illustrations by Jason Lin
Thanks to my Irish ancestry, I’m paper-white with pink cheeks – which means I can’t get a tan, blush easily and have a baby face. As a kid, I had nothing but contempt for my complexion but, as a teen, I grew to appreciate it. While friends battled acne with zit cream and concealer, I only got blemishes a few times a year. When people told me I had great skin, I had to agree.
That is, until last year. At my annual physical, I pointed out a strange-looking mole to my family doctor, who sent me to a dermatologist for a biopsy. On a Friday afternoon, a nurse called with the news: It was melanoma. Suddenly, I had a cancer team and a surgery date to remove more tissue from my arm and several lymph nodes from my armpit, to be analyzed in a lab. It would take two agonizing weeks for the results to come in. One day, I stopped into a Shoppers Drug Mart, where a sales associate approached me in the cosmetics area to say, “Wow, you have such beautiful skin. You’re so lucky!” It took a lot of restraint not to say, “No, I’m not. I have skin cancer!” But I bit my lip.Weeks later, I was given a clean bill of health: the melanoma hadn’t spread.Now, nearly a year later, I feel lucky once again – this time, for the health of my skin and not its appearance. Cancer reminded me that, as much as I want healthy-looking skin, I’d rather have skin that actually is healthy.
But there’s no Sophie’s choice to be made when it comes to the health and beauty of your skin; it’s possible to have both at once.
You’ve heard it before: Skin is the body’s largest organ. It’s the barrier that keeps our insides in and the outsides out (including harmful bacteria and the elements). Skin helps regulate body temperature and, via nerve endings, gives us the sensation of touch.
“It’s more than just a simple organ,” explains Dr. Jaggi Rao, a dermatologist, University of Alberta clinical professor and Avenue Top 40 Under 40 alumnus. All sorts of health conditions can change the appearance of the skin, making it a kind of barometer for your overall health. Liver problems, for instance, can cause skin to yellow (a condition called jaundice) and blood vessels to burst. Thyroid troubles can cause the skin on your face to get puffy or doughy-looking. Inflammatory bowel disease can create nodules on the skin.”Almost every organ internally can have a skin manifestation,” he says.
And, of course, the appearance of your skin can signal the presence of cancer. When a mole grows, changes colour or becomes asymmetrical, it may indicate melanoma (as I discovered). A new bump or rash, or cuts that don’t heal, may alert doctors to basal cell or squamous cell carcinomas. When a woman comes into Rao’s clinic complaining of acne, facial hair or melasma (dark spots appearing on the face), she most likely has a hormonal imbalance – but there’s a small chance she has a breast cancer.
How a patient feels in their skin can also tip doctors off, says Edmonton dermatologist and U of A clinical professor Dr. Marlene Dytoc. Once, a patient came to her complaining of itchy skin, but without a rash. The cause? Bladder cancer. Patients suffering from a mysterious itch can also be suffering from thyroid, kidney or liver problems. “I’ve diagnosed a number of patients who just had an itch but nothing to see,” she says.
It’s a compelling reason to seek skin treatments from an experienced dermatologist, as Dytoc recommends. But, on top of identifying health problems, a doctor or highly trained nurse can also safely administer cosmetic procedures like laser treatments or Botox injections.
In Alberta, spas can offer laser treatments without physician supervision. So before you buy that Groupon, do some research about how the company operates.
But, of course, there are plenty of ways to rejuvenate your skin that don’t involve setting foot into a clinic or medical spa at all.
There are two main determinants of skin aging, says Dytoc: Intrinsic, meaning your genetic makeup; and extrinsic, meaning outside factors like sunlight, which causes lines and wrinkles. “We can’t do much about genetics right now – hopefully in the future – but photo aging is something we can address at the moment,” she says. That’s why the best thing you can do to both keep your skin healthy and have it look better is to protect it from the sun. This isn’t true just for pasty-faced caucasians like me: “You can have sun damage and skin cancer even if you’re dark-skinned,” says Dytoc.
Dytoc recommends staying out of the sun as much as possible, particularly between the hours of 10 a.m. and 2 p.m., when the sun is highest in the sky for much of the year. In warm weather, sunscreen should be applied every two hours or, if you’re spending time around water, whenever you get wet. Sunscreen should be rated SPF 30 for the face and SPF 50 for the body, and provide protection from both UVA and UVB rays.Most people use only half the volume of sunscreen dermatologists recommend, so apply liberally.
Now that I’m a melanoma survivor, my docs advise me to wear sunscreen every single day – even when the snow flies. But according to Rao, wearing sunscreen in the wintertime makes sense for everyone. “There’s a lot of light in Edmonton in the winter,” he explains. “And, sometimes, at colder temperatures of the year, we get a higher UV index.” It doesn’t help that the sun’s rays reflect off of the white snow, which is why skiers can end up with bad sunburns. On top of this, plenty of Canadians take trips down south in the winter and may neglect sun protection while they’re away. So if you’re lucky enough to be a snowbird, don’t forget the hat and sunblock when you cross the border.
