As of Tuesday, April 8, 2014
DEAR DOCTOR K: I'm in my 60s and already have a lot of wrinkles. What can a dermatologist do for me that will make a difference but not be hugely expensive?
DEAR READER: Age isn't kind to skin. Years of sun exposure leave their mark in the form of fine lines, wrinkles and discoloration. I spoke to my colleague Dr. Kenneth Arndt, clinical professor of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center. He assured me that some of the damage can be reversed.
The first step is to slow the pace of further damage. Do this by staying out of the sun and by wearing adequate sun protection whenever you are outside. Completely cover exposed skin using a sunscreen with a sun protection factor (SPF) of 30 or higher. And wear sun-protective clothing and a wide-brimmed hat.
If you think this sounds like preaching, at least I practice what I preach. I was raised in Los Angeles and spent nearly every weekend of my life from the ages of 3 to 19 at the beach -- without sunscreen. Most of the time I had a "healthy tan." Like many people in Southern California, I looked "simply maahvelous."
Many skin cancers later, I realize that a "healthy tan" can have unhealthy consequences. Why don't I have the attitude: "The damage is already done, so why should I bother about protecting myself from sun exposure now?" The reason is simple: The past damage has made my skin even more vulnerable to cancer from new sun damage.
Besides protecting yourself from the sun, to minimize existing wrinkles and age spots, consider dermal fillers and neuromodulators.
Neuromodulators (Botox, Dysport, Xeomin) are injections that relax the muscles that create the appearance of wrinkles when you smile, frown or laugh. These products diminish frown lines and forehead lines and sometimes crow's feet.
Dermal fillers are injections that plump up sagging areas of skin. Dermal fillers are often used to soften the "laugh lines" that run from the side of the nose down to the mouth.
Often the two treatments are used together to enhance and prolong their effects. Both techniques are safe, with few side effects. To keep seeing results, however, you'll need to return for repeat sessions.
You mentioned cost, and these treatments can be pricey. For example, Botox injections range from $300 to $700 per session. If this is out of your budget, consider these options:
Chemical peels use chemicals such as glycolic acid to strip away the outer layer of damaged skin. A glycolic acid peel can cost as little as $80, but it needs to be repeated every few weeks or months to continue showing an effect.
Microdermabrasion uses tiny exfoliating crystals to buff off the top layer of skin and reveal the smoother surface below. Although the technique is different from a chemical peel, the results are similar. The cost is around $100.
In the past 40 years, we've learned a lot about how aging and lifestyle can damage skin, and about how to repair at least some of that damage. That's made many of my patients very happy.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)