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For love of beauty
Skin care treatments range from face cream to dermapigmentation

by Diana Reynolds Roome

Spring is the time of year when a glance in the mirror reveals what changes another season has wrought on the largest and most complex organ in the body — our skin. And Bay Area residents, including those in Mountain View, have a wealth of options for dealing with those changes.

Sunlight, which draws us outside, is ironically also the cause of much of the damage we observe. Ultraviolet light's two-pronged assault upon surface and deep skin cells, through UVA (aging) and UVB (burning) rays, causes most of those annoying blemishes that skin is prone to: brown sun-spots, irregular pigmentation, broken capillaries causing redness in the surface of the skin, lines, wrinkles and sags.

Other culprits include smoking, pollution, temperature change (due, for example, to heating and air conditioning), and time, the effect of which is often determined by genetics.

"It's important that we chip off the old barnacles," said Arlene Hebert, a licensed electrologist (for hair removal) who also practices dermapigmentation — a permanent makeup which helps redefine areas such as lips and eyes that have lost color and definition. "By looking better, people feel better."

Rejuvenating skin is a perennial challenge, and options range from face cream to plastic surgery. The majority of people seek a remedy that falls somewhere in between — results they can afford, with the least possible disruption to their lives.

"The public wants minimally invasive procedures that require only a local anesthetic," said Dr. Jean Gordon, a Mountain View dermatologist whose most popular treatment is Botox, which works by paralyzing small muscles to prevent the formation of more lines.

She often uses a combination of procedures, including chemical peels, Botox or collagen skin fillers, which are injected into the skin. Other options are laser CO2 resurfacing, and a milder procedure called Intense Pulsed Light (IPL) which causes less reddening.

Then there's prescription treatment creams (also known as "cosmoceuticals"), such as Obaji's, which use ingredients like hydroquinone, glycolic acid and high-dose Vitamin C and which cannot be sold over the counter. These claim to achieve similar effects, but more slowly, with fewer side effects and less risk.

Deciding what would work best for an individual's skin takes skill and knowledge. More and more dermatologists, who once dealt with diseases of the skin such as psoriasis, acne, moles, eczema and skin cancers, now offer a range of treatments to firm, plump and even the texture and color of skin. Plastic surgeons, too, have moved into the wider area of skin enhancement.

"Dermatologists are now more like skin surgeons, and surgeons more like dermatologists," observed Dr. Josh Korman, a board-certified plastic surgeon who also does surgical procedures such as autologous fat transfer (taking fat cells from a part of the body where they're undesirable to an area which needs to be plumped up), as well as many of the same skin-rejuvenating treatments that dermatologists offer. Like Dr. Gordon, Korman keeps his office in the El Camino Hospital complex.

The Bay Area has a high density of plastic surgeons, dermatologists and other medical specialists, such as gynecologists and ophthalmologists, who offer high-tech skin procedures — and many of those procedures make a highly profitable adjunct to their regular business. Spurred on by demand, new technologies constantly overtake each other in their claims to safety and effectiveness; all require a professional understanding of the way skin functions.

Lasers, for example, can cause burning, blistering and hyperpigmentation (brown patches) or hypopigmentation (areas of paler skin). People with darker skin have a higher risk for some of these complications because of the way the laser reacts with melanin, which causes pigmentation.

"I think it's dangerous for the public to go to spas for laser procedures," said Gordon, whose nurse, Sandra Merrill, performs laser and IPL procedures under her supervision. "If there's a complication, lasers can cause blindness and scarring."

"I get calls all the time from people who go to the malls for laser treatments. They're in pain because their skin is burned," said Tammy Schooley, a nurse at Korman's practice who performs hair removal and skin retexturing using laser and IPL machines.

Cosmoceuticals, too, can work aggressively and may have side effects.

"You can buy creams online, but you need to know how to use them under the guidance of a physician, otherwise you can end up looking like a raisin," said Korman. "They're medicines and there's a reason why they're not sold over the counter."

Many people are willing to put up with discomfort and even a level of risk, because the psychological effects of what they perceive as physical flaws can be intense. Young people worry about acne, birth marks or hair growth in the "wrong" places, said Schooley, who sees the effects of problem skin on people's self-esteem. Others come in with conditions such as rosacea, post-operative scars and stretch marks.

"Youth is a big part of the high-tech industry — I operate on many men who feel they need to compete with younger people," said Korman, whose patients range from 18 to 80 — an age, he said, that is "not necessarily over the hill any more."

Korman warned against miracle cures, encouraging people to inform themselves fully before making a decision on skin treatments.

"Everybody wants instantaneous," he said. "People are very impulsive — they're getting married next week and they want something done. But the body has to heal [after surgery or a laser procedure]. It's important to have a good practitioner, realistic expectations, and the right preparatory skin care.

"With skin care products," he added, "it's a slower process."

In the end, most doctors agree, nothing is guaranteed. A moderate lifestyle, drinking plenty of water, staying out of the sun — along with a generous dash of faith — remain the essential ingredients for healthy and smooth skin.