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 the 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 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, 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.

Frequently Asked Questions

What is photoaging and what causes it?

Photoaging is the result of prolonged exposure to UV radiation, primarily from sunlight but also from tanning beds. UV radiation damages the collagen and elastin fibers in the skin, leading to wrinkles, fine lines, age spots (liver spots), rough texture, and uneven pigmentation.

What are the signs of photoaging?

Signs of photoaging include:

  1. Wrinkles and Fine Lines: Especially around areas exposed to the sun like the face, neck, and hands.
  2. Pigmentation Changes: Such as age spots or liver spots, freckles, and uneven skin tone.
  3. Texture Changes: Skin can become rough, leathery, and lose its elasticity.
  4. Vascular Changes: Visible blood vessels (telangiectasias) and redness (erythema) may appear.
  5. Loss of Skin Tone: Skin may sag and lose its firmness.
How can I prevent photoaging?

To prevent photoaging, consider these strategies:

  1. Sun Protection: Use broad-spectrum sunscreen with SPF 30 or higher daily, even on cloudy days.
  2. Seek Shade: Limit time in direct sunlight, especially between 10 a.m. and 4 p.m. when UV rays are strongest.
  3. Protective Clothing: Wear hats, sunglasses, and clothing that covers your skin.
  4. Avoid Tanning Beds: UV exposure from tanning beds can accelerate photoaging.
  5. Skincare Routine: Use moisturizers and products containing antioxidants like Vitamin C to protect against UV damage.
Are there any treatments for photoaging?

Several treatments can help reduce the signs of photoaging:

  1. Topical Treatments: Retinoids and alpha hydroxy acids (AHAs) can improve skin texture and reduce wrinkles.
  2. Chemical Peels: Help improve skin texture and reduce pigmentation irregularities.
  3. Laser Therapy: Targets specific skin issues like wrinkles, age spots, and uneven texture.
  4. Injectable Fillers: Can plump up wrinkles and folds for a smoother appearance.
What lifestyle choices can help prevent photoaging?

In addition to sun protection, these lifestyle choices can help prevent photoaging:

  1. Healthy Diet: Eat a balanced diet rich in antioxidants (e.g., fruits, vegetables) to help protect your skin from damage.
  2. Hydration: Drink plenty of water to keep your skin hydrated and maintain elasticity.
  3. Avoid Smoking: Smoking accelerates skin aging and reduces circulation, which affects skin health.
  4. Manage Stress: Chronic stress can affect skin health, so practice stress-reducing activities like yoga or meditation.