once a year.
In the intermediate group, typically someone in their 40s or 50s with mild wrinkling and mild facial irregularity in color and tone, patients may want to have a fractional laser procedure, meaning that you may have 3-5 days of down-time, or a week of down-time before returning to ordinary activities, but with a slightly better result in terms of skin tightening and toning than you might have with a gentler approach. This normally does not require a series of treatments.
People with deep lines may really want something more aggressive. If we can't satisfy that expectation, it may done in combination with face lift. If the patient has deep vertical lip lines for which face lift is ineffective, there is also a more aggressive laser resurfacing technique. We do this in conjunction with plastic surgeons who do a lot of the more aggressive surgical approaches, whether for eyelids or face lift for sagging skin. If it's for texture and tone of the skin, laser procedures are particularly effective.
How can skin aging be prevented?
Dr. Goldberg: In terms of prevention of aging, still the most important things are the A, B, C's: Avoid the sun, Block the sun, Cover up. This is most effective way to prevent sun damaged skin, which will in turn delay or minimize skin aging.
Does smoking contribute to skin aging?
Dr. Goldberg: Smoking clearly is a contributor to aging, as well as any response to treatment. It delays wound healing, for instance, so it would be an added factor in terms of selecting an appropriate treatment. There's no question that, compared to non-smokers, people who smoke will look a lot more aged. A dermatologist can tell if a person's a smoker just from the characteristics of their skin at their age.
If I had excessive skin aging…
Dr. Goldberg: If I had excessive skin aging, or I was concerned about how my skin was aging and I wanted to do something about it, I would first try to identify what it is that I'm really concerned about. Is it the color of my skin? The texture? Wrinkles? What is it that truly bothers me? It may be something that's amenable to home cremes, or maybe to Botox if it's simply some muscle-related, or what we call dynamic wrinkles. It may be just some deep folds around the mouth, or what we call the nasal avial folds, where a filler might be adequate. But if you wanted to do something for the deep vertical lines, or some deeper wrinkles, you might then look into some of your options for laser skin rejuvenation, laser skin resurfacing or laser skin toning, whether by a fractional device or by a full laser resurfacing device.