Q: “As a child, I got lots of sunburn. Can my damaged skin be repaired?"

A: This depends on which kind of damage you mean. Fine wrinkles, scars and brown and red spots in the top layer on the skin (the epidermis) can be greatly diminished with exfoliating procedures. Sunburns cause freckling, wrinkling, pre-cancerous skin lesions and skin cancers later in life.

Exfoliation can be accomplished with various chemicals (like retinoids and glycolic acids) or physical techniques like microdermabrasion and laser. All of these techniques must be used skillfully to avoid skin irritation which can cause scarring and more pigment changes. The skin must be healthy in order to regenerate itself, so a good skin care program is essential before attempting exfoliation. Also, the skin can be more vulnerable to sun damage after these procedures, so strict use of sunscreen is a must. Look at a non-sun exposed area like your inner arm, to see the color and texture you skin would be if all the damage were repaired.

Damage involving a deeper layer of the skin is harder to address. Acne scarring, large brown spots, and deep wrinkles are more difficult to improve with exfoliation. For deep wrinkles, Botox and collagen injections are used. Large brown spots require beaching agents as well as exfoliation to correct, and they will readily return if area is exposed to the sun or the skin is irritated or inflamed.

Q: "What’s the difference between a peel and dermabrasion? What about lasers?"

A: The proliferation of treatments to rejuvenate the skin has made it difficult to choose the best treatment for
each person. All of these treatments are attempting to do the same thing: remove the upper layer of unhealthy skin and encourage the deeper layers of the skin to replenish themselves, all without injuring
the skin. Ideally the skin becomes firmer and more resilient, pores are opened and skin blemishes are reduced or removed.

In the past chemical peels and dermabrasion were often done too aggressively, essentially creating a 2nd or 3rd degree burn. This can also occur with laser treatments. The results can be dramatic if one heals well, but scarring and discoloration are common problems. Most practitioners now use more finesse, removing only the top layers of skin in a series of treatments. The era of the “lunchtime peel” (no down time) is here.

The laser and pulsed light facial treatments are able to stimulate the deeper skin cells. Results from these treatments vary depending on the type of equipment used and the skills of the operator. Usually follow-up treatments with chemical peels and microdermabrasion as well as a good skin care program are required to maintain results.

Prices for all of these procedures can vary widely. Laser and pulsed light are the most expensive, mainly due to the high cost of the equipment. They are a good choice for patients with deeper wrinkling or severe scarring. Microdermabrasion is effective for finer wrinkles and decreasing skin lesions. Chemical peels are safe and less expensive, but may not be strong enough to get good results. Professional facials are the safest and least expensive, however they will not remove unwanted skin lesions or wrinkles.

The best advice is to get full information, including credentials, experience and training of personnel. Have realistic expectations before committing to any of these exciting treatments.

Q: "Isn’t a little sun tanning healthy?"

A; The myth of the healthy tan is an old and difficult idea to change. With the thinning of the ozone layer and the love of outdoor lifestyles, nearly everyone in Hawaii is getting too much sun exposure. This induces genetic damage in the skin, which eventually leads to problems like irregular pigmentation (brown and white spots) and wrinkling, as well as more serious trouble like skin cancers. Although a base tan can protect somewhat from burning, it simultaneously injures the skin, eventually making it more susceptible to sun damage.

The only biological need for sun on the skin is to manufacture Vitamin D. Deficiency of this vitamin is now a thing of the past except for true ’shut-ins’ who get no vitamin supplementation. The need for vitamin D is the only reason people evolved with less melanin as they migrated to northern climates.

Self-tanning lotions are an effective way to temporarily darken the skin for those who feel they are too white. They also give a small amount of sun protection. Those lucky enough to be born with extra melanin still experience sun damage in Hawaii. 30% of melanomas in this state occur in non-Caucasians. Everyone, regardless of skin color, should protect themselves from he sun by using sunscreen and wearing hats, sunglasses, and protective clothing everyday.

See Dr Adee for a Healthy Skin Consultation, to learn about reversing sun damage. We utilize Jan Marini skin products, facial peels and microdermabrasion.