They use a cleanser with horsepower
We’ve all heard dermatologists endorse washing up with a mild, gentle cleanser. But in truth that’s not what they use at home. Most of the MDs we talked to lather up with formulas filled with glycolic or lactic acid (to accelerate exfoliation) and salicylic acid (to unclog pores and make them appear smaller). “As an African-American woman in my forties, I battle blotchiness. And for that, I find an exfoliating cleanser is best: It evens out the tone of my skin better than a basic, no-frills formula,” says Jeanine Downie, MD, coauthor of Beautiful Skin of Color. Some doctors do use a gentler cleanser but rotate in a more aggressive exfoliator (a scrub or at-home microdermabrasion kit) once a week to ensure that no skin-dulling dead cells are hanging around. Some favorites: Vivité Exfoliating Facial Cleanser ($39; viviteskincare.com) and the Patricia Wexler MD Microdermabrasion System Step 1: Resurfacing Cream ($35; bathandbodyworks.com).
They f?ight free radicals on the outside—and in
According to the doctors we interviewed, the danger of free radicals—from such sources as air pollution and the sun’s rays—isn’t marketing hype, it’s real. “Damage from free rad-icals is one of the primary causes of fine lines and uneven tone,” Downie says. So she and the others minimize future wrinkles and blotchiness with antioxidants, applying a serum or cream that contains a free-radical fighter such as vitamin C, phloretin, ideben-one, green tea or coffeeberry every morning, after cleansing and before putting on sunscreen (see number 3, below). Downie loves Revalé Skin Intense Recovery Treatment with CoffeeBerry ($130; re-valeskin.com). Other antioxidant serums to try: Elizabeth Arden Prevage Face Anti-Aging Serum ($155; elizabetharden.com, available beginning in March) with idebenone plus green tea, and SkinCeuticals Phlo-retin CF ($150; skin ceuticals.com), which contains three antioxidants: vitamin C, phloretin and ferulic acid. But most docs don’t rely on topical anti-oxidants alone. Mary Lupo, MD, a clinical professor of dermatology at Tulane University, in New Orleans, also downs smoothies made with yogurt and antioxidant-rich fruit, such as blueberries or acai. “I believe skin is a mirror of your overall health. So I treat the inside of me as well as I do the outside,” she says.
Protection is a priority
To skin doctors, applying sunscreen is like brushing teeth: It’s unfathom-able not to do it. Most apply a thin layer as the last step of their morning skin care regimen to prevent UV exposure, the chief cause of premature wrinkles and discoloration. Two formulas frequently cited: For dry skin, La Roche-Posay Anthelios Daily Moisturizer SPF 15 ($30; larocheposay.us) and, for oilier complexions, Neutro-gena Ultra Sheer Dry Touch Sunblock SPF 55 ($11; drugstores). Then, to further boost their skin’s sun shield, our experts layer on sunscreen-spiked makeup. Naila Malik, MD, a cosmetic derma-tologist in Southlake, Texas, sweeps on Neutrogena Min-eral Sheers Powder Foundation SPF 20 ($13; drugstores). “It’s light, safe for sensitive skin and doesn’t make me break out,” she says. Katie Rodan, MD, associate clinical professor of dermatology at Stanford University, uses her own Rodan+Fields Mineral Peptides SPF 20 ($29; rodanand fields.com), which absorbs excess oil. And Lupo applies L’Oréal Visible Lift Foundation SPF 17 ($15; drugstores), a moisturizing liquid formula with retinol.
