In this era of COVID and Circuit Breaker in Singapore, our team at the dermatology clinic TWL Specialist Skin and Laser Centre has been busier than ever with queries on how regular laser, chemical peel and aesthetic treatments can be taken offline and if any anti-ageing skincare regimens can be performed in the comfort of one’s own home. Thankfully, our patients are well-schooled by our Dermatology Education Nurses Joanne and Lakshmi who have taught the basics of a good cosmeceutical skincare routine, developed by Singapore dermatologist Dr. Teo Wan Lin.
In better days, the cosmeceutical skincare routine was an important adjunct to aesthetic dermatology procedures. For example, the Elixir-V Serum power packed with Centella Asiatica and Trans-Resveratrol was a favourite amongst our patients for its potent post HIFU recovery for face-tightening and lifting effects. Is there a shortcut to maintaining your skin after an aesthetic procedure? Or does one have to repeatedly go for treatments in order to retard the ageing process? Here’s a sneak peek into what our dermatologist Dr. Teo Wan Lin shares with all her aesthetic dermatology patients in her office.
1. First up, Dr. Teo, if I have been on BOTOX or XEOMIN before, been on fillers, regular lasers and peels. Does this mean that once I start I can never stop?
If this is the reason you are holding back on treatment, then the answer is a resounding no! Truth is, you can stop any treatment at any point of time without any significant events. However, the key question really is, what was the indication for starting it? If it was for photoageing – depending on what stage you were at- at a late 2 onwards you will likely regress to your pre-treatment state if you abruptly stop. The overall plan is also key. Did you discuss with your dermatologist your medium-long term goals to prescribe a maintenance regime?
In my practice, I tell patients it is not sustainable to rely solely on a single cosmetic regimen. Instead, a combination of these anti-ageing technologies in rotation works best in my experience. So in that sense, we do recommend “stopping” certain treatments after a period – which really is giving the skin a break. Also, it is wishful to believe that an in-clinic aesthetic treatment is a do-all and end-all of your anti-ageing skincare goals. The skin is beautiful when it is healthy. In fact, all of the body’s physiological processes cooperate in the functioning of a healthy organ — skin included.
What am I saying here? Just as we nurture our health with physical exercise and a healthy diet, the same goes for the skin. Just that the healthy diet in this case consists of regular topically applied cosmeceuticals as per a skincare routine. The “exercise” is best thought of as physical therapies. They could be in the form of deep-penetrating and superficial lasers, HIFU, injectables that target the dermis and SMAS layers. Furthermore, we have chemical peels which are effective maintenance tools for individuals on a anti-ageing plan developed by their dermatologist.
2. What are the most potent anti-ageing skincare ingredients?
The most potent anti ageing ingredients can be classified into two main categories. They include those which are under prescription medications, as well as nonprescription which would be cosmeceuticals. For the first category, dermatologists traditionally rely on retinoids. Retinoids help to stimulate the skin’s second layer, the dermis, to produce more collagen. This, in the process, evens out fine lines and wrinkles, increases skin elasticity as well as reducing development of hyperpigmentation. For the second category of non-prescription anti-ageing skincare ingredients, they comprise primarily of evidence-based cosmeceuticals, from either plant, animal or synthetic sources.
Plant derived anti-ageing skincare ingredients would primarily function as antioxidants. Some active ingredients off the top of my head in my skin care line, we use a derivative of a broccoli extract which comes from the genus of plants known as brassica oleracea, the same family that cauliflower, kale and broccoli are in. When tested under laboratory and clinical environments, they show that they have potent anti-cancer cell activity and also anti-ageing activities. In terms of the animal based and anti-ageing skincare ingredients we use salmon roe DNA. We incorporate that into our lip serum. Salmon roe DNA essentially works by activating college and production in the cells that produce collagen known as the fiberglass.
Now the third category is where our synthetic molecules use oligopeptides. These are actually protein sequences which mimic the body’s natural DNA. They help to restore the cycle of the skin cell, essentially resetting it to that of a younger skin cell. This causes the cell to be more efficient at reducing the superficial signs of skin ageing, pigmentation, fine line wrinkles and loss of skin elasticity. There are also molecules which directly repair the skin structure itself. So I would put that as a fourth category and the skin essentially functions as a barrier against the environment.
As one ages, the barrier actually weakens. This brings our attention to what holds the barrier together in a top layer, which is a fatty molecule – ceramide. The second layer, which is what keeps it plump and hydrated, would be molecules such as hyaluronic acid molecules. So if you are looking to activate your skin, you should also ensure that the skin barrier is also repaired by replacing these molecules.
3. What constitutes an anti-ageing product?
If you want to crystallize this concept of product formulation, specifically for anti-ageing skincare, I would say that it’s important to understand how the skin ages and why. The first thing to understand is that ageing by the process of biological aging is actually inherent in us as part of our DNA code. After the age of 25, the cells increasingly enter into a life cycle known as cell senescence. This is whereby they actually become sleepier and become less efficient at performing their duties. Any anti aging product has to address this issue of cell senescence. Another important concept in ageing is that it is partly genetic and partly environmental.
