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Do creams really work?

This is one of the most common questions I hear as a cosmetic doctor.  Without a doubt it is asked by at least one patient every day.

Well the quick answer is yes, but only if using the right creams for your skin and only if the ingredients in the creams are in stable forms and strong enough concentrations to be active.  Most of the skincare creams purchased in supermarkets/department stores and chemists do not meet these criteria.  In Australia, once a cream has enough active ingredients for it to be considered to make a physiological change in the body, the Therapeutic
Guidelines Administration (TGA) restricts its use.  Just like a drug, the cream must be prescribed by a Doctor.  For this reason skincare that contains effective concentrations of active ingredients can only be obtained from Cosmetic Medical Centres.

It is often similarly priced to a “good” cream from a department store, however because its ingredients are so potent only small (pea-sized) amounts are required.  Creams will often last for 4 to 6 months with daily use.  Serums, being less viscous, will often last longer.  The trick with skincare is not to lather it on.  It is only that which is in contact with the skin’s surface area that will do the work.

Looking at ageing, research shows 90% of visible ageing comes from the cumulative effect of UV rays.  It is not just sunbathing episodes but the everyday incidental exposure to the sun, for instance just going to the car or the washing line, that creates the damage.  This results in the loss of elasticity and collagen, which causes irregular melanin production and ultimately the formation of fine lines, wrinkles and pigmentation.

Consequently the most important cosmetic cream is sunscreen.  Again not all sunscreens are the same.  When choosing a sunscreen the most important aspect is not the SPF rating as this only represents the UVB protection.  It is both UVB and UVA radiation that causes damage.  UVB rays act against the epidermis while UVA acts against the dermis.  When the radiation hits the skin it causes initial damage, then secondary damage by creating free radicals.  These free radicals help stop the skin's melanocytes from working, reduce collagen production and stop macrophages from performing immune functions.  The presence of a broad-spectrum rating is a more useful indicator of its effectiveness.  The next aspect is whether the sunscreen acts as a physical barrier or chemical barrier.  Most sunscreens are chemical barriers.  These cause a chemical reaction in skin to prevent UV radiation damage.  They are absorbed by the body and excreted by the liver like many other drugs.  They nearly always require repeated application throughout the day, are oily and thick, have the typical sunscreen smell and are more likely to have chemicals that the skin can be sensitive to.  The alternative is physical barrier sunscreens.  ‘Good old zinc’ is one of these.  As we know nothing penetrates this, but what a sticky mess!  Fortunately through science physical barriers have been created using zinc and titanium dioxide that provide the protection of zinc but are so sheer that they can be worn alone or under makeup. These chemicals are inert, so sensitivity is unlikely. Application once per day is usually all that is required.  Only small amounts are needed and they don’t leave the skin oily, can be used as moisturisers and are made to smell very pleasant.  The use of such refined molecules allows sunscreens to be put into mineral makeup and finishing powders.  Remember, always apply sunscreen to your neck, décolletage and the back of your hands at the same time you put it on your face, to prevent ageing in these areas!

It is important to have an understanding of what the active ingredients in good skincare are and what they do.  This way you can be assured that you are getting the right skincare for you.  Just to reinforce, the success of these ingredients depends on their concentration and active state.

These are currently the most important active ingredients in skincare:

Vitamin A (retinol, retinoic acid and retinoin) has been shown to be the most important anti-ageing substance seen in skincare.  Multiple studies have shown that it not only protects but also can reverse the damage already present.  It does this via multiple mechanisms.  It promotes skin renewal by increasing the rate of cell division, increases collagen and elastin production and quality, decreases sebum production and restores skin cells to a more youthful type.  Vitamin A and its derivatives improve pigmentation, fine lines, skin texture and tone, closes pores and hydrates.  There is an adjustment period when using Vitamin A products where the skin may become red, dry, scaly and irritated.  This is usually only during the first 3 weeks.  Once adjusted the skin continues to improve.

Vitamin C (L-ascorbic Acid) acts as an anti-oxidant to bind to free radicals and inactivate them so as to prevent damage, and also to improve the quality and production of collagen and melanin.  This allows an improvement of the body’s natural sun protection, minimises fine lines, evens skin tone and may possibly help with scars.  The only truly active form of vitamin C is L-ascorbic acid

Vitamin E (L-tocopherol) is also an anti-oxidant that is highly effective in prevention of damage by free radicals.  It works with L-ascorbic acid to be recharged, which helps to prolong its effects.  The protective features of Vitamin E lead to maintenance of internal moisture and hence Vitamin E is great for dehydrated skin.

AHAs or Alpha Hydroxy Acids (glycolic, lactic, tartic, citric acids) and BHA or Beta Hydroxy Acids (salicylic acid) are naturally occurring acids derived from fruits. They act to dissolve the glue that holds dead skin cells to the surface of the skin leaving it smoother, clearer and with reduced pigmentation. They are commonly prescribed for dull, pigmented, acne prone and congested skin. Daily use of AHA or BHA allows other ingredients like vitamin A, C and E to penetrate more efficiently in the dermis. In high concentrations we use acids in chemical peeling. Initially these chemicals can irritate the skin and leave it open to increased effects of UV radiation. For this reason follow your cosmetic doctors’ recommendations and always use sunscreen.

Hyaluronic acid (glycosaminoglycan) is a naturally occurring substance in all living animals. It is the plumping matrix of the skin and joints and is also the active ingredient in some dermal fillers. When used in conjunction with L-ascorbic acid, it penetrates more effectively to allow a plumping of fine lines and wrinkles. Smoking and excessive dieting destroy the body’s natural hyaluronic acid.

Copper Peptides perform multiple functions in the skin including promotion of hyaluronic acid, collagen and elastin, acting as an antioxidant and in healing. They result in smoother, softer skin. Copper peptides are a favourite ingredient in many eye creams, as they appear to lighten dark circles.

Epidermal Growth Factors act to strengthen tissue and repair traumatised skin.

Lipoic acid is another super antioxidant that can fight free radical damage.

Peptides are amino acid combinations that aid in tissue repair and growth through collagen production.

Niacinamide (Vitamin B3) has dramatic anti-inflammatory properties making it ideal for use in rosacea, acne, dermatitis, eczema, and psoriasis or on very sensitive skin. It also improves the function of vitamin A.

DMAE (dimethylaminoethanol) is used topically for its firming properties.

Centella (Gotu Kola) is a natural substance used in Asia for centuries to treat skin disorders. It helps prevent excess scar formation and promotes wound healing. It is used in creams suited to sensitive or damaged skin.

Skin Lighteners (hydroquinone, kojic acid and L-arbutin) act to penetrate the dermis to fade pigmentation and, in the case of kojic acid and L-arbutin, also prevent melanin production. It is the ongoing use of these that provides results, and is the only safe option for pigmentation in darker skin types.

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