The First Step: Caring For Your Skin
Dan's Papers, September 3, 2004

Dr. Copeland explains the importance of skin and skin care.

by Dr. Michelle Copeland

Your skin is the way the world sees you. More than any other feature of the body, it announces, "I'm young and healthy," "I'm letting myself go," "I smoke like a chimney," or "I still haven't figured out that baking in the sun is harmful." The skin is a living, breathing road map of the lives we lead, right out there for all to see. The largest organ in the body, the skin acts first and foremost as a barrier to infection. Healthy skin is moist and supple; when dry and cracked, the barrier breaks down. Healthy skin constantly regenerates itself. But as we age, the skin becomes sluggish and doesn't "turn over" as quickly. Instead, dead cells pile up, causing wrinkles, discoloration, and laxity. Collagen—tiny fibers that control the elasticity of the skin—loses its alignment as its layers become more loosely stacked. Skin that isn't regularly renewed with healthy, young cells is at greater risk of discoloration, pre-cancerous changes, and malignancy. So taking care of the skin isn't just about looking good; it's part of a comprehensive approach to staying well.

How precipitous is this downturn in resiliency? It depends partly on heredity, musculature, bone structure, and hormones (adequate estrogen is connected to healthy, glowing skin). But there are also environmental factors that speed the skin's descent into old age, and many of these can be prevented. Sun exposure, pollution, smoking and yo-yo dieting are some of the leading offenders.


There are four phases to maintaining healthy skin: cleansing, exfoliating, moisturizing, and sun protection. Here's the drill:

1. Cleansing
For the same reason you brush your teeth every day, the skin surface must be cleansed of millions of bacteria. Inevitably, some of those bacteria find their way beneath the surface through cracks or dry patches, and weaken skin integrity. Regular cleansing helps eliminate these insidious germs. But not just any kind of cleansing will do. Soap can change the pH (or acidity level) of the skin, leading to irritation and dryness. I encourage soap users to ditch their standard bar in favor of a gentler cleanser, without perfume or additives. Such cleansers remove dirt while optimizing the environment for cell renewal. I also recommend using a toner after cleansing. Not the de-greasing, astringent toners that were popular a decade ago that stripped the skin of essential oils, but instead an alcohol-free toner that helps maintain proper pH balance.

2. Exfoliation and Cell Renewal
By removing the top layer of skin cells, the turnover process can be accelerated, and several types of exfoliants have been developed for this. Alpha-and beta-hydroxy acids derived from fruit, plants, milk and other natural sources (like glycolic acid, which comes from sugar cane) are the keys to this process. I suggest following an acid treatment with a topical antioxidant vitamin, such as vitamins C or E, to combat free radicals—the unstable molecules caused by exposure to the sun and pollution that age the skin. We've long known that vitamins are important for healing: Sailors who for weeks went without fresh citrus and hence became deficient in vitamin C would get scurvy and problems with connective tissue. More recently, we've discovered that applying vitamin C directly to the skin improves the alignment of collagen and triggers skin regeneration.

3. Moisturizing
Children's skin is naturally soft and supple, but with aging, the skin cannot replenish its own moisture. Drinking eight glasses of water a day, while good for the complexion, isn't enough to keep skin hydrated. Instead, a penetrating moisturizer is needed to deliver water to the skin's cells. Moisturizers that contain alcohol will exacerbate dryness; those with too much oil clog pores and allow dirt to accumulate.

4. Sun protection
In the summertime, I tend to cultivate a light suntan. I am an outdoors person: I enjoy gardening, swimming, biking, and jogging, and I walk miles to and from work every day. Like most people, I love how the sun feels on my skin. But I try to be smart about the amount of time I spend outdoors, and the kind of protection I wear. Sun penetrates cloud cover and even clothing, so you don't need much exposure at all to get even a little color.

The most effective way to stave off damage, short of avoiding the sun entirely, is to wear a broad-spectrum sunscreen whenever you're outdoors. This type of product blocks both ultraviolet-B light (the rays that burn) and the longer wavelength ultraviolet-A light (which penetrates more deeply). Not all sunscreens shield against both types of light. The most effective ones contain zinc oxide—the white stuff that lifeguards wear on their noses, but now available in a clear formula—which is considered a "physical barrier" because it's almost completely impervious to sunlight. It also acts as an antioxidant. Titanium dioxide is another effective broad-spectrum physical barrier.

SPF (sun-protection factor) is scale for rating the effectiveness of sunscreen against sunburn-causing UV-B rays only. An SPF of 10 suggests that the wearer can stay in the sun ten times longer without burning than they could without protection. But we know that damage occurs long before the skin appears to burn, so I recommend a minimum SPF of 30 if you're outside infrequently—and replenishing it often.

Your skin is the clothing that nature gave you. If you've abused it (as most of us have, to some degree), then cleansing, exfoliating, moisturizing, and sun protection are good ways to undo the damage.

Dr. Michelle Copeland is the first female plastic surgeon in the U.S. to have earned combined doctorate degrees in dentistry and medicine from Harvard University. A leading authority on facial rejuvenation and skin care, Dr. Copeland is the author of the best seller, Change Your Looks, Change Your Life: Quick Fixes and Cosmetic Surgery Solutions for Looking Younger, Feeling Healthier, and Living Better. She is the first and only woman plastic surgeon with her own skin care product line (Dr. Michelle Copeland Skin Care,