Botox and fillers are trending out, skin tightening procedures are in…

With a plethora of internet influencers and beauty magazine editorials offering their opinions, patients may turn to their GP for help improving and maintaining their appearance.

Cosmeceutical options can be really overwhelming, and the field is constantly evolving, says Dr Katherine Armour, a Melbourne-based medical and cosmetic dermatologist. “The things that come from beauty editors make me laugh sometimes because they’re just so hard to undo.”

The most widely believed myths, in her experience, are about drinking water for skin hydration, Vitamin C as a necessity, and the need for an eye cream. “Don’t spend more money on the same thing that is in your night cream, but in a smaller jar and is more expensive!” she laughs.

“Less is more, most of the time,” Dr Armour says. “Sunscreen’s about 99% of the battle, to be honest. The other stuff’s irrelevant if you’re not doing sunscreen.”

Apart from sunscreen, Dr Armour’s top recommended products are retinoid/Vitamin A and niacinamide/Vitamin B3 — or another antioxidant such as vitamin C or astaxanthin. However, she prefers astaxanthin over vitamin C “because it’s much better tolerated and it’s actually more potent.”

“Even just A and B3 is enough,” she says, “because if you start using Vitamin A and Vitamin C, a vast majority of people get irritation.”

That’s because Vitamin C is very unstable in formulation, and very sensitive to light and oxygen, so people may not even be getting it active on their skin, she explains. “There’s really nothing that Vitamin C does that Vitamin B3 doesn’t do,” she proffers.

Niacinamide is her favourite. “It’s tolerated by pretty much everyone, and it does everything,” she explains. “It stimulates new collagen production. It deals with unwanted pigment like melasma, and it supports epidermal barrier function. It goes well with Vitamin A, so it kind of minimises that irritation if you’re using a retinoid. And it’s anti-inflammatory as well.”

With regards to in-clinic cosmetic procedures, Dr Armour says we are seeing a shift away from botox and fillers. “Everything’s about skin quality. I guess in the past, there’s been a huge focus on volume and wrinkles, so neuromodulators and standard fillers, but the focus for a lot of people seems to be your skin looking good so that you don’t have to wear makeup.”

“There’s a big focus on skin tightening procedures,” she says. “The most effective ones are high intensity or microfocused ultrasound.” They work by stimulating collagen production and tightening the superficial musculoaponeurotic system.

Dr Armour describes these as effective treatments with essentially no downtime, meaning that you still look fine straightaway after the procedure. By contrast, she often warns patients that other office procedures like laser will leave them “a bit peely” afterwards—but that’s a sign they’ve had the intended effect.

Although high intensity and microfocused ultrasound can be expensive, she prefers them to older offerings in the skin-tightening realm that are less effective, such as non-invasive radiofrequency therapy.

“But the thing that’s newest and is also really appropriate for skin quality is biostimulators.” Dr Armour explains that these use injectable hyaluronic acid cross-linked in different sizes to hydrate without volumising. “The really clever thing they do is get your own fibroblasts to make collagen,” she says. Unlike fillers, she describes these as widely appropriate, because they don’t cause plumping. The downside of these treatments is that they need to be repeated for ongoing effect, roughly every six months.

For patients with issues like rosacea or acne, Dr Armour reminds us to emphasise the importance of gentle skin care. By the time they see her, most are quite averse to putting moisturisers and sunscreens on their skin, for fear of worsening their condition. Dr Armour’s take-home message for these patients is that both remain important. She recommends “a light, plain moisturiser and a gentle, non-foaming cleanser will help them tolerate their prescription treatments.” Applying the moisturiser before the treatment may prevent irritation and aid treatment adherence, decreasing the need for dermatology referral.

Dr Katherine Armour is speaking on management options for sun-related skin damage at Healthed’s free 5 March webcast. Register here to attend.

Editor’s note: This is an updated version of an article first published on 21 June 2023. It is reviewed and current as of 23 February 2024.