Health Features

Rejuvenation: Skin, Feet, Eyes

If it’s true that you’re only as old as you feel, then it’s no wonder cosmetic procedures are so popular. Through either surgical or non-invasive techniques, we can erase wrinkles, add volume, remove age spots, straighten toes and more. When you look younger, you feel younger.

The signs of aging creep up on us, and they are especially infuriating when they degrade skin quality. Slowly and steadily, we notice wrinkles, deep creases, brown spots and other discolorations/imperfections. But don’t despair, you can do something about it.

take responsibility
“The concept is twofold: one is prevention and two is reacting to what has already happened to your skin,” says Dr. Joseph A. Muccini Jr. of Mid-America Skin Health & Vitality Center. “No conversation about skin care is complete without saying you must have a good sunscreen.”

Wrinkling and dark spots are common reasons for visits to SLUCare Dermatology Services, as well, says Kimberly L. Brown, a physician’s assistant in the clinics. “Patients ask about sun damage that usually manifests itself in the form of wrinkles and dark spots. The most effective anti-aging products are a good moisturizer and a good sunscreen.”

What people don’t always realize, or believe, is that high-protection sunscreen is important even on cool, cloudy days when the sun does not seem to be dangerous, Brown says. “You should use sunscreen on a daily basis. On a cloudy day you are still getting the same amount of ultraviolet exposure,” she notes.

UV rays are not the only dangerous component of sunlight. “It is now clear that infrared rays also damage your DNA and your skin over the course of a lifetime,” Muccini says. He is horrified by the thought of intentional tanning. “You will not tan without damaging your DNA. With DNA damage, there are risks of cancer and pre-cancer.”

love the skin you’re with
Some degree of skin aging is inevitable, Muccini says. “You get hyperelasticity: The skin and collagen have a lax, disorganized quality so you start seeing the ruddy neck, chicken skin and red splotchiness.”

People don’t always realize how much they can do at home to improve skin quality, Brown says. “A moisturizer can immediately plump fine lines, but most products will take six weeks to three months to work,” she says.

Products that repair a portion of the sun’s damage are a step up from basic moisturizers.

“Free radicals result when you have DNA damages that ionize things in ways that are not supposed to occur,” Muccini explains. He says some products act as “free radical scavengers,” mopping up the harmful free radicals before they can cause damage.

“Vitamin C serums are some excellent ones, and vitamin C products can be used with other products having additional vitamins,” he suggests, saying they’re most effective when combined. “You also want to get some collagen remodeling creams.”

targeted therapy
For better results, products should be targeted to a specific need. At the doctor’s office, “discuss strategies for the zones you want to concentrate on rather than on a specific product,” Muccini advises. Prescription products generally do more heavy lifting when it comes to skin issues, Brown adds. “If you want something that is more effective, you should ask for a prescription Retin-A product from your dermatologist versus an over-the-counter retinol,” she says. “They are different.”

“There are many preparations of Retin-A,” Muccini explains. “If you use them over time, you will see an improvement with respect to wrinkling, mottling and pigmentation.” As for discoloration, that requires another group of products, he says. “There are agents that contain a bleaching element, the classic example is hydroquinone. Creams that contain hydroquinone are intended for short-term use, should be used under supervision and discontinued after a certain point.”

But there’s only so much you can achieve with products, Muccini points out.“ There’s a reason topical products have not put doctors out of the business of doing fillers, Botox, radiofrequency, ultrasound, lasers or micro-needling. To undo serious damage, products alone are not going to do it.”

Your feet need a hand in looking their best. That is the advice of local podiatrists, who explain why feet deserve all the TLC you can give them.

beautiful feet
“You can’t say that feet and hands are the same,” says Dr. Michael H. Horwitz, podiatrist and owner of Feet for Life. “The lower extremities are so different in the ways they retain water and do their work. I know people who have terrible-looking skin on their hands but have the most beautiful feet you have ever seen.”

On the other hand, or foot, some people are not so lucky. “Some of the aging that the feet undergo is mechanical,” says Dr. Michael D. Weiss, a podiatrist at Barnes-Jewish Hospital and assistant professor of surgery at Washington University School of Medicine. “As we age, the oil glands and sweat glands are not as effective, which causes the skin to break and crack. When people don’t wear socks, that causes a lot more rubbing and wear.”

first step
“Foot care can start with good skin hydration,” Weiss says. “You don’t have to lather it on, but do it twice a day.” So which hydration products work best? Weiss recommends creams with petroleum jelly. Horwitz prefers moisturizers with ingredients such as urea and shea butter. “Many people have learned that the only way to find what works for you is through trial and error,” Horwitz says, adding that efficacy is not necessarily tied to price.

