Visible Difference: September 2010

Aging is a fact of life, but, depending on the color of your skin, you may age at a slower or faster rate and completely differently than someone with lighter or darker skin. While all skin tones should take preventative measures and sun protection into consideration, there are some skin-related changes that are more specific to lighter and darker skin types, and the preferred method of treatment is often dictated by the color of your skin.

Fair skin - Light and fair skin is usually the first to show the signs of aging like fine lines and age spots, which can happen as early as the mid to late 20's. Because the skin is inherently thinner and contains less melanin, it's more susceptible to ren-related aging. Typically found in Causasians and Asian - ranges in color from milky white to pale with pink undertones.

Common Characteristics

· burns easily

· shows the signs of aging relatively early

· wrinkles tend to be more on the surface as opposed to deeper creases

· can be sensitive

· blemishes, rashes and injury are very apparent

· enlarged pores

Problems:

· age spots and freckles
Why They Occur - Brown spots and freckles are directly related to sun exposure from the past, which shows up years later. Since the skin can't naturally defend itself against the sun, it attempts to protect itself by producing melanin, causing freckles and pigmentation.

Responds Well To - Brightening creams with hydroquinone and retinol, Fotofacial treatment (IPL) and eMatrix Sublative Fractional Resurfacing.

· fine lines

Why It Occurs - The lighter the skin, the less melanin there is, which increases the amount of UV light that's absorbed, breaking down collagen.

Responds Well To - Botox. When it comes to treating fine lines, especially around the eyes and in between the eyebrows, Botox is the go-to solution. Botox relaxes the muscles that cause lines to appear, in turn smoothing out the skin. If the lines are coupled by changes in the texture of the skin, like crepiness, then we need to remodel and rebuild the collagen with something like FotoFacial (IPL) or laser resurfacing.

· dry skin

Why It Occurs - Dryness in lighter skin can occur from a multitude of factors. while the sun is partially to blame, the weather, lifestyle choices and even skin-care products can bring about dryness. When the outer layer of skin is void of water, the skin can't protect itself as well, and dead skin cells make their way to the surface, giving way to chalkiness.
Responds Well To - Moisturizer and retinol. Dry skin can be alleviated with the right moisturizer. Retinol will also help to regulate the pace at which the surface cells turn over, to eliminate the amount of dryness.

Yellow tones - Yellow-toned skin is common in those of Asian descent, ranging in color from light yellow to deep tan, and only becomes darker and more yellow with age. This skin tone may seem to age gracefully since the dermis is thicker and contains more collagen, but this skin type faces a bevy of aging concerns too. Yellow-toned skin is prone to hyperpigmentation, saggy cheeks, and droopy eyelids. Asian skin produces more melanin than Caucasian skin as a response to UVB light.

Does Asian skin need as much Botox as other skin types? Some studies say that Botox should be used slightly differently in those of Asian descent than other ethnicities, since the eyelids are naturally smaller and have a different anatomy of fat, which often results in a less defined crease above the lashes. It has been shown that, in Asian women, a slightly lower dose is preferred and offers a better cosmetic result in comparison to the standard dose tested mainly in Caucasions. The amount and position of botox injections should be different in Asians to achieve an improved but natural appearance.

Common Characteristics

· pigments and scars easily

· prone to acne and/or oily or dry patches

· thicker complexions with enlarged pores

· experiences skin sensitivities

· ages slower than lighter skin

· more collagen and melanin in the dermal layers

Problems:
· droopy eyelids and saggy cheeks

Why It Occurs - Those of Asian descent have inherently different facial structure and features, smaller eyes and a longer distance between the eyes. There's little or no upper eyelid, and as fat becomes more prominent and elasticity is lost, the skin begins to droop. The dermal structure ages and gives way to sagging skin in the cheeks as it becomes less elastic, making nasolabial folds more prominent.

Responds Well To - Injectables and Fillers. Rather than use lasers, it is preferable to use Botox and fillers to address dynamic lines and add volume. By filling the marionette lines and nasolabial folds, support is reinstated to the midface so it doesn't look saggy. Botox can also be injected under the eyes to open them up, a popular aesthetic technique practiced in many Asian countries.

Should Avoid - Lasers (Radiofrequency and ELOS devices are safe for this skin type). Lasers won't add volume, and there's the added risk of discoloration.

· post-inflammatory hyperpigmentation

Why It Occurs - Wrinkles may not be at the top of the complaint list for Asian women, but, when it comes to maintaining an even complexion, that's another story. Asian skin is comprised of many different backgrounds - East Asian, Southeast Asian and south Asian - so it ranges from fair to light to medium and dark. Although some Asian skin can seem light, it can behave differently than similarly colored skin since there is naturally a log of melanin, which lives deep in the dermis. Because the skin is highly pigmented, sunspots and melasma are big concerns.

Responds Well To - Hydroquinone, nonablative lasers. Like most skin tones, hydroquinone, coupled with retinol, is the go-to for lightening dark spots since it inhibits the production of pigment. You want to make sure that the treatment is not too strong or causing irritation, as any redness and inflammation can lead to post-inflammatory hyperpigmentation. Nonablative lasers (such as FotoFacial), which don't damage the skin's surface and produce little or no inflammation, can be used too.

Should Avoid - Ablative lasers. Yellow-toned skin and darker complexions can't tolerate some ablative lasers such as CO2 and erbium lasers, because of the potential for additional pigmentation. Nonablative or minimally ablative lasers and the eMatrix Fractional Sublative Laser are safe and effective for ethnic skin types.

