The Anti- Aging Chest

golden globe (2)Watching the red carpet parade of beautiful women at the Golden Globes, I was mesmerized by the flawless chests above the strapless or plunging gowns. While we usually focus on signs of aging around the face and eyes, the skin on chest is often more lined and sun damaged and in need of some TLC. These women who professional lives depend on their beauty clearly knew this and they take great care to create a smooth polished and sexy decollete.

After trying  out  a wide range of anti-aging tools for my face, I realized that   there was now quite a difference between the skin on my face and the skin on my chest.  Last year  I had most of the freckles  and age spots  on my chest removed by  laser, but one big oddly shaped splotch resisted treatment.   Normally one spot ( even though it was shaped like a medieval serpent)  would  hardly be worth mentioning. But I get so many  questions about the best way to even out chest skin tone, I decided  to explore other tools for this area.

I asked Dr Marmur to use  a Fraxel laser  but she pointed out  that  the brown  mark scan0257was  slightly raised and textured ( photo on right).  For this type of  spot she need to zap it with an electro cautery needle.    After  numbing the area  with a tiny shot of lidocaine, Dr Marmur  touched the  raised area with the heated  wired needle.   The skin actually sizzled  as the tip bNEXT DAY (2)urned off the raised  brown  splotch.   It took less than a minute.  The area was quite red and as directed, I dabbed on a bit of Aquaphor and covered it with a bandaid.   When the lidocaine wore off, my chest felt  just a bit sore.

The next day the area was still red and raw, but not painful ( see photo on left).  Dr Marmur warned  me that the chest skin will stay red for  up to several months.     Since  body skin tends to heal more slowly than on the face, winter time is an HEALINGexcellent time to have  laser work on  body parts hidden by pants and sweaters.  One week later the area  has healed to a slightly  dry,  faint brownish pink splotch ( photo to right).    In a month I’ll post a follow-up pix. If ever find myself walking  on  the red carpet,  at least my decolette  will be ready.

Question: What are BB creams?

Answer:  I love new beauty ideas that are based on good science and BB creams are just such a concept.  BB stands for ‘blemish balm”  where blemish is defined as a skin defect ( eg dark spots and splotches and acne scars), not  just  traditional breakouts.

The original BB creams were developed by a Korean dermatologist to help his patients care for laser treated skin.  After having both IPL and frying off my freckles with a YAG laser, I had difficulty finding  appropriate  moisturizers and sun protection products.  The treatments made my skin especially vulnerable to sun damage, yet traditional chemical sunscreens were irritating while  zinc based formulations left my  skin with a weird white sticky film. 

BB creams are a genuinely clever idea.  They are a zinc based high SPF moisturizer/sun block combo that have a flattering tint.  The result?  On the skin it looks  like a traditional, flattering foundation rather than  mime  make-up.  Most of them are enriched with anti-aging ingredients  like anti-oxidants and peptides that also promote healing.

BB creams from Dior, Mac, GArnier and Estee Lauder are promoted not so much for post- laser sensitive skin but as a skin brightener to erase dark spots and splotches.  By coating the skin each day with a high 40-50 SPF, the existing melanin in the skin will be breaking down and new melanin will be prevented.  The results should be a fresher, clearer complexion.

There is good theory here but does it really work?  General skin lightening aka brightness or luminosity, is a hard thing to measure and even harder to capture in a home photograph.  To see if  BB creams can actually make a difference, I am going to take a  Visia imaging scan that can actually see the melanin deposits in the skin.(  I’ve posted this type of photo  before and there results are  pretty startling.)  Then I will use a BB cream for a month and then do another Visia photo.  If the BB cream actually changes the melanin content of the skin, we’ll all see it.

Does Hydroquinone Cause Cancer?

