SCN: You believe that many people can become so focused on reducing wrinkles and sagging skin that they neglect other areas; please tell us more.

Doctor: No doubt you already know a great deal about ways of reducing wrinkles, straightening jowls, removing moles and fixing scars. However, a healthy and youthful appearance hinges on more than the absence of furrows, sagging skin and unsightly lumps and bumps.

Your skin is like a fabric or a canvass upon which everything sits. If I handed you a hot iron, and asked you to press a frayed, threadbare and badly wrinkled shirt, you’d likely be able to eliminate all of the creases. But, in the end, you’d still have a tattered garment, unfit for wearing.

So, too, with your skin.

In order to have fully restored and revitalized skin, you must also pay attention to the background fabric, to improve its luster, tone and texture.

SCN: When you say “background fabric,” what kinds of skin issues are you referring to?

Doctor: Unfortunately, there are a number of common imperfections that can mar the background fabric of our skin and detract from our appearance. These include a sallow complexion, roughened or leathery skin, dark circles under the eyes, persistent facial flush, liver spots, freckles, melasma, post-inflammatory hyperpigmentation and dilated pores.

SCN: Please tell us more about these skin concerns and how they develop.

Doctor: A dull and sallow (sickly yellow) tone can result from long-term photodamage, stress, lack of sleep, ill-health or improper skin care routines. Likewise, coarse, dry, alligator skin has its roots in chronic overexposure to ultraviolet light, chronologic aging and the overuse of hot water and harsh cleansers.

Dark circles under the eyes have been linked both to sun damage-related thinning of the lower lid — which increases the visibility of the dark, bluish vessels beneath — and to UV light-induced deposition of melanin within the region.

The presence of a persistent, embarrassing facial flush is most often an ethnic or familial trait or a manifestation of rosacea.

Liver spots, more correctly known as solar lentigines, have nothing whatsoever to do with the liver. They’re small, flat or slightly raised brownish discolorations commonly seen on the face and hands of fair-skinned people who’ve had a great deal of lifetime tanning. These spots impart a mottled and uneven look that accentuates whatever lines and wrinkles are present.

Another common discoloration, garden variety freckles or ephelides, might seem charming when just a few of them are scattered over the cheeks and nose. But, when they merge together and become densely packed, they can be quite unattractive.

Melasma is a common, inherited condition of blotchy brown pigmentation that typically affects the cheeks and forehead. It’s thought to be provoked by estrogens, birth control pills, the hormones of pregnancy and sunlight.

And finally, postinflammatory hyperpigmentation (PIH) are those annoying dark blemishes — the bane of all teenagers that can persist long after the healing of any intense or prolonged episode of an inflammatory skin condition such as acne or rosacea.

SCN: How are these skin problems treated?

Doctor: Decades ago, the following chemical peels were commonly used: medium and deep chemical peels using phenol and high concentrations (50 percent or greater) of trichloracetic acid (TCA). Today, however, most of these have largely fallen in popularity.

Though these methods are extremely effective for treating chronic sun damage, wrinkles and pigmentary and surface irregularities, they typically require extended recuperative and recovery periods.

Fortunately, today we use milder chemexfoliation agents such as low potency TCA, Jessner’s solution and maximal concentrations of glycolic acid and salicylic acid, which can achieve many of the same effects without the long downtime.

To distinguish these treatments from a chemical peel, the application of these substances is sometimes referred to as “skin freshening,” “skin renewal” or “skin rejuvenation.” And because they can be performed in a matter of minutes, they’ve been described as “lunch-hour peels.”

TCA in concentrations of 10-15 percent and Jessner’s solution — a preparation composed of lactic acid (an alpha hydroxy acid, see below), salicylic acid and resorcinol in relatively low concentrations — has a long, proven safety and efficacy record.

A series of six or more peels can be helpful for brightening the skin, adding luster, smoothing roughened areas and fading dark spots and larger discolored patches.

SCN: What do you typically use in your practice?

Doctor: In my practice, I rely more heavily upon what I have nicknamed “Fruit Washes” and “Beta Washes” for improving brilliance, luster and tone; achieving smoother texture; softening fine wrinkles; minimizing superficial laxity; evening out pigmentary irregularities; and diminishing pore size. Both kinds of peels may be used safely and effectively for the face, neck, chest and hands.

SCN: Please elaborate on these Fruit Washes.

Doctor: Fruit Washes are solutions of glycolic acid in its maximum 70 percent concentration. Glycolic acid is one of several alpha hydroxy acids (AHAs) — a group of naturally occurring substances often referred to as “fruit acids,” because they’re found in various fruits and other foods. In nature, glycolic acid is a component of sugar cane juice.

Topical anesthesia is seldom necessary before a Fruit Wash, although it may be occasionally needed to numb specific sites, especially the delicate areas under the eyes or around the mouth. Mild stinging, itching and burning are common shortly after application but are eliminated by plain water or bicarbonate compresses applied after about two minutes.

