Battle Plan for Wrinkles

• A state-of-the-art sunscreen whose formula goes beyond basic sun protection. The first and foremost best defense against wrinkles is the daily use of an effective, well-formulated sunscreen rated SPF 15 or higher. Daily application of a sunscreen (be it in your moisturizer or foundation) is critical to preventing new wrinkles and keeping existing lines from deepening each year. Ignoring this fundamental principle and focusing instead on anti-aging claims (which, if they don't involve sunscreen, don't require proof of efficacy) is an open invitation for more wrinkles, skin discolorations, and potentially, skin cancer. The basics to look for are a product rated SPF 15 or higher, and make sure it has one of these ingredients listed as active to ensure adequate protection from UVA rays: avobenzone (also known as Parsol 1789 or butyl methoxydibenzoylmethane), titanium dioxide, or zinc oxide. Outside the United States, Mexoryl SX and Tinosorb are effective UVA-protecting ingredients. Beyond that, it is extremely beneficial if the sunscreen you choose is also loaded with antioxidants, anti-irritants, cell-communicating ingredients and ingredients that mimic the structure and function of healthy skin. An abundant amount of scientific research is proving how antioxidants not only boost a sunscreen’s efficacy but also play a role in mitigating sun damage by reducing free radicals and skin inflammation that sun exposure generates. A state-of-the-art sunscreen contains not only effective UVA-protecting ingredients but also includes antioxidants and other ingredients that help skin look and feel better. In short, for optimal benefit and healing, your sunscreen needs to go beyond just deflecting ultraviolet rays; it must also work on a cellular level to prevent damage. (Sources: Journal of the American Academy of Dermatology, June 2005, pages 937-958; Photodermatology, Photoimmunology, and Photomedicine, August 2004, pages 200-204; and Cutis, September 2003, pages 11-15.)
  
  
• Retin-A, Renova, Avita (drug name tretinoin) and Tazorac (drug name tazarotene), prescribed by your doctor or dermatologist, are still the gold standards among topical prescription products for improving the appearance of sun-damaged (wrinkled and discolored) skin. Tretinoin has the ability to return abnormal skin cell production back to some level of normalcy—think of it as the guru of cell-communicating ingredients. The result in most cases is an improvement in skin's collagen production, which makes skin smoother and offers a modest (but noticeable) decrease in the depth and appearance of wrinkles; Tazarotene is believed to work similarly to tretinoin (Sources: Cutis, February 2005, pages 10-13; Mechanisms of Ageing and Development, July 2004, pages 465-473; and Dermatologic Surgery, June 2004, pages 864-866).
  
  
• An effective AHA or BHA product. One significant consequence of sun damage is that the outer layer of skin becomes thickened, discolored, rough, and uneven. The best way to help skin shed abnormally built-up layers of dead, unhealthy skin is to use a well-formulated alpha hydroxy acid (AHA) or beta hydroxy acid (BHA) product. Such exfoliation will not only even out skin tone it will also produce a significant improvement in the texture of skin. Another benefit is that exfoliating away accumulated layers of dead skin cells helps other products you use, particularly moisturizers, penetrate skin and be far more effective. The most researched forms of AHAs are glycolic or lactic acids. Salicylic acid is the sole BHA option. For AHAs, look for products that contain at least 5% AHA, but preferably 8-10%. If the percentage isn’t listed on the label, then the ingredient should be at the top of the ingredient list. For BHA products, 0.5% to 2% concentrations are available.
  
  The difference in concentrations between AHAs and BHA is not a qualitative one. AHAs are not more effective or better than BHA because of the increased concentration needed for one versus the other. Rather, leave-on, daily use AHAs are effective at 5% to 10% and BHA at 1% to 2%. (Sources: Women’s Health In Primary Care, July 2003, pages 333-339; Journal of Dermatological Treatment, April 2004, pages 88-93; Dermatology, January 1999; pages 50-53; and Journal of the American Academy of Dermatology, April 1997, pages 589-593). There are many examples in skin care (and baking for that matter) where percentage of an ingredient doesn’t demonstrate superiority.
  
  If you are battling wrinkles and stubborn blemishes or blackheads, BHA is the better choice because salicylic acid can also improve the shape of the pore. Whether you choose an AHA or BHA product, it is essential that the pH of the product is between 3 and 4. This range is necessary for either ingredient to exfoliate skin. You can find products with a pH lower than 3, but these tend to be too irritating for all skin types, which negates their benefits. (When I rate skin-care products with AHA or BHA, the pH is always tested to be sure it can indeed exfoliate skin.) (Sources: Plastic and Reconstructive Surgery, April 2005, pages 1156-1162; Dermatologic Surgery, February 2005, pages 149-154; and Experimental Dermatology, December 2003, pages 57-63.)
  
