Anti-aging; prevention

Anti-aging treatments; At A Glance

  • Best ResultsFor life
  • Treatment Recovery0-1 day
  • Procedure Time5 to 90 min
  • Skin SpecialistDermal therapist, nurse
  • Duration of ResultsVariable
  • AnaestheticNA
  • Back to Work0-1 days
  • Cost $-$$

Anti-aging; prevention

Ideally prevention strategies for anti-aging include skin care at home, supplemented with clinically proven office procedures such as chemical peels, laser resurfacing & injectables. The use of antioxidants, niacinamide, ascorbic acid & retinol can slow down the aging process. Photoprotection, stress relief & diet play an important role in slowing down intrinsic & extrinsic ageing.

FactsFacts on Anti-aging

  • Starting an effective anti-aging program can slow down the aging process
  • The very first step is habitual use of sunscreen
  • Antioxidants protect your skin from toxins & DNA damage
  • Retinoids build collagen & thicken the dermis & epidermis
  • Niacinamide enhances skin barrier function & reduces inflammation
  • Ascorbic acid protects against free radical damage to DNA
  • Oral supplementation with resveratrol & Nicotinamide Mononucleotide can reduce stress to cells
  • Chemical peels, lasers & skin tightening procedures can effectively build collagen & should be incorporated into anti-aging skin care

What is the best anti-aging skin care routine?

Start off with sun protection. It is a lot harder than it seems to get it right. Use a SPF 50+ twice a day.

The next step are antioxidants. They form the second layer of defence against UV & environmental stressors (see below).

Vitamins are essential for skin health. A good starting point is retinol, followed by niacinamide and ascorbic acid. AHA’s including glycolic & lactic acid can be used once a week to exfoliate dead skin cells & increase absorption of other actives.

Clinical peels including high strength AHAs & retinoic acid can be performed once a month.

What are antioxidants?

Antioxidants are the second layer of defence after sunscreens. These molecules protect your collagen & DNA from free radical damage due to UV radiation & environmental pollutants. Antioxidants can be found in your diet, taken as a supplement (eg Resveratrol), or applied topically on your skin. Ideally applied in the AM, under your sunscreen. Look for the following ingredients-

Vitamin C or ascorbic acid is one of the most powerful antioxidants. This is why most dermatologists will advocate its use in the AM, under SPF. Formulation range 10-20%, go on the lower end if you have sensitive skin. The activity depends on the formulation pH. You should aim for a pH range of 2.5 to 3.5 for maximal penetration into the deeper epidermis.

Vitamin E or alpha tocopherol is a fat-soluble vitamin & often incorporated with ferulic acid & ascorbic acid. It has a low irritation potential.

Vitamin B can also have antioxidant effects, however not as powerful as vitamin C, E or ferulic. Good choice for sensitive skin.

Ferulic Acid is a naturally occurring antioxidant found in cereals like oats. It stabilizes vitamin C & E, and hence has synergistic effects with these skin vitamins. The best formulations will have CE & Ferulic mixed in.

CoEnzyme Q 10 is a benign, cost effective antioxidant. Can be found in food and or topical formulations.

Resveratrol is one of the most powerful antioxidants taken orally. It is found in plants including grapes & nuts.

Green tea, isoflavones, soy, ginseng, & botanical berries: all excellent naturally occurring antioxidants found in organic skin care products.

Why start with retinol?

Understanding what your skin can tolerate is the first step in good skin care. Prescription retinoids such as tretinoin, retinoic acid, adapalene & tazarotene will cause skin irritation. A sensible approach is to start off with over-the-counter retinoids including retinol, retinyl esters, & retinaldehyde. These compounds require conversion to pharmacologically active retinoic acid. These conversion steps slow down the process to yield bioavailable retinoic acid, in turn markedly reducing side effects.

Start off with a good formulation of retinol, 0.5% every second night, then slowly increase as tolerated. You can step up to 1.0% after a few months.

Why are retinoids the number one topical for anti-aging?

