By Katie Lau
Upon meeting Bianca Di Salvo, you would never have guessed she was sixty-six years old. Even bare faced, her skin is glowing, her bright eyes dart with energy, and she radiates a youthful spirit.
Di Salvo credits all of this to her painstakingly meticulous skincare routine, honed over two decades. Every morning, she washes her face with jojoba oil cleanser, then presses in witch hazel toner to tighten her skin. Next, she applies her collagen boosted and vitamin C-infused eye cream to instantly target fine lines and wrinkles. This is followed by a serum bursting with natural neuropeptides and melon leaf stem cells, and lastly, a layer of anti-wrinkle firming moisturiser with grape seed extract and hydroxy acids. Before sleeping, she uses a different round of products. “No one ever believes I’m sixty-six”, Di Salvo says. “They always mistake me for twenty years younger.”
Skincare is a massive, billion-dollar industry permeating our lives, through television adverts, YouTube influencers, magazines, billboards – you name it. Many of us want better skin. Many of us want to prevent showing our natural aging process. Yet it seems as if companies are always pushing customers to buy more and more products. Companies will pounce on every opportunity given to play on people’s insecurities.
So, do skincare products that claim to “lift”, “tighten” and “improve the appearance of fine lines” actually work? Is Bianca’s skincare routine really “worth it”, as L’Oreal would say? This review will discuss the scientific basis behind some of the common ingredients in anti-aging products.
Ultraviolet (UV) radiation generates reactive oxygen species (ROS) that can oxidise nucleic acids, lipids, and proteins in the skin. This is associated with skin cancer and premature aging of the skin (photoaging). UV radiation has also been shown to induce matrix metalloproteinases (MMPs), which degrade proteins in the extracellular matrix, including collagen and elastin (Nolan & Marmur, 2012). The skin, however, can protect itself using antioxidants – these neutralise the ROS. This has led to the skincare industry scrambling to label their anti-aging products with antioxidants. Retinoids are derivatives of vitamin A and are naturally occurring antioxidants in the skin. They can be present as Retinol in over the counter (OTC) products. A study in 2000 found that treatment with Retinol on both photoaged and naturally aged, sun protected skin led to decreased MMP production and increased collagen synthesis (Varani et al., 2000). Retinol is one of the best studied ingredients in OTC products and consistently has been shown to improve photoaged skin. Randomised, double-blind, 24 week trials have shown retinol improves fine lines associated with aging, most likely as a result of increased collagen production, but also increased induction of glycosaminoglycan – extracellular matrix components that increase tissue stiffness (through cross linking to other matrix proteins) and retain substantial amounts of water (Kafi et al., 2007).
Hyaluronic acid (HA) is a glycosaminoglycan distributed throughout connective tissues and a key component of the extracellular matrix. It is difficult to find the packaging of an anti-aging cream that does not scream its name in capitals. It is used as a dermal filler in cosmetic surgery, to fill in facial wrinkles and provide facial volume. Due to its strong water-binding potential, it is proposed to retain moisture and elasticity in the skin. A 2011 study found improved measurements of wrinkle depth after sixty days of using 0.1% HA formulations, as well as improved skin hydration and elasticity (Pavicic et al., 2011). Regular use (for over three months) of HA-containing anti-wrinkle creams has shown positive effects on skin elasticity and tightness – assessed by measures of wrinkle depth, skin-tightness, and elasticity (Poetschke et al., 2016). Analysis of scientific literature has found HA does indeed treat skin defects including wrinkles and aging and has been associated with inducing fibroblasts (cells that secrete collagen proteins). Many studies have found that HA-based formulations play a significant role in restoring facial volume and skin elasticity, demonstrating that this glycosaminoglycan is a promising biomedicine for slowing down physiological changes in aging (Bukhari et al., 2018).
This all sounds hopeful. Maybe Bianca is right after all. However, and a big however: there are many studies evaluating specific active ingredients, yet there are only a few studies evaluating them in OTC formulations, which contain a mix of other ingredients; there is a lack of rigorous trials on the efficacy of these products (Nolan & Marmur, 2012). It seems there is a clear necessity for more of these – especially since such products form a significant percentage of the cosmeceutical industry. With a lack of information, it is difficult for consumers to make well-informed choices that do not exploit their desire to care for their skin.
What is more, all this conflicts with dermatologists, who state that only retinoids have been proven to increase collagen; other products that claim to do not, unless they are retinoids. Most anti-aging products have apparently never been shown to achieve what they claim to: through a “placebo-controlled double-blind study that has been approved by the FDA”, according to Rebecca Baxt, a dermatologist in Paramus, NJ. And when it comes to hyaluronic acid, “We’re talking about the surface of the skin. How do we know the molecule is even penetrating beyond the epidermis? The molecule is too big to penetrate the skin. That’s why we have to inject it.” According to Linda Katz of the Food and Drug Administration (FDA), “to say something increases collagen production is a drug claim”, meaning it is a term over which the FDA has purview. It is an “illegal claim” to use such a statement for anything other than retinoids. As for Shari Lipner, a dermatologist at New York Presbyterian and Weill Cornell Medicine, “Some of these products are interesting, such as antioxidants; peptides, which are small proteins that can supposedly stimulate new cells to grow and encourage skin to heal; alpha hydroxy acids that can exfoliate the skin. But really, these are based on theoretical evidence or really small studies that were not well-controlled, so I don’t really recommend any of the products to my patients.” She agrees that retinoids and retinols are “really the only medication that we have evidence for in reducing the signs of skin aging.”
None of this fazes Bianca Di Salvo, who says that regardless of what the science shows – her skincare ritual keeps her feeling good about her age: “Just the fact that I’m taking care of myself makes me feel better.”
It seems the jury is still out on anti-aging skincare. Some components are undoubtedly effective, just how much effective is still to be determined, considering that formulations are not the same as injections, and positive results are not the same as rigorous trials.
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Nolan, A. & Marmur, E. (2012) Article. JDDonline – Journal of Drugs in Dermatology. 11 (2), Available from: https://jddonline.com/articles/dermatology/S1545961612P0220X. [Accessed Oct 17, 2020].
Poetschke, J., Schwaiger, H., Steckmeier, S., Ruzicka, T. & Gauglitz, G. G. (2016) [Anti-wrinkle creams with hyaluronic acid: how effective are they?]. MMW Fortschritte Der Medizin. 158 Suppl 4 1-6. Available from: https://pubmed.ncbi.nlm.nih.gov/27221554/. Available from: doi: 10.1007/s15006-016-8302-1. [Accessed Oct 17, 2020].
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