This is followed by a pleasing blush, and most people are delighted by an almost immediate overall improved glow or radiance.

For best effect, a series of six to 12 treatments spaced at one- to two-week intervals is often necessary followed by periodic maintenance treatments as needed. Fees range from $100-$150 per session.

SCN: What are Beta Washes?

Doctor: Beta Washes contain salicylic acid, a beta hydroxy acid, in a maximal 30 percent potency. Salicylic acid has been used safely as a peeling agent for more than 60 years. Prior to treatment, the skin must be thoroughly cleansed and degreased. Here, too, topical anesthesia is rarely required. After application, most people experience an intense stinging and burning sensation, which stops in about three minutes without any need for neutralization.

Beta Washes possess several distinct advantages. For one thing, since the skin turns a powdery white as the solution dries, it’s easier to confirm an even and complete application without any skipped areas. Moreover, because it’s lipid soluble, a Beta Wash can more easily penetrate follicles to unplug and tighten pores and improve acne-prone skin. And finally, it’s especially safe, because the peel stops by itself, limiting the depth of penetration.

As a rule, Beta Washes more rapidly achieve some of the effects of multiple fruit washes, particularly for smoothing fine lines, lightening darkened skin and hastening the resolution of active acne.

A series of two to four treatments at two- to four-week intervals is typically required followed by periodic maintenance as necessary. Fees range from $350-$750 per session.

Immediately after treatment, most people note an incredible smoothness and softness to their skin. However, it usually takes a few days for the surface to completely return to normal. A faint reddish-white appearance and slight puffiness isn’t unusual for a day or two.

And during the next few days of healing, renewal and repair, the skin might also feel a bit taut. Not infrequently, there will be a mild, sunburn-like flaking of the topmost layer. No particular aftercare is generally necessary, however, and patients can apply regular makeup right away.

SCN: What other treatments are used?

Doctor: A variety of ablative and non-ablative lasers have also been used for the treatment of the above conditions. In my opinion, they tend to be more expensive, and none have been shown to be consistently more effective than the peeling methods described.

By contrast, electrosurgery (the application of electric current) and radiosurgery (the use of radiowaves) are each useful and relatively inexpensive methods for treating liver spots when they’re few in number. Fees typically range from $100-$300 for up to six lesions.

SCN: What’s effective for people with larger pores?

Doctor: While most people are gratified with the improvement they see in the tightness of their pores after several Beta Washes, others with more dilated pores can profit from the use of trichloracetic acid 100 percent instilled directly down the shaft of the pore.

The resulting irritation of the lining of the follicle leads to its permanent shrinkage with complete healing. This technique, known by the acronym CROSS (Chemical Reconstruction of Skin Scars), was developed to treat ice pick scars from acne. Depending upon the number of sites treated, fees may range between $150-$500 per session.

Also successful in treating patulous (dilated) pores is microneedling — using a roller device arrayed with numerous tiny spokes projecting from it. This treatment is performed after topical anesthetic cream or ointment is applied. The microchannels — created by the roller as it passes over the skin — stimulate new collagen synthesis, which in turn serves to better anchor the skin and diminish the size of the pores. Between two to four treatments spaced at monthly intervals are often needed for optimal results and each session may range from $300-$500, depending upon the size of the treated area.

SCN: Many of our readers complain about facial flushing; how can you treat this issue?

Doctor: I find that individuals complaining of a persistent flush to the cheeks (not “broken” blood vessels) are most effectively treated by a combination of small amounts of Botox injected superficially in a gridlike pattern over each flushed area, accompanied by a series of intense pulsed light (IPL) therapy sessions.

The Botox helps to “calm” the over-reactive neurons believed to contribute to blood vessel dilation, and the IPL targets and heats the hemoglobin in the minute blood vessels, causing them to shrink. Fees for the Botox (usually only one session is needed) typically run $400-$600; IPL costs $350 per session for a series of four to six treatments spaced at two-week intervals.

SCN: Returning to Fruit Washes, how soon can patients go out in the sun after receiving this treatment for melasma?

Doctor: Since UV exposure figures so prominently in causing or aggravating many of the discoloration conditions of the skin, including melasma, it would be prudent to protect yourself at all times from sun exposure with the use of high SPF sunscreens.

It’s important to understand that one 15-minute exposure to high intensity ultraviolet light can undo six months worth of treatment.

SCN: Are Fruit Washes and Beta Washes used to treat other parts of the body besides the face, neck, chest and hands?

Doctor: Both kinds of chemexfoliation — particularly Fruit Washes — have been used quite successfully on all areas of the skin, including the back, arms, thighs and buttocks. These treatments can be used to treat a variety of conditions, including PIH, folliculitis and acne. When they’re used in this fashion, the technique is sometimes referred to as “body painting.”

See also:

Minimally Invasive Lunchtime Beauty Fixes: Age Spots

Minimally Invasive Lunchtime Beauty Fixes: Cellulite and Stretch Marks

Minimally Invasive Lunchtime Beauty Fixes: Scars