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Wrinkle Free Forever

The Murad Method for ageless skin
by Howard Murad, M.D., with Dianne Partie Lange

The Next Generation in Skin Care

You know the feeling. You look in the mirror and are shocked to see that the laugh lines at the coners of your eyes linger seconds longer than your smile. For a fleeting moment you can actually see the crow's-feet in your future. Maybe you're frustrated that the fine lines on your cheeks never give way to the precious ounces of costly creams you use every night.

By the time you celebrate your fortieth birthday; you may notice that the frown lines of disappointment and worry on your brow and the corners of your mouth have become permanent furrows. You might have picked up the habit of widening your eyes when you look in the mirror, trying to "lift" your descending upper lids. Perhaps you've made some attempts to approximate what a face-lift might do for you, tugging up on the skin over your cheekbones to see if the creases and folds on your face disappear.

If you've done your time in the sun, your mottled skin tone and sagging jaw line make putting on foundation downright depressing. And, noticing that those scattered lines above your lips have become a feathery filigree doesn't do much to lift your spirits or improve your self-image.

For some women, awareness of these changes comes as a sudden surprise. "Did that happen while I was sleeping?" you wonder at your reflection in the toaster one morning. Or perhaps it was the off guard glance as you passed by a store window that got your attention. "For a second, I thought I saw my mother," you may have confided to a friend.

I know about these reactions to the visible signs of aging because as a dermatologist who has cared for more than forty thousand men and women over thirty years, I've heard your stories. And too often I've seen the unfortunate results of hasty desperate measures taken to turn back the clock. I've tried to erase the face-lift scars along the hairline of a woman embarrassed by the red, ragged edges of an old incision that made her appear as if she were wearing a mask. I've seen how distraught a man can be when he learns that the pasty white tone that follows an overzealous peel cannot be reversed.

In skilled hands most cosmetic surgery procedures either tighten or resurface skin without complications. But even when a quick fix is successful a post-operative let down isn't unusual. In fact, studies have shown that half of the people who have plastic surgery suffer from anxiety and depression afterward.

One reason for the letdown may be that while the person looks different, he or she doesn't necessarily appear any younger. The sagging may be gone, fine wrinkles may be improved, but the skin still appears old and unhealthy: There's something about the new face that doesn't look normal. That's because no quick fix, no laser beam or surgeon's scalpel, changes the way the skin functions. Surgery to pull the skin tighter doesn't restore its youthfulness.

Reversing signs of aging and making skin more resilient and vital require treating it from the inside as well as the outside. This concept is the basis for the internal skin care that is an integral part of my program. Internal skin care repairs and rejuvenates. It repairs the supportive structures deep within the skin that give it support and elasticity. And, it rejuvenates the cellular machinery that produces fresh, new skin cells.

Dermatologists are skilled in using the tools of the trade to correct surface imperfections-the lasers and scalpels, and injections of botulinum toxin (Botox) and wrinkle fillers. But when patients ask for the latest anti-aging procedure they've seen on the news or read about in a magazine, I ask them first to give me five weeks. That's how long studies have shown it takes for the benefits of my skin care program to begin becoming visible. Sometimes, I ask the esthetician in my office to give the patient a topical vitamin C infusion treatment before he or she leaves the office. The smoothness and brightness that occurs after only one fifteen-minute treatment usually convinces the person to try the five-week program. More often than not, when my patients see how much their skin improves without costly procedures or down time missed from their work and social life, they make a lifelong commitment to the program.

Back to TopTAKE CARE OF YOURSELF, INSIDE AND OUT

The rate at which your skin ages, what signs appear and when, depends largely on how you care for yourself inside and out. The same steps you can take right now to begin making over your skin will also improve the health of your body. I include taking care of the body as part of my program because the skin and the body can't be separated any more than the mind and body can. After all, the skin is the largest organ, and it's only visible reflection of the body's health.

My program is not complicated. In fact, most people are amazed at how quick and easy it is.

Not counting the time I'm in the shower, the morning regimen takes less than 5 minutes," says Linda, a thirty-one year-old marketing executive who has put her career on hold until her children, who are now eight, six, and two, are older. Her schedule juggling resembles her days as a busy executive, and she says she's becoming an expert in multitasking, "I clean my face as I shower. As soon as I step out of the tub, I spray my face with toner, apply the antioxidant renewal serum, and towel-dry my body and brush my teeth while the serum seeps in. Then I moisturize. Swallow the supplements and boom, I'm finished and out the door."

Linda keeps sunscreen in the car and applies it liberally, rain or shine, while the children are buckling up and settling in for ride to school. (They've already learned to put on sunscreen after washing their faces.) The morning steps have become a habit that I don't even think about," she says.

At night Linda completes her evening regimen soon after dinner so if she falls asleep while reading to her children, as she often does, there's no chance of missing the second part of the daily program.

