Dr. Jessica J. Krant is a dermatologist based out of New York and founder of Art of Dermatology, LLC. She is also the assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City.
Dermatologist Jessica Krant reveals the products that can save your skin--while saving you money.
Posted on November 01, 2011
Navigating the world of anti-aging creams is a harrowing process. They range in price from $15 at the drugstore to $400+ at department-stores, all promising smoother, tighter, more youthful skin. So which ones will actually work--without breaking the bank? We posed this question to Dr. Jessica Krant, a New York dermatologist with a passion for helping women make educated decisions about their skin. Unlike many dermatologists, Dr. Krant has no financial relationship with any beauty companies, so she’s a great source of honest info.
Before you start recommending products, can you explain why there is so much confusion around this issue? How can so many different products, at such different prices, all claim to work?
It's very hard to know what "really works.” To understand why, it's helpful to understand what a "cosmeceutical" really is. Riding the gray area between cosmetics, which only claim to alter the appearance of skin, (think bronzer or eyeshadow), and pharmaceuticals, which alter the body's biology (think Botox), cosmeceuticals try to have it both ways. Companies that make these products want the public to believe they actually do change skin scientifically, but they don’t want to spend hundreds of millions of dollars and many years going through FDA drug trials to prove it.
The result: most anti-aging creams, both in the drugstore and in the department store, avoid the FDA entirely, which means they can make lots of claims without the need to prove anything. They just have to pass muster with the Federal Trade Commission, which requires that they maintain a level of safety. (Even this is difficult to rely on, since most safety issues come up only after the product has been out on the market and caused enough trouble to get attention.)
Wait, so are you saying that none of these products work?
It's possible some anti-aging products really do work, but there is currently no independent group that is testing and validating these products’ claims. A company may advertise that it's put a product through "clinical trials," but that only means it has been tested on actual humans--as opposed to cells in a dish. Clinical research is vital, but when it's presented by the company that's selling the product, you need to take it with a grain of salt. Often, results are reported such as a reduction in the "appearance" of fine lines or dark spots. That does not mean that the lines and dark spots have been reduced, only that it looks better.
What ingredients have been tested so that we KNOW they have benefits? Are there inexpensive products that contain these ingredients?
The most proven anti-aging ingredient on the market is the only one that has gone through the formal FDA-approval process. This is tretinoin, a vitamin-A derivative known as a retinoid. The most recognized brand name is Retin-A. Tretinoin is the gold standard for anti-wrinkle treatments. It's also proven to reverse other signs of aging, as well as help to reduce the risk of skin cancer by keeping skin cells growing in a healthy, ordered way. Because it is irritating to skin if used improperly, hard to get because it requires a prescription, and expensive, we look for other anti-aging options.
So are there other ingredients that have been shown to work?
Several ingredients on the market are known to have real results in basic science research--the science behind them looks good, even if they haven't been formally tested by the FDA. These include over-the-counter retinoids (retinol, retinyl palmitate, and retinaldehyde), antioxidants such as soy, green tea, feverfew, licorice, mushrooms, vitamin C, coffeeberry, and other formulations proprietary to different companies. Finally, glycolic and salicylic acid and their relatives are also useful ingredients in many anti-aging formulations.
What affordable products do you recommend to your 50+ patients and why?
In choosing anti-aging products, try to go for the most emollient (moisturizing) versions tolerable, such as heavier night creams. This allows the skin's top layers to absorb creamy moisture which allows it to be plumped up, giving more of a translucent glow as well as swelling tiny lines and wrinkles full of moisture so they smooth out temporarily. In fact, this is how some of the most expensive anti-wrinkle creams do their best work.
Is there a benefit to spending more to get a prescription anti-aging cream?
The benefit of using tretinoin by prescription is that it has the most research evidence behind it; it's rigorously evaluated and proven in an unbiased way; and it not only reduces the "appearance" of fine lines (which plain moisturizers also do), but actually does reduce the fine lines. A tube of tretinoin, which is sold under various brand names as well as the generic, does cost a bit more than some drugstore creams, but less than some department store creams [editor's note: a prescription for a 20-gram tube of tretinoin could cost anywhere from $40 for a generic to $75 for a name brand]. However, a little goes a long way, and it may be the best bang for the buck, if one knows how to use it properly to avoid issues.
Do you recommend any expensive anti-aging topicals--department store brands? Are there any that you think have interesting science behind them?
Physician-dispensed anti-aging topicals and some of the more expensive department store brands claim to have higher concentrations of active ingredients, formulated in more expensive ways, to justify their higher prices. This may indeed be true, but since formulas are often proprietary, it is hard to know exactly how much more of the ingredient you're getting. Some of the more reliable brands are SkinCeuticals, which has highly researched antioxidant serum formulations; Revaleskin, which is a line containing active coffeeberry extract that performs multiple anti-aging functions; Neocutis, a company whose product line is based largely on their proprietary PSP (purified skin protein) formula, which aids wound healing—a finding they extrapolate to claim anti-aging effects in intact skin; Obagi, a line which contains many well-tested products; and Neova, a line which contains many copper peptide and antioxidant products.
What anti-aging products and services are, in your opinion, worth a “splurge?” In other words, they may be more costly, but they make a huge difference in the longterm?
In my opinion, any of the products mentioned here are worth a try, remembering that it may take 6 months to be able to tell whether a product is making any difference. The most reliable anti-aging treatments are still tretionin--the prescription retinoid--and some of the more invasive procedures, including peels, Intense Pulsed Light photofacials, laser treatments, and the injectable neurotoxins (Botox, Dysport) and fillers (including Restylane, Juvederm, Radiesse, Sculptra, and others). All of these treatments have risks that are important to discuss in great detail with your dermatologist before starting, to have a clear understanding of the medical risks involved as well as costs and realistic expectations of change and length of benefits.