Estrogen levels in women decline faster than testosterone starting in their late 20s. Now what this means for the skin is Testosterone, which is an androgenic hormone, causes the masculine qualities of testosterone to increase and become more visible. Examples include facial hair growth around the chin, jawline and cheeks, as well as oil production which can clog pores and cause blemishes. At the same time, the decrease in estrogen causes fine lines and wrinkles to develop, as well as loss of elasticity, dry and thinning skin, and a lackluster complexion. And even if you did not experience breakouts at a younger age, about a third of women will get adult acne, usually in their 30s.

As an aside, the difference between adolescent acne and adult acne is rather than presenting as painful, cystic pimples, adult (or, hormonal) acne is usually small red bumps that often run along the jaw line and around the mouth area. A few examples of how to combat hormonal acne would be to go on the birth control pill, or take spironolactone, a water pill with anti-androgenic effects.

But what exactly causes facial wrinkles? Facial wrinkles occur when the skin loses elasticity, support,and volume. This is caused by a reduction in elastic tissue, collagen, and hyaluronic acid in the skin. Basically, your skin becomes too big for the tissue underneath. The first place a woman will usually start seeing fine lines is around the eyes (the peri-orbital region) where the skin is the thinnest. Next will be the areas that crease the most when we smile or laugh, such as the nasolabial folds, which run from the corners of our nose to the outer corner of our mouth.

How do we combat the effects of Natural Hormonal Progression on the skin? I recommend a two-prong approach to anti-aging: Procedures and Products. Procedures include Botox to relax the muscles that cause creases, Laser Skin Resurfacing to smooth away fine lines and regenerate fresh new skin, and Injectible Fillers to plump deep creases, as well as plump hollows under the eyes, temples and cheeks. Depending on the look you want to achieve, a combination of different procedures might be the right solution for you.

The second prong to anti-aging is Products. If someone only uses Procedures, they are doing nothing for the quality and texture of their skin. Look for skincare products that treat all 3 causes of skin aging (time, environment and natural hormonal progression) AND contain ingredients such as Soy and Black Cohosh, which mimic the positive effects of estrogen on the skin. The key to any skincare regimen is using quality products that contain multiple active ingredients so every application is like nourishing your skin with a multivitamin.

Understanding the difference between Procedures and Products, and combining the benefits of both prongs, will give the most complete approach to fighting skin aging. And of course, limit your sun exposure!

I am interviewed frequently these days on whether I see any cosmetic trends due to the challenging economic climate. And the answer is absolutely, trends in cosmetic procedures are changing. In these challenging economic times, patients are definitely looking for the most value. For some, that means shopping for venues that have the cheapest Botox prices. However, patients learn that if Botox is too cheap, it is watered down and not effective.

Other patients understand this and either wait longer between treatments, allowing some lines to return, or have their Botox done regularly, but just have fewer areas treated each visit.

The second trend I see is more patients choosing Botox and fillers such as Juvederm, Restylane, Evolence, Radiesse, and Sculptra, as an alternative to plastic surgery. While not as dramatic as a face lift, Botox and fillers are a lot less expensive yet provide significant results, and most importantly, a result that looks natural. Botox and fillers also have no down time, which means you don’t have to miss work or use up accrued vacation. In fact, if done by a skilled physician, you achieve results that are natural and fit your face, so you can keep your family, friends and co-workers guessing!

Interestingly, laser procedures are still quite popular. I think this is because there are few alternatives to laser in terms of changing the texture and quality of our skin. Lasers are so versatile in that they smooth rough skin, improve acne, resurface and diminish scars, remove hair, and treat blood vessels.

For patients that do not need the dramatic improvement that laser gives, chemical peels are a good alternative, and reasonably priced. So I have not noticed a significant reduction in chemical peels.

Lastly, I notice patients are understanding the value of buying skincare products that contain multiple active ingredients in one bottle, rather than buying 1 product per symptom. We are a society on the go, so it only makes sense that we are trending toward quality products that are an “all-in-one” solution.

At the end of the day, we all only have one face…and looking good makes us feel better no matter what the economic situation.

Your mother knew what scientists are just learning – a good night’s sleep of eight hours helps your skin.  A rested body keeps the immune system strong, and allows the skin to repair itself.

