Skin Remodeling Lesson 8: Taking Action

This entire E-course is intended for informational purposes only and does not replace medical advice. Please consult our warning page before using aggressive measure like chemical peels or skin needling.

Starting Out

The first step to treating most forms of skin damage is properly exfoliating your skin. Start using mild forms of exfoliation for a week or two before you use any topical actives so that you can be sure they will penetrate the skin. Try using a 5%-10% AHA lotion every other day or use a microdermabrasion treatment or two. During this time, you should also start fine-tuning your diet. Reduce or remove all refined sugars and white flour, increase your intake of vegetables and fatty fish, and start taking supplements if you desire. You should also start using sunscreen daily at if you do not already.

Sample Routines for Initial Exfoliation

For your face: Use a 5% lactic acid lotion every other day for a week.

For your body: Use a 10% glycolic acid lotion every other day for 2 weeks.

Microdermabrasion: Perform 2 treatments over 2 weeks on your face. Perform 3 treatments over 2 weeks on body skin.

The next step is adjusting to the topical actives you’ll be using with strength building techniques. The most powerful actives are ascorbic acid (Vitamin C) and prescription retinoic acid. They are also the most irritating, but these ingredients will likely give you the most matrix regenerating properties. Try one or both of them first if you are treating wrinkles, acne scars, stretch marks or scars. If you are treating discoloration or fine lines, start out with ascorbic acid and only use retinoic acid if you have to. If you can’t tolerate those, then move on to the other actives. Use a soothing moisturizer in the day time to help your skin deal with the irritation.

Ascorbic acid, prescription retinoids, retinol, and retinaldehyde will all have exfoliating properties. Once you are using those regularly, additional exfoliation is not needed for proper absorption. Peptides and other forms of Vitamin C do not have any exfoliating effects, so you’ll need to keep using occasional mild exfoliation.

Long Term Treatment

After your skin tolerates actives well, you should decide which approach you’ll use to treat your skin damage. If you are using the “Topical Only” method, then you have done most of the work already.

If you choose the “Regular Strong Exfoliation” method, then you should start adding more exfoliation to your routine. Remember, strong exfoliation also requires strength building. Gradually increase the frequency and intensity of your treatments. This approach can weaken the skin barrier, so use a barrier repair product regularly.

You should start preparing for your resurfacing treatment if you are taking the “Sporadic Resurfacing” approach. Diet is very important with this method because your skin needs to heal well. Supplementation is recommended. You will typically need 4 weeks to prepare for aggressive treatments. You may need a week or more to resume your full strength topical formulations after a treatment.

After 6 to 18 months, you should move to a maintenance routine. Do not continue aggressive exfoliation indefinitely.

Recommendations for Specific Types of Damage

Here’s some advice about how to apply the principles in this courseto specific types of damage. The Sample Routines given are examples of end game regimens; don’t start out with them. You need to strength build to tolerate the actives, and gradually introduce the exfoliation and resurfacing treatments. These routines may be too strong for your skin type altogether and you’ll have to use milder products and strengths. Be sure to use sunscreen and a barrier repair product if your routine involves a lot of exfoliation.

Discoloration – Discoloration will generally respond well to the milder methods, unless it is severe. The topical only approach is usually sufficient for mild to moderate discoloration. Ascorbic acid (Vitamin C), retinol, retinaldehyde, and alpha hydroxy acids work very well on discoloration, but it takes some time. Other skin lightening ingredients such as kojic acid and alpha arbutin are also helpful. If your discoloration is severe or doesn’t improve after 3 months of using these topicals, consider using retinoic acid. Occasional superficial chemical peels may also work. Most discoloration is caused by sun exposure, so wearing sunscreen daily is very important.

Sample Routines for Discoloration

Topical Only: Use a 15% or 20% ascorbic acid serum nightly and a 5% or 10% ascorbic acid serum in the morning. Be sure to wear a good sunscreen every day. An alpha arbutin or retinol cream can also be used at night.

