Any patient that undergoes a facelift has understandably great expectations given the commitment involved. But a facelift alone can not correct all facial aging problems. Preparing for a facelift is not only a matter of education but also benefits from before and after surgery skin care. When a patient is looking for and is ready for a facelift, their skin is also ready for a makeover as well.

Because a facelift only treats the sag in the skin and underlying tissues due to effects of gravity and other environmental factors, additional skin issues such as finer wrinkles, brown spots, large pores, red spots and generalized poor skin texture are not treated. Simply lifting up and pulling the skin tight will not get rid of every facial imperfection. Undergoing skin treatments both before and after a facelift can really put the ‘icing’ on the effects of the surgery.

Treatment options before a facelift can include microdermabrasion combined with light chemical peels (what I call a medical microdermabrasion) or medium-depth chemical peels like a Vi peel or the Perfect peel. These should be done no sooner than three or four weeks before surgery. These skin treatments will really freshen up the skin and an immediate improvement in skin texture will be seen.

In addition, the use of Retin-A is a great topical daily treatment in addition to or in lieu of the patient’s existing skin care regimen. While Retin-A has been around for decades and is not a sexy new topical agent, its benefits to the skin are well proven. It makes the skin healthier by thickening the dermis and improving its vascularity. This makes it heal better after surgery or just skin resurfacing. The strength of the cream or gel and how many times to apply it daily depends on the patient’s skin. The thicker the skin, the greater strength and number of applications it will tolerate without becoming too irritated.

After facelift skin care initially can include oral and topical Arnica and mineral makeup to cover the bruising. A return to one’s normal skin care regimens should wait a few weeks after surgery until the bruising is gone and most of the swelling has subsided. A month to six weeks after a facelift is a good time to have a microdermabrasion treatment to exfoliate the skin and buff up the facelift result. While there are many skin care product lines available, the use of topical Retin-A at some frequency of application after a facelift is always a good product to incorporate into one’s skin care regimen.

For many facelift patients, this surgery may be done only once in their lifetime. Many of these patients have never had a good skin care regimen and this surgery provides an opportunity to embark on one. Helping the facelift patient enhance and protect their surgery efforts is a valuable educational service.

Dr. Barry Eppley

Indianapolis, Indiana

Everyone knows the benefits of drinking water for hydration and ultimately for survival. But what is the deal with mineral water? While tap and many bottled waters have a modest amount of minerals, it is just a fraction of what is found in various mineral waters. Such water is derived having flowed through rocks and other natural materials so that it contains high levels of dissolved minerals. The FDA regulates how much dissolved solids are in mineral waters and they do not allow the bottlers of it to claim any specific health benefits from it. But such minerals in water has numerous health benefits beyond hydration which includes naturally balancing electrolytes such as potassium, magnesium and chloride as well as providing antibacterial and antifungal benefits. Mineral waters often have significant levels of calcium and magnesium which can be hard for some people to get enough of in their diet alone. Some mineral waters may also contain levels of silica which have numerous skin benefits including reducing inflammation and giving it a smooth silky feel.

Topical skin care has come a long way since the days of my mother’s  Ivory soap and Noxzema. Beyond the explosion in available products from drug stores, retailers and doctor’s offices, the potential capability and claims of contemporary skin products at times seem extraordinary if not unbelieveable in many cases. But the hope that miracles do exist in a jar or bottle will always continue to drive consumer sales of these products which topped $10 billion dollars in 2011.

While the number of exotic ingredients in skin care has continued to expand, so has what they promise to do and what consumers now expect them to do. This is discussed in a recent article in the August 23^rd 2012 Wall Street Journal entitled ‘When Skin Cream Gets Bossy’. As skin care products have made increasingly bigger claims, the level of expectations of consumers has similarly increased. And with the price tag that many of these products have, they had better deliver or consumers will stop buying. This is where better instructions are needed in how to properly use the products to get the best result. (the bossy part)

How to improve and ensure compliance with today’s skin care products is essential to seeing their potential benefits. From package inserts, the design of the dispensers to online webpages and videos, companies are educating and coaching consumers like never before. Consumers no longer need to rely on the sales person at the department store counter to learn how to use them. This is not as true for physician-dispensed products as there is more of a one-on-one relationship with the doctor or aesthetician and a higher level of credibility given their education and expertise. There is also the opportunity for follow-ups and monitoring progress in the amount of skin improvement.

