Dr Zein Obagi discusses designing a treatment plan for optimal results
The popularity of skin rejuvenation procedures has increased exponentially over the past decade as a result of increased patient interest and technological advancements. Patients are becoming better educated and more aware of different treatment options for skin rejuvenation via the Internet and media coverage. In addition, more practitioners are now offering skin rejuvenation procedures of varying degrees in clinics, malls, salons and spas, and on the High Street.
This convergence has resulted in consumer confusion about which treatments and products are safe and most effective, and how to sort through the myriad options on offer.
Skin rejuvenation redefined
Skin rejuvenation is not just about selecting a cream to improve the skin’s surface. Nor is it about one type of procedure, such as a laser or other energy-based device, a chemical peel, dermal filler or neurotoxin injections. It is also not just about undergoing invasive surgery, such as a facelift, blepharoplasty or browlift.
My philosophy of skin rejuvenation is a comprehensive treatment plan with a combined approach. This includes the art of transforming skin to its original state through use of:
• Topical agents that restore general skin health.
• Topical agents to treat existing disease (acne, rosacea, actinic keratoses, etc.) when they are present.
• Procedures (lasers, energy-based devices, chemical peels, fillers, and/or neurotoxins) when topical agents alone do not completely restore skin to its original state.
Restoring and maintaining skin in its optimal original state is the main objective of skin rejuvenation. This is accomplished by designing an appropriate topical protocol and overall treatment plan that is appropriate for each patient’s needs.
The optimal plan should be based on selecting:
• Topical agents that restore general skin health and treat any concurrent skin disease.
• When indicated, adding an appropriate procedure, based upon its mechanism of action and the desired result.
• When choosing a procedure, identifying the safe depth of penetration for a particular skin type, to ensure maintenance of skin integrity and a natural appearance.
After classifying the patient’s skin and making the diagnosis, the practitioner should formulate a comprehensive treatment plan that includes both short and long-term goals. The plan must clearly inform the patient of the reason for each part of the overall plan. Monitoring patient compliance with short-term treatment recommendations, for example, assessing the patient’s daily use of a comprehensive topical regimen, allows the practitioner maximal control over the entire process.
Photodamage is a universal problem that can affect any skin type. It starts at an early age (two to three years old), and is undetectable initially. However, as a person experiences more sun exposure over the years, damage becomes clinically significant, as localised and generalised pigmentation increases, and texture (wrinkling, loss of elasticity) become apparent.
Unfortunately, many skin care professionals as well as consumers do not recognise sun damage until it becomes severe and extensive, for example when actinic keratoses and skin cancers appear. Thus they ignore the early signs of photodamage that are more easily corrected, such as tanning, freckles, and lentigines.
Recognising and treating photodamage in its earliest stages will help patients avoid the more severe and clinically challenging types of photodamage, and perhaps, more importantly, to prevent all photodamage, which is our ultimate goal.
The best way to address photodamage is not to have it occur in the first place. This requires going beyond basic sun protection, and incorporating my four Key Principles of Skin Health Restoration that are imperative to teach your patients:
1. Avoid tanning—skincare professionals must educate consumers so they know that tanning reflects DNA damage and a host of unhealthy skin changes that can have major consequences over time.
2. Do not rely on sunscreens alone—regardless of how high the sun protection factor (SPF), chemical and physical sunscreens wear off after one to two hours. Research shows consistently that people under-apply sunscreen and fail to reapply it often enough.
3. Practice sun avoidance—wear protective clothing (wide-brimmed hats, long pants and sleeves); pursue outdoor activities before 10 AM or after 4 PM, with adequate sunscreen and protective clothing.
4. Adopt a healthy skin protection programme as part of a daily routine:
• Load the skin with antioxidants (four to six types) in a proper formulation that also provides DNA protection and repair agents
• Enhance skin barrier function by using appropriate concentrations of retinol and AHAs daily, and before applying sunscreens.
• Increase the skin’s ability to repair and renew itself by following a skin care program that provides effective stabilization of the epidermis (keratinocytes and melanocytes) and the dermis (fibroblasts).
ZO Oclipse Smart Tone SPF50 is a highly advanced, broad-spectrum SPF 50 sunscreen that offers a sheer tinted primer, designed to match any skin tone. Broad spectrum UVA/UVB protection provides additional protection against high-energy visible (HEV) light. It also includes an exclusive 12-hour time-release antioxidant complex to guard against photodamage, plus Avobenzone 3%, Homosalate 10%, octisalate 5% and octocrylene 10% for maximum UVA/UVB protection plus fractionated melanin to shield skin from HEV light. Iron oxides and mica offer a unique pressure-release colour system for customisable skin tone, and tetrahexyldecyl ascorbate is incorporated to promote pigmentation inhibition.
Eyelid rejuvenation treatments
The delicate eyelid area is one of the first places that signs of ageing tend to appear, mainly due to prolonged sun exposure. Brown spots, fine lines and wrinkles, sagging, herniated orbital fat are among the age-related changes that affect the eyelids and patients complain about most.
Skin discolouration is caused by cumulative sun exposure and sun spots often begin to appear in the mid-30s just below the eyes. Fine lines form around and below the eyes that are exacerbated by sun exposure. Dynamic wrinkles caused by repetitive facial movements are also related to ageing; for example, parallel vertical lines that form between the eyebrows in the glabella, crow’s feet in the lateral corners of the eyes, and horizontal wrinkles that run across the forehead. Under eye bags are caused by a combination of loose skin and protruding pockets of fat. With advanced age, the muscles of the lower eyelids tend to weaken, skin becomes lax, and more fatty deposits get stored that bulge forward and become more visible. In addition, hollow grooves may develop under the eyes in the tear troughs that create the appearance of dark shadows.
Treatment options for eyelid rejuvenation include neurotoxin injections to soften dynamic lines and wrinkles, dermal fillers and fat to plump hollows, TCA peels, lasers and light based treatments to improve skin laxity and discolouration. Older patients may also benefit from upper and lower blepharoplasty to remove excess skin and fat if needed, and tighten loose muscles. Another commonly used technique is fat transfer where fat is repositioned from the lower lid to fill in the groove.
Selecting a treatment plan for your patients must also include topical agents to maintain a youthful and healthy skin condition. We have developed two essential eye treatments in the ZO range to target the key components of eyelid ageing.
Dr Zein Obagi is a board certified dermatologist in Beverly Hills, Calif. and the Medical Director of ZO Skin Health (zoskinhealth.com) and is responsible for the development of new skincare treatments, protocols and products to achieve healthy skin.