5 ways lasers and dermatologists can reverse skin ageing

The real culprit of facial ageing is not wrinkles but skin pigmentation - the freckles, redness, sunspots and skin damage caused mostly by sun exposure when we were children, says dermatologist Dr Natasha Cook. She talks to Citro about the skin ageing exposome and the new lasers and energy-based devices dermatologists use to rectify the damage that shows up on our faces once we hit our 50s and 60s.

There's nothing wrong with ageing skin, but ...

Our skin ages. We all know it. But did you know that it’s not wrinkles that make you look older so much as uneven skin tone? 

Pigmentation - the brown discolouration in our skin which shows up as blotchy spots, sun spots, age spots or freckles - is not only a sign of dreaded sun damage but makes us appear older than our biological age.

Specialist laser, cosmetic and skin cancer dermatologist Dr Natasha Cook says the other form of discolouration or pigmentation that contributes to skin age is increased redness. This redness or flushing can present as flakey pre-cancerous sun spots (known as actinic keratosis) and as collections of capillaries in the skin, all of which are usually caused by the sun.

“Fixing the skin’s canvas is one of the most powerful things you can do to maintain a youthful healthy appearance. Even and smooth skin tone is visually more powerful than getting rid of wrinkles,” Dr Cook says.

Skin ageing exposome: it’s worth understanding

There’s nothing inherently wrong with ageing skin, except that most of it - 80%, according to Dr Cook -  is caused by lifestyle factors such as:

• smoking
• sun exposure
• infrared heat such as that in saunas, which degrades collagen and elastin enzymes in a similar way to the sun’s UV rays
• sleep
• nutrition.

Dr Cook says the other 20% of ageing is due to genetic factors and our inherited DNA, which is the natural consequence of getting older.  

“Uneven skin tone has as equal if not greater impact on the perception of our skin age than wrinkles. You are much better to invest in evening out your skin tone than directly addressing wrinkles in the skin," Dr Cook says.

"This means addressing pigmentation, capillaries and redness."

Why does the pigment in our skin misbehave as we get older?

Mostly because we've had more years of sun exposure.

"The exposure occurred before the age of 20 but shows up on your face in your 50s and beyond," Dr Cook says.

Our skin loses its even tone, texture and colouring thanks to how we live and UV exposure from the sun.

Dr Cook suggests we take a look at the skin on our non-exposed buttock to see the colour, tone and texture of the way our face would look if it had stayed out of the sun.

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Treating pigmentation

Dermatologists are the true experts in diagnosing and treating pigmentation, especially if they have skills and experience using lasers and energy-based devices.

They can accurately diagnose the type of pigmentation and pathology and therefore match it with the right technology to achieve perfect even skin tone. It's also important to rule out skin cancer and melanoma.

Most of us know that lasers can be used for hair removal, but they can also remove scars, tighten skin, smooth out wrinkles, treat red and brown pigmentation.

Cutting edge technologies have transformed laser medicine. From hair laser through to fractionated CO2 and erbium skin resurfacing, there are a heap of new technologies that resolve pigmentation and sun damaged skin.

To get highly technical, these include BroadBand Light (BBL) and Intense Pulsed Light (IPL) energy, fractionated CO2 and erbium lasers, Q-switched lasers and picosecond lasers.

Prescribing the right laser treatment requires careful diagnosis by a doctor or dermatologist (not the ‘dermal therapist’ at the shopping mall). It’s important to trust your skin with a medical expert to get the best result aesthetically and to rule out sun cancer.

People with excess redness and blood vessels - or conditions like rosacea - will need a different type of laser treatment to someone with brown-coloured pigmentation issues like melasma or chloasma, for example.

“Patients have to be vigilant about staying out of the sun and wearing a good quality sunscreen after laser treatments. The main reason is so their pigmentation does not come back and to get the best results," Dr Cook says.

"The skin is NOT more sun sensitive after laser. This is a myth. Make sure you are wearing your SPF (sunscreen) every day and ALWAYS practicing the best sun safe precautions. Never underestimate the UV rays that go through the car window! You must sun protect even when driving in the car."

Topicals and active cosmeceuticals can also treat pigmentation

Topical treatments with specialised ingredients can also help even out skin tone. The common options include:

Retinoids: These have anti-inflammatory properties. For patients with sensitive skin, the newer lotions may be less irritating than older retinoid formulations. They can also be used in combination with corticosteroids. Most dermatologists prefer the prescription type and recommend using it 3 nights a week after your nightly moisturiser.

Alpha Hydroxy Acids and Beta Hydroxy Acids (AHAs and BHAs): Daily use of a serum containing these pigment-removing and preventing ingredients should be part of everyone's daily skin routine. They also have multiple skin worthy benefits including smoothing out your skin texture, refining pores, removing blackheads and over the long term will increase skin collagen production.

Hydroquinone: A thin layer is applied with fingertip 1 to 2 times a day for 3 to 6 months. If there are no results after 2 to 3 months, hydroquinone should be discontinued. It is essential to evenly apply hydroquinone to prevent uneven pigmentation. You need a compounded prescription from a doctor who understands pigmentation to get the optimal formulation. These last only 3 months as hydroquinone “oxidises” and becomes less active after a 3-month period.

Chemical peels: By penetrating deep into the skin, chemicals break up clusters of melanin that are responsible for the appearance of dark spots. The top layers of skin are stripped away during a chemical peel, allowing for the formation of new, healthy skin beneath. There are side effects like burning and skin irritation, and potentially infections and unwanted pigmentary shifts.

The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional health care provider.