In Synergy |

5 mins

In Synergy


Dr Maryam Zamani is an oculoplastic surgeon and facial aesthetics doctor. She has gained an international reputation for her pioneering rejuvenation techniques. As founder of the awardwinning MZ Skin range and a pioneering woman in high-performance skincare, Dr Zamani has a unique grasp on the female aesthetic. Owing to her extensive experience in Oculoplastic surgery and skin rejuvenation, Dr Zamani is known as ‘the eye doctor’.

Flawless skin is the most universally desired human feature and is used to advertise health, wellbeing, fertility with an even-toned, clear, and radiant complexion.1Extrinsic ageing includes ultraviolet rays, pollution, and lifestyle choices, such as smoking, diet, and skincare habits; together, this accounts for approximately 80% of visible signs of skin ageing. Intrinsic ageing, determined by one’s genetic make-up, overall health, and stress/ inflammation, accounts for only 20% .1

Extrinsic signs of ageing include dullness, wrinkles, and pigmentation issues. Intrinsic signs of skin ageing include thinning of the skin, fine lines and dryness. Complete renewal of the epidermis takes 40-60 days in the elderly when compared to 28 days in a young adult.2Dermal collagen production decreases by 68% by the age of 80. 3,4When comparing the sun exposed facial skin with the sun-protected skin of the upper inner arm, the difference in pigmentation, skin texture, tone and sagging can be profound. There are now a plethora of services, including injectables, light treatments, laser resurfacing treatments, other energy-based treatment modalities and surgery to help turn back time. However, unless the patient’s at-home skincare routine is addressed, optimal and enhanced results may not be achievable. Daily skincare routines can have a significant long-term impact on the overall quality of the complexion. An individualised at-home skincare routine can help address specific concerns and support professional in-clinic treatments. Skincare can either be composed of cosmetics or FDA-approved actives, including over-the-counter, prescription or cosmeceutical products. A purely cosmetic product or ingredient is used for ‘cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body’s structure or function.’5However, an FDA-approved OTC contains an active ingredient that is capable of altering the structure or function of the skin.

Cosmeceutical is a popular, but ambiguous, marketing term coined by Dr Albert Klingman to describe cosmetic ingredients that have biologically active ingredients.6The combination of OTC and cosmetic skincare can significantly assist in improving skin physiology and conditions, including acne, pigmentation, and overall skin luminosity.

Cleansing, nourishing, and protecting are essential to any skincare regimen. The key attribute to youthful skin is radiance, which is determined by the light reflectance from the surface of smooth skin.1As we age, the epidermal cell turnover slows down, resulting in a build-up of dead keratinocytes and the appearance of rough, dry skin, enlarged pores and poor light reflection. 1

Cleansers and exfoliators are used to remove make-up, pollution, and excess sebum from the skin, while other ingredients are used to enhance and nourish the skin. Exfoliators, in particular, help remove excess corneocyte build- up and stimulates cell turnover. Chemical exfoliates, such as glycolic, lactic and malic acids (AHAs), salicylic acid (BHA), and polyhydroxy acids, like lactobionic acid and gluconolactone, are commonly used with almost immediate demonstrable benefits. Concentrations in excess of 10-15% are often administered in the clinic. Physical exfoliates often contain abrasive particulates creating immediate desquamation, which can disrupt the skin barrier, and for this reason, I do not recommend home use with such exfoliators.

Daily skincare routines can have a significant longterm impact on the overall quality of the complexion

Skincare formulations should help enhance the activity of specific ingredients. Clinical testing and before and after photos are useful in making educated decisions. Epidermal and dermal thinning occurs as keratinocytes and fibroblasts slow, and this is further exacerbated by UV exposure.1,7Epidermal thickness decreases by 6.4% per decade. Dermal thinning decreases by 6% per decade. 1,8

A cornerstone in the prescriptive treatment of ageing skin has been in the form of tretinoin, a topical form of vitamin A that functions to modulate the proliferation and differentiation of collagen. The non-prescription forms of retinoic acid precursors are much lighter than the prescription all-trans retinoic acid. Improving the skin barrier can be achieved with humectants like glycerine and hyaluronic acid, as well as ingredients that help prevent transdermal water loss like petrolatum. Ceramides and lipids can also function to strengthen the skin’s barrier function and can be particularly useful with inflammation of the skin. In my practice, less is more, and I recommend a limited number of ingredients at the same time.

Acne is a complex condition involving excessive production of sebum, bacterial proliferation and an inflammatory immune response that can require a combination of treatment modalities to improve. Similarly, pigmentary issues need to use a combination of treatments containing prescription, or non-prescription, strength hydroquinone and retinoids and sun protection to help lighten abnormal skin pigmentation. Brightening agents like kojic acid, AHAs and vitamin C can also be used in pigmented skin. The use of daily sunscreen is paramount to help block UVA and UVB rays.

The correct at-home skincare regimen can work synergistically with in-clinic procedures to maximise the outcome and increase the longevity of benefits.


1. Katie Rodan, MD, Kathy Fields, MD, George Majewski, and Timothy Falla, PhD. Skincare Bootcamp: The Evolving Role of Skincare. Plast Reconstr Surg Glob Open. 2016 Dec; 4(12 Suppl): e1152.

2. Sadick NS. Futuristic approaches to skin care. In: Sadick NS, Lupo M, Bersen DS, editors. Cosmeceutical Science in Clinical Practice. Boca Raton, FL: CRC Press; 2010.

3. Varani J, Dame MK, Rittie L, et al. Decreased collagen production in chronologically aged skin: roles of age-dependent alteration in fibroblast function and defective mechanical stimulation. Am J Pathol. 2006;168:1861–1868.

4. Bonta M, Daina L, Muţiu G. The process of ageing reflected by histological changes in the skin. Rom J Morphol Embryol. 2013;54(3 Suppl):797–804.

5. Federal Food, Drug and Cosmetics Act. 1938. Available at: http://www.fda. gov/regulatoryinformation/legislation/ federalfooddrugandcosmeticactfdcact/.

6. Farris PK. A Critical Look at the Term Cosmeceutical: Descriptive or Deceptive? Dermatology Times Available at: http:// dermatology-times/content/tags/cosmeceuticalproducts/critical-look-term-cosmeceuticaldescriptive-o.

7. Shuster S, Black MM, McVitie E. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol. 1975;93:639–643.

8. Branchet MC, Boisnic S, Frances C, et al. Skin thickness changes in normal ageing skin. Gerontology. 1990;36:28–35.

This article appears in September 2022

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September 2022
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