One of the cleverest marketing and educational approaches that I have seen from manufacturers is the inclusion of laminated cards with either instructions, skin color or wrinkle tracking photos and phone numbers to call skincare advisors. This allows the consumer to engage with the company and provide some measure of their progress. Consumers buying over-the-counter products are much more fickle and will quickly abandon a product if they don’t see very quick results. This is why I tell many female patients that I can go to their bathroom and finds half-empty jars, bottles and tubes of products that they no longer use but won’t throw away. (until they are all dried up and useless to anyone)

Despite the improvements in over-the-counter skin care product lines, most of what they can accomplish is still largely preventative or maintenance. That feat is not to be minimized. But real improvement in brown spots, wrinkles, pore size and skin texture require topical skin care supplemented with more aggressive exfoliative therapies .(e.g., microdermabrasion, chemical peels, light and laser therapies) This is particularly true in those who already have some significant skin damage and aging changes.

Dr. Barry Eppley

Indianapolis, Indiana

The skin throughout our bodies is often perceived as being fairly similar. Although the basic makeup of the skin (epidermis and dermal components) is the same from the face to the toes, there are substantial differences in their ratios and thicknesses at different bodily locations. These differences can not only take advantage of , but require, the benefits many topical products that are available. This is particularly relevant in the unique skin around the eyes and the lips. These areas are often where cosmeceuticals can have the greatest impact on their appearance.

The skin around the eyes, particularly the eyelids, is very thin and one of the thinnest on the entire body. What makes it so thin is that it has an epidermal layer on the dermis that is substantially thinner than that found on the rest of the face. This scant epidermis is exposed to the constant effects of blinking, squinting and smiling which easily lends to the formation of wrinkles. This is exacerbated by the lack of any substantative oil glands in eyelid skin to keep it supple. While Botox can help with reducing the dynamic component of eye area wrinkles, moisturization of eyelid and periorbital skin is critical. Because of the thinness of the epidermis, it is also an area that can be exquisitely sensitive to exfoliating and peeling agents. This is why every skin care product line has specific eye topical agents which usually have lower concentrations of and milder exfoliating agents to reduce reactive redness and the flaking of the skin.

The skin on the lips is also unique. Besides being less thick than the surrounding facial skin, the lips have no sweat or oil glands. As such there is no natural protective barrier to keep the lips smooth. When exposed to theenzymes that the saliva in our mouth contains, the lips can be a facial area of constant dryness and irritation. This becomes exacerbated in colder weather where moisture loss occurs more rapidly and the lips become drier. Similar to the eye area, lips have their own need for topical products that both hydrate and exfoliate. Lips need more hydration than exfoliation so a topical lip product contains different ingredients than that used around the eyes. This has led to many types of lipstick containing more than just color. Reactive inflammation is better tolerated aesthetically in the lips due to the swelling which can occur. The creation of a temporary enlargement of the lips is more pleasing then swelling around the eyes.

The eyes and the lips are unique areas of facial skin that are prime targets for the benefits of topical products. Such products are an integral part of any skin care maintenance program as well as after aesthetic eyelid (blepharoplasty) and lip augmentation procedures.

Dr. Barry Eppley

Indianapolis, Indiana

The use of lasers and light therapies has dominated the talk about skin retexturing and resurfacing over the past decade. While they do produce some wonderful results, their use has overshadowed the historical approach of chemical peeling of the face. Chemical peeling today has been largely relegated to the superficial peels done by aestheticians and not physicians. When combined with microdermabrasion, they are known to produce a nice refreshening effect but the results are not comparable with laser treatments.

