These products are referred to as cosmeceuticals. Cosmeceuticals are skin care products that contain ingredients that influence the physiological functioning of the skin. When a cosmeceutical is applied to the skin, the biologically active ingredients within the cosmeceutical are absorbed into the skin, resulting in improved skin appearance. The most commonly used active ingredients in cosmeceuticals are vitamins, herbs, plant extracts (which are referred to as botanicals), and oils. Regardless of what other facial rejuvenation techniques are used, everyone should have a good cosmeceutical regimen to treat, nourish, protect, and moisturize his or her skin.

The cosmeceutical market has grown rapidly over the past few years as the baby boom generation has gotten older. This growth has led to the introduction of literally thousands of different skin care products. Many of our patients have become confused regarding how the different active ingredients in cosmeceuticals help the skin. In order to better educate our patients about cosmeceuticals, the paragraphs that follow will review the most common ingredients that are used in today's cosmeceuticals and how they help the skin look better and more refreshed.

Retinoids – Retinoids are derivatives of vitamin A and are the most common type of cosmeceutical used today. In the skin, retinoids act as antioxidants and they neutralize the free radicals that result from exposure to ultraviolet light. In addition, retinoids increase cellular turnover, stimulate a beneficial thickening of the epidermis, and promote the removal of excessive skin pigment. The use of retinoids leads to the deposition of new collagen in the skin. As a result of these actions, retinoids are known to reduce wrinkles, decrease skin laxity, improve skin color, and produce a smoother skin surface.

Tretinoin (retinoic acid, Retin A, Renova) and tazarotene (Tazorac, Avage) are two of the most commonly used retinoids. Skin care products that contain either of these two ingredients are available by prescription. Retinol is another frequently used retinoid. It is chemically identical to Vitamin A. Because it is a naturally occurring vitamin, skin care products that contain Retinol do not require a prescription and are available over-the-counter.

Hydroxy acids – Hydroxy acids are another very commonly used active ingredient in cosmeceuticals. They are classified as either alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) depending on their molecular structure. Commonly used alpha hydroxy acids are glycolic acid, citric acid, and lactic acid; the most commonly used BHA is salicylic acid.

The AHAs used in cosmeceuticals have been shown to produce younger looking skin. Cellular turnover is increased, and the skin appears smoother and more uniform in color.

Salicylic acid is used as a skin conditioner and is especially useful in patients with oily skin and acne. It is considered to be one of the most effective acne treatments. Salicylic acid would be of particular benefit to individuals who have both aging skin and acne.

Antioxidants – Although it may seem obvious, an antioxidant is a chemical that prevents living tissues from becoming "oxidized" and undergoing a chemical change. In the body, highly reactive substances called free radicals are constantly being produced. Free radicals can quickly damage the body's own cells. In living tissues, antioxidants remove free radicals before they can damage normal tissues.

From the dermatology perspective, exposure to ultraviolet radiation from the sun and other sources will result in the production of free radicals. Several studies have suggested that antioxidants help protect the skin from the damaging effects of the free radicals that result from exposure to ultraviolet light. The most common antioxidants that are used in cosmeceuticals are Vitamin C, Vitamin E, Panthenol, Lipoic Acid, Ubiquinone, and Niacinamide.

Depigmenting Agents – Depigmenting agents are skin-lightening ingredients. They remove excessive melanin pigment from the skin. A depigmenting agent works best on "epidermal melanin," which is melanin in the top layers of the skin. When the excessive melanin is located deeper in the skin in the dermal layer, a depigmenting agent may not be as effective.

Hydroquinone is the most commonly used depigmenting agent; it works by decreasing the production of melanin pigment. Some physicians also add tretinoin (retinoic acid) and a steroid to the hydroquinone. The tretinoin acts by increasing cellular turnover, resulting in a quicker response to treatment, and the steroid acts by reducing inflammation in the skin. Tri-Luma cream conveniently combines hydroquinone, tretinoin, and a steroid in one medication, and is available by prescription.

Other compounds that are used for skin lightening include azelaic acid, kojic acid, and peels containing alpha hydroxy acids such as glycolic acid.

Botanicals – With the modern trend toward the use of more natural ingredients, botanicals have become a component of nearly every cosmeceutical product available and form the largest category of active ingredients used today. An appropriate botanical can be chosen to reduce inflammation, sooth the skin, or act as an antioxidant. Some of the most commonly used botanicals are prickly pear and aloe vera (for skin soothing), ginkgo biloba, willow herb, and green tea (anti-inflammatory), and goji berry and soy (antioxidants).

Peptides – A peptide can be thought of as a small part of a much larger protein molecule. Peptides were developed for use in skin care to either increase the production of collagen or to reduce the breakdown of collagen. This is important because loss of collagen in the skin is one of the causes of wrinkles.

One of the best known peptides used in cosmeceuticals today is referred to as a "pentapeptide." This peptide is actually a small fragment of the protein that makes up human collagen. This "pentapeptide" has been shown to increase collagen production.

Matrix Metalloproteinase Inhibitors (MMPIs) – Matrix metalloproteinases are proteins found in the skin that break down collagen. They are activated by exposure to ultraviolet light as well as by exposure to air pollution, smoking, and the natural aging process.

