Turn Back The Hands Of Time

We would all like our skin to look its best, and certainly want to decrease our chances of developing skin cancer. If you’ve tried creams, lotions and gels and been unsatisfied with the results, discuss topical regimens and procedures with your dermatologist. Treatments exist that can enhance both your looks and your health.

If you have been diagnosed with early pre-cancerous skin changes, there are topical preparations that contain imiquimod, diclofenac, and fluorouracil which, when applied under your dermatologist’s supervision, can effectively reverse some of this damage. In addition, chemical peels are an excellent choice. This treatment has been around since Cleopatra’s time, and for something to be in use that long, it must be good!

On the strictly cosmetic front, I have seen numerous topical agents and lasers come and go over the years. These are often done in a series of treatments and do have some risks, but can be very effective when done by a competent physician (not by an assistant or an aesthetician). PDT (photodynamic therapy) is a newer therapy where an agent is applied to your face for one to three hours before undergoing a treatment with either a pulsed-dye laser or blue light. While shown to be an effective treatment, expect some down time as your skin will be red and flaky for one to four days. Another effective option is the more aggressive ablative laser resurfacing, which uses either a traditional carbon dioxide or Erbium laser. Often only one treatment is required, but the big hindrances are the one to two weeks needed to heal and the possible side effects of infection, persistent redness, or scarring. Newer fractional ablative lasers have been developed which decrease the chances of these side effects; the downside is that multiple treatments may be required. Furthermore, the results do not always meet patient expectations for such a costly procedure.

If you just want to get rid of sun damage such as fine lines, broken blood vessels, and discoloration, there are less aggressive measures that are effective. Again, the chemical peel is a great option, despite the scary misinformation in an episode of Sex in the City. I don’t have much faith in micro-dermabrasion as a very effective option for reversing sun damage, though it may be good to rid your face of blackheads or to just “freshen up” your skin a little. A pulsed- dye laser can be used to improve skin texture, decrease visible blood vessels and lessen the persistent redness that sun damage often causes. Other procedures include the diode laser, which improves overall skin texture and quality, and IPL (intense pulse light) machines that can be used to reverse sun damage.

Once more, I would recommend that these procedures not be done at your local spa by a friendly aesthetician. I firmly believe that laser surgery should only be performed by a qualified board certified dermatologist or plastic surgeon. I have seen too many avoidable “mishaps” that were referred to me for correction.

It is never too late to try and reverse the damaging effects that sun has on your skin. Start slow and consistently follow a steady course with a simple but effective topical regimen. Discuss effective and proven treatments with a knowledgeable dermatologist who practices evidence-based medicine. And when considering various procedures, always ask questions about the risks and the benefits of each. Most importantly, take continuous care of your skin: have your doctor instruct you on performing self skin examinations on a monthly or bi-monthly basis, get a complete body examination on a yearly basis, see your dermatologist if you notice any new or changing skin lesions, and apply generous amounts of sunscreen.

Emmanuel R. Loucas, MD, is the Director of the Alpha Aesthetic Dermatology and Laser Center of Manhattan at 69 East 76th Street and an Assistant Clinical Professor in the department of Dermatology at Mount Sinai School of Medicine. He has been in private practice for 15 years.

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Dr. Loucas was listed as one of New York Super Doctors 2012 in the May 20th 2012 issue of The New York Times Magazine.