For the genetic aspect, it is not possible to reverse it at this current time. However, for the environmental factor, for example the increased exposure to UV radiation, both UVA and UVB, as well as emotional stress, increased travel and lack of sleep would accelerate the process of aging. In terms of how the products work to address this problem, it really is best thought of providing a bit more reserve to your skin. If you are applying a skin antioxidant, say something from a plant ingredient, that enters through the skin, it encourages your skin to perform at its maximum function.
4. What other common signs of aging and how do you prevent these from appearing early?
We always refer to a staging system known as the Glogau ageing system, after American dermatologist Dr. Richard Glogau. Most of us from the mid 20s to mid 30s would be in Glogau Stage 2 in Asians. Stages 3 and 4 would be individuals who have more pronounced wrinkles, increased pigmentation over the skin, loss of skin elasticity as well as reduced moisture of the skin.
5. How early can we start adding anti-ageing skincare to our routine?
The good thing about anti-ageing skincare products is when we formulate them well and without irritating ingredients. For example retinols and chemical peels acids such as alpha-hydroxy acids, I have excluded these from the formulation in my cosmeceuticals. This is because they can potentially irritate the skin and give rise to eczema of the skin especially when one’s skin is a little bit more sensitive.
Without these ingredients, all cosmeceutical skincare essentially becomes beneficial. This is because maintaining a healthy skin condition is like maintaining a healthy body. It would be much better in a proactive maintenance, than addressing the issues only when you fall sick. Realistically speaking though, I think from the time one enters into puberty and starts off higher production of facial oils, then it is a good chance to get on a cosmeceutical skincare routine. This is because the bioactive ingredients can also help to regulate the oil production as well as prevent future development of skin conditions.
Now the other thing is the normal person really starts paying attention when they already have issues to their skin such as dullness and some fine lines wrinkles. By then, honestly, it is a little late and topicals alone would not give the same kind of result that you expect from starting earlier. Therefore, it’s never too early to start. Reasonably speaking, I think a good time to start is from the time one is in their mid 20s. You know of course we always talk about the importance of sun protection. However, beyond that, I think it’s important to know that there are active ingredients from synthetic and botanical sources, as well as home devices which increase the absorption of the topicals, that can be easily incorporated into our home regime.
So on that note, what I have been encouraging my patients, especially those who do not need in office treatments such as lasers or peels, is to get on a regime which incorporates our radio frequency device. This is an FDA approved device, the CollagenUP facial wand, that is designed for use together with our amino acid mask. The device also carries a mode of electrical muscle stimulation which tightens and activates the fiberglass to increase more collagen. While this addresses the deeper layers of the skin because it’s really targeting the dermis, one mustn’t forget that you know a lot of things happen at the top mostly of the skin because that’s essentially the the first barrier that is in contact with the environment.
To address skin dullness, fine lines wrinkles and surface irregularities, I have traditionally recommended chemical peels to my patients. Since the launch of our SilkPeel device late last year, I have noticed equivalent if not better results in patients. These are patients who have chosen to use the microdermabrasion device on their own regularly at home. It contains a copper iron head which basically, in a very gentle way, resurfaces the top layer of your skin and also activates to skincare ingredients for better absorption.
6. What are some misconceptions that people have about anti-ageing skincare?
I think one misconception would be that you have to be old in order to use them. To replace a term called anti aging, I feel is more evidence-based to use cosmeceuticals. This is actually a term coined to describe a category of topically applied serums and cream. These topicals cross the line between efficacy of a prescription drug, as well as something which overall is non-toxic. With this, there are therefore no concerns for cosmeceuticals to be prescribed over the counter.
Maybe like a quasi drug sort of description. Cosmeceuticals are best thought of as super multi-vitamins for your skin. There is a lot of evidence increasingly that besides retarding the aging process, it can also help as an adjunct as a supportive way to help people with actual skin conditions such as acne, rosacea and eczema get better.
7. What is one non-product tip you would give?
I think exercise is often overlooked. Something that I find in my patients who have very active lifestyles, is that they tend to respond very well to both the topical skincare products as well as the in-office anti-ageing treatments such as lasers peels and high intensity focus ultrasound (HIFU). Research actually shows that high intensity interval exercise can actually stimulate your skin’s powerhouses to kind of reset itself and hence it behaves younger. In my experience, it makes them more responsive to these treatments as well. It all boils down to being physically healthy. All these will also show on your skin.
I would also like to highlight the use of home devices which use technologies such as radio frequency that are suitable for home use. Another example is electric muscle stimulation. This works on the deeper layers of the skin that products are unable to penetrate to.
In addition, facial massage is proving quite popular to use. For example, using a facial roller. It only works in a limited way, that is if it is to increase absorption of a topical product. This is because you are increasing blood flow to the area and it translates into better skin absorption. But on its own, I think the benefits of doing facial massages are rather limited.