Submental sparing, where have you gone?
Not long ago, when we wanted to see how the sun aged our skin, we only had to look right under our chins. The chin area remained free of the hallmarks of aging: no wrinkles, sagging or age spots. In fact, the area was firm and young-appearing well into our 60s and beyond.
But times, and physical findings, have changed. In my South Florida practice, submental sparing is a concept of the past. The best ‘anatomic oasis’ of aging skin is now the buttocks - the area that has been exposed the least to the environment and its pollutants, as well as other triggers of free radical formation. In the 21st century, the term “photo aging” should be replaced by the more accurate “environmental aging” in my opinion.
To demonstrate the effects of environmental aging quickly and effectively, I often take out the mirror, or I take a photo on my smartphone. Most clients notice they have variation in the color of the skin that is chronically exposed to the elements. They are concerned about the clear demarcation of facial skin in the more vulnerable areas compared to the preauricular area which is often protected by the hair. The advantage of using a camera is that if you don’t see the demarcation at first glance, you can enlarge the photo. 9 times out of 10, the person will see the light! It is not as easy as the old submental ‘tell,’ but it’s still a big help.
The Big C-Word
When it comes to protecting yourself from the elements, we must use not only sunscreens, but also ingredients that act as a shield from non-UV triggers of free radical formation. Enter antioxidants! Antioxidants are vital, whether we are indoors or out.
The real buzz in the past decade has been about an antioxidant that also helps protect you from the sun: Vitamin C. Dr. Sheldon Pinnell was the first to document how L-ascorbic acid prevents the formation of the necrotic keratinocyte, or ‘sunburn cell.’ Some 20 years later there is a cadre of new vitamin C analogues. Vitamin C is arguably the most marketed antioxidant, and we dermatologists can best describe it as a non-sunscreen sun protectant. Vitamin C is excellent for skin brightening, skin firming, and anti-aging. Scientific papers confirm that vitamin C stimulates collagen synthesis, reduces inflammation, suppresses pigmentation, retains moisture, enhances UV-protection, and even replenishes vitamin E.
Lessons Learned: Combine and Conquer
In my practice, I have often seen synergies from using more than one product with vitamin C, so do not shy away from recommending multiple formulas. The patient above, for instance, did best when we combined a lipophilic form of vitamin C with L-ascorbic acid, and you can see resolution of some photo damage within the first three weeks of use. These kinds of successes in skincare help me to build a most loyal cosmetic patient base and I hope some of this advice will help you too!