Conservative approach benefits nonsurgical rejuvenation

When dealing with topical treatments, dermal fillers and botulinum toxin, an expert advises sticking to products backed by rigorous science and minimizing patients' risks wherever possible.

When it comes to daily regimens, "Dermatologists need to know there are a broad range of cleansers,"from mild formulations to foaming and exfoliative preparations,? says Marsha Lynn Gordon, M.D., clinical professor of dermatology, Mount Sinai School of Medicine in New York.

"Exfoliative scrubs are very popular right now," she says. Using these products is "almost like doing a mini microdermabrasion every time one scrubs the face because they take off a few cells of the stratum corneum and leave the skin feeling smoother," Dr. Gordon says.

As for other topical agents, she says those that definitely work include tretinoin (Retin-A, Renova; Ortho Dermatological), which is FDA-approved for treating photodamage. "The other thing we know improves the appearance of photodamaged skin is tazarotene (Tazarac, Avage; Allergan). Tretinoin and tazarotene are derived from vitamin A, and we have studies good enough for the FDA to approve these ingredients as drugs that improve the appearance of the skin," although they may cause drying and irritation in some patients, Dr. Gordon says.

"It's important for dermatologists who are constantly being barraged by new products to remember that we really do have agents that have undergone strict scientific studies and proven to be useful," she says.

Sun protection offers similar utility, adds Dr. Gordon. She says, "A fantastic amount of what we're treating could have been prevented if patients would just protect their skin from the damaging rays of the sun."

Conversely, Dr. Gordon says the following topicals might work, but they lack sufficient scientific studies to prove their efficacy:

• Peptides (pentapeptides, hexapeptides)

• Soy
• Other antioxidants (coenzyme Q10, idebenone and vitamin C)

• Anti-inflammatory products (aloe, green tea)

Regarding fillers, Dr. Gordon says, "My personal philosophy is that I want my patients to look like themselves, but maybe five or 10 years younger. I definitely don't want anyone to look like they've had work done."

Accordingly, she says she prefers temporary fillers, which currently last approximately six months.

Established temporary fillers include bovine and human collagen.

"I love the collagen products. However, collagen lasts about three months if one is lucky," Dr. Gordon says.

Because hyaluronic acid (HA) lasts longer, "That's become a favorite filler," she adds.

FDA-approved products in this category include Restylane (Medicis), Hylaform and Hylaform Plus, Captique and Juvederm (all from Allergan).

Regarding Juvederm, Dr. Gordon says, "The advance notice I've gotten from a colleague out of the country is that it's absolutely terrific, and it lasts longer than the currently available HA products."

Other FDA-approved semi-permanent fillers include Sculptra (poly-L-lactic acid, Dermik Laboratories) and Radiesse (calcium hydroxyapatite, BioForm Medical). "With Sculptra," she says, "people must remember that it must not be used in the perioral/lip area. There have been reports of granulomas and draining sinuses when it's used around the mouth and lips," though the product works excellently for approved uses. DT

Disclosure: Dr. Gordon serves as a consulting dermatologist to St. Ives, a division of Alberto-Culver.

Hear Dr. Gordon?s full presentation from 7:15 to 8:45 a.m. today in FOC616.