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More Hope In A Jar? The Anti-Aging Skin Care Promise
WebMD investigates the newest crop of anti-aging skin care ingredients ― Do they work?
By Colette Bouchez
WebMD Feature
Reviewed by Norman Levine, MD
From magazines and newspapers to web pages and online blogs, it is hard to miss the promises being made for products designed for beauty and skin care. And the most tantalizing promises of all? Those that touch not just our vanity, but also our fears of growing old.
It’s an approach that seems to be working. According to Euromonitor International, anti-aging products now account for close to 9.8 billion dollars of the skin care market. That’s a nearly 109% increase since 1997.
But is the drive to deliver on the promise of still more hope in a jar bringing us any closer to finding the fountain of youth? The answer, it seems, depends on whether you are looking for a trickle or a gusher.
“A lot of satisfaction has to do with the condition of your skin before you start an anti-aging treatment,” says NYU Medical Center dermatologist Sumayah Jamal, MD. If you have pretty much never used anything on your face, she says, you are probably more likely to see results simply because you are doing something for your skin.
And that observation, in fact, may explain at least some of the reported differences in effectiveness ― differences recently highlighted in a Consumer Reports investigation. Researchers found the current crop of anti-aging creams fall short of delivering on their promises ― a conclusion shared by at least some doctors.
“Many of these products are claiming changes in the skin that would automatically classify them as drugs,” says NYU professor and dermatologist Rhoda Narins, MD. “And they are not [drugs]. So it's clear they likely can't do all they say they do.”
But is it possible that the upcoming crop of skin care “miracles” may actually be closer to delivering miraculous results? Some doctors believe there are intriguing possibilities on the horizon.
The antioxidant anti-aging promise
One of the major ways skin ages is through a loss of collagen. Collagen is a naturally occurring substance that helps keep skin looking plump, lifted, and line-free. Although Jamal says we lose some collagen because of the natural aging process, an even greater amount can be lost through environmental assaults, particularly sun exposure and pollution.
These exposures, Jamal tells WebMD, increase the rate at which a natural cellular process occurs ― one which releases molecules called “free radicals” into the skin. The link to aging? Free radicals attack and destroy collagen. When left unchecked, Jamal says, free radicals destroy the skin's support structure, and without that support, skin sags. Eventually, wrinkles form.
That is one reason why the up-to-the-minute ingredient generating the loudest anti-aging buzz right now is antioxidants ― nutrients that attack and disable free radicals before they have a chance to destroy our collagen supply. Some may even help increase natural collagen production.
Ken Beer, MD, director of Palm Beach Esthetic Center and author of Palm Beach Perfect Skin, tells WebMD, that if the products are well designed, a level of antioxidants can be achieved that may have wide-ranging effects, including attacking free radicals. Other experts agree and say antioxidants disable free radicals, reducing or even reversing collagen damage. That means younger looking skin.
But is it just wishful thinking ― or a promise we can count on?
Although research on topically applied antioxidant green tea showed it has strong anti-inflammatory and even anti-cancer properties, an 8-week medical study conducted at Stanford University was disappointing from a cosmetic perspective. The study failed to demonstrate anti-aging effects.
More promising, however, were studies conducted, by David McDaniel, MD, of the Eastern Virginia College of Medicine on a number of other antioxidants. Specifically, McDaniel looked at the protective capacity of several topically applied antioxidants, including vitamins C and E, kinetin, alpha-lipoic acid, and idebenone. While all showed some benefits to the skin, McDaniel found idebenone to be the clear leader of the pack.
A powerful micronutrient related to CoQ10, (another natural defender against cell damage) idebenone appeared to also provide a strong defense for skin. “Clinical studies thus far have shown that idebenone...quench[es] inflammatory reactions and... is a powerful antioxidant that destroys free radicals,” McDaniel recently told the Dermatology Times.
According to dermatologist Bruce Katz, MD, however, many women cannot tolerate idebenone products. "It can cause redness and irritation in some women that makes it difficult to use," says Katz, director of Juva Skin and Laser Center in New York City. He advises women with sensitive skin to check with a dermatologist before trying products containing idebenone.
There is still a lack of overwhelming evidence to show that, for humans, topical use of this or any antioxidant can actually halt the aging process of the skin. But McDaniel believes that as manufacturers increasingly apply pharmaceutical standards to testing and developing products, the necessary data may soon become more prominent.
The coffee berry craze
Some of the testing may have already paid off for an ingredient derived from the little known fruit called the “coffee berry” that some now hail as the strongest antioxidant ― and possibly the most powerful anti-aging ingredient ― to date.