Most chemical peels that produced any significant results, such as trichloroacetic acid (TCA) and phenol, have involved significant recovery and discomfort. Medium to deep-depth peels done by physicians required significant skin penetration to produce their results. This produces significant upper layer skin sloughing and downtime. Personally, I had assumed that ‘state-of-the-art’ chemical peeling was more about technique than the chemical compositions of the solutions.

My understanding of chemical peeling has undergone a change in the past year since we have begun using the Vi Peel. This chemical peel is an innovative combination of different ingredients. Cleverly combining TCA, phenol and salicylic acid peels with retinoic acid, Vitamin C and a proprietary mineral blend, a very interesting chemical peel has been created. It can create a significant skin change (repair) without the associated pain on application and with very little downtime. I am not sure of the chemistry of exactly how it works since skin results from peeling have been historically associated with the concept of ‘deeper = better results = more pain and recovery’.

My Indianapolis plastic surgery experience with the Vi Peel has shown that it is a real revolutionary peel. I say this for the following four reasons. First and initially important is that the peel produces a significant anesthetic effect on the skin on application. So one can have the peel without pain. That is really important to patients and encourages them to return for further treatments. I assume that the anesthetic effect is from the phenol component of the solution. Secondly, it does produce real skin improvement that appears to be equivalent to that obtained from micropeel laser treatments. (less than 50 microns) A series of Vi Peels can be a comparatively cost-effective skin rejuvenation program. Third, it can be safely used on all skin types (even a Fitzpatrick V or VI) as well as on the more sensitive areas of the neck and the chest. (historical ‘no-peel’ zones) Eliminating sunspots from the hands and chest and decreasing wrinkles in the décolletage areas has always been problematic with traditional peel solutions. Lastly, the peel can be safely applied by a trained aesthetician and does not require a physician to do so.

The Vi Peel is not a complete substitute for laser and light therapies. But it is a valuable addition to skin rejuvenation by providing a real effective option for the under 100 micron retexturing  needs in the face. For the neck and chest, however, this might be the best option that currently exists for real improvement without the risk of scarring.

Dr. Barry Eppley

Indianapolis, Indiana

1.      What is the best approach to make my skin look better?

To make your skin look and feel more healthy and attractive, one must reduce or prevent wrinkles, sun spots and loose skin, improve skin texture and color, and remove blotches or damaged blood vessels.

Such total skin rejuvenation requires a program approach. Skin care is very similar to exercise and dieting…there is not one single thing that makes the big difference. It is a combination of different methods over the long-term which attains improved and better looking skin. One needs to avoid the idea that a single product applied daily is what works the best.

A comprehensive skin care program includes a daily topical regimen (at-home products), periodic exfoliative maintenance and refreshening (microdermabrasion and superficial chemical peels) and therapeutic laser and light treatments if needed. (deeper wrinkles, brown spots, and red lesions and vessels) Putting a individualized program together with the right products and types of treatments requires a skin care professional. (aesthetician) The skin care world is full of thousands of products and treatments. Knowing which is best for you requires a professional guide.

2.      How does microdermabrasion work?

The concept of microdermabrasion (often referred to as getting a  microderm) is to remove the most outer layer of the skin. (known as the stratum corneum which is dead skin cells) This is done by light abrasion usually using a wand with a roughened surface. It is not a painful procedure and requires no anesthetic. It is done either as a stand alone procedure but more commonly, and effectively, as part of a comprehensive facial treatment procedure.

Besides being a refreshening skin procedure, removal of the outer skin cells allows applied topical products, like light chemical peels, to penetrate deeper for more of an effect. It is part of a periodic maintenance facial skin treatment which is done every six to twelve weeks. Microdermabrasion is often touted has having benefits for scars and other superficial skin lesions but this is not true. It simply doesn’t go deep enough or remove enough skin layers to have any significant effect on these problems.There is no evidence that it can stimulate collagen formation either so it does not have a ‘rejuvenative’ effect on skin. Microdermabrasion can also be used as part of a treatment program for acne but chemical peels are usually more effective and less irritating. Because it is a superficial exfoliation treatment, there is no recovery needed.

