Well- if we knew the answer to that question, there would only be one brand of skin care products instead of hundreds or thousands. The answer is that there are many great ways to take care of your skin and that each person is different.
There are two things that work for sure:
Sunscreen! Everyone who is concerned about their skin should be wearing sunscreen every day and avoiding sun exposure. This is the most important way to avoid skin aging and reduce the risk of skin cancer. There are many types of sunscreen, and I won’t go into all of them here. The most important thing is that you find one you like and wear it all the time.
Retinoids! This is the only other type of skin care that we know for sure works. Retinoids work by causing skin cells to turn over more quickly and also prevent collagen breakdown. They are also used to treat acne. There are many different retinoids, both non-prescription and stronger prescription strengths. Many people have sensitivity to retinoids and can have redness and irritation when they first start using them, but if you start with a lower strength product and stick with it, you can usually build tolerance and get past this phase.
Beyond these two types of products, we don’t have any evidence based studies. Other categories include moisturizers, antioxidants, and growth factors. I like to approach skin care the way I grow my garden- I try different products out, and when I find something that works and I love, I stick with it. The same night cream that I swear by might give you a rash, or maybe you hate the way a certain product smells.
My personal favorites (for now):
Sunscreen: Avene Antirougeurs Day Redness Soothing Cream- this sunscreen doesn’t irritate my skin or pill and it has a slight green tint that disguises redness. I like to combine it with the Antirougeurs Fort Relief because I have sensitive skin with red spots.
Retinoid: Generic tretinoin cream. It works. I’ll write you a prescription.
Night cream: Replenix Restorative Nighttime Biotherapy. It has a little of everything in there and I like that you can use the pump but also has a screw on cap so you can get the last little drops out of there- who wants to waste fancy face cream?
Beyond Basic Skin Care
There are a lot of ways to treat the surface of the skin- these methods all basically work by buffing the outer layer of the skin to renew skin cells. These include facials, chemical peels, microdermabrasion, non-ablative laser treatments. All of these can improve the outer skin texture and appearance. However, these do need to be repeated regularly as the results go away fairly quickly.
Other treatments work beneath the surface of the skin for more lasting results:
Toxins like Botox, Dysport, Xeomin and Jeuveau work by paralyzing the muscles in the face to soften existing wrinkles and prevent new ones from forming. It is really important to get injected by someone who understands where these muscles are located and how they interact to get the best results. For example, overinjecting forehead lines can get rid of wrinkles but lead to a droopy brow. All of the toxins do wear off, usually after a few months, so these also need to be repeated regularly for the best results.
Fillers are gel type substances that are injected under the skin to add volume and disguise indentations or wrinkles. There are many types of fillers out there, many are made of hyaluronic acid in different levels of thickness. Most fillers last about 6 months to a year, so they are longer lasting than toxins. It is important to inject the right type of filler in the right location to get the best results. If the filler enters an artery in the face, it can lead to tissue dying or even blindness if it is injected near the eye, so it is especially important to get filler injections from someone who really understands the anatomy of the face and where all of these vessels are located. The fillers we most commonly use are Juvederm, Restylane, Voluma, Vollure and Volbella. Sculptra is a different type of injectable that works by stimulating the body to make more collagen. The effects are longer lasting, usually 1-2 years but a series of 2-3 injections is recommended for best results.
Deeper skin treatments involve deeper layers of the skin, such as ablative laser treatments, radiofrequency microneedling (Fractora), and radiofrequency with liposuction (Facetite). Because these treatments go deeper into the tissues, local anesthesia and sometimes sedation can be required. They have longer lasting results with actual skin tightening, but they are more invasive, and will have a bit more recovery involved.