Pollution and graceful aging

Some people age gracefully, some do not. Why is that? The answer is quite complex, with genetics, personality, stress, environment, diet, and exercise all playing a likely role. A recent article in the Journal of Cosmetic Dermatology discusses the role of pollution in aging and skin health.

We’ve all heard stories of persons in rural areas across the world living for over a century robustly and in good health. Such observations have always incited speculation and investigation. These kinds of inquiries have led to multiple diet plans and health movements. But it makes sense on multiple levels that maybe avoiding pollution is also a key component to graceful aging. 

Pollution, particularly pollution from various forms of combustion, creates nanoparticles and reactive oxygen species in the atmosphere. These are toxic in that they cause damage and mutations in various regions of each cell’s DNA.  

A portion of DNA that directly correlates to aging is the telomere.  Telomeres are pieces of DNA found on the end of chromosomes (a large unit of DNA) that are designed to protect the ends from degrading. The shorter the telomere gets, the older the cell is.  And it is possible that this DNA damage predisposes the skin to premature aging.

Thankfully, there are many ways to help combat these effects such as healthy diets high in antioxidants and diligent sunprotection. Also, there are many easy and noninvasive procedures that work nicely to correct and improve the signs of aging and damage. Chemical peels and a variety of laser and light treatments are quick and effective ways to cosmetically treat the signs of aging that combustible pollution and ultraviolet radiation can cause.  

However, there is no treatment that works as well as prevention.  And while avoiding pollution may be impractical for many and impossible for some, your skin will certainly thank you for trying.

Noninvasive fat reduction?

You may have seen or heard of the many different machines and treatments now available in spas and cosmetic physicians office’s for non invasive fat reduction. Sometimes touted as easier nonsurgical options to the more invasive traditional liposuction, these treatments claim to help you lose fat without the downtime. You’ve seen the advertisements or otherwise heard of these machines right? If you haven’t, check them out. I’ll name just a few: CoolSculpt, Zerona, iLipo, Thermage, Ulthera, and Liposonix.  If you have heard of some of these and you’re still confused, don’t worry. I think many physicians are too.

In recent years, a number of different treatment modalities have become available for the noninvasive reduction of adipose or fat tissue, and the discerning patient is bombarded by claims of quick fix options and promises of dramatic results. A lot of different energies are employed by these various devices. Whether it’s cryolipolysis, radiofrequency, low-level laser, or high-intensity focused ultrasound, advertisements and sales representatives may be hard to interpret, as most of these biased sources leave us thinking that these treatments sound too good to be true. Honestly, I think many of them probably are.

Each technology employs a different mechanism of action to try to get rid of the fat. Some Heat or burn, some freeze, and some claim to poke holes in the targeted fat cells. Among the previously mentioned technologies, cryolipolysis, popularly known as CoolSculting, freezes the fat. Not only has this treatment been commercially available for the longest time, but it has also, in my opinion, has been the best researched.

The principle behind cryolipolysis is based on the fact that fat cells are more susceptible to the cold than other cells in the skin. Thus, the precise and careful application of cold temperatures can trigger the death and slow clearing of the treated fat cells, without causing significant damage to the overlying skin.

In clinical studies, cryolipolysis was shown to reduce subcutaneous fat at the treatment site by up to 25% after one treatment. Improvements are generally seen in over 80% of treated subjects, and patient satisfaction rates are relatively high.

Cryolipolysis has been proven to be a safe method for targeted fat reduction, or “body contouring”, and is accomplished with only minimal discomfort in the vast majority of cases. Expected side effects include temporary redness and bruising. Occasionally, transient numbness will occur in the treated area. If this happens, it usually resolves within 2 weeks. Rarely, late-onset pain, occurring about 2 weeks post-procedure, is reported. This resolves without intervention.

I find these technologies fascinating, and while many have not yet made me a believer. I’m sure to be revisiting this topic.

Don’t be scared of Botox.

Needles can be scary, but don’t be scared of Botox.

Botox treatments offered by David Ross Smart, MD in Salt Lake City

Whenever I meet people and tell them what I do a conversation about skin health usually ensues. I love what I do, and contrary to what you might think, I actually tend to enjoy these conversations. Sometimes we talk about past or current skin problems, what their friends have done before, or what they’d like to have done in the future. Some people get excited about cosmetic work, and some downplay it.

Botox, being one of the first things people seem to think about when discussing cosmetic dermatology, often gets mentioned. Usually people say they need it or want it, but frequently I also hear people say that they would never do it. They’ll play it off and say that while maybe fun to think about, they wouldn’t want to do it because they don’t want to look plastic or overdone. Now, I’m not saying that everybody should want botox, and clearly wanting to avoid that look is reasonable. It’s what any normal person would think after seeing horrible pictures of now alienesque appearing celebrities that clearly have a problem overindulging in cosmetic procedures.

But to think that this horrendous appearance is the result of Botox injection is completely false.  It’s a misconception, and I want to fix it.

Botulinum toxin is possibly the fundamental intervention of minimally invasive cosmetic medicine. It is a simple, quick, and affordable procedure with proven and reliable results. In the hands of an experienced or well-trained injector, the results of botulinum toxin injection can be wonderfully impressive.

The skin is like highly specialized, bio-engineered wrapping paper. And wrinkles in the skin are caused by the repeated contraction of underlying musculature that causes that wrapping paper to crease. Botox can be used to stop the underlying muscles from contracting which results in the resolution of the wrinkles in the overlying skin. The puffed up look, does not happen with judicious Botox injection.

However, it can also be used in smaller concentrations to simply weaken those muscle contractions, rather than causing complete paralysis. I’m a big fan of this approach, especially in men. Its also nice in younger women who want to prevent the wrinkles from appearing or becoming deeper but don’t like either the look or feeling of an unexpressive upper face. That’s right people.  Preventative Botox is a thing.

Another benefit of the injections is the decrease in sweat production that botulinum toxin causes in the areas in which it is injected. In my experience, this can be a nice side benefit for those that like it.  It gives the face a smooth matte finish instead of the shiny glisten.

In short, the benefits are clear in a wide age range of patients, the side effects are minimal and, in the worst case, it’s only temporary. Don’t be scared of Botox!

As a side note, to make certain we’re all on the same page, Botox is a brand name.  My use of the term does not refer solely to that brand, but I use it as more of a shorthand referring to the injection of botulin toxins in general for medical purposes.  We also inject Xeomin or Dysport in the cosmetic clinic.

Below I’ve included a short list of the commercially available varieties by their molecular names followed by a short list of their approved medical uses.

OnabotulinumtoxinA (Botox®, Botox Cosmetic®)  Cervical dystonia, severe primary axillary hyperhidrosis, strabismus, blepharospasm, neurogenic detrusor overactivity, chronic migraine, upper limb spasticity, Moderate to severe glabellar lines, moderate to severe lateral canthal lines, known as crow’s feet.

AbobotulinumtoxinA (Dysport®) – Cervical dystonia, moderate to severe glabellar lines.

IncobotulinumtoxinA (Xeomin®) – Cervical dystonia, blepharospasm, moderate to severe glabellar lines.

RimabotulinumtoxinB (Myobloc®) – Cervical dystonia