Regular Strong Exfoliation: In addition to a topical like Vitamin C or alpha arbutin, use a 5% to 10% glycolic acid lotion daily or every other day.

Fine Lines – Fine lines are the start of wrinkles. The skin matrix beneath them has only just started to degrade. This type of skin damage can be treated with the topical only approach, but many people get faster, more impressive results by incorporating regular exfoliation. This type of minor damage responds well to mild actives for young users. Using strong ascorbic acid formulations or retinoic acid is preferable for people over 45. Be very careful treating fine lines around the eyes.

Some fine lines are the result of a dry, overly thick stratum corneum, when the excess layers of dead skin crease with facial expressions. This is very common in people in their late twenties. Since the damage isn’t the result of irregularities in the skin matrix, it doesn’t need matrix-regenerating actives. A few good exfoliation treatments can take care of these false fine lines very quickly. Maintain results by exfoliating regularly with facial scrubs or mild AHA products, and be sure to use a good moisturizer daily.

Sample Routines for Fine Lines

Topical Only: Use a 20% Vitamin C serum and 1% retinol cream nightly. Use a sunscreen and antioxidant moisturizer in the daytime. Consider using prescription retinoid if you are over 40.

Regular Strong Exfoliation: Use a 10% glycolic acid cream every night or every other night. Alternatively, use a very superficial chemical peel every week, like a 20% glycolic acid or 8% TCA peel. You should also use topical regenerating actives like Vitamin C or retinoids. If you find these too irritating, try Matrixyl products.

Wrinkles – This type of damage typically needs a more aggressive approach, particularly if you are over 40. The topical only approach will often help immensely, but if you are looking for complete or near complete resolution, resurfacing treatments are usually necessary. Sporadic resurfacing gives the fastest results and allows your skin barrier to recover between treatments. Be careful with regular strong exfoliation because it is easy to get out of balance. Many skin care products contain low levels of glycolic or lactic acid in addition to a regenerating active, so check your product label. Remember to add new products and techniques into your routine slowly.

Deep wrinkles, particularly on the forehead, can sometimes extend beyond the skin matrix. The tiny muscles beneath these wrinkles can warp, causing a permanent crease. Frownies or even small pieces of medical tape can be worn while sleeping to reshape the muscles over time.

Sample Routines for Wrinkles

Regular Strong Exfoliation: Consider using prescription retinoid if you are over 40. Use a 20% Vitamin C serum, Matrixyl cream, and 10% glycolic acid cream every night. Use a sunscreen, an antioxidant moisturizer, and a 5%-10% ascorbic acid serum in the daytime.

Sporadic Resurfacing: Do a series of four 15%-20% TCA peels, with 4 to 8 weeks between each peel. Use a 15% – 20% Vitamin C serum and Matrixyl cream every night. Use a sunscreen, an antioxidant moisturizer, and a 5% ascorbic acid serum in the daytime. Discontinue topicals at least 48 hours before the peels and reintroduce them gradually after the skin has completely healed.

Acne and Other Facial Scars – Facial scars are treated much the same way as wrinkles. Depressed scars or pitted acne/chicken pox scars are the most difficult to eliminate. They tend to remodel well with needling or a series of chemical peels. Raised, hardened scars respond well to daily use of AHA products. If you are going to use regular strong exfoliation, be sure to use a barrier repair product. Never treat keloid scars without consulting a dermatologist.

Sample Routines for Acne Scars

Topical Only: Use a 20% Vitamin C serum and 1% retinol cream nightly. Use a sunscreen and antioxidant moisturizer in the daytime. Consider using prescription retinoid.

Regular Strong Exfoliation: Use a 10% glycolic acid cream every night or every other night. Alternatively, use a very superficial chemical peel every week, like a 20% glycolic acid or 8% TCA peel. You must also use topical regenerating actives like Vitamin C or retinoids. If you find these too irritating, try Matrixyl products.

