Collagen Conundrum
By Jennifer Tung

Cosmetics companies are bending over backward to find a cream that regenerates collagen, the basis of smooth, plump skin. The challenge: In order to stimulate new collagen, a product's active ingredients must penetrate the junction between the top layers of skin and the dermis – and that's not easy. "The epidermis itself prevents things (including collagen) from getting into the dermis," says San Francisco dermatologist Richard Glogau. "I see creams that demonstrate activity in a test tube, but it's an enormous leap to say that they'll have the same effect on skin, because the ingredients will never arrive at the right place." Especially if the main ingredient is collagen. Collagen is a large molecule. You can't put something like that through the skin topically. Even soluble collagen, which has been broken down into smaller components, may still be too large to permeate the skin. There are ingredients that dermatologists are hopeful about: Topical vitamin A (Retin-A, Renova, Tazorac, and retinol) can stimulate collagen production substantially, Glogau says. Dermatologists also report that vitamin C, copper and synthetic growth factors can be successful in boosting collagen. Until more research is done, however, the experts disagree on exactly how helpful each of these ingredients is. Bottom line: Collagen in a cream

Out, Damned Spots
By Jenna McCarthy

The occasional blemish is an increasingly common part of adult life. The latest treatments can effectively make it a thing of the past.

Facial Expressions

Dermatologists tell patients not to pick, poke, or otherwise maul their pimples. And yet nearly every facial includes the extraction process, in which the aesthetician presses her gloved fingertips or an instrument on either side of even the tiniest blemish until it's contents erupt. "Steaming and extractions can be very beneficial for blackheads and whiteheads," Jaliman says, explaining that steaming softens sebum so it can be easily removed. According to the experts, that nifty tool known as a comedone extractor is better at this task than fingers because the even pressure won't stretch or tear pores. When acne is visible, an aesthetician should avoid creamy or oil-based products, but there's nothing wrong with requesting gentle, noncomedogenic alternatives. If acne lesions are inflamed, it's best to postpone a facial, as "handling can make the situation worse," Glogau explains. Stroking the skin can disrupt any inflamed cysts. (Manipulating facial muscles can also break down collagen and elastin, Jaliman says, producing more wrinkles.) Women using topical antibiotics should bring them to apply after a facial, along with whatever makeup they normally use. "I encourage women to cover their pimples," Jaliman says. "They're much less likely to pick at them if they can't see them."

"There's been a lot of speculation about adult female acne being a relatively modern phenomenon, " says Dr. Richard Glogau, professor of dermatology at UCSF. "It's certainly a lot more common than it was 100 years ago."

"People who have inherited sebaceous glands that are sensitive to hormonal fluctuations react by making high amounts of oil," Glogau explains. Because of the genetic component, the oil-production tendency can come from one parent or both, and there's no gender link, and the fact that there's no actual cure for acne, Glogau believes that most afflicted adults suffered to some extent as teenagers as well.

"This is less about bacteria than about mechanics," Glogau says. "Acne lesions are very fragile, and any type of repeated banging or pulling can make them worse."

Face The Facts

Lie: Dirty skin causes acne.

Truth: Many people think if you wash enough, the acne will go away." Dr. Richard Glogau says. "But washing is a really good way to irritate it.

Next on Lines

Botox is no longer the only injectable botulinum toxin in town. One newcomer, Myobloc, is in clinical trials for FDA clearance. Another, Dysport, is approved in the U.K. and is expected to be introduced in this country by the end of next year with a different name.

There are eight types of botulinum toxin, each with biologically distinct properties like acidity and protein content, and each with different effects. Myobloc, a type B botulinum toxin, has already been approved by the FDA for the treatment of neck and shoulder spasms.

For now, doctors can only use it off-label cosmetically for crow's-feet and other sets of multiple wrinkles, its most effective domains. Dysport is a type A botulinum toxin like Botox. "The injection of botulinum toxin, in whichever form, is one of the most elegant solutions for wrinkles to date," says San Francisco dermatologist Dr. Richard Glogau, who is conducting FDA studies of Botox and Myobloc. "All three of these, Dysport included, are going to find their niche."

Here's a guide to those niches.

The Botulinum-Toxin Tally

Botox

Is approved for cosmetic use
Takes effect in 3-5 days
It lasts about three and-a-half months
Pain: The shots sting, but most patients don't require numbing cream

Pros: Considered safe after 20 years of clinical application

Cons: One in 300 patients gets a drooping eyelid for up to three weeks. The body can become immune.

Myobloc

No clinical trials are under way
Takes effect in four to six hours
It lasts six weeks to three months
Pain: Injection hurts more than Botox or Dysport - a lidocaine pre-injection helps

Pros: Quick results - can be used as a booster shot

Cons: Painful. May take more injections to achieve aesthetic effects of Botox

Dysport

Not approved for cosmetic use and not available in the United States
Takes effect in three to five days
Lasts about three and-a-half months
Pain: The shots sting, but most patients don't require numbing cream

Pros: About 10 percent cheaper than Botox in Britain

Cons: Higher in protein than Botox; could lead more quickly to immunity.