Every month Linda has a vitamin C infusion facial at my day spa to further nourish her skin with antioxidants. These salon treatments also give her an hour to herself. The relaxation of being pampered helps her skin too. As I'll explain in chapter 14, I'm convinced that relaxation and being touched during a massage or a facial are essential antidotes to the cascading side effects of stress on the skin.

There is no single procedure, not even a deep face-lift or peel or a single ingredient, not even my favorite antioxidant and sun protectors, pomegranate, that will reverse all the aging changes etched on your face. What does work is a complete, holistic program that addresses all the causes of those changes. Also, by restoring the skin's internal environment, all of the skin's layers-from the deepest layer of fat to the topmost layer of skin cells-are fully hydrated and protected from further damage.

In nourishing, repairing, and protecting your skin, you will also be restoring health to your body. Think about it. The cells of your vital organs, like those of your skin, need a constant supply of oxygen, water, and nutrients. The cells of your heart, liver, and skin have similar needs, which I don't believe can be provided by the food that most of us eat.

In repairing and rejuvenating the connective tissue that makes skin resilient, for instance, this program also encourages the health of connective tissue in blood vessels, nerves, tendons, and joints. Curtailing inflammation in the skin also diminishes inflammation in the blood vessels that supply the heart and the brain. And every cell needs to be well hydrated in order to perform. That's why I think it's so important to take hydrating supplements such as fatty acids.

Back to TopAN INCLUSIVE PROGRAM

The anti-aging program I've developed is an inclusive program. By inclusive I mean that the program includes

• treating the surface signs of aging that bother you
• enriching the body internally with the materials needed to maintain a healthy water balance, stimulate new cell growth, and repair vital skin structures
• reducing the influences of negative emotions and stress on the skin and body

Clinical studies have shown that each step of my program has its unique, measurable benefits, and I'll be describing the results of that research in the following chapters. The daily regimens combine what you need to do in the morning and the evening in an easy-to-follow format. The products in the regimens are those that I prescribe to my patients, use in my spa, and distribute to estheticians throughout the country. Because I've designed these formulas and tested them, I'm certain that they will work for you. However to give you choices, I've included alternative products that contain a similar recipe and are also widely available. In the appendix is a list of the key ingredients in those products. Cosmetic companies do not share their product formulations, and while products may contain the same ingredients, they are not identical and the amounts can vary considerably: How the ingredients are combined is important, too. You may have to do some experimenting substitution that works best for you.

I have also designed and patented supplements that contain the necessary ingredients in the amounts that I have found most effective and that are safe. However, if you prefer to assemble your own brand of formulas, I have provided a breakdown of the results. Keep in mind, though, that supplements are not regulated as drugs are, so different brands may vary in quality. Also, if you have any health conditions or on any medications check with your personal physician before taking any supplements since there may be an interaction that could be harmful.

By following my program, you will turn back the clock in a natural way. One part of the program assists in repairing collagen. One boosts hydration. Another part focuses on sun protection. These steps work synergistically, meaning the combination of the steps in the program is more effective than each single step alone.

To achieve what I call an ageless face, a face that is youthful and natural yet has definition and character, all you have to do is follow a simple morning and evening regimen, eat a skin-healthy diet and take some time to relax. But as simple as my program is, some people may be tempted to take short cuts, especially when it comes to taking time out for a facial or to eat in a more healthful way. It’s true that if you’ve relied on fast food and frozen prepared entrees, shopping and preparing fresh food takes time. In my experience most people get more efficient at it, and you'll look and feel much better that the time investment will be worthwhile. If you're tempted to skip a step, think about this: Isn't it time you took care of yourself as well as you care for others?

Back to TopHOW MY PROGRAM EVOLVED

Scientific breakthroughs are rarely sudden, and skin care discoveries are no exception. These advances come as a result of uncovering one piece of the aging skin puzzle and putting it together with another over many years. The new theory must be tested in the laboratory and then in humans. Researchers must then prove that the results are consistent and reproducible, and that the ingredient or product that helps treat the skin is safe for most people.

This painstaking process is not done by one person in one laboratory, but by scientists all over the world. We meet and share results of our efforts and question each other's work frequently. We publish the results of our tests and talk about them at scientific meetings. A discovery by a researcher in Berlin may be the missing piece that a physician in Los Angeles has been searching for. That's the way science works.

I'm telling you this because I think it's important to appreciate the years of study, experimentation, and testing by others and myself that have culminated in the program I'm going to share with you. The evolution of my inclusive skin care program mirrors the cutting edge of several important advances in skin physiology, nutrition and psychology.

An example is the fairly recent awareness that stress directly affects the skin. Throughout my years of medical practice, I've seen the impact of stress and the havoc that hormones released as a result can create. And I've seen how people's skin improves when they add some form of emotional self-care to the treatments I prescribe.

Just last year, researchers at the University of Dresden in Germany made an important discovery that may help explain what other Dermatologists and I have observed. The German scientists found that a particular stress hormone fits like a key into the lock of a receptor in the skin and causes damaging inflammation, the kind that leads to wrinkles and hair loss. Another piece of the puzzle linking stress and skin function, has been found.