The same plant that bears the fruit of your Starbuck's buzz, may also add a kick to your complexion. “Coffee berry,” says Beer, “is becoming popular, and it does contain high levels of antioxidants.” He goes on to say that clinical trials are now underway that may show it is a significant advance.
Coffee berry was introduced to doctors at the 2007 American Academy of Dermatology annual meeting, and many believe it shows real promise.
“[It's] arguably the hottest thing out there now,” says Joel Schlessinger, MD. Schlessinger, who is president of the American Society of Cosmetic Dermatology and Esthetic Surgery, tells WebMD there is a current study showing coffee berry “has higher antioxidative properties than any product ever tested ― including green tea and idebenone.”
While experts are hopeful that these antioxidant properties may translate into anti-aging effects on the skin, we won't know for certain until the study is published sometime in the coming year. (At publication, WebMD was unable to confirm details of the study or its precise publication date.) Meanwhile, consumers may weigh in a lot sooner.
The first coffee berry product ― a skin cream called Revale ― has already hit the market with more from other companies on the way. And coffee berry won’t be alone on the shelf. A number of other new and unique antioxidant cocktails sit poised and ready to steal the thunder.
One is Estee Lauder's new “Future Perfect” line, boasting a “skin recharge cocktail” that offers the anti-aging protection of an antioxidant known as NDGA that occurs naturally in the body. Recent studies have shown that, when applied topically, it may act somewhat like estrogen, helping to prevent the loss of collagen in skin.
Clinique's Continuous Relief Antioxidant Moisturizer boasts eight antioxidants. At least one ― Eukarion-134 ― supposedly has the unique ability to recycle itself after each free-radical hit. This is significant because most other antioxidants lose their protective power after attacking and disabling a single free radical molecule. By recycling itself, this new antioxidant keeps on working, continuing to fight the damage that leads to aging, for a longer period on the surface of skin.
But are these and other antioxidant advances enough to guarantee anti-aging results?
Not all experts agree. According to Beer, “The degree to which any product works depends partly on the ability of the ingredient to get to the right place, which means it has to penetrate into the skin.” He believes that level of penetration is possible with the right combination of ingredients. And so, he says, some anti-aging effects are possible.
Narins, however, points out that without published clinical trials, it is impossible to know for certain. “With no FDA approval of these [ingredients], and no agency overseeing the claims, it's impossible to know if a product does what it says it does,” she says. “And my guess is that most don't.”
The tripeptide trifecta
Bearing a slightly more scientific pedigree are ingredients known as “peptides.” The frenzy actually began several years ago when the National Institutes of Health funded studies on wound healing. These studies showed that a chain of five peptides could instruct the body to ratchet up collagen production in response to wounding. More recently, smaller studies found that when applied topically, this same peptide chain seemed to respond to aging, collagen-deficient skin as if it were wounded and so encouraged collagen production.
While the level of activity is still under debate, the next generation of this technology ― known as tripeptides ― is already here.
“These are designer peptides,” says Beer, who describes them as “groups of amino acids” that inhibit some of the natural enzymatic ― and yes, aging ― processes that break down and destroy critical components of youthful skin, including collagen. “By providing stability for these and other critical components,” Beer says, “[tripeptides] tip the scales in favor of remaining more youthful and less damaged.”
Lumene, a Scandinavian company exporting moderately priced skin care to the U.S., is counting on that. They combine tripeptides with the antioxidant properties of sea buckthorn oil, for their new Premium Beauty line ― with research they claim proves it works.
The much more costly Osmotics Anti-Radical Age Defense Line offers a tripeptide formula that not only has antioxidant properties, but also claims to stimulate collagen production.
Narins continues to site a lack of published medical data. Schlessinger is even more blunt. “Cosmeceuticals can do some wonderful things for the skin,” he says, “including diminishing brown spots, improving texture, and making the skin feel smooth again. But filling in wrinkles ― I don’t think so.”
Until published medical studies do surface, it may be up to consumers to decide for themselves if even the cosmetic results have merit.
DNA repair and younger skin
One more class of products offering new hope in a jar takes the sci-fi approach of tinkering with DNA to turn back the clock one molecule at a time. One such product is called “Remergent.” Sold through doctor's offices, Remergent reportedly works by delivering to cells small packets of enzymes with the capability of repairing DNA. When DNA, the basic component in all living cells, is damaged ― whether by too much sun exposure, or through the chemical assaults of pollution ― cells undergo changes that can result in anything from accelerated aging to disease, including cancer. The company's website points to several published clinical studies they say document their product's ability to control or even reverse DNA damage.
