Skin Is In: The Growing Focus On Skin Quality

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is Skin is In: The Growing Focus on Skin Quality and How to Achieve It. Dr. Bass, we all want to be beautiful. Our skin is our biggest and most visible organ. So what should we be doing to maximize beauty? And what specifically is skin quality?

Dr. Lawrence Bass (00:35):
Well, skin quality can be broken down into multiple factors in a few different classes. But for almost any aspect of skin quality an approach is typically multiple treatments, and it's typically multi-modality. So let's say skin texture, you know, if we get a little improvement by using a skin product and doing a little improvement with an energy treatment, overall we cumulate to a really obvious, really beautiful and quality to the skin, so that's important. Skin quality more recently has been defined in a little more quantitative terms, and the distinction between skin quality and other skin facial features like skin laxity, which were often all lumped together in the past, have really been teased out and separated because each attribute really needs its own individual approach and treatments.

Doreen Wu (01:51):
Okay. So it sounds like skin changes are among the most noticeable signs of aging. How does that start to show as we get older?

Dr. Lawrence Bass (01:59):
As we age, our skin thins, the metabolism of the skin slows down the rate at which the cells produce energy and which they turn over or reproduce the tissues of the skin. The structural proteins in the skin, collagen and elastin diminish, become less organized and have some other damage changes, and that also happens to the ground substance materials, sort of the glue or gel that sticks together the structural proteins. That diminishes in amount as we age. We also get some dyschromia, irregular pigmentation of the skin and other pigment issues. We get some redness issues, including rosacea, sort of red, plethora appearance to the cheeks and other parts of the face, often with some bumps or some actual breakouts. And we get a lot of changes in surface smoothness. The visibility of pores, the roughness of the skin, and eventually fine surface wrinkles, and then deep edged in wrinkles.

Doreen Wu (03:22):
Those are quite a lot of changes. I never realized how much was going on beneath the surface. So, Dr. Bass, what are some of the main approaches that we have to treating skin quality?

Dr. Lawrence Bass (03:33):
There are a few big categories, each of which contain many, many entries. So skin products like moisturizers that contain biologically active agents. Basically, medications that not only protect the skin, but induce the skin pharmacologically to behave more like youthful skin, energy based treatments, and injectables. Those are the big groups of things. So any selection of treatments has to be focused on whatever the most visible or most troublesome attributes of skin quality are at that given point in time. But again, often more than one treatment done, just a little bit done lightly works best and between a few different options, cumulates to a real substantial improvement in skin quality. You know, the problem is skin quality is a very subtle attribute. You know, how much glow does the skin have? How firm and fold does it look separate even from all the other issues that I listed earlier? So it's subtle, but it's also a very emotionally persuasive feature. People see it without thinking consciously about it, but they can recognize young, healthy skin and older worn out skin without any difficulty.

Doreen Wu (05:16):
Is skin quality only an aging feature?

Dr. Lawrence Bass (05:19):
That's a great question, and the answer is no. There are plenty of young people who have one or more skin quality issues from teens with active acne to very senior years. A variety of things show on our skin, but, but typically we're showing more of these things as we age.

Doreen Wu (05:42):
Given that people of all ages are affected. Why haven't I heard of this before? Is it new?

Dr. Lawrence Bass (05:48):
It's not really new, really what dermatologists and facialists and aestheticians have been trying to help people with since time was. But more recently, there's been much better definition of the degree or severity of specific findings and parsing out all these different aspects in skin. So we've basically had more clarity that allows us a more rational basis for diagnosis, for treatment planning, and for outcome assessment. And that's led to a big emphasis on skin quality as an important thing to chase at all stages of aging, including when you're young. So it's resulted in a lot of new products things that are probably a better fit. You know, the big selling point for skin lotions 20 years ago was, you know, facelift in a bottle or liquid facelift. And these moisturizers, even medicated ones don't really impact skin laxity, but they can have all kinds of effects depending what medications are in them on skin quality.