Microdermabrasion should not be confused with dermabrasion, a much deeper form of skin removal. This requires some form of anesthesia, is effective for deeper scarring and wrinkles and requires a recovery period.

3.      How effective are IPL (photofacials) and what skin problems are they good for?

Light-based treatments are non-invasive procedures that are known by a variety of names, most popularly IPL or intense-pulsed light or BBL. (broad- based light) Unlike focused wavelength light (lasers), IPL treatments use non-focused broad-spectrum light targeting red and brown pigment which commonly develops from sun-damaged and aged skin. These treatments can leave skin with a more even colored complexion.  They are a safe and effective method to improve the signs of aging from the face, neck, chest, arms and hands.

Pulsed-light treatments have been credited for improving fine wrinkles and skin texture but theses effects are minor and not their primary benefits. One newer use for pulsed light is to help tighten skin. Without damaging the skin’s surface, pulsed light can safely heat the inner layer – dermis – of the skin, inducing the formation of collagen causing some mild skin contraction.

4.      What is a good skin product?

The plethora of over-the-counter skin care products is overwhelming and certainly confusing. Yet there are some significant similarities amongst many of them. The majority of them are basically moisturizers with additional components of sunscreen and botanicals. The moisturizer component (petrolatum, dimethicone and/or glycerin) acts both as a humidifier for the skin as well as a delivery vehicle for the other active agents.

The botanicals, such as soy, silymarin, curcumin, green tea and retinol  provide antioxidant properties that may help in the reduction of facial lines and wrinkles. The botanicals have tremendous marketing appeal but they are not the most important component of the skin care preparation.

Whether the product is an anti-aging night cream or a facial foundation, find one that does not irritate your skin and contains sunscreen protection and some antioxidant agent.

Prescription skin care products have significant proven potency, particularly in wrinkle treatment and prevention and in skin lightening. (bleaching) Vitamin A (Retin-A) and hydroquinone and kojic acid are well known for their effectiveness. A prescription product used with a moisturizing over-the-counter cream can be a very useful combination.

5.      How do lasers help reduce wrinkles and improve skin texture?

Removing layers of the skin, like sanding wood, can help get a  more even and smooth skin surface. Lasers do this by literally burning off the outer layers. Unlike microdermabrasion, lasers go much deeper being capable of removing up to one-third of the skin’s thickness. This is known as deep or CO2 laser resurfacing and requires some form of anesthesia. The effects of the heat of the laser on the dermis can also cause some skin tightening. It will usually take a week for the skin to heal after this laser treatment.

To decrease the recovery and make it an office-based procedure without anesthesia (topical is still needed), the concept of microlaser or erbium peeling has become popular. Going less deep than the CO2 laser, this treatment requires a series of laser peels done every six to eight weeks. They require just a few days to heal and, when done over time, can create a skin result that may approximate a single deep laser peel in some cases.

A newer variation of laser skin treatments is that of fractional skin resurfacing. It strives to decrease the time it takes for the skin to heal after a treatment but to stimulate the deeper collagen layers of the skin. Fractional laser does this by only treating a small percent of the skin’s surface but goes much deeper. By cutting deeper holes in the skin that are spaced out (like aerating a lawn), less skin surface is treated but those areas that are have deeper channels cut into them.

Laser skin resurfacing today can be done at different depths which can be tailored for the patient’s lifestyle. Significant wrinkle reduction and skin texture improvement can be achieved by computer-controlled skin layer removal.

6.      What role does chemical peels have in improving skin?

Chemical peels have a long history of use as a skin improvement treatment. They work by the acid acting with the top layer of the skin, ultimately resulting in it being sloughed off. The acid penetrates into the skin until it is neutralized. This controls its depth of penetration.

Chemical peels come in three basic types based on how deep they penetrate, superficial, medium, and deep. Salicyclic lactic, and glycolic acids are superficial, trichloroacetic acid (TCA) is medium, and phenol is deep. They are differing concentrations of each. Superficial peels are part of most aesthetic facial and at-home treatments, require no anesthetic and heal in a day. Medium-depth TCA peels are done by physicians, require at least a topical anesthetic, and heal in less than a week. Phenol is a deep chemical peel that has largely been replaced by CO2 laser resurfacing.

