What a Skin Care Expert Does to Prevent Signs of Aging

As I've gotten older I've become more conscious of the appearance of my face. I began looking for an optimal facial care regimen and came across Dr. Kotlus, an expert in the field.

Dr. Brett Kotlus, MD, is a New York City oculofacial plastic surgeon who specializes in both non-surgical and surgical cosmetic and reconstructive procedures of the eyes and face. He is one of only a few specialists who are certified and fellowship-trained in both oculoplastic surgery and general cosmetic surgery.

He has written a book called Pause and Reverse: How to Look Younger Than Your Age With or Without Cosmetic Surgery and has been interviewed on the Peter Attia Drive, a high-quality podcast I recommend. The information in this article is derived from his book and interviews.

Why our skin ages

The face is different than other parts of your body, such as your back. The face requires flexibility to express emotion and for movement, while the back is taut with tension. That’s why scars don’t heal well on the back and tend to stretch out.

However, this flexibility of the face can make the signs of aging more prominent. If you look at the face of a young child they have chubby round smooth cheeks. But as you age you lose fat, bone, and skin thickness. Small blood vessels form and age spots appear.

The earliest signs of aging include horizontal forehead lines, under-eye shadows, loss of cheek fullness, faint brown spots, fine blood vessels, and heaviness of upper eyelid skin.

Sun protection

The most important anti-aging product is sunscreen. You should start now, even if you have a darker skin type. The ultraviolet radiation emitted by the sun leads to a process called solar elastosis which degrades collagen and elastin in the skin causing an acceleration of wrinkles and sagging.

Studies have been done on this topic. In one study, participants were randomly assigned to a group that applied sunscreen each day or a group asked to use sunscreen at their discretion. Pictures were taken of the participants’ hands at the beginning of the study and then examined for microscopic changes of aging 5 years later. Those in the daily-use group were less likely to have skin aging.[1]

Free radical theory of aging

Oxygen in biology is essential for life. However, it comes at a cost during cellular function, where reactive oxygen species (ROS) are generated by oxidative metabolism.

It's known that human skin exposed to ultraviolet radiation dramatically increases ROS production and oxidative stress. It's theorized that skin’s aging over time and in response to the sun occurs due to these ROS events, so the goal is to oppose or neutralize ROS insults to maintain good skin health.

Choosing a sunscreen

Sunlight contains two wavelengths of ultraviolet radiation. UVA ages your skin while UVB turns your skin red, but both can cause cancer. The SPF ratings on sunscreen refer to protection from UVB radiation only, so to protect from UVA look for a "broad spectrum" sunscreen with an SPF rating of at least 30.

There are two main categories of sunscreen: chemical and physical. Chemical sunscreens use active ingredients that absorb the ultraviolet rays and disperse the energy as heat. Some chemicals, such as octinoxate, are known hormone disruptors and should not be used on children. Physical sunscreens use inorganic elements such as zinc or titanium as reflective agents and are a better and safer option.

The optimal skincare routine

According to Dr. Kotlus, three simple habits make up the optimal skincare routine: apply topical vitamin C in the morning, wait for it to dry and put sunscreen on top, then use vitamin A at night.

If that's too complicated, the most effective habit is to simply use sunscreen every day. In addition, you can combine these habits with two lifestyle changes: reduce sun exposure and stop smoking.

  • Vitamin C (L-ascorbic acid) – Protects against UV damage and is a cofactor for collagen synthesis. It's believed that L-ascorbic acid is the most effective version but needs to be stabilized and packaged in dark bottles because it oxidizes easily. Sun-damaged skin is known to have lower vitamin C levels.
  • Sunscreen (Zinc) – You want to use broad-spectrum (at least SPF 30) "physical" sunscreen like zinc as opposed to chemical sunscreens that can be hormonal disruptors, such as octinoxate. Use the sunscreen on your hands, face, neck, and chest. Brands such as Elta, MD Solar Science, Replenix, and SkinCeuticals, among others, are recommended.
  • Vitamin A (Retinol) – Retinol is a form of vitamin A that acts like a hormone and works at intracellular levels to affect collagen synthesis and turnover of skin cells. They are proven to fight wrinkles and reverse signs of skin aging. Next to sunscreen, this is the most important anti-wrinkle cream you should have in your cabinet. You can buy retinol over the counter or you can get a higher potency prescription of Tretinoin from your doctor.

These are products recommended by Dr. Kotlus. He has also partnered with Replenix to make his own line of skincare products called BKMD.

  • Vitamin C – SkinCeuticals C E Ferulic – This vitamin C serum comes in the right form: L-ascorbic acid 15% with vitamin E to make it more effective. Apply in the morning after cleansing and toning, using 4-5 drops on a dry face, neck, and chest before other anti-aging skincare products. Wait for it to dry and then apply your daily sunscreen on top.
  • Sun Screen – Replenix Sheer Physical Sunscreen SPF 50 – This is Dr. Kotlus's daily sunscreen. It‘s easy to apply to your face, and it doesn’t feel thick or make you look pasty. It uses micronized zinc as the active ingredient which makes it a physical sunscreen and is preferable to chemical agents. An alternative is Colorescience Mineral Powder Brush SPF 50 which is a sunscreen powder that comes in several shades to match your skin tone.
  • Vitamin A – Replenix All-trans-Retinol Smoothing Serum – Available in four strengths: 2x for sensitive skin, 3x for normal skin, 5x for tolerant skin, and 10x (1% Retinol) for advanced treatment. Apply 3-4 pumps each night before bed because sun exposure renders retinol ineffective. An alternative is Replenix RetinolForte Treatment Serum which is a newer formula that supposedly has an improved delivery system.