Get the skinny on skin care from doctors

By Paula Rath
Advertiser Staff Writer

Peels, creams, fillers, lasers and injectables — the anti-aging arsenal just keeps on growing.

We asked five Hawai'i dermatologists for their take on what's out there, what's coming, what's worthy and what to watch out for, and they gave us the lowdown.

Our team of experts: Dr. Norman Goldstein, who practices in downtown Honolulu; Dr. Philip Hellreich, Windward side; Dr. Kevin Mott, Restaurant Row; Dr. Carla Nip Sakamoto, Queen's Physicians Office Building; and Dr. Jenny Stone, Straub Clinic.

What's most requested?

Cryosurgery with liquid nitrogen for acne, warts and some skin cancers. — Goldstein

Micro-dermabrasion. — Hellreich

A tie: between Thermage treatment with Thermacool TC, a radio-frequency skin-tightening procedure for patients not wanting a surgical face-lift, and Fotofacial skin treatment with intense pulse light, for sun damage, broken blood vessels and skin pigment from sun damage. — Mott

Hydraquinone-based bleaching agents coupled with Retin-A-related products and other topical agents that can help reduce brown spots on the face. — Sakamoto

Botox or fillers (injectables that plump up skin, reducing wrinkles). —Stone

What's most exciting?

New topical medications, including a cream to reduce facial hair in women; noncortisone creams that stop eczema; new bleaching creams for pigmentation. — Goldstein

Earlier diagnosis and treatment of malignant melanoma because of increased public awareness. — Hellreich

More treatments are available that rejuvenate facial skin without downtime or surgery. Used in combination in well-selected patients, they can achieve dramatic results without missing work or going under the knife. — Mott

Biological-response modifiers or "biologics," a class of recently FDA-approved drugs used to treat psoriasis (Raptiva, Amevive, and Enbrel). — Sakamoto

New filler substances that last longer, such as Restylane. — Stone

Any cause for concern?

Nondermatologists who take a few courses and claim miraculous cures for everything from acne to herpes zoster. Some beauty salons and spas do some procedures that should be done by a physician. — Goldstein

The unsupervised, nonphysician use of lasers. — Hellreich

Aestheticians, nurses or spouses of physicians are having lasers purchased for them under a physician's name and opening treatment centers. Most of these devices require training that is beyond the scope of their expertise unless performed under immediate supervision of a qualified doctor. — Mott

Spa facilities are popping up everywhere. If procedures such as laser, botox or chemical peeling are performed, physician involvement is critical. Comprehensive treatment planning and complications can best be managed by those with a thorough understanding of skin structure and function. — Sakamoto

Nonphysicians using lasers without adequate supervision i for example, clinics for laser hair-removal with no physician on site to supervise. — Stone

What's too risky?

"Many cosmetic procedures such as hair transplantation, face-lifts and breast procedures are not risky, but I do not do them; I refer these patients to other properly trained physicians." — Goldstein

Botox (botulinum toxin) injections for strictly cosmetic purposes, as opposed to therapeutic uses such as hyperhidrosis (excessive sweating). — Hellreich

Ablative procedures (where skin is significantly wounded, such as laser resurfacing or dermabrasion) carry inherent risk of scarring, pigmentary disturbance, etc. They can be performed safely but patients must be aware of the risks as well as alternatives. — Mott

Botox being used to correct "sagging" skin around the mouth, vertical bands of the neck and drooping breasts. These are areas where practitioners do not have a lot of experience yet. — Sakamoto

Botox to minimize calf size or minimize size of muscles to modify square shape of face (reported in Japan). — Stone

What's most promising?

Cosmetic tattooing (micropigmentation) i not just for lips, eye liner and brows, but for post-traumatic scars, breast (nipple) replacement, vitiligo (white patches), dotted tattoos for scalp scars and other indications. — Goldstein

Enbrel, Remicade and Raptiva for psoriasis and other inflammatory disorders. — Hellreich

Minimally invasive face-lifts such as the feather lift, using a special suture with small barbs (APTOS threads) to raise the sagging skin. Phosphatidyl choline injections to dissolve the fat causing lower-eyelid bulges. "We are still looking for an effective non-ablative wrinkle laser i a lunchtime procedure that can eliminate wrinkles without surgery or deep laser peels." — Mott

"Chemoprevention," which will enable use of various agents to help prevent skin cancers, especially in at-risk populations such as organ-transplant recipients and other immune-challenged individuals. — Sakamoto

Nonablative resurfacing with radio-frequency (Thermage unit) sounds interesting, but it remains to be seen whether this is reproducible in all patients, and what the best techniques are. Too early to tell. — Stone

Chemists still aiming for eternally young skin

Hyalouronic acid. Grapeseed oil. Micro-sea-plant extract. Papaya enzyme. Licorice. Mugwort. Tea-tree oil. Salicylic acid. Dead Sea salts. These are just a few of the ingredients touted as your skin's best friend.

All over the world, chemists are working overtime in their laboratories to find the secret to youthful-looking skin. They're researching, mixing and matching ingredients from the earth and sea in an all-out effort to formulate a potion that promises to turn back the clock and reveal a more youthful, radiant, wrinkle-free complexion.

Some of these skin care products have a medical pedigree. Among them is ReVive, developed by Louisville, Ky.-plastic and reconstructive surgeon Gregory Bays Brown, after doing extensive research on wound-healing for burn and other post-operative patients.

While at the University of Kentucky, Brown studied general surgery under Dr. Robert Fields, who left a comfortable retirement to become a consultant to Bays Brown Laboratories.

The 64-year-old Fields, who has the complexion of someone at least 25 years younger, was recently in Hawai'i to talk with ReVive customers about the latest from the Kentucky-based company.

Brown and Fields have both given up the practice of medicine to focus on ReVive.

The raison d'etre of ReVive, Fields explained, is epidermal growth factor, a human hormone that is released from cells upon injury and stimulates cell production, speeding up the healing process. From 1987 to 1997, Bays Brown Laboratories conducted research on growth rates for human skin, finding that the hormone sped up the regenerative process.

While creams containing the growth factor didn't quite give the effects of a face-lift, Fields said, "it renewed the skin to an adolescent growth pattern," adding that "Molting takes three or four weeks when you're an adolescent, but nine to 12 weeks when we reach 50."

Here's an inside scoop: Brown and Fields first experimented with using epidermal growth factor in a cream "by going to Walgreens (a drugstore chain) and mixing it with Pond's cold cream, Noxema and Elizabeth Arden's Visible Difference," to see how to turn it into a useable cosmetic.

They added a stabilized version of vitamin C, which is an antioxidant, and they were ready to go to market with their first product, which they named Moisturizing Renewal Cream.

This extensively researched, patented product comes at a price. ReVive products sell for $52 to $375 at Neiman Marcus.

ReVive recently added products with insulin-like growth factor, which is said to boost collagen and stimulate fluid production in the dermal layer of the skin. It's produced from cloned synthetic human molecules. Fields said the two Intensite products, a moisturizer and eye cream, are for those 35 and older.

"The aging of skin is like a depletion in volume," Fields said. "I like to compare it to a balloon. The full-blown balloon is a baby's skin. When you let a little air out, it becomes duller and duller. Let a lot of air out and it wrinkles, then it begins to sag. That's what age does to skin."

Reach Paula Rath at 525-5464 or prath@honoluluadvertiser.com.