You can take steps to minimize wrinkles and other signs of aging, but the reality is this: Science has never discovered a single ingredient that slows, stops, or reverses the complex aging process. Of course, you’d never guess that from the number of skin-care products lining store shelves that hint at being able to take years off your face.
“There’s a lot of deception out there,” says Fayne Frey, M.D., a West Nyack, N.Y., dermatologist and creator of FryFace.com, a skin-care education site. “Anti-aging is an 85 billion dollar industry that’s feeding off of insecurities, and there’s no need to spend a lot of money on these products. I tell people if you want to look 20 years younger, you’re going to need surgery or a very significant ablative laser procedure. There’s no fountain of youth in a bottle. I call these products ‘hope in a jar.’”
Frey has long been a staunch advocate for consumer education on skin-care products and jokes that she’s quickly becoming the Ralph Nader of the skin-care industry. Health After 50 spoke with her recently about the business of skin care, anti-aging and what every consumer should know before opening his or her wallet.
Q: Are there any long-term benefits to using over-the-counter (OTC) skin-care products?
Frey: From the Food and Drug Administration's (FDA’s) perspective, OTC moisturizers are considered cosmetics and have no medical value. As moisturizers, they may temporarily increase the water content of skin and thereby decrease the “appearance” of fine lines and wrinkles. But they will not get rid of them. Think of it as taking a raisin and pumping water into it. You get a grape. A grape is definitely firmer and has fewer wrinkles. But the effect is temporary.
Q: Are they safe?
Frey: Cosmetic products do not need FDA premarket approval, nor do they need to prove efficacy or safety, though many of the major skin-care manufacturers belong to the Personal Care Products Council. As members of this national trade organization, manufacturers strict guidelines as to what ingredients they use and at what concentrations. It's a relatively safe industry, with few reactions or allergies. Prescription and OTC drugs must go through the FDA approval process because they claim to change the actual structure of skin.
Q: There must be something about expensive products to justify charging more than $100, right?
Frey: Almost all OTC products have the same basic formula, no matter the price tag. The majority are water-based and include occlusives, which are substances that trap water in the skin and prevent it from evaporating; humectants, which act as a sponge and draw water into the skin; emulsifiers, which keep the oil and water components of the product together; preservative; thickener; and fragrance. But then the manufacturer adds a tiny amount of an ingredient, almost always named near the very end of the ingredient listing. With very little evidence-based science showing the efficacy of these ingredients, I feel they are added as “marketing tools.” These ingredients might include retinol, collagen, hyaluronic acid, or one of many “antioxidants.”
They may also add expensive oils, which act as emollients, giving the product a wonderful aesthetic value, making the skin feel soft and supple, but often have very little therapeutic value. The overwhelming majority of these products are formulated like moisturizers, increasing skin hydration, temporarily improving the appearance of fine lines and wrinkles, and yet, some companies charge $170 to $300 an ounce (that's $2,700–$4,800 per pound!) There is no correlation between the cost of a moisturizer and its ability to increase water content of the skin. We buy them and think the product is doing something phenomenal for us.
Q: What about products geared for specific uses, such as night cream? Do these work?
Frey: Ingredients don’t know what time of day it is. Look at the formulation of these products and it’s the same as others: water-based, humectants, occlusives, preservatives, perhaps more thickener, and fragrance. The only difference, in my opinion, is that there’s no sunscreen in night cream. As for products such as eye cream, there’s nothing specific to these products for use around the eyes. I’ve talked to formulation experts, chemical engineers, and asked them what ingredients they use specifically for eye cream and they say none. If you can’t put the same product you’d use on your cheeks under your eyes, then you shouldn’t be putting that product on your face.
Q: Should I pay more for something that’s paraben-free? I heard parabens are bad for you.
Frey: Parabens are preservatives. Although they are some of the most controversial preservatives, they are also the most studied. You need preservatives in water-based skin-care products; otherwise, you’re going to have an overgrowth of mold and bacteria within two weeks. A study published several years ago found parabens in breast tumors, so women immediately thought it caused breast cancer.
Parabens do have very mild estrogenic activity, about 10,000 to 100,00 times weaker than your own estrogen. Many compounds found in nature also have mild estrogenic activity, such as soy. Parabens are found naturally in many fruits and vegetables such as carrots and blueberries. Additional studies have not linked them to breast cancer, and parabens are approved in countries that traditionally have some of the strictest regulations on additives, including Japan and the European Union.
The big question people should be asking themselves is, what preservatives are these companies using then? An alternative is DMDM hydantoin, which is a formaldehyde-releasing preservative that can be very irritating to those with sensitive skin and those with eczema. Formaldehyde has also been linked to cancer (though no such connections have been made to the preservatives).
Q: What about prescription creams?
Frey: There’s a physiologic problem with all these products, in that they don’t get down deep enough in the skin to where the damage is. The most popular prescription cream that the FDA has approved to lessen fine lines and wrinkles is Renova. Renova contains tretinoin, a vitamin A derivative that has been shown to make changes in fibroblasts (the cells within the dermal skin that produce collagen) at the cellular level. Even the package insert of prescription tretinoin reads in bold lettering, “Does not eliminate wrinkles, repair sun-damaged skin, reverse photoaging, or restore more youthful or younger skin.”
It has been shown to only mitigate fine lines when used in conjunction with a comprehensive sun avoidance program, which includes sun avoidance and sunscreen use. The drug gained FDA approval because its trial results showed a moderate improvement in 10 percent of those using Renova and a sun avoidance program compared to 3 percent of those who only used a sun avoidance program—a statistically significant result. But when you look at the numbers, aside from the 10 percent of study participants who had moderate improvement, the rest saw no improvement, had only minimal improvement, or had their skin actually worsen, as was the case for many patients with dark skin. Is it worth $300? One must truly ask, “Do the benefits outweigh the risks?” Tretinoin is also a dermal irritant, as stated on the insert. It can cause redness and inflammation, and it’s sun sensitizing.
Q: So there’s no magic skin-care product? Frey: There is no magic potion, but there is a product that can help: sunscreen. Sunscreen is the most biologically active ”anti-aging” product on the market, bar none. And you’re never too old to start using it. The majority of changes to skin we associate with aging is sun damage. Overall, good habits go a long way: Eat a healthful diet; get good sleep; exercise; don’t smoke; follow a simple regimen using a mild cleanser, moisturizer, and sunscreen with SPF 30 or higher; and skip the exfoliating—the first 15 to 20 layers of your skin are self-moisturizing, so why remove them? There are no shortcuts to good skin.
Editor’s Note: Fayne Frey, M.D., is a board certified dermatologist in West Nyack, N.Y., with more than 20 years of experience. She received her medical degree from Weill Cornell Medical College.