The sun’s ultraviolet rays cause the most damage to our skin and most of this damage is done by the age of 20 years. UVA light damages collagen and elastic fibers and long term exposure causes photoaging and skin cancer. UVB light causes sunburn and contribute to photoaging. UVC is normally filtered out by the ozone layer. Chronic sun exposure results in dyschromia, irregular melanin deposition, and wrinkled, rough, leathery skin with a dull complexion, age spots, and spider veins (telangiectasia). Tanning beds primarily deliver UVA resulting in a tan without a burn, but chronic exposure to tanning beds is very damaging to skin. Both sunblocks and sunscreens are graded by their sun protection factor (SPF) which measures protection against UVB rays but it is important to select a screen that blocks or absorbs both UVA and UVB. SPF multiplies the amount of time you can spend in the sun without getting burned.  

Striae, stretch marks typically seen following pregnancy or significant weight loss, are scars in the dermis and little, if anything, can be done to prevent or to cure this problem other than excision.  

Skin Care Products

Soaps come in liquid or bar form and function by forming micelles (clusters around foreign objects). Sensitive individuals should choose uncolored and unscented soaps. Liquid soaps are milder than bar soaps. Natural soaps also contain non-alkaline materials and tend to be more harsh than synthetic soaps due to a higher pH.  Most beauty soaps are synthetic with a lower ph, and they are ideally, less drying and may have a moisturizing additive. Some soaps, known as Super Fatted soaps, are less drying and may make the skin oilier because of the addition of fatty additives such as cocoa butter, lanolin or petroleum. Deodorant soaps contain antimicrobials which can be irritating in some individuals.

Moisturizers apply a film on the skin which reduces water evaporation.  It is beneficial to most individuals, but if one already has oily skin, it can clog pores and aggravate acne. Oil based moisturizers (Eucerin®) derive their function from emollients. Oil free moisturizers are water-based creams that usually contain humectants (glycerin or propylene glycol) that bind water from the environment to rehydrate the skin. 

Toners contain alcohol and other ingredients to remove impurities, cleansers, surface skin cells, oils and soap residue. They may be beneficial for oily skin by removing excess oil and they may be beneficial to dry skin by removing excess horny layer of epidermis, but toners can also be very irritating to the skin and limited trial should be used prior to significant use. 

Exfoliants are designed to remove excess cells from skin. When effective, they leave the skin looking smoother and shinier but long-term effects are still poorly understood. 

Alpha Hydroxy Acids (AHA) break cell adherence to aid in the shedding of dead skin, essentially the result of a superficial burn and the depth of activity depends on the concentration of the acid.  Treatment gives the skin a smoother, fresher look, but it will not eradicate wrinkles, clogged pores, or acne. 

Glycolic and lactic acids are commonly used because of their excellent skin penetration. 

Beta Hydroxy Acids (salicylic acid, benzoic acid, butyric acid) also function by disrupting skin cell bonds, but are lipid soluble, improving the care of oily skin. 

Tretinoin (Retin A®, Renova®, and Activa®) is a synthetic derivative of Vitamin A generally prescribed for acne, sun damage, dyschromia and treatment of fine wrinkles. 

Antioxidants such as selenium and Vitamins A, C, and E may protect the skin from free radicals but are still being investigated.

All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” .