As the baby boom generation grows into middle age and beyond, the rules of what’s considered old are taking on a new wrinkle. And it’s not just baby boomers that are regretting their wrinkles. They are also starting to worry about the state their skin is in. Not only is vanity concerning women it is also a matter of health and wealth. Sun-damaged skin increases the risk of skin cancer. And for the first time in history the majority of women are working outside the home- getting a job, a promotion or keeping up with the competition might depend on a youthful appearance.

In the past a surgical facelift was the primary treatment for wrinkled and sagging skin. Today dermatologists have a wide range of options.

Skin is a made up of a number of layers:

• the thin epidermis is the layer visible to the world;
  
• beneath that is the dermal layer which contains nerves, glands, strands of collagen protein which give the skin its structure and the protein elastin which provides elasticity;
  
• beneath the dermal layer is the fat layer which gives skin its plumped up look.
  
  

Resurfacing techniques include chemical peels, laser energy, and friction using microderm-abrasion. These techniques that remove the top layer typically cause some pain during recovery and take time as a new and smoother outer layer of skin is grown.

Ablative laser resurfacing has been used for some time to treat photoaging as well as remove blemishes and mild acne scarring. The high-energy carbon dioxide laser (the most common type used for resurfacing) directs a beam of light onto the skin, and the laser energy is absorbed by water in the skin cells. The outer layer of skin is removed (ablated) and the patient must wait days or weeks for the new skin to grow. The carbon dioxide laser is effective for patients with deep wrinkles and extensive sun damage. Erbium or combination lasers can be used to treat more superficial wrinkling or sun damage as well as skin blemishes and irregular pigmentation. These lasers produce less initial skin damage and have a faster recovery time.

Patients who have had an ablative procedure must be thorough about wound care to protect against infection. Side effects can include scarring or uneven pigmentation. The same kind of recovery period and care are required for both microdermabrasion and chemical peels, since they also work by removing the protective outer layer of skin.

If you don’t like the thought of having the top layer of skin removed from your face, there are other, newer options, including non-ablative laser treatment and a light emitting diode (LED) technique. Non-ablative lasers target the deeper, dermal level stimulating collagen to thicken and tighten. The effect is to improve the tone and texture of skin with less pain and a faster recovery time than surface methods.

Light emitting diode therapy is simple to deliver and painless. With LED the patient sits in front of two light panels, which flash light onto the face for less than a minute. Although the light doesn’t heat or damage the dermal layer, scientists think that it stimulates collagen and elastin to increase production and tighten skin. LED is painless, and there’s no recovery time needed. The effects are not as dramatic as with laser techniques, but patients do see improvements in skin texture, discoloration and fine lines. Up to 10 treatments over two months are needed and then three or four treatments per year to maintain the benefits. Patients with darker skin tones should consult a dermatologist skilled in treating similar skin types and discuss techniques best suited for their skin type as well as possible side effects.

Women contemplating any kind of facial resurfacing should do their homework before deciding on a dermatologist and type of procedure. The physician you choose should have considerable experience doing your procedure and should be willing to take the time to discuss your expectations and, even more importantly, possible complications.

An equally important part of your homework is checking within. Can you afford the procedure? If it’s cosmetic, it’s generally not covered by health insurance. Do you have a realistic idea of the likely results? Skin resurfacing may make you look a little younger, but the effects will be lost over time. The procedure won’t change your life, so it’s important not to build up exaggerated expectations of how you’ll feel after it’s done. Regardless of age or interest in resurfacing techniques, all women can act to protect their skin from present and future damage by avoiding excessive sun exposure, tanning booths and smoking.

It’s estimated that 80% of the skin damage we attribute to aging is actually the result of damage from chronic sun exposure. Protecting skin from sun damage is a smart way to keep skin appear more youthful. Four elements of sun protection that all of us can heed:

• Slip–into clothing that will keep you protected;
  
• Slop–on sunscreen liberally;
  
• Slap–on a hat;
  
• Wrap–yourself in a pair of sunglasses.
  
  

Casey M. Valiente, PharmD