Ethnic Skin: South Asian

South Asians make up one quarter of the world’s population. The skin tones vary from very light to very dark, with many of us falling in the mid range, which we refer to as the color of “Wheat”. Being South Asian, I treat many other South Asians. What are the most common concerns I see in my patients at Shanti Medical Spa & Wellness center are unwanted hair, discoloration, and acne. This of course does not cover the wide array of skin conditions experienced in our community, but are the most common ones I see everyday.

For many South Asians, we have the genetic predisposition to have more hair than other people in the world. Our hair is thicker, coarser, and denser. There is no part of our bodies that is not affected by this! Almost 70% of the laser hair removal done today is done on South Asians even though we make up less than 2% of the population in the US. The love and desire to be hairless is insatiable in our community. It is best to start earlier rather than later. The reason is the hair that has been waxed, tweezed, and threaded responds slower to the laser than hair that is “virginal” to hair removing techniques. What hair removal techniques due to the hair follicle is it makes it crooked from the constant trauma and thus, when the laser light hits it, the whole hair follicle is not penetrated, which extends the hair removal process even longer. The earliest one can start is two years after a young teenage girl has had her period. For young teenage boys, they can start after 16, since most have started growing by then. If for whatever reason, one has not experienced pubertal changes, I do not recommend proceeding with hair removal. The body will go through a change during this time, and it is important to wait and see what happens.

When you choose a laser hair removal place, go to a reputable place that has had training working on South Asian skin. Many places literally train staff overnight and let them loose on unsuspecting clients. I think the hardest area to treat on my women patient’s is their lip area because it tends to be lighter and finer hair. It usually responds less than areas that have thick and coarser hair. Remember, because we have more hair than most people do, it will take us longer to respond to any hair removal technique than other people. Don’t worry, laser hair removal is great. I have done my whole body!

South Asians also suffer from acne just like the rest of the world. I do think that some of the acne is due to the excess hair we suffer from. I like to do a multi-faceted approach for my South Asian patients. I usually begin acne treatments along with hair removal to get the best treatments. Depending on the severity of acne, the treatments will vary. Please refer to the previous blog on what causes acne and acne treatments for more information.

For mild acne, topical treatments and peels work well. For more severe acne, laser treatments will probably help more. Talk to your local expert to see what a better treatment option is for you.

Discoloration is a common concern in the South Asian community. You can have discoloration from acne, bug bites, scratches, picking, hormonal changes, and just from aging. Treatment once again varies on how much discoloration one has and how long it has been there. For patients who just don’t want to do anything but use topical creams, I love the OBAGI line for South Asians. I use it and all the women in my family use it. It is an amazing line that helps with acne, brown spots, and slows down the aging process as well! Go to obagi.com to learn more!

For patients who have more severe discoloration, peels or lasers are better options. If the scarring has been there for years, the lasers will work better because they penetrate deeper and thus are more effective. I use the Pixel, our resurfacing laser on many South Asian patients. It is an amazing treatment that improves skin tone, texture, evenness and it even fills in soft lines and wrinkles! I love this laser for myself and my patients. To learn about South Asian skin and aging, stay tuned!

Is there a Wrinkle Cure?

When I do a skin care consult, the most common concern people want to improve upon is wrinkles, wrinkles, and wrinkles. Wrinkles are associated with aging. No one wants to look older and wrinkles are definitely not attractive. The problem is that just about every product and brand claims to have something to prevent wrinkles and most of the time, only minimal changes are seen and maintained. Is there a wrinkle cure?

Well to understand wrinkles, let's talk in brief about why and how they occur. One reason why we wrinkle is that as we age, certain genes become turned off spontaneously, thereby causing us to form wrinkles. The genes that are turned off are the ones that produce collagen. The second phenomena is the constant exposure to free radicals. As described in a previous blog, free radicals are cells that are unstable and cause a vicious cycle of destruction when they try to become stable. We are exposed to free radicals every where. It comes from the air, solar radiation, ozone, and pollutants. Normal cell metabolism also cause free radicals to form. It is the accumulation of these free radicals that causes us to age. And lastly, there are natural decreased levels of anti-oxidants in the skin that decrease our ability to fight off the free radicals and accelerate the aging process.

There are two types of skin aging: Intrinsic Aging and Photoaging. In Intrinsic Aging, the natural collagen production will decrease by 1% per year throughout the adult life span. What we see is reduced collagen formation at the nuclear and cellular level. This produces the chronological changes we see with age. In Intrinsic aging the skin appears dry, dull, pale with fine wrinkles. There is some laxity to it and it is prone to benign skin growths. With Photogaing, this is aging related to sun exposure. The UV radiation causes direct damage to the DNA of the skin cell damaging its ability to repair itself as well as reproduce normal skin cells. It greatly reduces the body's ability to form collagen and repair collagen, and lastly, there is a very large amount of free radicals accumulating that worsen everything I just mentioned. The more sun damage there is, the reduced ability the body has to repair itself, leading to more damage and more wrinkles. It is a vicious cycle. The skin with photoaging has very coarse, deep wrinkles, a leathery look, dry, and mottled appearance. It also is suspect to precancer and cancer lesions of all types.