Each time I do a post on  skin lightening and mention hydroquinone, I get a flurry of concerned emails warning  me against using it.  Often  they point  out that hydroquinone can cause cancer and was banned in Europe.  Yet  the usually  quick to pull the recall trigger FDA still permits hydroquinone to be sold here– both in over the counter  formulations and in prescription only preparations.    I was both confused and worried.  Digging into the literature and talking  to a few trusted experts, here is the current  take on hydroquinone.

Hydroquinone is considered the most effective skin lightenens currently available and is one of  the very few on that acts by preventing melanin formation. There are three problems associated with hydroquinone:

1)  Tthe British Cancer Journal published  a study that linked  very high doses of hydroquinine to cancers in mice.  A second similar study found similar results.  Subsequently, hydroquinone was banned in Europe ,Australia and parts of Asia and Africa.    In 2006, the FDA  issued a four month moratorium on hydroquinone to review the data, but then allowed it to be used for”severe melasma for a short period of time”.   Animal studies linking something to cancer is certainly a big, ugly, red flag, but to date there are no studies that  show  it affects people the same way.

There is also concern that hydroquinone is linked to increased risk of skin cancer, because it  makes the skin more vulnerable to UV rays.  For this reason its important to use an SPF50   when treating the skin with hydroquinone based products.

2) Hydroquinine is thought to cause a condition called  ochronosis  which provokes the appearance of dark blue/black pigment in the skin.  If you pick up almost any article on hydroquinone  you will read about this problem.  However current wisdom now believes that  this problem is actually due to  the illegal presence of mercury in hydroquinone preparations, a common practice overseas including products from  South Asia,  and Africa.  It was interesting that at a national dermatology meeting this summer, the speaker  pointed out that  most dermatologists  had never seen a case of  ochronosis from hydroquinone in this country.  She asked the audience of 500 dermatologists to raise their hand  if they had seen the problem in any patient.  Only 2 out of the 500  raised their hands and both  had seen these patients  outside of the US– one in Africa and the other in Jamacia.  Interesting.

3) Hydroquinone  has been known to cause irritation and redness  which in women of color can lead to increased  patches of irregular pigmentation.  I personally experienced  the mother of all  reactions when I did a patch test of popular skin lightening product when I was still in high school.  A small dab in the crook of my arm produced  a five inch patch of red, itchy skin.  However, I was able to use Triluma without any problems, and I wonder what else was in that  old time skin bleach.  Because of its itrritation potential, doctors  agree that  it should not  be used on skin that is already sunburned, dry, chapped or inflamed.

So to bottom line it, hydroquinone is strong stuff  and certainly has some baggage.  But its still the most effective skin lightening  we have in out tool kit.   It seems to work beautifully with other ingredients like vitamin C, retin A and alpha hydroxy acids.  You can use lower concertrations and get addtional benefits from complementary ingredients.  Always keep the concentration of hydroquinone as low as possible.  Over the counter preparations can have up to 2% while those available by prescriptions usually have around 4% hydroquinone.  And only  buy skin lightening products made in the US.  Mercury has been  banned  for decades  and this seems to be a  major source of problems in skin bleaching  preparations from other countries

Kojic Acid– Can it lighten my skin?

Kojic Acid  has been around for almost  100 years.  It was originally discovered by Japanese scientists  who were working on different fermenting methods  to turn malted rice into sake.  As the story goes, the scientists noticed that spots and freckles on their hands disappeared after working with Sake production.  Kojic Acid has been a popular Japanese beauty aid for generations.  In recent years we’ve learned that Kojic Acid acts somewhat  like hydroquinone by preventing melanin  formation.

Research has shown that Kojic Acid can be effective but it has its problems.  On the one  hand it tends to be unstable and high concentrations are often needed to be an  effective spot buster.  On the other hand, Kojic can be very irritating and is known  to cause allergic reactions.  Often the best solution is to combine lower concentrations of Kojic acid with other skin lighteners like soy or hydroquinone.

If you want to try Kojic acid skin lightening creams, make sure you do a little patch test on your arm before slathering it on your face.

Can A Soy Moisturizer Brighten My Skin?

