Can Your Skin Be Saved?

Zits and blackheads. Clearasil and BufPufs. Remember your introduction to the confusing, frustrating, hope-filled quest for flawless skin? Skin envy starts at 12 or 13 and never really stops. Fair-skinned frecklers pine for Cameron Diaz's golden membrane, so smooth it looks like it was poured onto her. The olive-toned yearn for Nicole Kidman's milky-white translucence. Then, when our faces begin to pleat with every smile and droop even after a full night's sleep, we suddenly wish for our own maligned skin--as it looked 20 years ago.

By now everyone knows the cardinal rules for beautiful skin. Keep it clean, don't smoke and stay out of the sun. But millions of women in their 40s and 50s aren't satisfied with the results of those simple steps. They're exploring a multiplying array of chemicals and technologies in an attempt to smooth wrinkles and restore glow to their faces. Do these scalpel-free treatments work? Here's the bottom line that beauty magazines never quite get around to telling you: most improvements are modest and temporary. Continuing the treatments simply maintains that improvement, rather than steadily pushing your skin to new heights of beauty. But there's good news, too. Those temporary improvements can last months, or as long as several years. Here's the skinny on today's skin savers:

The basics: The sun may be your skin's worst enemy, but sunscreen won't necessarily save you from it. Most of the sunscreens you've used in the past have blocked the sun's UVB rays, preventing visible burning, but have not obstructed deeper-penetrating UVA rays. "You can't go out with sunscreen and think you're protecting your skin from aging," cautions Dr. Lawrence Gibson, a dermatology professor at the Mayo Clinic. He steers patients toward lotions containing zinc oxide and titanium oxide (the white stuff that lifeguards paint on their noses), which create a physical barrier against both kinds of rays. You don't have to look like a mime when you wear the compounds. New products can be smoothed on in a thin coat that leaves your skin looking close to its natural color.

Keeping skin clean is important, of course, but it's not as hard as cosmetics companies suggest. The key point to remember for dry, aging skin is that oil can irritate hair follicles, causing adult acne. So while it's important to remove makeup at the end of the day, it's equally important to avoid a heavy, oil-based foundation. Mild soap and water does an excellent job of cleansing without drying.

Facials: Dermatologists are unimpressed with these spa staples. At best, facials temporarily hydrate skin, plumping out wrinkles. At worst, the squeezing, picking and rubbing can permanently damage skin. "I've seen people with mild acne go for facials and come out with inflammatory lesions and possible scarring," says Dr. Alan Liftin, a dermatologist in Livingston, N.J. "Skin problems should be taken care of first and foremost with chemical treatment [rather than manual manipulation]." For example, Adapalene, a prescription gel, is good for clearing up acne and blackheads with few side effects.

Anti-wrinkle creams: Most of these creams use glycolic or alpha-hydroxy acids to rid your face of old, scaly surface skin. Loofahs and shaving do the same thing by physically scraping off the cells. Neither approach actually changes your skin or the aging process. They simply reveal a fresh layer of skin a little sooner than normal. Most over-the-counter preparations will make your skin appear slightly firmer, but use them carefully. Applying an acid-laced cream too near your eyelids or other sensitive areas will cause irritation. Also, understand that two lotions that list the same acid content may affect you differently, depending on their composition. Test a new concoction on a small area for several days before coating your face with it.

The only creams that really kill wrinkles are those containing retinoic acid. Unlike "retinol," a compound found in many over-the-counter products, retinoic acid must be prescribed. Researchers have found it effective for reducing fine wrinkles and evening out skin color. And some studies suggest that after a year or more of use, it helps skin produce new and better collagen, the elastic material that gives young skin its cushiony texture. The downside: retinoic acid does little for deep wrinkles, causes irritation in many people and leaves you very sensitive to sunlight.