Two other things can cause skin to age faster are smoking and reduced hormone levels. Smoking accelerates the formation of free radicals and works synergistically with sun damage to cause wrinkles. Reduced hormone levels occur in both men and women as they age. We begin to lose critical hormones after 30 by 1-3% per year. This loss of hormones causes a decrease in collagen and elastin production which causes us to age even more. For women, the decrease in collagen production after menopause is 2.5% per year, which is more than 1% as seen with intrinsic aging. That is why in our center, we talk about hormone optimization as being part of the skin care program. Patients who don't want to do that, end up spending more money and see less change per treatment. My patients who do the wellness with the advanced skin care, have the best results because we can heal from the inside out and the outside in.

So, to stop wrinkles, you must use sunblock and vitamin C topical. Sunblock which has both UVA and UVB protection should be used everyday to prevent solar radiation exposure. Vitamin C serum is important to use as a topical anti-oxidant to reduce the formation of free radicals.

For patients who have wrinkling, I add Retinols which if used over time (for one year) will correct intrinsic damage done to the skin. OBAGI is a great skin care line to use for those with both deep and fine lines.

The other items I recommend are treatments. Patients with fine lines can see changes with both peels and laser skin rejuvenation. Laser skin rejuvenation involves an Intense Pulse Light (IPL) which penetrates the skin about 20-25 microns deep to improve skin tone, texture, and soften fine lines. This IPL treatment reorganizes damaged collagen and elastin but does not cause new collagen and elastin production. Most patients typically need about 5-6 treatments to obtain maximum improvements. They will need a touch up every three to four months.

Peels can help as well but are not as dramatic mostly because superficial peels penetrate only about 5-12 microns deep in the skin. The skin damage is usually 100's of microns deep in the skin. Peels are a great starting point for young people who want to prevent wrinkles, but for my more mature clients, I think the skin rejuvenation is better. The more deeper peels, are generally losing favor due to the down time of 5-10 days. Most of my clients work and that is not something they want to do or can afford to do. We don't even offer it in our centers because we have other laser treatments that work even better without the down time.

For patients with deeper lines or a lot of fine lines, I use our fractional ablative laser, the PIXEL. This is the newest technology to improve skin with minimum down time. The PIXEL uses the same Erbium laser that was used in the past with ablative lasers (the lasers used to peel off your whole skin and made you look like Freddie Kruger for a few weeks. The new skin would be regenerated over time improving appearance) However the down time associated the old lasers was too much and were falling out of favor. This new fractional ablation is great. We can have about 30-150 microns deep penetration in skin with each treatment and causes the formation of new collagen and elastin. This is what fills in the wrinkles resulting in a more even, health look. There is about two days of looking sun burned and two more days of some mild peeling but nothing to stop you from going to work with each Pixel treatment. Most people need about 3-6 treatments for optimal results and then maintenance every 6-12 months. It works for wrinkles, sun damage, melasma, scars, acne, and just overall appearance in skin tone and texture. It

The Pixel's counterpart is the Fraxel. The fraxel uses the same fractional ablation technology but the physician has to buy a whole new system for it (which means to the consumer, a more expensive procedure), a blue dye is placed over the skin to see where it has gone, and is more painful than the Pixel. I think as a consumer you should check out both but for cost and effectiveness, the Pixel is better.

The other things you can do to help reduce wrinkles is the skin tightening laser. Most people use this for the laxity around the jawline and turkey neck. This laser uses infrared technology to heat up the dermis to pull closer the stretched out collagen and elastin fibers, resulting in a tighter firmer look. Most clients need about 4 treatments once per month for optimal results and then a maintenance treatment once every six months.

For patients, who want to try injectables, there are lots of options. Botox is used for lines in motion whether they are on the forehead (your worry lines), the glabella (the frown lines you get when you get mad; also called the 11's), the crow's feet area (the smile lines around your eyes), the smoker lines around the lips, and for depressed mouths. It is a small injection done over these areas using Botulinum A. This weakens the muscle so it can not move but still allows for normal facial movements. It last about 3-6 months. My patients tell me that when they do the PIXEL and Botox, the Botox last longer.

For lines at rest, we use fillers. The most common fillers are Restylane and Juvaderm. Both are made from Hylauronic acid and both last about 6 months. The difference from the two is more what the individual physician and patient feels, thus far. Juvaderm is newer and less information is out on it in the United States. It came from Europe and has an excellent track record there. It uses slightly more hylauronic acid then Restylane and feels softer when applied. It is also the first filler approved for People Of Color. Restylane has a long track record of working well with minimum side effects. It does last about 6 months in average, and most patients require some block to be used before it can be injected. I use both and I prefer Juvaderm because it is easier for me to apply and less painful. I will have to see anecdotal which one last longer!

For the longer fillers, there is Sculptra and Radiesse. Sculptra was approved for HIV lipodystrophy (the thinning of the face from fat loss that is seen in HIV patients) but is now cosmetically used for aging on our thin, hollowed out faces. It is suppose to last about 1-2 years. Radiesse is the longer filler like Restylane and Juvaderm which is suppose to last 1-2 years. I recommend it only to my patients that love the way they look with the Juvaderm or Restylane since it is so long lasting. Patients do complain that it feels hard but not enough to stop anyone from getting it done.

As you can see there are lots of options for wrinkles. To find out which is the best for you, it is best to speak with a professional. Remember, skin care products and healing from the inside are just as important as healing from the outside!