Sporadic Resurfacing: Needling treatments performed every 4 to 12 weeks work well for acne scars. Use Vitamins A, C and E daily, unless the skin is currently healing from needling. If you still have active acne, try a series of Salicylic Acid or Jessner’s peels.

Stretch Marks – Stretch marks take a long time to resolve. In many cases, the dermis is completely torn through and needs to rebuild from the sides. They tend to get thinner as they remodel. Since stretch marks often cover large areas of skin, it can be expensive to use facial products. A homemade ascorbic acid serum is a very economical option. Needling is very effective on stretch marks, but it will typically take at least a year of regular treatments. Regular exfoliation using strong AHA creams and lotions is a common approach that yields good results. Balancing exfoliation and regeneration is easier with body skin, but it is still a good idea to use a skin barrier repair product.

Sample Routines for Stretch Marks

Regular Strong Exfoliation: Use a 15% glycolic acid lotion and copper peptide products every evening.

Sporadic Resurfacing: Needling treatments performed every 4 to 12 weeks work well for stretch marks. Use Vitamins A, C and E daily, unless the skin is currently healing from needling.

Body Scars – Body scars are treated similar to scars on the face, but thicker body skin often needs more aggressive treatment. Needling and chemical peels are very effective. Try to confine the treatment to the actual scar, not the skin surrounding it. Raised, hardened scars are often covered with a lot of dead skin, so you may need more exfoliation in the beginning before your topical actives will absorb well. Never treat keloid scars without consulting a dermatologist.

Sample Routine for Body Scars

Regular Strong Exfoliation: Use a 15% glycolic acid lotion and copper peptide products every evening.

Sporadic Resurfacing: A series of chemical peels or needling treatments performed every 4 to 12 weeks work well for most scars. Use Vitamins A, C and E daily, unless the skin is currently healing from needling.

Skin Sagging – Sagging skin is one of the most difficult forms of skin damage to treat. Severe skin sag can only be treated surgically. Mild to moderate skin sagging can be improved by treatments that stimulate elastin synthesis. Needling and prescription retinoic acid are the only proven ways to stimulate elastin formation. Another option is the topical application of DMAE. This ingredient temporarily tightens the skin for roughly a day following each application. It’s best to start treating skin sag when you start seeing the early signs or reach your early forties. DMAE and elastin stimulating treatments work well to prevent or slow skin sag.

Sample Routines for Sagging Skin

Topical Only: Use a 5% DMAE cream every morning.

Sporadic Resurfacing: Needling treatments performed every 4 to 12 weeks work well for mild to moderate skin sag. Use Vitamins A, C and E daily, unless the skin is currently healing from needling.

Age Prevention – Don’t use strong actives on young skin to prevent skin aging. The most important steps you can take are using sunscreen, antioxidant, and barrier strengthening products, along with maintaining a good diet and regular exfoliation. Minimizing sugar intake will reduce glycation. Non-irritating actives like mid strength (10% ascorbic acid) Vitamin C products, peptides, and other actives like kinetin and beta glucans are ideal for younger users. If you are over 45, you can use the stronger formulations like prescription retinoids and strong Vitamin C serums. You can also use chemical peels and needling as preventative measures at this point.

Remember, aging isn’t only seen on the face. Your neck, hands, forearms, and décolletage are also very telling. Sun exposure is one of the biggest reasons these areas wrinkle and discolor, so using a good sunscreen daily will help immensely. You can also use your facial treatments on these areas.

Sample Routines for Age Prevention

Under 45: Use a good sunscreen and antioxidant moisturizer every morning. Use a 10% ascorbic acid serum and an oat beta glucan cream every night.

Over 45: Consider using prescription retinoids. Use a good sunscreen and antioxidant moisturizer every morning. Use a 20% ascorbic acid serum and a 1% retinol cream every night. Get a superficial chemical peel every 6 months.