They rave about Retin-A
Dead cells are complexion enemy number one, say our skin experts, because they clog pores and give skin an ashy appearance. So, after exfoliating in the evening, most docs slather on a retinoid cream (a topical form of vitamin A found in Rx options such as Retin-A and Renova, and over-the-counter in retinol), which has been shown to speed up the rate at which the body sheds dead skin. But reti-noid benefits don’t stop there. Vitamin A also stimulates collagen production (making skin look plumper and fine lines smoother) and normalizes cells exposed to UV rays, effectively undoing sun damage. But there’s a downside: Retinoids, dermatologists say, can be irritating if overused, so most advocate a flexible retinoid regimen. Lupo alternates daily between moisturizing Renova and the more aggressive (and more drying) prescription Tazorac. Downie rotates Vivité Vibrance Therapy, which has retinol ($119; viv-iteskincare.com), with Tri-Luma Cream, an Rx-strength retinoid that also contains spot-fading hydroquinone. And every night, Rodan applies her own Rodan+Fields Anti-Age Night Renewing Serum ($89; rodanandfields.com), an over-the-counter treatment with retinol. Then, once a week, she applies Tazorac as a mask for 15 minutes: “Tazorac is the strongest retinoid, but it’s too irritating for me to wear all night. Using it as a mask boosts the effects of my retinol serum without causing flaking.” Some doctors also apply a moisturizer under their retinoid to dilute the strength. Or they cut back on how often they apply it (e.g., every third night rather than seven days a week) if they see signs of sensitivity. (For more on what to do if your skin is irritated, check out “Ch-ch-changes: Your Skin Is Suddenly So Sensitive,” on page 50.)
They freeze and fill in moderation
Almost every dermatologist we spoke with says that when it comes to in-office treatments, Botox (or Dysport, its brand-new competitor) gives you the most bang for your buck. They inject their foreheads to relax frown lines; a few also target their eyes’ outer corners to minimize crow’s-feet. Patricia Wexler, MD, a cosmetic dermatologist in New York City, says one of her favorite new spots is along the jawline, which gives her neck a lifted appearance. For areas where deeper wrinkles have formed, most doctors say they turn to hyaluronic acid fillers like Juvederm or Restylane to plump up the crevices. The most frequently treated spot: the nasolabial folds (aka the marionette lines beside your mouth). Rodan and Lupo both inject this area once or twice a year. Docs, of course, get these treatments at cost; even so, they avail themselves only three to four times a year, which they consider moderate usage. You can expect to pay $375 and up for one Botox or Dysport treatment, and $600 and up for one filler treatment.
Maintaining skin bounce is essential
Yes, retinoids boost collagen and elastin production in the skin. But most skin doctors don’t feel that vitamin A alone does quite enough plumping, so over this they layer a second topical containing either peptides or a growth factor. Popular peptide picks: Neocutis BioRestorative Cream ($130; derm store.com) and Olay Regenerist Daily Serum ($19; drugstores). Best of the growth factor bunch: SkinMedica TNS Essential Serum ($250; skinmedica.com) and RéVive Moisturizing Renewal Cream ($165; neimanmarcus.com). Note: Most peptide and growth factor creams are hydrating, so you won’t need an additional moisturizer. Like you, these docs don’t have time for an eight-step regimen. So at night they just cleanse, apply a retinoid cream, top it off with a collagen-boosting cream—and hit the sheets. And there is a reason doctors typically save the big-gun treatments like retinoids and peptides for nighttime. “Your body temperature goes up while you sleep, and the heat helps products penetrate skin better,” Rodan explains.
They sleep on their backs
Fetal-position snoozers, take note: A surprising number of doctors believe that smashing your face into a pillow leads to permanent creases—so they try never to do it. “Sleeping on your face not only etches wrinkles into the skin, but fluid pools on the side of the face that’s pressed against the pillow, stretching out the skin,” Lupo says. Rodan went so far as to buy herself a Therapeutica Sleeping Pillow ($79 to $110, depending on the size; therapeuticainc.com), which is contoured to cradle your head and neck, making it easier to lie on your back. “The connection between wrinkles and how you sleep is no joke. I can look at 80 percent of my patients and tell you which side they sleep on,” Rodan says.
They exercise for better skin
Most female MDs cited improved circulation and reduced stress as workout benefits that help their appearance. “I get stress relief from working out, which I think keeps my worries off my face,” says Downie, who runs, hits the StairMaster or kickboxes seven days a week. Malik goes to the gym for 60 to 90 minutes, six or seven days a week because she believes it reduces her level of the stress hormone epinephrine: “This hormone can cause constriction of blood flow and make your skin lose its glow.” Wexler swears by the long-term effect of Pilates on skin tone; Rodan, a former runner, now goes Spinning. “A plastic surgeon I trust told me to stop high-impact workouts once I entered my forties,” she says. “He said over time it causes tiny tears in the microscopic attachments in the skin, which can ultimately lead to sagging.”