But while Beer is certain the technology is possible, he is less sure it is here. “None of these (studies) correlate the reversal of any age related symptoms or of any skin cancer treatment with their ingredients,” he says. “So while I believe that the technology for DNA repair holds great promise, I am awaiting evidence to convince me that it comes in a bottle.”
Jamal is even more skeptical: “In order for DNA repair to occur, the effect has to take place in the nucleus of the cell ― and my question is, are the agents able to affect nuclear processes [in your skin] as well as in the dish in the lab?”
Perhaps time ― and more research ― may answer that question.
So in the meantime . . . what's a girl to do?
“Stay out of the sun, wear sunscreen, keep skin well moisturized,” says Jamal. And, she says, use anything that you believe makes a difference. Much like beauty, in the end, the look of youth may be in the jar of the beholder.
Anti-wrinkle creams may age skin more rapidly
Dermatology Times Sept, 2000
London -- Scientists are now reporting that anti-wrinkle creams containing alphahydroxy acids may actually cause the skin to age more rapidly, according to an article on ABCNews.com.
The European Commission, the administrative arm of the European Union, is considering placing tough, new limits on anti-wrinkle creams because the AHAs present in the products may actually cause the skin to age more rapidly than without, scientists said.
AHAs claim to exfoliate or rejuvenate the skin by peeling off the outer layers to reveal the fresher skin beneath. They also claim to smooth fine lines and surface wrinkles, to improve skin texture and ton, and to improve skin condition in general.
However, both European and U.S. scientists are finding the chemicals may actually be causing long-term damage instead.
Recently, the European Commission's Scientific committe on Cosmetic Products made available a number of studies, including research from the U.S. Food and Drug Administration, about this issue.
The commission found that the chemicals appear to increase the number of skin cells that are damaged, stimulate reddening, blistering and burning and put users at greater risk of ultraviolet damage from the sun.
"Improper use, too frequent use, and use by those with sensitive skin -- this is where you see the damage," Nick Lowe, M.D., a dermatologist, told ABCNews. "Products using AHAs should be administered in a clinic."
Products with AHAs are marketed as a "natural" way to rejuvenate skin. Alphahydroxy acid ingredients may be listed as:
- * glycolic acid
- * malic acid
- * citric acid
- * glycolic acid + ammonium glycolate
- * alpha-hydroxyoctanoic acid
- * alpha-hydroxycaprylic acid
- * hydroxycaprylic acid
- * mixed fruit acid
- * tri-alpha hydroxy fruit acids
- * triple fruit acid
- * sugar cane extract
- * alphahydroxy and botanical complex
- * L-alpha hydroxy acid
- *glycomer in crosslinked fatty acids alpha nutrium (three AHAs)
Please Click Here to Go to Skin Resurfacing Page
Asian community as double vision of eyelid surgery
cnn staff reporter (c) 2000 Columbia News Service
NEW YORK--Asian Americans are identified by their eyes more than any other feature. So, for this community, cosmetic surgery on the eyelids goes to the heart of identity politics and ethnic pride.
Eyelid surgery is the country's third most popular cosmetic surgery, surpassed only by liposuction and breast augmentation, according to the American Society of Plastic Surgeons.
The society's board-certified plastic surgeons performed 120,001 cosmetic eyelid surgeries in 1998, twice the number performed in 1992. Cosmetic eyelid surgery, blepharoplasty, is usually meant to reduce signs of aging, but among younger Asian Americans--especially those of Korean, Japanese, and Chinese descent--one method of blepharoplasty has gained significant popularity.
The majority of Asians have upper eyelids that appear to be taut from brow to lashes, rather than segmented by a crease. Asian blepharoplasty patients often request the creation of an upper eyelid crease, or "double eyelid," which uncovers a portion of the natural eye contours, making the eyes slightly larger, rounder and more amenable to makeup, as well as exposing more of the eyelashes.
Since non-Asians are typically born with double eyelids, this procedure has been construed as "Westernization," implying that Asians desire a more Caucasian appearance. But many in the Asian American community argue that the point isn't to look Western, but to look more like other Asians, many of whom have double eyelids naturally.
The notion of Westernization has sparked some criticism in the Asian American community. Authors Maxine Hong Kingston and David Mura are uncomfortable with the popularity of the surgery, and believe that altering eyes, features by which Asians are so easily identified, is an attempt to conceal or deny Asian heritage and conform to mainstream American beauty ideals.