Soy is a fascinating ingredients in anti-aging  skin care products.  Studies  have shown that its a powerful antioxidant and help the growth of healthy new collagen.  In addition, genistein, a chemical in soy, prevents melanin pigments from attaching to skin cells.  This makes soy a great addition to sun protection and indeed soy  is effective for preventing and reducing  brown spots and freckles of sun damage.  However, soy does not work nearly so well for melasma, those dark patches that usually appear on the cheeks and forehead.   This type of hyperpigmentation appears to be fueled by estrogen and in fact genistein is a type of pseudo-estrogen.  In theory soy might actually  make melasma worse.

So to bottom line it, if you have been a sun baby and have lots of small freckles, soy enriched  moisturizers could  brighten your skin.  If you  have larger patches, especially  if they developed after you’ve been on “the pill”  and or had a baby,  soy  won’t be of that much help.

One final thought.  Some doctors  are concerned that the estrogen-like compounds in soy  could increase risk of breast and ovarian cancers.  They have recommended limiting soy intake in foods and are  now increasing that advice to include soy enriched skin care products.  If you or  your family have a history of breast or ovarian cancer, you might  be wise to avoid  soy based beauty aids.

Skin Lightening, Week One

  Here is the two step  jar of Elure, the new skin brightening agent.  The jar is divided into two compartments.  As per instructions, I used the first little spatula to put a dab of cream from the first side on  the BIG FRECKLE, waited a  minute then spread the same amount from side two on the same spot.  Totally simple, but I’ve yet to get into a routinue to do it twice a day.  So far, I’ve put  on about half  the recommended doses.  I’ve got to step up my game to give it a legitimate chance to work. I keep forgetting to put it on  either in the morning or evening.  I think that if I was using  on my face, it would be easier to remember, and just add it to my skin care routinue– but I’m not  used to treating my forearm twice a day. Guidelines are also to top the treated areas with a sunscreen but since sweater weather is here, the arms are not exposed to the skin, and I skip this step.

On the plus side, I didn’t have any irritation or rednesss that has been a problem with other skin lighteners.  Doctors also recommend  combining Elure with other brighteners   such as glycolic acid, kojic acid and arbutin.  I’m going to try that in the next  round, but right now I want to see  what this contender can do all by itself.

My BFF– Best Friend with Freckles

Intense Pulsed  Light (IPL) is a type of photorejuvenation  that uses  a blast of light to remove freckles, unwanted hair and  little red lines on the skin.    Often called the “lunchtime laser”  it does not burn off the top layers of the skin like a tradtional laser and the skin looks beautiful and smooth within a week.    I had IPL  last year in June  with Dr Marmur and was so pleased with the results.  I thought  it made my skin look tighter and fresher and I posted before and after pics on the blog.  My BFF ( best friend with freckles) liked  the changes so much that  she went  for her own IPL date.  I think her results were even better.  Not only does she look 10 years  younger, her skin  has a new radiance.  She is so pleased with the results, that she  has now joined  me in my anti-aging journey.

First we developed a plan.   In the morning  she is using a strong sunscreen  to prevent  the return of freckles.  When she  was in school, BFF was a super athlete.  Her current passion is gardening and she is developing a new style of wall garden.  For either activity  she is often in direct sun, and needs  an uber sunscreen.   At night she is using Retin A to stimulate  circulation and new collagen. After a few months on Retin A, she will have Pelleve and will share the results on No-Nonsense Beauty Blog.  Have you tried out an anti-aging  tool or technique?  It would be wonderful if you could share your experience and before and after photos.  There are so many options out there its hard to know  which work and which are empty promises?  As Mulder would say to Scully–” The Truth is  out there”.