Retinoids have many anti-aging effects, including-

  • Stimulation of collagen, elastin & hyaluronic acid. This accounts for the anti wrinkle & plumping effects of retinoids.
  • Reduction of pigmentation as retinoids suppress tyrosinase. This can improve melasma, dull skin & age-sun spots.
  • Retinoids compacts the stratum corneum, accelerates cell turnover & thickens the epidermis & dermis. This results in better light transmission, more luminous skin & less wrinkles.
  • Retinoids increase blood vessels, a term called angiogenesis. This results in glowing dewy skin.

When is a good time to start anti-wrinkle injections?

The best time to start ‘B Injections is controversial. It really depends on how dynamic or expressive you are. In truth the age ranges from early 20s to late 30s. Some people just don’t wrinkle – that’s a fact.

Expression also changes with your lifestyle, job, & relationships. You may go through many years without frowning, or added stress, only to find yourself in a shitty job, relationship or time of your life. As a guide, small units of anti-wrinkle injections starting in your mid to late 20s can reduce static wrinkles.

When is a good time to start dermal fillers?

Dermal fillers can be used in two ways. Firstly, to correct & enhance genetically deficient areas. Examples include recessed chin, maxillary hypoplasia, jawline deficiencies, & bumps on the nose. In this context, dermal fillers can be initiated in early adult life as part of a non-surgical approach to correct.

Dermal fillers can also be used to replace volume loss. As we age, we lose 1% of collagen for every year of life starting in the 20s. Hence, in this context dermal fillers can be useful in your late 20s to early 30s. The amount of volume depends on your genetic makeup as well as your metabolism. 

A sensible way to approach dermal fillers is to start off with one syringe at a time. One syringe contains one ml of hyaluronic acid filler, the same volume as ⅕ of a teaspoon. Not much once you put things into perspective.

Can collagen supplements be useful?

At the time of writing, there are no great studies to suggest that collagen supplements are useful in the context of skin rejuvenation. There are however many studies that support glycosaminoglycans for joint health.

My thoughts? Given the joint benefits of collagen supplements, the safety profile & costs, this supplement does no harm.

What are other scientifically proven anti-aging supplements?

Metformin has been used by anti-aging doctors for nearly a decade. This modulates glucose, insulin, AMPK & IGF levels, reducing inflammation & oxidative stress. Dermatologists prescribe metformin for conditions like PCOS, hidradenitis suppurativa, & acanthosis nigricans. A typical dose ranges between 500 mg to 1000 mg daily.

NMN or Nicotinamide Mononucleotide supplementation helps promote DNA repair, via the sirtuin pathway. This molecule has been shown to improve the body’s longevity and anti-aging genes.

Resveratrol is well known in the skin care industry for its antioxidant properties. This polyphenol can be found in plants, including grapes & nuts. Supplementation can reduce oxidative stress to DNA. Studies have shown that it can potentially prolong life.

Bioequivalent hormones are controversial in Australia, but well accepted in more medically advanced countries such as the United States & Europe. Our FDA lags 5-10 years behind the TGA & CE. These hormones include human growth hormone, testosterone & estrogen.

Disclaimer: I am a procedural dermatologist; my work focuses on surgical, injectable, lasers & deep peels. I do not prescribe skin care. For topical anti-aging, please consult my clinical team. For systemic agents, consult an anti-aging physician.

Davin’s Viewpoint on Prevention of Aging

You know who is eventually going to win. Anti-aging is such a misnomer, you can’t ‘anti’ the course of nature, nor can you prevent it. What you can do is to slow it down.

Start off with the basics, namely protect, preserve, build & correct. Antioxidants include ferulic, ascorbic, acids, tocopherol, resveratrol, & green tea. Add retinoids, B3 and vitamin C, exfoliate once every 2 weeks.

Supplement your anti aging skin care routine with in office treatments including chemical peels, lasers & injectables.

The implementation of injectables including neurotoxin & HA dermal fillers can be controversial. If there are attributes on examination that can be corrected (eg redness, enlarged pores, fine lines, wrinkles, recession), injectables can, if so elected, be commenced in the early 20s. Micro doses can be delivered with devices like the V2 Injector, Aquagold, Tixel & thulium lasers.

Bioequivalent hormones & supplementation with resveratrol, NMN & metformin is considered mainstream antiaging in the United States & throughout Europe. Provided it is managed by a physician, these systemic anti-aging hormones & supplements are safe. The mainstream medical fraternity in Australia may not know about these methods.

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