Olive skin - Although thick, olive skin is affected by melasma, discoloration, and even rosacea. Olive skin is golden to lightly tanned in color, can be light or dark, and is typically found in Latinas, Mediterraneans, Asians and Native Americans. Lasers and chemical peels can exacerbate existing pigmentation and make it worse, if not used properly.

Did you know that even though stretch marks are a concern for women of all skin colors, they are more of a problem for darker-skinned women because the color of the skin against the white marks creates more of a contrast.

Failure to protect from the sun - Most Latinas neglect to wear sunscreen regularly. Because the skin is dark and has more pigment, many Latinas think that it's naturally protected from the sun, but that's not the case. Like all other skin types, olive skin is prone to photo damage and sun-related conditions and diseases. To correct wrinkling and damaged skin, radiofrequency skin-tighteners can be used to firm the skin and build collagen, as can fillers and fractional lasers.

Common Characteristics

· skin is supple and soft

· larger pores

· hyperpigments easily

· prone to dark under-eye circles

Problems:

· rosacea

Why It Occurs - Unbeknownst to many, olive skin can suffer from rosacea, a condition that generally affects light skin. While many questions about why rosacea occurs are still unanswered, there are certain triggers that prompt it to surface. Rosacea is accompanied by tiny pimples, and Latin skin contains a lot of melanin, so there is an increased chance of discoloration. Some topicals, like retinol, make rosacea worse.

Responds Well To - Antibiotics and laser light treatments like FotoFacial (IPL). Rosacea is one condition that won't diminish on its own - some course of treatment is needed. A combination of treatments including oral and topical antibiotics, laser and FotoFacial treatments that target those little vessels and prescription-strength azaelic acid is used.

· melasma

Why It Occurs - Olive skin, especially in those of Latin descent, is very susceptible to developing melasma. The exact reason why it is epidemic-like for these women is unknown. But the fact that there is a lot of melanin in the skin has something to do with it. Part of the problem may be a resistance to wearing sunscreen, and the sun increases melanin activity.
Responds Well To - Hydroquinone, light chemical peels, topical steroids, retinoids and microdermabrasion. Treating melasma with hydroquinone and retinol along with hydrocortisone is the preferred plan of attack at Cosmetic Laser MD. The Melanage Peel is very successful and light microdermabrasion is also helpful. Anything too strong will produce more discoloration.

Dark skin - Known for being virtually wrinkle-free and not boasting visible signs of aging until later on in life - because the skin is typically oily and thick and the dermis is more compact - darker skin has a whole other host of skin-related problems to deal with. Dark skin is typically found in African-Americans, Arabic/Middle Easterners and Indians, ranging in color from light cocoa to dark brown and black. Dark skin is predisposed to sagging and drooping and unevenly toned skin.

Common Characteristics
·       outer layer of skin is strong
·       naturally contains a low amount of ceramides and has a lower pH level
·       skin is oily and pores are usually large; body has a propensity to be dry
·       signs of aging appear about 10 years later, if not more, than lighter skin
·       pigments easily

Problems:

· dark circles

Why It Occurs - Dark circles seem to be more apparent, and harder to camouflage, on dark skin. Even though the skin is thick, the amount of melanin is dense, making the under-eye area very pigmented.

Responds Well To - Dr. Tanne can inject the area under the eye with hyaluronic acid filler (such as Juvederm), which plumps up hollows and creates the illusion of less darkness. "The area under the eyes is very vascular, and if a blood vessel is punctured, you will have bruising, which, in darker skin, can lead to long-lasting hyperpigmenttion.

· saggy, droopy skin

Why It Occurs - Most skin tones encounter sagging, lines, and wrinkles, but dark skin primarily faces just sagging. As fat in the cheeks slides down, fullness is lost, nasolabial folds appear and the skin hangs around the jawline. Sagging is a part of intrinsic aging. There's a decrease in skin thickness, a loss of elastin and a redistribution of fat, all of which cause the skin to become loose and sag.

Responds Well To - Volumizing fillers and skin-tightening treatments. Radiesse, Juvederm Ultra and Ultra Plus, Selphyl and other products all add volume. It's not so much about erasing the folds as it is rebuilding the cheek area. The key is to inject the product deep, not superficially. Unlike light-skinned women who have wrinkles that need to be filled, dark skin needs volume to reinflate the face. Skin-tightening treatments, such as ReFirme, can also be used.

· post-inflammatory hyperpigmentation (PIH)

Why It Occurs - Dark skin can experience hyperpigmentation from anything that causes inflammation. Many African-American women complain about breakouts when it's really the end stage of a pimple that has left behind a brown spot that's bothering them.

Responds Well To - A combination of treatments. A mix of methods, like peels or nonablative lasers with at-home use of hydroquinone, works well. Dr. Tanne likes the Melanage Peel for stubborn pigment problems. Nonablative fractional lasers may be use, but even better is the new e² tip for the eMatrix Fractional Sublative Resurfacing. eMatrix is excellent for treating pigment and, best of all, is safe for all skin types.

In summary, skin color plays a major role in determining how you will age, but with proper prevention, product and treatments, the process can be slowed and/or reversed.

Ps- Do you have an idea for an article, or need advice? Please write me at info@cosmeticlasermd.com!