Dr. Joseph M. Perlman Advanced Plastic Surgery Centre


We are constantly exposed to the sun throughout our lives. As a baby living in upstate New York, my mom used to dress me up in my snowsuit and “plant me in the snow on the front lawn” on sunny winter days to get some sun and fresh air. We know that there are benefits and adverse effects from sun exposure. We know that sun is a source of vitamin D, although in the northern half of the United States, during the winter, the angle of the sun is such that we don’t get much benefit. During the rest of the year though, the sunlight, and more specifically the UVB rays trigger our skin to send vitamin D precursors into our circulation.

UV radiation from the sun is basically in two forms, UVA, which has a longer wavelength, and UVB, which is a shorter wavelength. The shorter the wavelength the less penetration into the skin. UVB causes most of the visible changes and premalignant and malignant lesions. UVA causes more photoaging problems. UV damage primarily causes molecular damage in the skin, releasing free radicals, which are unstable atoms. These unstable atoms cause cells to disrupt and cause other damage within the DNA of the cells.
What we see in aging skin is pigment changes such as “old age spots,” deep lines and wrinkles, thicker skin, and dilated blood vessels. The pigmentation changes are due to the overproduction of melanin by the pigment-producing cells of our skin. The deep lines and wrinkles and thicker skin are due to the accumulation of abnormal elastin fibers and a decrease in collagen production. The broken blood vessels are due to changes in the walls of the capillaries, causing them to permanently dilate. In addition, as we age, our skin cannot retain water as it did when we were younger and dehydrates.

There are many things we can do to help our skin look more rejuvenated. Number one is to drink a lot of water. Drinking four glasses of water a day will help keep us hydrated, particularly in the summertime. Secondly, use a good sunscreen. Even though sun damage starts when we are children and accumulates during our life, it’s never too late to be proactive in treating our skin. Sunscreen should have UVA blockers as well as UVB blockers. Check the label or ask your skin care specialist if you’re using the right product and make sure that your product is at least an SPF 30.

You should be using a good moisturizer on your skin as well as products that contain vitamin A (retinoids) and vitamin C. Not only do they help accelerate the skin turnover rate and limit melanin production, but they also are good antioxidants to help clean up the free radical damage. Bleaching agents that contain hydroquinone to decrease pigment production are also recommended. There have been reports in the literature, that high concentrations of hydroquinone can cause liver damage, so use these products judiciously and only after discussing them with your skin care specialist.

In-office treatments include chemical peels, which remove the top layers of skin and promote increased collagen production. Peels such as glycolic acid can remove the top layers but, for the deeper lines and wrinkles, one needs to use peels that penetrate the dermis, such as TCA (trichloroacetic acid) peels.
In our office, we also offer microdermabrasion, to mechanically remove the top layer of skin. This is a sandblasting form of skin peeling and is often used in combination with chemical peels.

IPL (Intense pulsed light) is another popular treatment. This is done as a series of light therapy treatments using specific wavelength filters to treat various problems such as dilated blood vessels, pigmentation changes, and fine wrinkles. There’s no downtime and the results are quite good.

The gold standard for skin resurfacing is the fractional CO2 laser. This is a laser treatment that vaporizes cells and using the fractional method, it allows deeper penetration into the skin with minimal risks of scarring or hyperpigmentation. Recovery time is 3-7 days, but the results are quite dramatic.

Have fun this summer, but remember to take care of your skin. Consult your skin specialist, especially if you notice any changes in moles on your skin, such as darkening, increase in size, ulceration, or thickening.