  
• Hydroquinone-based, skin-lightening products. If sun- or hormone-induced discolorations are present, a skin-lightening product is needed. Look for one with a texture you prefer (cream, lotion, gel) that contains 1% or 2% hydroquinone. This ingredient has an abundant amount of research showing its safety and efficacy in improving the appearance of brown discolorations by inhibiting melanin production. Hydroquinone is also available in higher concentrations by prescription (an example would be TriLuma, which combines 4% hydroquinone with tretinoin and a corticosteroid). You may want to consider a skin-lightening product that also contains glycolic or salicylic acid because these exfoliants can speed up the results. Although hydroquinone has the highest efficacy and longest history of safe usage behind it, there are alternatives that have shown some promise for lightening skin, but these have been minimally researched and the results pale when compared to hydroquinone. It is interesting to point out that these alternative ingredients are, ironically, derivatives of hydroquinone. They include mitracarpus scaber extract, Uva Ursi (bearberry) extract, which contains arbutin, and forms of arbutin. Other options with some degree of research regarding their potential skin lightening abilities are kojic acid, licorice extract, azelaic acid, and stabilized vitamin C. What has not been conclusively established for most of these hydroquinone alternatives is how much is needed to obtain an effect. Compared to the extensive research concerning hydroquinone's effect on human skin, these alternatives may very well disappoint. (Sources: International Journal of Dermatology, August 2004, pages 604-607; Journal of Drugs in Dermatology, July-August 2004, pages 377-381; Facial and Plastic Surgery, February 2004, pages 3-9; Dermatologic Surgery, March 2004, pages 385-388; Journal of Bioscience and Bioengineering, March 2005, pages 272-276; and Journal of Agriculture and Food Chemistry, February 2003, pages 1201-1207.) Interestingly, hydroquinone is not only a hero for those with sun- or hormone-induced discolorations but its components have potent antioxidant abilities (Source: Journal of Natural Products, November 2002, pages 1,605-1,611).
  
  
• Be gentle! Don't forget that gentle cleansers and products that don't contain irritating ingredients play an important part in helping your skin look better. Using a gentle, water-soluble cleanser further minimizes skin irritation, prevents moisture loss, and won't leave a skin-dulling residue. No cleanser will change a wrinkle, but cleansing skin gently and reducing irritation and inflammation helps the healing process that occurs from such products as sunscreens and tretinoin. For more details, see How to be Gentle to Your Skin.
  
  
• A well-formulated, state-of-the-art moisturizer (serum or liquid textures if you have normal to oily or blemish-prone skin) can go a long way toward improving skin's texture, enhancing its radiance, and creating a smoother, more supple surface. A gel, cream, serum, or lotion that is loaded with antioxidants, ingredients that mimic the structure of skin, cell-communicating ingredients, and anti-irritants can generate new collagen, create normalized skin cells, and reduce further damage. Make sure the packaging will keep its beneficial ingredients stable once the product is opened. That means opaque tubes or bottles with pump applicators or small openings, and avoiding clear packaging and jars of any kind. For more details, see What Makes a State-of-the-Art Moisturizer?
  
  Because most cosmetics companies (and the cosmetics industry at large) are acutely aware of consumer desire to forestall aging and stop wrinkles in their tracks, you will repeatedly encounter products at every retail venue promising to lift, firm, and tone the skin, along with decreasing (or dramatically reducing) wrinkles via this week's miracle ingredient or complex. Don't fall for it, at least not at the expense (and it often is very expensive) of not using an effective sunscreen or considering the proven options above for improving the appearance of sun-damaged (wrinkled) skin. Almost without exception, if an anti-wrinkle claim sounds too good to be true, it probably is. That doesn't mean the product in question isn't worth considering, just that is isn't the fountain of youth so many of us are perpetually seeking.

Paula's Choice Battle Plans for Wrinkles

Battle Plan for Normal to Dry Skin with Wrinkles

1. One Step Face Cleanser Normal to Dry Skin
2. Moisture Boost Hydrating Toner, Normal to Dry Skin or Skin Recovery Toner, Normal to Very Dry Skin
3. 1% Beta Hydroxy Acid Lotion or 8% Alpha Hydroxy Acid Gel
4. Extra Care Moisturizing Sunscreen SPF 30 (daytime)
5. Hydrating Treatment Cream (nighttime)
6. Super Antioxidant Concentrate
7. Skin Recovery Hydrating Treatment Mask (as desired after cleansing)

Battle Plan for Dry to Very Dry Skin with Wrinkles

1. Skin Recovery Cleanser
2. Skin Recovery Toner, Normal to Very Dry Skin
3. 1% Beta Hydroxy Acid Lotion or 8% Alpha Hydroxy Acid Gel
4. Extra Care Moisturizing Sunscreen SPF 30 (daytime)
5. Skin Recovery Moisturizer
6. Skin Recovery Super Antioxidant Concentrate
7. Skin Recovery Hydrating Treatment Mask (as desired after cleansing)

Battle Plan for Normal to Oily Skin with Wrinkles

1. Skin Balancing Cleanser, Normal to Oily/Combination Skin
2. Skin Balancing Toner, Normal to Oily/Combination Skin
3. 1% Beta Hydroxy Acid Gel or 2% Beta Hydroxy Acid Gel
4. Essential Non-Greasy Sunscreen SPF 15, Normal to Combination/Oily Skin (daytime)
5. Skin Balancing Super Antioxidant Mattifying Concentrate
6. Skin Balancing Moisture Gel (nighttime)

• Cleansers
• Toners
• Exfoliants
• Blemish & Oil Control
• Sunscreens
• Moisturizers