(07:17):
So even people who have no laxity, they've had a great facelift and laxity has been brought down to a bare minimum, we still see that the fabric of the skin on their face is aged. You know, it's had decades of age, sun exposure, all the things that make us look older than we did in our teens or twenties. And so working on the fabric of the skin itself does a tremendous amount to improve and rejuvenate our appearance when we're in our fifties, sixties, seventies, and working to protect and prevent those kind of changes when we're in our twenties, thirties, and forties delays when we have to address the big aging features and preserves our skin at its youthful best. It improves how we look, you know, even while we're still relatively youthful.

Doreen Wu (08:18):
So does this mean that skin quality is for everybody?

Dr. Lawrence Bass (08:23):
Basically, yes. You know, we all have to just as part of basic hygiene, take care of our teeth and our hair and our nails, and we also have to take care of our skin. But how far you want to take it varies depending on your personal preferences and what other more prominent features may be showing. if you are older with a lot of laxity in your skin, that laxity may stand out a whole lot more than some of the texture and pigment changes and laxity probably should be the starting place for what you do with your appearance. but if laxity has been corrected, you can get a big improvement in pigment, irregularity, and texture, and that projects a much more youthful appearance early in the game. In your twenties to forties, skin quality has a much more central role in how good you look, and it's also your chance to have prevention and keep yourself out of trouble for the longest possible time. so you may not get a drastic improvement, but you're still likely to get to get an improvement in appearance but you're also preventing aging changes, slowing the whole process down, and that's going to pay you huge dividends down the line.

Doreen Wu (09:58):
Now, you've touched on some of these treatments throughout the episode, but what are some specific treatment examples?

Dr. Lawrence Bass (10:05):
Skin products are always the basics, and retinoids alpha and beta hydroxy acids are things that are very commonly used increasingly as we go forward. There are growth factor products in skin moisturizers and post-treatment skin preparations to protect the skin, help it heal and help amplify the results of energy based treatments. Energy based treatments of many types are also important for skin quality. And what's happened more recently is the beginning of introduction in the United States of more superficial fillers. So we've had, you know, mid-level fillers for more than 15 years in the United States, like Restylane and Juvederm, the initial products that were introduced. And increasingly, we've gotten specialized fillers that are designed for cheeks or lips or jawline line. but the unmet need up till recently was a superficial filler that, again, plums the surface of the skin. So fine wrinkling and roughness in texture are a faced, and within the past few months in the United States, we've seen the introduction of one or more fillers, FDA approved specifically to chase these more superficial kinds of issues. Another example is biological injectables in the United States. That's principally platelet rich plasma. other countries in the world, in Europe and elsewhere are using other biological things stem cells and exosomes, which are subunits out of cells and other kinds of things to try to biologically modulate the skin. Now we don't know what will come to the United States and when that will happen, but we know that's a lot of interesting development and clinical application taking place elsewhere that gives us a glimpse of what might be in our future in the United States.

Doreen Wu (12:45):
Lastly, before we close Dr. Bass, what should our listeners take away from today's episode about skin?

Dr. Lawrence Bass (12:52):
First, there's categories of skin quality. Skin quality is not a single attribute. It's classes of attributes, texture, glow, turgor or fullness, pigment issues, and redness issues, just to put it in simple terms. It's worth working on to maximize your appearance in youth and to prevent and maintain the skin in the early aging process. It's a key additional component of facial aging. So correcting the skin itself separate from shape restoration or laxity correction has a major impact on how aged you look. Understand that this is some ongoing work. It's a maintenance process, and we need to take multiple small steps on a fairly frequent basis to help our skin stay healthy and to restore it to its youthful appearance so you look your best.

Doreen Wu (14:09):
Thank you, Dr. Bass for sharing your knowledge and expertise with us. And thank you to our listeners for joining us today to hear about how your skin changes with aging and what can be done to maintain a youthful appearance. I hope you found this episode as fascinating and informative as I did. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in an upcoming episode, please reach out by email or Instagram. We'll see you next time. This is Doreen Wu thanking you for joining Dr. Bass and me for this discussion of skin quality and aging. Be sure to tune in next time, and don't forget to subscribe to our podcast to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (14:48):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast. Consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.