There are two ways to block the activity of matrix metalloproteinases, and in so doing, help to preserve the skin's collagen. The first is with a good sunscreen that protects against ultraviolet light. The second is with substances that actually block the activity of the matrix metalloproteinases; these substances are referred to as matrix metalloproteinase inhibitors (MMPIs). Substances that act as MMPIs include derivatives of green tea, tretinoin (retinoic acid), beta-carotene, vitamin E, vitamin C, and flavonoids. The use of MMPIs in cosmeceuticals is one of the newest and most exciting innovations in skin care, and MMPIs are expected to receive much more attention in the near future.

Cosmeceuticals are formulated and available for purchase from a large number of manufacturers, and their use has become a standard component of modern skin care. Because there are literally thousands of skin care products in the marketplace from which to choose, it can be quite confusing as to which products are best for a particular person. For this reason, it is ideal for each patient to have his or her skin care program designed by a skin care expert. These professionals are able to select from the large number of available products those products that are best for an individual person.

With summer and the traditional summertime outdoor entertainment season starting soon, our office is offering an exceptional eyelid rejuvenation package so that more of our patients can look their best. The package begins with the eyelid Thermage procedure to lift and tighten the skin of the eyelids and the tissues around the eyelids. To ensure the best possible result from the eyelid Thermage, all of our patients receive a minimum of four or five complete passes of the Thermage treatment tip over the treated areas. After the eyelid Thermage, our patients can choose between having either a Botox treatment to the tissues around the eyes and eyebrows or a treatment with one full syringe of Restylane or Juvederm. We are offering this package for $1850 during June and July, which is more than a $750 discount from the regular price. We have been very pleased with the results we have achieved with eyelid Thermage, and our patients have truly enjoyed the cosmetic improvement the procedure provides.

In our office, the eyelid Thermage procedure is performed only by Dr. Anterasian, a board certified physician and surgeon. He was one of the first physicians in Los Angeles to perform eyelid Thermage, and he has extensive experience with the procedure.

Eyelid Thermage is one of Dr. Amerian's favorite procedures, and Dr. Anterasian has performed the procedure twice on Dr. Amerian's eyelids during the past nine months. Dr. Amerian will be happy to show any of our interested patients her "before and after" photographs.

Any of our patients who wish to take advantage of this special opportunity to rejuvenate their eyelids are invited to call our office at 310-829-9396 and make an appointment with either Dr. Amerian or Dr. Anterasian.

What are the major differences between care of the skin in summer and care of the skin in winter?

In general, most people will experience less dryness in the summer months than in the colder winter months. For this reason if you have dry skin, it may feel better during the summer.

If you have oily or acne prone skin, the heat of summer can make the skin even more oily and acne prone, especially if the humidity is high. For this reason, if your skin is oily or acne prone and you use a mild cleanser in winter, you may need to use a stronger cleanser during the summer. These stronger cleansers include such products as Beta-hydroxy Acne Cleanser and B Prox 10 Wash, both by DCL.

After cleansing the face, people with oily skin should finish with a toner. The use of a toner will further cleanse the skin and remove any remaining makeup. Toners suitable for patients with oily skin include Moisture Balance Toning Lotion by Exuviance, Rejuvenative Toner by Skin Medica, which is slightly stronger, and Acne Treatment Toner, which is the strongest.

Fine particle exfoliating scrubs should only occasionally be used, once or twice a week at most, and should be used gently. Alternatively, one can use a cleanser with an alpha-hydroxy acid and a moisturizer. These cleansers will improve the skin's tone and texture by producing a mild chemical exfoliation. A good medium strength cleanser for normal to oily skin that contains alpha-hydroxy acids is Simply Clean by SkinCeuticals. Generally, women with dry skin will not benefit from using a cleanser with an alpha-hydroxy acid, as it will tend to further dry their skin.

If you normally use a moisturizer every day, you may find that your skin will benefit from a lighter formulation in the summer. A moisturizer should be selected based upon your skin type. Our favorite moisturizers are Evening Restorative Complex by Exuviance or Rejuvenative Moisturizer by Skin Medica (for normal skin), Ultra Light Hydrator by DCL or Ultra Sheer Moisturizer by Skin Medica (for acne prone and oily skin), Facial Moisturizing Cream by DCL or Skin Medica Dermal Repair Cream (for dry skin), and Light Textured Moisturizer by DCL (for normal to oily skin).

If you are not anticipating significant sun exposure, you might wish to lighten your daytime skin care by using a moisturizer with sunscreen instead of separate moisturizer and sunscreen products. Fundamental Multiprotective Day Fluid with SPF 15 by Exuviance and DCL Daily Moisture with SPF15 would both work well on normal or oily skin. For dry skin, we like the UVA/UVB Moisturizing Cream Sunscreen SPF 25 by DCL. Women who do not need to use a moisturizer regularly should also consider using a foundation with an SPF and a daily sunscreen.

With a multitude of skin care products to choose from, it can get confusing as to which skin care products are best for a given person. Jonee and Barb will be happy to help any of our patients who have questions regarding which skin care products are best for them. Feel free to speak with either of them at any time for help with your unique skin care needs.