How deep a chemical peel goes is affected by a variety of factors other than the concentration of the acid. Chemical peeling is very much an art form that requires a lot of experience to get consistent and safe results. Medium and deep depth chemical peels should only be done by an experienced physician.

7.      Which is better for improving wrinkles, chemical peels or laser resurfacing?

Both can significantly improve wrinkles and the quality of facial skin depending upon the type and concentration of the chemical peel and the depth of laser resurfacing. In well-trained and experienced hands, both treatment methods are effective. Laser resurfacing is better for the treatment of scarring and skin irregularities.  

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Antioxidants are a common buzzword in both skin care and numerous health care supplements over the past decade. Preventing ‘oxidation’ in aging certainly seems like a good idea. But few who use these products probably understand how they work and what exactly are they supposed to treat. In addition, when and how are you supposed to get the benefits of antioxidant therapy?

Antioxidant products are geared to combat free radicals. A free radical is an unstable molecule in cells which occurs as a result of its electrons becoming separated. This can be caused by such damaging sources as ultraviolet rays, smoke and pollution. The natural aging process and cellular metabolism also causes free radical production. This separated electron desperately wants to  find another electron to which it can become paired. To do so, it may steal one from a healthy cell causing it to become damaged as well.

We generate millions of free radicals every minute and our bodies are very clever at repairing the cellular damage they cause. But over time, the repair process weakens and our skin begins to show ‘its age’. This results in wrinkles and otherwise dull skin externally. And it also causes localized inflammation that affects a lot of internal tissues and organs as well. Overall, free radicals are believed to be a primary cause of the general aging process.

Antioxidants work fundamentally by neutralizing free radicals and stimulating cells to repair their damage. They are ‘happy’ to provide that missing electron whichi helps stabilize and repair cells. To affect the skin, antioxidants must be part of a skin care formulation. Eating and drinking antioxidant compounds helps repair internal structures such as organs and the celplular glue that holds tissues together.

Numerous ingredients in skin care products have been shown to have these properties. Well known ones include coenzyme Q10, kinetin, idebenone as well as vitamins C and E. No evidence currently exists that shows any of the antioxidants to be more effective than another. Regular use in your skin care products, both during the day and at night, will get the best benefit. In otehr words, twice daily application of antioxidant-containing skin care products is ideal.

Eating a diet rich in antioxidants  can also help the body reduce its number of free radical effects. Consume a few servings of brightly covered food and drink each day. Highly concentrated antioxidants foods include apples, pomegranates, dark chocolate, red wine, artichokes, pecans, blueberries, strawberries, and spinach. A multivitamin daily supplement is also recommended.

There is real benefit to the use of antioxidants in skin care products. Their benefits can be maximized by additional use of good dietary selections and supplements which contain high levels of antioxidants. Together, the damaging effects from free radical s on your skin’s appearance can be lessened. While the use of antioxidants alone is not sufficient for all your skin care needs, it is one important step in the program.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Methods of decreasing the effects of aging on skin continues to find new and innovative approaches. The most recent one that I have come across is that of what you can do while you are sleeping…and it doesn’t come from an applied cream or lotion.

Rather it is something that is embedded in pillowcases and it may have a beneficial effect by reducing wrinkles while you sleep…copper-oxide infused fibers. Copper has proven antimicrobial properties and is an important elemental component of many of the body’s  tissues. There is a well known association of cooper peptides being used for skin enhancement. Several cosmetic skin products from well known manufacturers have it as part of their active ingredients.

Cupron, the company that makes the pillowcases here in the U.S. and sells them through Bed Bath and Beyond stores, published a study earlier this year in the  International Journal of Cosmetic Science. This study evaluated the pillowcase’s effectiveness in the appearance of wrinkles in patients who slept on them. The study looked at the skin of  fifty-seven women after two and four weeks of sleeping on the pillowcases. Those sleeping on the pillowcases containing the copper oxide had significant reduction in the appearance of wrinkles, a significant reduction in the appearance of fine lines, and overall improvement of skin glow.