Not getting enough sleep affects your skin:

•    Increases inflammation, which can cause acne flares.
•    Increases insulin resistance, which can worsen diabetes as well as acne.
•    Can lead to obesity, since sleep affects hormones that control glucose metabolism and appetite.  Lack of sleep leads to cravings for fatty foods and carbohydrates.
•    Increases stress since a sleep deficit puts the body in a state of high alert, increasing the output stress hormones and driving up blood pressure.  This also affects the immune system.
•    Excess of stress hormones caused by the lack of sleep can slow collagen production in the skin.
•    may alter the regulation of blood vessel tone and thus contribute to puffiness or bags under the eyes.

A good night’s sleep

•    avoids eye puffiness
•    releases growth hormone, which helps repair skin and keep our skin stay young
•    releases melatonin, which helps skin, as well as the immune system
•    Skin regeneration is faster during the night, than during the day.  Sleep allows our body to repair itself, and that means our skin as well.

Make the most of your sleep time by giving yourself a beauty treatment while you sleep.  Use those eight hours and use skin care products especially designed for overnight.

Remember: Sleep allows skin care products to work better. Many anti-aging ingredients stay active longer if they are not exposed to sunlight.  Retinol, which speed cell turnover, deteriorates faster and loses its effectiveness when exposed to UV light.  Topical Vitamins C and E also break down faster when exposed to sunlight.  And since there is no sunlight at night, you get more bang for your anti-aging buck when you apply night creams before you go to sleep.  The best thing to do is use a night cream that contains numerous anti-aging ingredients and antioxidants all in one, like the kaplanMD Replenishing Night Cream. This product not only contains Retinol, Soy, Grapeseed Extract, and Matrixyl 3000 (a fantastic anti-aging peptide), but Vitamins A, C and E as well.

Keep in mind that sleep gives your skin the time it needs to repair the daily damage of pollution, UV rays, and other environmental damage.   These cause thinning of the skin, dehydration, lines, wrinkles and pigmentation. Rest and relaxation allows your body time to heal itself, so our skin, which is our body’s largest organ, has the time to repair itself, and reverse this damage.  Using an antioxidant-rich night cream boosts this repair process. If the skin is given these repairative nutrients at night, it can better protect itself the following day.

Nighttime also gives you eight uninterrupted hours to hydrate skin with formulations that don’t mix well with makeup or that might give you a shine you would avoid during the day. These superhydrators not only attract moisture to the skin, but also prevent moisture from evaporating from your skin. Active ingredients penetrate the skin better when you’re sleeping, because they have complete access to your skin.  While you are sleeping, these active ingredients are the only thing on your skin.  There is  no interference from sun, pollution, or makeup.  Eye creams that smooth and reduce puffy eyelids also work better at night, when make-up can’t interfere with their absorption.

Now that you know the amount of sleep you get is important, let’s talk about how you sleep

1.  Sleep flat on your back:  Do you wake up, and see wrinkles on your face from your bed or sheets?  When you were younger, you could wash your face, and as the circulation flowed, the creases disappeared.  Have you noticed that they are not going away as fast, now that you are getting older?  Natural hormonal progression, in both men and women, starting in our twenties, reduces the amount of collagen, elastic tissue and hayaluronic acid in our skin.  This means that the skin is thinner and less elastic, and doesn’t bounce back like it used to.  Lying flat on your face creates creases that worsen over time.

Think about how you sleep.  Sleeping on your side forms chest, cleavage and cheek creases.  Sleeping on your stomach, and smushing your face into a pillow can cause a furrowed brow, and deep face creases as well.  Try sleeping on your back.  It will allow your face to fall back, and help reverse the effects of gravity that have worked all day to pull your face down.

2.   Stay hydrated: Drink plenty of water.  Also, to avoid moisture loss from the skin while sleeping, use a humidifier.  This is especially important in winter, when dry heating sucks all the moisture out of the air

3.  Use a thicker moisturizer after bathing: Seal in the moisture that your skin has absorbed after bathing.  You are going to bed, not putting on an expensive silk blouse.  Use a body and face cream that is rich and moisturizing, even if it is one that you would not feel comfortable using during the day.