Beautiful skin for all ages

Viji Krishnan speaks to immediate past president of the Dermatological Society of Malaysia, Dr. Allan KC Yee, for tips on how to care for your skin at any age.

Our skin looks and functions very differently when we are in our 20s compared to when we are in our 30s, 40s, and so on. The ‘needs’ of our skin will change, and how we care for it in those age brackets will also differ.

Equipped with the right skin care regimen and advice on what treatments to opt for, we can have radiant skin well into our later years!

IN YOUR 20s

Skin Profile: Skin has a radiant, youthful glow and the epidermis (outer layer of skin) is well toned. In our late 20s, cell turnover starts to decrease; dead skin cells are not as easily shed, and external factors such as sun damage start to have a greater impact, leaving skin slightly duller than before. Skin can have uneven texture and clogged pores.

Skin Care: Be regular in your skin care
regimen – cleanse, moisturise and exfoliate. Cleanse face morning and night. Choose a cleanser that is suitable for your skin type – gel for oily skin, milky for dry skin and soap-free for combination skin.

Choose a moisturiser with antioxidants to fight free radicals and hydrate skin. Common antioxidants include vitamins A, C and E, and beta-carotene, which assist in skin repair and strengthening of blood vessels.

Malaysian dermatologist Dr. Allan KC Yee states, "Even patients in their 20s can start having early signs of photoaging due to too much sun exposure." Therefore, choose moisturisers that contain a Sun Protection Factor (SPF) of at least 15. It is important to note that having sunblock in your moisturiser is not good enough as it is too weak. Using a sunblock separately works better in preventing sun damage and photoaging.

Choose a hydrating fluid night cream or one that is an oil-free moisturiser. Use skin care formulas that contain protective ingredients, such as antioxidants and/or anti-inflammatories, for example green tea extract, pomegranate extract and vitamin E.

Exfoliate your skin once a week with products that contain alpha and beta hydroxy acids to remove dead skin cells, allowing new skin cells to surface. Regular exfoliation is especially beneficial when you’re in your late 20s as your skin’s natural process of exfoliation slows down and starts to lose the ability to "renew" as quickly as before.

Skin Treatments:

Chemical Peels

Frequency: Three to five peels, performed at two week intervals.

Cost: About RM200 per session.
A chemical peel removes the dead skin cells from the skin’s surface layer and stimulates cell turnover. Mild scarring, certain types of acne, pigmentation (in the form of sunspots, age spots, liver spots and freckles), and skin that is dull in texture and colour can improve after a chemical peel. A chemical peel can also reduce fine lines and crow’s feet around the eyes.

There are several different types of peels – alpha hydroxy acid peels with glycolic acid or lactic acid (the mildest form); beta hydroxy peels (gets deeper into the pores than alpha hydroxy peels); Jessner’s peel (a combination of salicylic and lactic acids); trichloroacetic acid (TCA) – which is a deeper peel than the first three; and carbolic acid or phenol (produces a deep skin peel).

Glycolic acid peels are particularly popular because they offer the least risk of pigment changes and scarring, as well as the shortest period of cosmetic disability after the procedure.

This procedure is performed on an outpatient basis and does not require anaesthesia.

IN YOUR 30s

Skin Profile: Skin starts to lose its natural moisture and cell turnover slows down. Dry patches can develop. Skin starts to show the effects of environmental damage from pollution, smoke and sunlight. Collagen breakdown begins to exceed collagen production, and fine lines start to develop, especially around the eyes and mouth. Subcutaneous fat forms around the mouth ridges and the first wrinkles may start to appear.

Skin Care: Use moisturisers that contain collagen-boosting ingredients, such as copper peptide, which enhance wound healing. Copper peptides also stimulate production of collagen and enhance the action of antioxidants.

A serum or moisturiser with vitamin C ester (ascorbyl palmitate) is an excellent antioxidant that fights against skin damage and free radicals. Vitamin E is also a great ingredient that can help the skin repair itself and stay moist.

Skin Treatments: According to Dr. Yee, "Patients in their 30s may benefit from relatively non-invasive anti-aging treatments, depending on the state of photoaging observed."

Botulinum Toxin Type A (BTA)

Frequency: Repeat treatments required every three to four months.

Cost: Between RM600 to RM900 per cosmetic area. What’s a cosmetic area? For example, crow’s feet on both sides count as one cosmetic area; frown lines in the glabellar area (between the eyebrows) as another.

By decreasing muscle movement, BTA injections (common brands being Botox and Dysport) help in reducing the appearance of wrinkles such as crow’s feet, forehead lines, and frown lines, though effects are temporary. It is injected directly into the muscle with a very fine, small needle. The injection is relatively painless and well tolerated, even without local anaesthetic creams.

IPL (Intense Pulsed Light)

Frequency:Two to four sessions at monthly intervals.