This is an interesting concept and the first one that I have seen that moves a potentially skin-enhancing product into an everyday part of life. And a significant part it is, occupying up to a third of many people’s life.

While the effects of copper on skin emanating from a fabric sounds appealing, there is much science to prove that it actually works. While copper peptides are being effectively used in topical applications, it is copper oxide that is in these fabrics. Copper oxide is a much more reactive form of copper which continuously releases ions. Whether this copper ion release is significant enough to have any effect on stimulating collagen formation in skin is unknown.

Other important considerations are whether the skin can actually absorb any of the released copper ions and how long the fabric releases them. What happens after repeated washings and what effect different detergents and softeners may have on them would also be useful information.

Despite these drawbacks, this fabric-infused approach to wrinkle reduction remains appealing. While it may not be as effective as many other well-established methods, it may have an adjunctive skin rejuvenation role. And a good product to offer as part of a comprehensive skin treatment program.

Dr. Barry Eppley

Indianapolis, Indiana     

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Medical Skin Care was discussed. Covering the popular facial treatments of ayurvedic facials, medical facials, microdermabrasion, chemical peels, and laser micropeeling, the medical aestheticians from Ology Spa explained when and why these are used and how they fit into a skin care program. Other skin care topics covered were laser hair reduction, micropigmentation, light therapies for brown spots, and eyelash rejuvenation with Latisse medication and eyelash extensions.

The benefits of a medical skin care porgram with the proper selection of treatments and topical products can have a real anti-aging effecte with better skin texture and reduced wrinkling.

Medical skin care and Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Heaslth West Hospitals at 317-706-4444 or sending an inquiry by e-mail to: info@eppleyplasticsurgery.com.

The warm and seemingly healthy glow from a good tan is an irresistible appeal for many, particularly those under the age of 35. Most everyone recognizes the potential skin damage that occurs from excessive natural sun exposure and people are much more vigilant today about using sun blocks and limiting sun exposure. These concerns, as well as that of convenience, has led to the rise of tanning beds and tanning salons over the past two decades which are used by tens of millions around the world.

There remains vigorous and sometimes rancorous debate between the medical world and the tanning bed industry about the safety of acquiring a tan by this method. The medical world will argue that any artificial UV exposure is just as harmful as that by the sun. The tanning bed world will counter with that its effects are much safer than that of the sun.

Weighing in on this debate is now the International Agency for Research on Cancer. (IARC) They have now included sunbeds in its highest cancer-risk category. The French-based agency of the World Health Organization originally classified sunbeds as a probable cancer-causing agent in 1992 but have now raised that concern to its highest-risk category. Quoting IARC researcher Vincent Cogliano, ‘The use of sunbeds is carcinogenic to humans. It causes melanoma of the skin and melanoma of the eye. I cannot see any reason why a healthy person should use them.’

According to the new IARC assessment, which appeared in a recent article of Lancet Oncology, the risk of melanoma increases by 75 percent when use of tanning devices starts before the age of 30. It is reported that tanning beds emit a higher concentration of UV rays than natural sunlight, thus their potential carcinogenic effects on the skin are no less harmful.

What does all of this mean? I think it is fair to say that many of those who seek tans will continue to do so, regardless of the potential risks. Tanning for some is a lifestyle, for others it less frequent and often event or vacation motivated. Not everyone, based on skin type and amount of exposure, has the same skin cancer risk. However, medical evidence is clear that more UV exposure, regardless of the source, does increase the risk of skin cancer later. But when you are young and the negative effects are years to decades away, it is hard to have any appreciation of those risks.

Like most things in life, moderation and judgment is the key. As an Indianapolis plastic surgeon, I tell my patients that a little tanning occasionally is probably alright as long as it is not excessive and does not result in any sunburn injury. Even in a tanning bed, think of some low level SPF and sunscreen protection to guard against inadvertent excessive exposure. If you are fair-skinned and anyone in your family has a history of skin cancer, I would consider skipping it entirely.

Dr. Barry Eppley

Indianapolis, Indiana