Health: The price of eternal youth

New anti-ageing treatments promise to slow the process of growing old - if you can afford them.

Once, the bearer of a crinkling complexion had two options: to grow old gracefully or to submit to the scalpel. Now dermatologists seem to have discovered a Third Way. The latest option for those hoping to turn back time lies in cosmetic dermatology, a relatively new medical specialty. This involves the use of recently developed skin drugs to reverse some of the age-related changes that mark out mature faces, and devices, such as lasers, that quite literally obliterate them.

As with so much in Western life, the US is at the forefront of these developments. There are just 300 dermatologists serving the entire UK population, compared with tens of thousands in the US. Extraordinary advances in the understanding and treatment of ageing skin has meant that there are many more medics willing and able to eradicate your lines and age spots.

Not all wrinkles are inevitable signs of the ageing process. Many, if not most, are in fact the result of sun damage. The result of both holiday burn and imperceptible daily wear and tear is what's now termed a "prematurely" aged skin - a thinner, less elastic dermis (the lower level of your skin) and a thicker, toughened epidermis (the outer layer). The naturally aged skin, by contrast, exhibits a fine, thin epidermis and a springy, thick dermis with lines forming almost exclusively where the skin folds to allow for facial movements.

So if you feel your face belies your youthful grace, what exactly can cosmetic dermatology offer? An initial foray into this brave new world might involve alpha hydroxy acid creams or peel procedures. This family of naturally occurring acid compounds have been the darlings of the cosmetic cream concocters for some years now (with no drug classification, AHAs, as they are known, are open to use, and indeed abuse, by anyone with a mind to create a face cream). In the dermatologists' rooms they are administered at much higher percentages than you can get over the counter - anywhere from 15 per cent in a cream to 90 per cent in a chemical-peel procedure. These acids dissolve the protein chains that bind skin cells together and, depending on the concentration used, will do anything from brighten a young but dry and dull complexion by clearing cellular detritus, to burning away sufficient layers of epidermis in older skins to engender fresh new growth devoid of many of its previous lines and blotches.

Next on the agenda might be a vitamin-A-derivative preparation. If your skin displays many of the classic signs of UV- induced premature ageing or photo-damage - thick, rough, brown-spotted surface, with finely criss- crossing lines over cheeks and forehead that are normally undisturbed by expression creases - tretinoin, or Retin-A as it is familiarly known, may be indicated. It is a drug and so requires a prescription, and was first used in the early Eighties by a US dermatologist, Dr Albert Kligman, who administered it to acne patients. The cream did such a good job of getting the skin to increase its cell turnover rate that it prevented dead skin cells from lingering long enough to clog pores and cause spots, and sufficiently increased the volume of cells in the epidermis to plump out wrinkles.

If your concern is, instead, the depth of the creases that traverse your face, or the deflating nature of once full and youthful lips, a filler may be prescribed. Collagen is the best known of them, but is rapidly being eclipsed by newer replenishing agents. Your own fat can be a source of facial-line filler and many dermatologists now believe that it can be the longest-lasting of all the temporary fillers. The newest filler, however, is permanent, albeit reversible. Softform is a surgically inserted, hollow, pliable tube of non-porous Gortex. It is usually used along naso-labial folds (the "smile" lines running from the nose to around your mouth) or along the vermilion border of lips to increase their volume. Once in place, your own tissue grows into the hollow to anchor it.

Botox is perhaps the most exciting weapon in the dermatologist's anti- ageing arsenal. It's not a filler, but it can soften existing lines and prevent future ones. It is taken from the botulism bacterium, but is purified before being injected into the muscles that are responsible for frown lines, crow's feet, and even neck lines. Its effects are temporary, up to three months for the first injection but progressively longer for each subsequent treatment.

But if your complexion is crinkled beyond the help of these methods, you might try laser resurfacing, the newest variation on the chemical- peeling process. The latest generation of lasers can obliterate a birthmark, zap warts, erase spider veins, remove unwanted hair, and iron out wrinkles and age-spotted skin.

Of the many different lasers in use, the two employed for skin resurfacing procedures are the CO2 and the erbium-YAG. Both work by vaporising the water content of a cell, which results in a burn. The skin is so keen to regenerate itself that it does so without bothering to replicate many of the lines it built up over time.

With all new medical technology come voices of caution. And those raised in relation to cosmetic dermatological should be doubly heeded, not least because the rules and regulations governing who can do what to whom in this country are astonishingly lax. You can't really go too far wrong with AHAs, but higher-strength ones - those above 15 per cent - should be used under the supervision of a trained physician. Retin-A, or Retinova, can only be prescribed, but some disreputable companies got around this by setting up GPs in offshore locations who issued "prescriptions" to mail-order customers. Use too much Retin-A, or use it on the wrong sort of skin, and you can end up with a very red, raw face. And despite their "new improved" status, lasers remain highly destructive. Dermatologists admit they are on a steep learning curve as to what they can do, and that it's a full-time job keeping abreast of the developing technology.

There is now much more than simply "hope" in a jar of skin cream. But those keen to benefit from the latest advances should be aware that these treatments are not as risk-free as the sweet-smelling concoctions we're used to buying. With any cosmetic procedure, you want to be certain you're remedying an existing problem rather than creating a new one.

PS

For a list of dermatologists, contact: British Association of Dermatologists (0171-383 0266)