Cost: About RM950 per session.
IPL treatment is a no-downtime procedure and uses a broad band of intense pulsed light rather than a laser beam. IPL can improve surface pigmentation and minimise the appearance of broken blood vessels, birthmarks, fine lines, uneven skin tone and freckles. Skin may turn pink at the point where the IPL is in contact with the skin and can feel hot for several hours immediately after treatment. An ice pack will help until this sensation dissipates.

Non-Ablative Laser Collagen Remodelling

Frequency: Three to five sessions at monthly intervals (depending on age and severity of skin condition).

Cost: RM900 to RM1200 per session.
Non-ablative laser collagen remodelling (photorejuvenation) deals with wrinkles, sun damage, acne scarring, and open pores. Examples of this procedure are Cool Touch Laser (anaesthetic cream required) and the Aramis Laser (no anaesthesia required). Both use light energy to stimulate collagen synthesis and remodelling, and are no-downtime procedures.

Minimal risks are associated with photorejuvenation, but some skin redness (which disappears within a few hours) and mild swelling may be observed. If the energy settings are too high, blistering can occur.

IN YOUR 40s

Skin Profile: Skin starts changing texture due to decreasing collagen balance – facial tone appears duller and pores become visible. Skin loses its elasticity and fine lines and wrinkles become prominent on face and neck.

Skin care: Use moisturisers containing retinol (vitamin A) which increases cell turnover and smoothes the surface of the skin. Retinol has been shown to have strong effects in reversing both photo-damaged and naturally aged skin. However, the application of products that contain vitamin A can cause skin irritation for some.

Make sure your skin care products contain antioxidants such as vitamin C, which works to fight skin damage and improve collagen
synthesis. A rich nourishing night cream will help rejuvenate the skin.

Exfoliate two to three times a week with a facial scrub that contains rose oil, jojoba oil, or something similar, as these contain natural alpha hydroxy acids (AHAs) which help remove dead skin cells.

Skin Treatments: "In your 40s, the skin’s texture becomes more of a concern. Patients will experience early to moderate signs of
photoaging such as early sunspots, smile lines around the mouth and crow’s feet at the corner of the eyes," says Dr. Yee.

Fillers

Frequency: Repeat treatments every six to nine months.
Cost: RM900 to RM1300 per vial, plus injection costs.

Cosmetic fillers (hyaluronic acid is a popular substance) are injected underneath the skin to ‘fill out’ the wrinkles and furrows in the face, to restore that youthful plump in the skin. Fillers are commonly injected into areas such as the lips, cheeks, forehead and lines that develop between the nose and around the mouth. Local anaesthesia may be administered before the injections to avoid any discomfort. The effects of hyaluronic acid fillers last between six to nine months.

Laser Resurfacing

Frequency: One time procedure.

Cost: RM3000.
Laser resurfacing (e.g. Erbium:YAG laser) works to improve the texture, clarity and overall appearance of the skin and can help rectify superficial to moderate wrinkles, mild surface scars, skin discolouration, and sun-damaged skin in delicate areas such as around the eyes and mouth.

The procedure is considered relatively painful as the laser removes the whole depth of the skin from the epidermis down to the dermis (deeper layer of skin). Topical anaesthesia is required. Recovery could take seven to 10 days with skin turning red or pink, which may last anywhere from several days to a few months.

According to Dr. Yee, newer forms of laser resurfacing are less painful, require less downtime (two to five days), and have fewer complications like redness or changes in pigmentation.

IN YOUR 50s & BEYOND

Skin Profile: The skin will, more likely than not, show the aesthetic changes of age such as loss of radiance, dyspigmentation, broken facial veins (telangiectasias), visible rough liver spots, wrinkles at rest, wrinkles around lips and mouth, and skin drooping.

Skin Care:The loss of collagen and elastin will result in sagging of the skin and loss of definition of facial contours. Skin care products with DMAE (dimethylaminoethanol) produce a firming effect on the skin. Apply moisturisers with antioxidant and exfoliating ingredients such as alpha and beta hydroxy acids, and urea.

Skin Treatments: "Patients in their 50s with very severe photoaging signs may be candidates for a facelift if there is excessive loose or sagging skin. However, most less severely affected individuals will do well with the newer non-surgical treatments available, for example, radio frequency to tighten loose skin; fractional laser resurfacing (Erbium or CO2 fractional lasers); plasma skin resurfacing; and fillers. A combination of these with BTA appear to have a synergistic effect in improving results, probably by allowing collagen to re-form without interference caused by muscle movements around the eyes and forehead," says Dr. Yee.

Radio Frequency Deep Skin Tightening

Frequency: One time procedure.

Cost: Between RM2000 to RM4000 depending on area to be treated.
Radio frequency (e.g. Thermage) is considered a type of non-surgical facelift for those with sagging skin, for example, prominent nasolabial folds, smile lines around the mouth and loose jowls. The treatment uses radio frequency to penetrate deep into the skin to heat up collagen and fibrous strands of fatty tissue – the deep heating effect causes collagen to contract causing wrinkles to be less prominent and also encouraging new collagen to form.