Like sun protection, there are both health and beauty benefits to keeping your skin well-hydrated. Rao explains that, when skin dries out, it can cause eczema – patches of itchy, scaly skin – and acne, since the skin may compensate by creating more oil. Dry skin is also prone to getting wrinkles and lines (the downside of my zit-free youth, I’m discovering). Edmonton’s dry climate makes it hard to keep our skin hydrated, so a good moisturizer is crucial. “Hydration has to come from the outside in,” says Rao.
Dytoc explains that a good moisturizer draws water from the lower levels of the skin upwards, while trapping the water in the skin and making the skin feel smooth and supple. It should also be hypoallergenic and irritant-free, since many people with dry skin also have eczema, which makes skin more sensitive. Some moisturizers on the market contain seramide, a chemical found naturally in skin that can reduce brown spots, and also sun protection.
To get the most benefit from your moisturizer, apply it when the skin is damp. “If you apply a cream after the shower, you’ll absorb more of targeted ingredients then when it’s dry,” says Dr. Ron Brown, a physician and medical director of Sherwood Park medical spa True Balance. It’s also wise to apply a moisturizer before bed at night and make sure to drink plenty of water during the day.
When nurse Laura Riehl-Tonn began working in dermatology 11 years ago, she wasn’t interested in getting any work done herself. She declined the Botox treatments offered by the clinic’s dermatologist, figuring her high-end skin-care products would soften her frown lines. Eventually, she gave it a try and was shocked at how well it worked.Now she gets Botox injections and dermafillers, knowing that genetics trumps even the most conscientious skin-care regime. “Some people have great skin and some really don’t,” she says.
As the advanced nurse injector at MD Spa and Laser Clinic in Beaumont, Riehl-Tonn administers injections of Botox and dermafillers to clients. Botox, of course, is the drug made from the bacteria that causes botulism and has been used cosmetically since the early 2000s. Although it sounds a bit terrifying, it does amazing things to frown lines and crow’s feet by relaxing certain muscles in the face. Botox can also treat chronic migraines, bladder spasms, and severe underarm sweating.
Fillers work by adding volume to areas of the face that have begun to sag or shrink over time (like cheeks and lips) and by filling in wrinkles. Many different materials, including collagen, can be injected for this purpose, depending on whether the effect is meant to be permanent, semi-permanent or temporary. “With permanent or semi-permanent fillers, you need surgery to remove it if something goes wrong,” says Riehl-Tonn. That’s why she’s a proponent of temporary fillers, specifically products made from hyaluronic acid, a chemical already found in skin tissue. If the filler isn’t working properly, she can inject an enzyme into an area to break down the chemical.Riehl-Tonn is a big believer that less is more. She wants to help clients age gracefully, not stop the clock: “It’s good to have some lines. It’s beautiful, too, to age, and it’s something we should embrace.”
While she won’t try to deter clients from softening frown lines, which can make people look angry when they aren’t, she encourages people to keep the pretty smile lines around their eyes.
For your skin, light is both friend and foe. The sun’s UV rays can damage the skin, while laser therapy can actually improve its appearance by reducing redness and brown spots, wrinkles, scars and more. Lasers can also improve the tightness of skin. Although there are many lasers out there, Brown considers Intense Pulsed Light (IPL) to be the most cost-effective option for improving pigmentation and redness.
But laser procedures aren’t painless or without risks. While fractional lasers target certain areas of the skin with minimal discomfort, ablative lasers are more aggressive and can cause some crusting or oozing. That’s why Dytoc uses fractional ablative radiofrequency, which can be applied to many of the same problems. This technology involves sending high-frequency sound waves into the skin for the purposes of rejuvenation, but also treating acne and acne scarring.
When it comes to cosmetic dermatology and skin rejuvenation, new technologies abound. Case in point: platelet-rich plasma. This technique involves injecting patients’ faces or scalps with platelets and growth factors derived from their own blood, says Dytoc. This may be helpful for both skin rejuvenation and hair regrowth, but it’s not yet a common procedure in Edmonton.
Another new technology is bioidentical hormone therapy (BHT), which aims to improve a patient’s overall health – and improve the look of the skin – via hormone supplements. “The concept is to take a patient’s blood work, analyze it, determine what’s deficient, and supplement it in some fashion using a cream,” says Rao. While there’s evidence to suggest it does improve the appearance of skin, side effects and long-term consequences aren’t understood: “I’m very cautious about it.”
Brown is also hesitant to embrace cutting-edge technology, preferring to wait out the fanfare and see whether a product is as effective and safe as a company proclaims. “There’ve been so many that have fallen by the wayside.”
With your skin’s health on the line, early adoption might be best reserved for the next iPhone or social-media platform.