Chemical peels: Dig ever deeper and you'll find ever more pristine skin. That's the theory behind chemical peels, which are usually applied in a dermatologist's office and come in three strengths. A light peel involves getting swabbed with a glycolic-acid solution, waiting several minutes and then being mopped with a neutralizing agent. You can do it on your lunch hour and go back to work with a slightly red face. A medium-duty peel requires an application of trichloroacetic acid, which makes the skin turn white the first day. The next day your face turns red, and then the skin actually peels off. The effect is as strong as some laser treatments. The most powerful peels employ phenol acid. These are rarely used, because they have such serious side effects that they must be performed in a hospital setting with cardiac monitoring.

A peel, or a series of peels, will smooth out superficial irregularities and blotchy coloring, making your skin look younger. The technique is relatively inexpensive ($100 to $500 for a light peel, $500 to $1,000 for a trichloroacetic peel). But to avoid burns, inflammation and infection, you need a skilled practitioner. Dark-skinned women should be particularly cautious. Their skin sometimes responds to irritation by making more pigment, which means a peel could increase blotchiness. Because peels usually lighten the skin, the newly peeled need to be slavish about sun protection.

Laser treatments: Getting zapped is all the rage. Dermatologists say cosmetic laser use has exploded over the past five years as the devices have become safer and more precise. Lasers will remove hair and erase birthmarks, but age-conscious women use them most often to resurface their faces and shrink blood vessels on the nose, cheeks and chin. The first thing to know about these treatments is that every beauty objective requires a different laser--and every laser demands a different set of skills. Because any licensed doctor who can afford a laser can use it on patients, the only way to assess competence is to find out how much experience a practitioner has with the treatment you're considering. Pulse dye lasers are extremely safe for shriveling veins, and their effect can last a year or two. For resurfacing, there are two options. An erbium laser vaporizes the top layer of skin; a carbon laser goes a step further, heating the underlying tissue and possibly tightening the skin's collagen, says Dr. David Becker, director of dermatologic and laser surgery at New York Weill Cornell Medical Center.

These therapies are safer than the deepest chemical peel and a huge improvement over an invasive procedure called dermabrasion, which involves sanding the skin's surface. Lasers are also far more precise than other treatments, because a doctor knows exactly how deep he's chiseling into a patient's skin with each pass of the instrument. But laser resurfacing still has some serious side effects. "Most patients are frightened the first day or two after having laser treatment," says Becker. A recovering face will ooze clear fluid for several days. Your doctor may tell you to apply dressings or ointment. Then an alarming redness sets in, fading about a week after an erbium treatment and two weeks after a carbon-laser session. Sun avoidance is critical for freshly lasered faces. The price for three to four years of rejuvenated skin: $2,000 to $4,000 if you use an erbium-light machine and $3,000 to $6,000 for carbon-laser beams.

Botox: When you hear that the popular botox treatment involves having the deadly botulinus toxin injected into your face, you have to wonder just how far you'll let your vanity take you. Fortunately, dermatologists don't give you enough of the stuff to cause botulism--just enough to temporarily paralyze the facial muscles that cause furrows when they contract. Whew--what a relief! People swear by botox as a remedy for those creases between eyebrows and across the forehead. The treatment, which consists of several tiny toxin injections, has to be repeated two or three times a year. But it's painless and very fast. "It can make a huge difference and allow patients to put off surgery for a few years," says Liftin. You can get similar effects by injecting bovine collagen. It's considerably cheaper than botox, but it lasts only two to three months. Some dermatologists use it on the lines that run from the sides of the nose to the corners of the mouth, and on the marionette lines that begin at the corners of the mouth and wander down toward the chin.

Does having your face squeezed, picked, burned, abraded and paralyzed strike you as extreme measures? There is an alternative to this ever-escalating schedule of high-maintenance, high-expense procedures. It's called letting nature take its course. It would mean looking old, of course. Really old, in fact, because so many of your friends will be peeling and lasering their way to artificial dewiness. You could be Georgia O'Keeffe amid a sea of Cameron Diazes and Nicole Kidmans. But skin envy dies hard. Now more than ever, aging gracefully means enduring your share of ungraceful procedures.

Five Ways to Fix a WrinkleIf you're not ready for surgery, a chemical or laser peel offers a halfway measure. Some options: