1.  Retinoic Acid

Retinoic Acid, a form of Vitamin A, is a very effective anti-aging ingredient.  Topical application of retinol to aged skin has been shown to reduce the appearance and severity of fine lines on the arms [1], under the eyes and other areas [2], and to improve overall skin tone [2].  Retinoic acid stimulates the cells at the basement membrane increasing cellular turnover and stimulating collagen formation in the skin.  This process causes the superficial layer of the skin to peel as the damaged cells are sloughed off and increases blood flow to the skin.  It is really important to sun block your skin while using retinoic acid as the peeling and increased blood flow makes the skin sensitive to the sun.  Retinoic acid can be found in low concentrations over-the-counter or in higher concentrations through a physician.  I usually recommend retinol-based creams for individuals who wish to reduce fine lines and/or improve skin tone as one component of a non-surgical approach to combat aging.

2. Hyaluronic Acid

Hyaluronic acid (aka hyaluronan or hyaluronate) is a substance normally found in the connective, neural, and epithelial tissues.  It is commonly used to treat arthritis through direct injection into the affected joint.   It is also available as an injectible filler to lessen the appearance of wrinkles (e.g. Restylane, Juvederm).  More recently it has been used as an ingredient in wrinkle creams, although its efficacy as a topical agent has been disputed.  I’ve heard physicians argue that the hyaluronan molecules are too large to pass through the epidermis rendering the creams ineffective.  On the other hand, Brown et al. claims that certain formulations do penetrate through to the dermis [3] and Pavicic et al. claim that their subjects experienced significantly better anti-aging results (including better skin elasticity, decreased wrinkle depth) using a hyaluronic acid-based cream compared to a placebo [4].  A benefit of topical hyaluronic acid that is less debated is its ability to keep and attract moisture on the skin.

3. Vitamin C

Applying topical Vitamin C blocks chemical reactions in the skin that cause damage.  It neutralizes free radicals caused by sun damage and stimulates collagen formation.  In addition, vitamin C can restore some of the skin’s immune function that has been damaged by ultraviolet rays.  I often recommend it to clients with hyperpigmentation since it can help lighten blemishes and improve overall skin tone.  It is crucial to note that vitamin C in its oxidized form can have an opposite effect and be harmful to the skin.  Thus, it is important to make sure that you only use vitamin C products that aren’t expired and that are stored properly in the right container (something air-blocking).  If you notice the product has changed color (e.g. from yellow to a brownish color) definitely don’t use it.

4. Glycolic Acid

Glycolic acid is an acid used as an exfoliating agent.  It forces cellular turnover, speeding up the clearance of irregular pigmentation caused by aging, sun damage, or acne blemishes.  Glycolic peels are often performed by a plastic surgeon or a licensed esthetician in concentrations between 20-70% depending on the desired effect.  It is also found in over the counter products in smaller concentrations.

Next time:  Best Wrinkle Creams Part 2:  Product Reviews

[1] Kafi R, Kwak HSR, Schumacher WE, et al.  Improvement of naturally aged skin  with vitamin A (Retinol).  Arch Dermatol. 2007; 143: 606-612.

[2] Bellemere G, Stamatas GN, Bruere V, et al.  Antiaging action of retinol: from molecular to clinical. Skin Pharmacol Physiol. 2009; 22 (4): 200-209.

[3] Brown TJ, Alcorn D, Fraser JR.  Absorption of hyaluronan to the surface of intact skin. J Invest Dermatol. 1999; 113(5): 740-746.

[4]  Pavicic T, Gauglitz GG, Lersch P, Schwach-Abdellaoui K, Malle B, Korting HC, Farwick M. Efficacy of cream-based novel formulations of hyaluronic acid of different molecular weights in anti-wrinkle treatment.  J Drugs Dermatol. 2011; 10(9): 990-1000.

Two types of microdermabrasion machines are popular today:  one that abrades the skin by dispensing aluminum oxide crystals and one that uses a diamond tip.  I’ve been asked recently why I prefer using crystals instead of diamond tip microdermabrasion, as many practioners have opted to use diamond tips over crystals in their practices.  Although both methods are effective and my machine can support either, I prefer crystals.  Here are several reasons why:

1.  Crystals allow me to control the level of abrasion thus providing a more individualized treatment.

The diamond tip always provides a very intense abrasion and cannot be adjusted.  I can adjust the flow of crystals to suit my clients’ needs.  For example, when treating a person with more sensitive skin I can reduce the crystal flow.  For someone who can withstand a more aggressive treatment, I can increase the level of abrasion by increasing the crystal flow.

2.  Crystals are more hygenic than the diamond tip.

After abrading the client’s face, the crystals are sucked up into the machine and stored in a container for disposal.  New crystals flow through the machine from a separate clean container so that fresh, unused crystals are always used.  The diamond tip, however, is not disposable and must be cleaned thoroughly between each client.

Of course, the establishment owner has more of an incentive to prefer the diamond tip unit.  Aluminum Oxide crystals are costly, an expense not incurred by the diamond tip owner.  Still I find that the benefits of using crystals over the diamond tip are worth the added cost.

How laser tattoo removal works in a nutshell:

Lasers are a safe and effective method for removing tattoos because they can target certain structures in the skin (in this case a tattoo) without damaging the surrounding area.  This ability is called selective photothermolysis.  When the laser light makes contact with the tattoo, the ink particles under the skin absorb the laser energy and convert it to heat.  If the heat is sufficient, the ink particles are destroyed and are then removed by the immune system.  It is common (and a good sign) to see a temporary whitening of the skin following a tattoo removal session.  For selective photothermolysis to occur, the device must have a pulse duration in the nano- or pico- second range.  If instead the device has a pulse duration in the millisecond range, the tattoo is exposed to the laser energy for too long and heat diffuses into the surrounding area.  If enough heat is produced, some clearance of the tattoo ink may occur but damage to the skin (scarring) is likely!

Now for the scary part….

It is not uncommon to see clinics around the country attempting to remove tattoos using devices with pulse durations in the millisecond range!  Despite overwhelming evidence that it is extremely dangerous to do so, clinics still offer tattoo removal using Intense pulsed light (IPL).

What is Intense pulsed light (IPL), and why SHOULD IT NOT be used for tattoo removal?

Intense pulsed light (IPL) devices emit high-intensity light. Unlike lasers, which are composed of only one wavelength, IPL’s contain many wavelengths.  They are able to limit the number of wavelengths delivered to the skin by using filters (for example, they could block out wavelengths that aren’t in the 400nm to 1200nm range), and can be used for hair removal in people with very fair skin.  However, they are a very poor choice for tattoo removal.  IPL’s deliver pulses in milliseconds,  meaning that when an IPL device is used selective photothermolysis does not occur.  As I stated above, this results in damage to surrounding tissue and often causes scarring.  IPL’s deliver pulses at relatively low intensities, resulting in incomplete clearance of the tattoo.  Furthermore, after scarring occurs and the skin undergoes textural changes, it can be difficult or even impossible to fully remove the tattoo.

What other devices MUST BE AVOIDED when inquiring about tattoo removal?

Avoid any device with a pulse duration in the millisecond range!  This includes typical hair removal lasers such as the Nd:YAG 1064 nm and Alexandrite 755 nm lasers (non Q-switched).  These lasers are excellent for hair removal and other procedures such as skin rejuvenation (Nd:Yag 1064 nm) but are bad for tattoo removal.

What devices ARE BEST for tattoo removal?

Right now Q-switched lasers are the safest and most effective devices for tattoo removal.  Only Q-switched lasers can provide high-intensity light with very short pulse durations (in the nanosecond range), making them the best choice for tattoo removal. There are several types of Q-switched lasers, including but not limited to the Q-switched Nd:YAG 1064 nm the Q-switched Alexandrite 755 nm.  The type of Q-switched laser used depends on the client’s skin type and the color of the tattoo ink.  Research is currently focused on developing lasers in the picosecond range, and they may replace Q-switched lasers as the best lasers for tattoo removal in the near future.