One good product already may be in your bathroom. “Hair conditioner is an inexpensive way to make your feet soft,” Horwitz says. What about sleeping with socks over your moisturized feet? Sounds good, Weiss says, suggesting that you take it a step further. “If you have an area that is extremely dry, apply your skin cream, put Saran wrap over that and then put the sock on. It will cause the blood vessels and pores to open up and you will get more hydration into the tissues.”

watch your step
We’ve all heard of pedicure horror tales, but is there real danger? “That is a touchy area,” Weiss says. “It is important to make sure the place you go uses proper disinfection practices.” Horwitz agrees, adding that regular pedicures in reliable salons are beneficial for feet. “I really do think people who get biweekly pedicures without a doubt have the most aesthetic feet. They don’t necessarily have the healthiest feet, though, because there is a genetic component to that.”

Cracked heels, a common occurence, can be worrisome. “You have to be sure there is good blood circulation in the feet and you are not diabetic,” Weiss says. “Also, bacteria can get into those cracks. You should be careful and see a doctor.” Horwitz adds that if the cracks are bad enough, you might need a professional to debride the dead skin.

Athlete’s foot and toenail fungus bring additional threats, too, he adds. “People can develop little cracks in the skin between the toes from athlete’s foot and toenail fungus,” Horwitz says. “About 75 percent of cellulitis (a skin infection) in the legs starts with little cracks between the toes. If the skin is breaking down, you should see your doctor.”

They’re the center of attention, thin-skinned and become more difficult as time goes by—no, we’re not talking about spouses, but about eyes.

careful consideration
“The skin surrounding the eyes is delicate and damages easily from smoking, sun exposure and simply aging,” says plastic surgeon Dr. Michele Koo. “It also loses elasticity with age. That allows the normal fat that is behind it to become visible, hence the puffiness around the upper eyelids or the bags below the lower eyelids.”

And there’s more, she says. “The skin also becomes damaged over time and creases develop, giving the eyelids a wrinkled, crepe-like look.”

Fortunately there are plenty of solutions for tired eyes. “There are three types of changes that typically occur under the eye area,” explains Dr. Mike Nayak of Nayak Plastic Surgery. “They are bags of fat or puffiness; dark circles, hollows or emptiness where there should be more fat; and skin that becomes wrinkled and spotted. We can treat two of theses issues non-surgically.”

focus on prevention
You’ve heard it before: prevention is easier than cure. “The best intervention for eyes is early sun protection, early use of Botox, and targeted other products,” Koo says. “Once the creases are present and the damage is done, it is nearly impossible to remove them without surgery and lasering.”

“Skin creams, plus persistence and time can make a nice improvement in the ‘crepiness,’ the brown spots and wrinkles,” Nayak adds. “But creams aren’t going to make the bags go away or fill the troughs. They can treat the fabric but not the lumpiness under the fabric.” He says the best non-surgical alternatives are found in the doctor’s office, not in a jar at the pharmacy. “There are creams on the horizon that will improve the puffiness and bulges of fat but they are not FDA-approved and still are in the research phase,” he notes.

“Botox around the eyes will make the deep creases appear more shallow, like fine lines rather than furrows,” Koo says. “Laser therapy surrounding the eyes will help shrink and smooth the skin but won’t completely remove the excess skin folds that create the tired look and bags.”

Nayak adds, “From a non-surgical standpoint we can fill the emptiness—that depression we call the tear trough—using injectable fillers. It is super popular but costs $600 to $2,000. It is the single most powerful non-surgical thing I can do under the eyes.”

beyond botox
“The laser makes a dramatic improvement in wrinkles, crepiness, pigment and spots under the eyes. The cost ranges from $700 to $1,000, but the effects will last for years,” Nayak says. Excess skin and droopiness in aging upper lids are more difficult to fix,” he says. “There is not a lot we can do. We can try to remove some of the excess upper eyelid skin by raising the brow to take some of the slack off the upper lid.”

Ultherapy, another option, is an energy-based ultrasound device. “It gives a modest lift of the brow and a modest improvement in the upper eyelid skin,” he says. The results show over the next couple of months after a single treatment. “It takes 20 minutes and lasts a couple of years, with a cost of about $700.”

The doctors stress, however, that surgical approaches offer the most long-term improvements. “Surgery is extremely effective for removing the fat and excess skin, recreating the crisp fold of the upper eyelid, and smoothing the skin of the lower eyelid,” says Koo. And they are relatively easy procedures. “Some can be performed in the office in an hour or two.”


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