IN A SEASON WHEN EVERYTHING seems fresh and new, it’s natural to want the same thing for one’s skin. And it’s not out of reach. Doctors and day spas all have lovely new tricks up their sleeves. Whisking away a top layer of skin to reveal the fresher, finer-textured skin beneath isn’t the risky business it was back in the days of wire brushes and deep chemical peels; skin-refining processes are gentler, more finely calibrated, less prone to human error. At the same time, cosmetics counters now offer treatments with ingredients that once were available only by prescription. If you’re just looking for a way to put the roses back in those gray little cheeks after a long, hard winter, one of the minor miracle workers listed on the facing page may be all you need. On the other hand, a person-even quite a young person-might react to the hard light of spring with one of those epiphanies straight out of Bridget Jones’s Diary: “Feel need to do something to stop aging process, but what? Cannot afford face lift.”
The simplest “something” is probably a regimen of prescription-strength tretinoin in a preparation like Arita or Renova. Tretinoin is a derivative of vitamin A and what it does (nobody knows quite how) is speed up the skin’s natural exfoliating process, at the same time shaping up the skin’s DNA so that the new cells are more like their younger antecedents than like the sun-damaged cells they replace. Skin is literally thickened (except for the top layer of dry, dead cells, which is blessedly thinned); new, younger-acting collagen is produced; and the ultimate result is firmer, finer-textured, more translucent-looking skin with what Nia K. Terezakis, M.D., a clinical professor of dermatology at Tulane University Medical School in New Orleans, calls “a noticeable glow.” “Besides,” she adds, “it’s the only thing that will actually reduce the size of pores.” The drawbacks are possible redness and irritation at first; an increase in sun-sensitivity; and-for the young woman in a hurry-the fact that it can take fr om six months to a year for one’s complexion to come into full bloom.
For more immediate gratification, one might want to consider a tiny peel. In fact, doctors often recommend a course of tretinoin in conjunction with peels. Used before a peel, tretinoin stimulates the skin to heal itself faster; as a follow-up, it helps skin keep on improving itself from within.
Probably the mildest peel available is done with glycolic acid (one of the sugar-derived alpha-hydroxy acids that have been getting so much attention; they help skin shed its tired layers and produce more collagen). In over-the-counter creams and cleansers, glycolic acid, like its AHA sisters, works to freshen and brighten skin. In stronger concentrations-and preferably in the hands of a good dermatologist- glycolic acid peels make what Michael J. Bernhardt, M.D., a dermatologist in private practice in Jacksonville Florida, calls “an excellent facial rejuvenating agent.” Glycolic acid peels are done in baby steps-typically a series of five or six visits (which costs $450 to $900). The first peel lasts only about thirty seconds, after which the acid is washed off with great sloshings of water. Subsequent sessions may last longer, and the immediate aftermath–depending on how deep you and your doctor want to go–varies from a slight pinkening of the skin to what looks and feels a bit like a bad sunburn.
If one wanted to be a touch more aggressive, one might consider microdermabrasion, a gentle, noninvasive mechanical peel that’s as far removed from the wire brushes and sandpaper of the 1950s as the microchip is from UNIVAC. While you lie back in comfort, a dermatologist or well-trained aesthetician goes over your face with a small, wandlike machine that pelts out superfine aluminum oxide crystals and simultaneously vacuums up the skin’s top layers of cells. The sensation? “Like being licked by a cat,” purred one client. The result? Nothing but a rosy glow–at first. But after six to eight sessions ($600 to $800 at a spa; about twice that at a doctor’s office), you should notice a silkier texture and smoother coloring. “It’s particularly good for fine lines, acne scarring and people of color with uneven pigmentation,” says Bruce E. Katz, M.D., director of both the Cosmetic Surgery and Laser Clinic at the New York-Presbyterian Hospital and Juva, a medi-spa in New York City. It’s also one of the best procedures for thin-skinned areas like the neck, chest and hands. “But it’s not forever,” says Katz. The effects fade after about three months, and some doctors suggest monthly booster sessions. Perhaps it’s best to think of both kinds of mini peel as part of an ongoing journey.
For deeper lines and extensive sun damage, the treatment of choice is lasers. Think of a laser as an incredibly fine light saber. Zzp! Zzp! In tiny, millisecond bursts of energy, it slices away microscopically thin layers of skin, vaporizing rather than cutting, and cauterizing as it goes, so there’s no bleeding. It’s guided by a computerized scanning device, which minimizes what doctors politely call “technique-dependent variability” and the rest of us might call the “oops!” factor. Lasers fall into three categories. The [CO.sub.2] carves the deepest swath and achieves the most dramatic results with deep lines (up to seventy percent improvement) and deep acne scars. There’s also a significant firming effect, thanks to the jolt it gives collagen. The erbium: Yag laser, which doesn’t dig as deep, is used to erase more superficial lines and minor flaws. While the recuperation time for erbium is about half that for [CO.sub.2] (one week as opposed to two), both require sedation and topical anesthetics, pose a sma ll risk of skin discoloration down the line, and cost about $2,000 to $5,000. Still, the peaches-and-cream effect is good for five to ten years.
The nonablative laser works differently. It skips past the epidermis and goes to the next layer down, where it bounces around creating the kind of havoc that causes a huge surge in collagen production. Because it works from within, it’s terrific at plumping up specific areas, like lines around the eyes and mouth (though the new smoothness won’t show up for about six months). There’s no tearing up the surface, no anesthesia, no recuperation. It’s often used with a surface treatment like microdermabrasion or erbium lasering, typically takes three to five sessions (costing $2,500 to $3,500).
One caution that applies to everything here is that the sun (which causes most damage to begin with) can undo all your good work very quickly unless you wear a broad-spectrum sunscreen religiously. “Every day of your life,” specifies Dr. Terezakis. It’s smart to stay on the alert for improved formulas, too. One new ingredient to watch for: phytolyase, an enzyme discovered in sea plankton that both prevents and corrects sun damage. A study at Heinrich Heinz University in Dusseldorf found that a sunscreen rich in synthetic phytolyase gives skin’s immune system, which UV rays weaken and confuse, exactly the nudge it needs to correct sun damage. Look for phytolyase in future sunscreens. But you don’t need to wait–or even to look further than your nearest cosmetics counter–for treatments that can make a real difference.