When shopping around for a tattoo removal clinic, MAKE SURE you ask about their devices.  Avoid clinics that remove tattoos with anything other than a Q-switched laser.  Make sure that the laser operator is knowledgeable about tattoo removal and that your expectations are realistic.  Not all tattoos can be removed completely, and some are better left alone.  Make sure you have a thorough consultation with a reputable clinician to discuss your options prior to beginning treatment.  In the meantime, if you have any questions, feel free to contact me.  I’d be happy to help.

Recently, evidence has surfaced indicating that dying the unwanted hair and subsequently applying intense pulsed light (IPL) might be an option for individuals hoping to remove white hair. Alijanpoor et al (2011) conducted a randomized, single-blinded research trial to evaluate the effectiveness of IPL in treating white facial hair in women with hirsutism (excessive body hair where hair is not typically present or is minimal. It commonly occurs in women with polycystic ovarian disease or other endocrine disorders with testosterone production). The participants were divided into 2 groups – those whose white hair would be dyed with black eyeliner (n=31) and those whose white hair would be dyed with black hair dye (n=31) (3).  For the participants in the first group the hair was colored on the same day as the IPL session, and for the participants in the second group the hair was colored 2 days prior to the IPL session (3). In both groups, ice was applied for 10 minutes after coloring the hair to cure the dye, followed by application of zinc oxide cream (3). The participants had six sessions spaced 4 weeks apart as well as 3- and 6-month follow-up sessions (3). Outcomes were based primarily on clinical observation (scored from poor to good), but participant satisfaction (self-assessed on a scale from poor to desirable) was also considered (3). Alijanpoor et al (2011) found that all participants in the eyeliner group responded either “fair” or “good” to the treatment and all but 1 participant in the hair dye group showed a response that was either “fair” or “good” (3). The participants’ satisfaction reports closely matched the above clinical observations (3). Thirty-one participants (11 from the hair dye and 15 from the eyeliner group) attended the follow-up sessions, and all but 8 showed significant improvement 6 months following cessation of treatment (3). Interestingly, older participants appeared to respond better to the therapy than younger participants (3).

IPL devices work by heating a large area superficially, whereas lasers heat small areas more deeply. IPL devices are less selective than lasers, which is why they should only be used in individuals with fair skin and dark hair. It is possible that the apparent success of IPL in treating dyed white hair is somehow related to the non-selective nature of IPL.  Since IPL is non-selective, using this device on individuals other than those with very fair skin is (at best) ineffective and (at worst) very harmful. The amount of heat likely required to remove white hair would cause burns and pigment changes in olive- and darker-skinned individuals.

Still, it is exciting that IPL may be an efficient and affordable method for removing white hair in fair-skinned individuals.  Although IPL may not be the best choice for hair removal in most clients with pigmented hair, larger and more comprehensive studies with longer follow-up periods may reveal that IPL devices are an extremely valuable addition to one’s laser practice.

1. Ibrahimi OA, Avram MM, Hankes CW, Kilmer SL, and Anderson RR. Laser hair removal. Dermatologic Therapy 24: 94-107 (2011).

2. Sand M, Bechara FG, Sand D, Altmeyer P, and Hoffman K. A randomized, controlled, double-blind study evaluating melanin-encapsulated liposomes as a chromophore for laser hair removal of blond, white, and grey hair. Annals of Plastic Surgery 58(5): 551-554 (2007).

3. Alijanpoor R, BejehMir AP, and Mokmeli S. Successful white hair removal with combined coloring and intense pulsed light (IPL): A randomized clinical trial. Photomedicine and Laser Surgery: DOI: 10.1089/pho.2010.2940