"It's evidence of internalized racism," says Mura. "It really indicates something about the way in which Asians in America are indoctrinated by white standards of beauty. They feel less beautiful than those who fit the Caucasian standard of beauty."
The main reason for that, Mura says, is the low representation of Asians in the media.
"People grow up watching the media, which is where people are beautiful and powerful. You see very few Asian faces. The message is: the way you look is not beautiful, or doesn't count, or doesn't even exist," he says. He believes the American media also account for much of the surgery's popularity in Asia.
"The power of the American media and American culture stretches all over the globe, and can cause people to devalue their own culture," says Mura.
Asian Americans who disagree with Mura's interpretation often point out that a large percentage of Koreans, Japanese, and Chinese are born with creased eyelids, although they certainly tend to be shaped differently than those of, say, Caucasians. In fact, in some regions, such as in southern China, as many as 70 percent are born with them. In addition, double-eyelid surgery is enormously popular in Asia, and has been considered attractive since well before the infiltration of Western media. Therefore, many argue, Asians seeking double eyelids are simply trying to look like the more attractive members of their own race.
"The desire for double eyelids has taken on a strange idea in the U.S. that Asian women want to look like Caucasians and that they desire [moon-shaped] eyes," says Shi Kagy, editor of AsiaMs, an online Asian beauty magazine (www.AsiaMs.net).
"In truth, Asian women want double eyelid folds that look like natural Asian type folds, and dislike the Caucasian type," she says.
For ten years, Dr. Jeffrey Ahn, Director of Facial Plastic Surgery at Columbia University Medical Center, has performed about 200 Asian blepharoplasties a year. He dispels the idea that his patients have tried to obscure their racial identity.
"I don't get a single patient asking to be 'Westernized,'" he says. "A lot of doctors still call it Westernization of the eyelid, which proves they have little understanding of the Asian patients." He stresses the importance of going to a surgeon who is accustomed to operating on Asian eyelids, because of the fundamental differences in facial anatomy.
"The surgeon should have aesthetic appreciation of the Asian eyelid," Ahn says. "A lot of the Caucasian surgeons think making it more like the Caucasian eyelids makes it more beautiful, and that's where unnaturalness results."
Ahn repeats, "I don't remember any Asian patient requesting to look less Asian."
Dr. John A. McCurdy, Jr., a plastic surgeon in Hawaii and author of the book "Cosmetic Surgery of the Asian Face," has performed thousands of Asian blepharoplasties over the last 20 years. He agrees that patients want to preserve their Asian characteristics--but says that wasn't always the case.
"A lot's changed over the years," McCurdy says. "It used to be that Asian girls, especially immigrant girls, were requesting the Westernization procedure. They wanted to look Caucasian. But now what they're requesting is a procedure to enhance the double eyelid while maintaining the other characteristics of the Asian eye."
In general, the hour-long process of Asian blepharoplasty involves excising a crescent- or tilde-shaped piece of skin out of the eyelid, removing some of the underlying fat, and then stitching the sides back together. There are different methods to accommodate variation in the height and curvature of the desired crease.
The average cost of the surgery in the U.S. is $1,734. During recovery, which takes about a week due to painful swelling and discoloration, the eyes must be treated with topical antibiotics and cannot be washed.
Ji Jeong Han, who had the procedure at age 15 by Ahn, is aware that non-Asians might misunderstand her intentions. "It's like if a white girl got cornrows, people would say she's trying to look black. People always think they are being copied," she says. "Obviously, white people have reason to think people want to look more like them. If you look at movies, you know how Hollywood stars have blond hair and perfect figures and all that."
She insists that she had the surgery primarily to correct her eyelashes and believes most Asians have the surgery for simple aesthetic reasons.
"All my Korean friends had it done just because they wanted bigger eyes," she says. Han, now 18, was encouraged by her grandmother, her mother, and her aunt, all of whom she describes as having naturally large eyes. "Before I got mine done, we used to look at Korean magazines or TV, and all the Korean actresses had big eyes or had had it done. They think it's prettier," she says.
Whatever the reason for the surgery, one thing seems certain: the pressure to conform the physical appearance to an ideal is not exclusive to either Western or Asian culture. And, in any attempt to meet a standard, there's always a risk of losing individuality.
"After I got it done, my parents said it looked nice because it was rounder," Han says, "but on the other hand something special was gone. Uniqueness."
In fact, Han says, "I think people look better the way they're born."