A Beauty Bonus for my Neck

Here is a pix of my neck ten days after removing the various bumps and splotches.  The scabs are gone and  the redness is slowly fading. To avoid awkward stares  questions,  I am still wearing scarves and chuncky necklaces to cover them up.  I found that powder mineral foundation does hide them,  but then rubs off and stains  my tees and blouses, soI’m sticking to camouflage rather than make-up.  Now that I’ve worked so hard to  polish up   my neck and chest  I want to protect it from new problems.  I had three types of spots:

Brown spots:   These are a combination of age and sunlight.  The former I can’t so anything about– the latter just needs a daily sunscreen.  Done.

Skin tags: These are also linked to age and to high blood sugar levels. Not surprising, since I have type II Diabetes. As a matter of fact, it was Park Avenue dermatologist Dr Lefkovits who saw them  15 years ago and told me  to get tested for diabetes.  If I keep my blood sugar under control,  they do  not reappear.

Red spots:  These are called cherry angiomas and result when a small group of tiny blood vessels clump together.  They are a genetic thing and there is nothing I can do to prevent them.  However  they can develop  little extensions which are known as spider angiomas.  Both sunlight and alcohol can provoke these to appear.  I’m a two glasses of wine a week kind of drinker, so that’s not a problem.  Remembering to apply aunscreen to  my neck and chest is  my  new summer routinue.

And I’ve noticed an extra bonus to  this round of freckle removal.  In the area where  I had laser treatment,  the neck skin  looks smoother and less bumpy.  This ability to  tighten skin is one of lasers best benefits and spot tightening is actually the principle behind the Fraxel Laser. Rather than  totally burning off the top layer with the ultimate C02 Laser, Fraxel  works on a grid to treat tiny areas. but leave adjacent skin untouched.  The result?  A  more natural looking tightening.  I had not been that interested  to do Fraxel, but now  that I see how the principle works, its something I will explore it a bit, especially  for my neck.

Neck and Chest Freckles, Day 1

No, I didn’t get attacked by a flock of vampire bats.  This is what my neck looked like the day after Dr Marmur  removed some freckles, skin tags and red spots.  As before, I had  applied a lidocaine cream to numb the area, but Dr M felt that I needed a  bit of injected lidocaine to be more comfortable. She used a laser on the freckles, cut off the skin tags and eliminated the red spots, called cherry angiomas, with electricalcauterization.  Thanks  to the lidocaine,  the whole procedure was painless.   She topped each spot with a dab of Aquaphor and a non-irritating strip to cover  them.

The treated spots look alot  worse  than they feel.  In fact, I had far less discomfort with this treatment than I had when I lasered off the freckles from  my hands.  It does look pretty gross so  I have been exploring neck  hiding techniques.  The first night I want to a birthday dinner with two BFF’s.  It was too warm for a scarf so I turned up the collar of a white shirt, pinned the collar closed and then wrapped  my neck with a triple strand of fake pearls. It hid my red spots, but it was hot and uncomfortable.  The next day it turned cold  and I think I am the only person in New York who is happy it  is scarf weather again.

Red Carpet Shoulders

Watching the celebs walk the red carpet during awards season, I began to focus on the flawless  chests and creamy  shoulders of the stars  in their strapless gowns.  Was I  the last woman in America with  age spots  on my upper body?

The short answer is  no.  This is an often overlooked spot until a dress or bathing suit suddenly reminds you that sun damage doesn’t stop at the chin. That’s the bad news.   The good news?   There a buffet of spots removers including skin bleaches, IPL, lasers, Fraxel, peels and  microdermabrasion. The question is  which one  is the best.   According to Dr Marmur, I have several  different types of discolorations that require  different types of treatments.  For example the true freckles can be easily treated with a YAG or Ruby laser– the same type that I used on the freckles ( aka age spots) on my face and hands.  The raised spots are actually skin tags that are best cut off or burned away with electrocauterization.  As you can see  from my before photo, the red spots are atually more numerous and I’ll find out what they are  and how they are treated when I  get them removed tomorrow.  Its a good thing its still scarf weather here, since I  know from past experience that I’ll have a bunch of red scabs  on my neck for at least a week.