Q. I have recently read about the benefits of Retin-A® for decreasing wrinkles of the face.  Does this cream treatment really help preserve skin quality?

A. The short answer to your question is absolutely yes.  However, there is more to it than just using Retin-A® to improve skin quality and slow the onset of wrinkles.  First, Retin-A® is an FDA approved prescription cream for the treatment of wrinkles of the face.  It works by stimulating collagen in the skin which helps to smooth out fine wrinkles.  Regular use of this product will help to smooth out fine lines, but not heavy course wrinkles.  However, there are other products that work in conjunction with retinol products (Retin-A®) and will improve the skin more than just using retinols alone.  For example, adding an antioxidant topical serum such as Vitamin C to your treatment program will help slow the daily damage that takes place in our skin, thereby slowing the aging process.  It is important that you select the correct formulation of a Vitamin C.

They are not all equal in terms of the absorption of the key ingredient, Vitamin C.  The best Vitamin C formulation will be available through your plastic surgeon or dermatologist’s office.  A good Vitamin C serum is not cheap, but can work very well in conjunction with Retin-A®.  The third leg of a good skin care program is the use of collagen growth factors such as the product made by the company Skinceuticals called TNS®.  This is a product that contains more than 100 different growth factors that are important in stimulating collagen in the skin.  Like a good Vitamin C product, TNS® is also fairly expensive, but this product has stood the test of time in terms of its ability to improve skin quality, tone, and texture.  To achieve a healthier complexion, it is also helpful to reduce brown spots on the skin.  These brown spots, also called sun spots, are areas of hyperpigmentation caused by years of environmental damage to the pigment cells of the face.  The use of a skin bleacher, such as hydroquinone, can be very helpful in fading brown spots.  Although these spots are not usually harmful, they can detract from a healthy complexion and therefore fading them can make a big difference in the appearance of your skin.

Finally, and perhaps the most import and final leg of a treatment regimen for improving your skin, is the regular use of a broad spectrum sun screen applied during all seasons of the year.  If you are not willing to add a good sunscreen to your daily skin care program, it is probably not worth doing any of the above treatments.  Sunscreen is the least expensive of my recommendations and likely the most important.  A visit to either a dermatologist or plastic surgeon that has a keen interest in skin care and a devoted skin care staff would be of benefit for you as well.

Q. I am contemplating a breast augmentation.  I have heard different opinions about whether breast implants last forever.  Will they eventually break? 

A. This is a simple and short answer.  All breast implants, whether they are saline filled or silicone gel implants, will eventually need to be replaced.  The most common reason for needing replacement is failure or leakage of the implant shell.  I advise my patients who get saline implants to expect 15-20 years before they break, although some will break earlier and some will last longer.  As for silicone gel implants, my recommendation for the new silicone implants is to change them every 15 years.  Be proactive with silicone gel implants and do not wait until they have broken or leaked.  The reason for this is that most silicone implants will likely not be broken at 15 years, and it is a much easier surgery to replace an intact gel implant than one that has leaked its gel into the breast.  You must have a frank discussion with your plastic surgeon regarding this topic.

William Byron Barber II, M.D.

has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com