I began devising my skin care program in 1972, as I was completing my residency at the University of California at Los Angeles. At that time I was like most dermatologists in believing that my job was to treat skin disease. Yet soon after I started my private practice it became clear to me that many of my patients were complaining of what medical professionals considered "cosmetic" problems. These men and women not only had psoriasis, they had wrinkles, too. Yes they had acne, but melasma, or hyperpigmentation that created dark blotches on their complexion, also troubled them. Rather then ignore the "cosmetic" problems that were causing my patients so much distress, I gave them my full attention. At the time this was an enormous leap in medicine.

In 1984 I became one of the first dermatologists to invite an esthetician to join my practice. I shared with her my knowledge of how healthy skin functions and how it needs to be treated, and she shared with me her years of experience in deep cleansing, and massaging the skin. I began to realize that being touched and cared for, which is what happens in the hands of a good esthetician relieves stress and helps people feel better about themselves. I saw that taking care of one’s self is healing medicine too.

I opened A Sense of Self skin care spa in 1987 in Brentwood, a Los Angeles community. It was one of the first day spas to integrate health and beauty into what I called an Optimal Health Care program. In addition to medically oriented skin care, clients could consult with a nutritionist, a fitness trainer, and have treatment facials by a trained esthetician.

Before I became a medical doctor, I was a pharmacist, and in the 1970’s I began working with a cosmetic chemist to design unique treatments and products that met my patients' individual needs. In 1990, I made the now ubiquitous alpha hydroxy acids (AHAs) available to the public. Alpha hydroxy acids speed up the skin's natural shedding process. By removing the dead, dry cells from the surface of the skin, moisturizing products can be more easily absorbed, and the skin immediately becomes smoother. Alpha hydroxy acids remain an important part of my program for most skin types, and you'll be learning more about them later in this book.

Initially, the formulas I developed were only available to patients in my care. Then, my experience using AHAs in thousands of patients and spa clients and seeing how exfoliation improved their skin convinced me to formulate a line of AHA-based products. In 1990 I introduced AHAs to the professional skin care industry with home care products and the AHA Rapid Exfoliator Professional Treatment, both of which are now standard treatments. With AHAs, "feel good" facials became true treatment facials.

Back to TopCOSMETICS GET SERIOUS

Products with AHAs are included in a category of skin treatment products called cosmeceuticals, a term introduced twenty years ago by dermatologist Albert M. Kligman to describe agents applied to the skin that are more active than cosmetics but not so active that they have uncomfortable or harmful side effects, as drugs do. Cosmeceuticals have been medically defined as "product[s) with an activity that is intended to treat or prevent a (mild) skin (abnormality)." Although the Food and Drug Administration (FDA) has not officially recognized cosmeceuticals and doesn't regulate them, other countries have acknowledged that some cosmetic ingredients have a biological effect on skin. In Japan, for example, these active ingredients are called "quasi-drugs" and must be proven mild and safe.

Several of the ingredients I'm going to suggest you look for are in cosmeceutical products. However, keep in mind that since the FDA does not regulate these products, the activity of the ingredients will vary. You'll need to pay close attention to how your skin reacts to them, and perhaps modify your regimen to suit your own skin.

Back to TopFEEDING THE SKIN

Skin is a responsive, active organ. In a sense, it's a factory, because it continually maintains its own supporting structures and manufactures skin cells and the gel-like material that holds them together.

Whatever goes into the body affects how the organs function. So if you want healthy skin, you have to supply it with the necessary building blocks for cell membranes and connective tissue. These include proteins or amino acids; water-bonding elements such as phospholipids; fatty acids; lecithin, vitamins B and C; and trace minerals.

The concept behind my program is that as this skin cell factory ages, it becomes less efficient. (There are several theories for this decline in efficiency--or aging-which are discussed in chapter 6.) I have found that by increasing the supply of raw materials-protective and reparative agents-the factory can resume normal, more youthful production.

This concept is also the basis for the rapidly developing field of nutraceuticals. Nutraceuticals are nutrients that act like pharmaceuticals to prevent or treat chronic conditions and disease. When it comes to aging skin, nutraceuticals are one more means to replenish the skin cell factory. I began recommending nutraceuticals in the 1980's and became especially partial to pomegranate extract. It is a powerful natural antioxidant, and after my research confirmed it could boost the effectiveness of sunscreen, I began including it in sunscreens and supplements in 2000.

Because the skin is such an efficient barrier, and its upper layer has no blood supply, it's difficult to get nutrients and other vital materials from the skin's surface down into the deeper layers of the epidermis, where the cells are nourished. By seeing what could be accomplished with nutraceuticals in other health conditions it became clear to me that supplements-nourishing the skin from within, from the bloodstream--could make up for deficiencies in the skin.

Now scientists are on the cutting edge of techniceuticals, a term I coined for enhancing new technologies with other agents. Along with laser resurfacing, for instance, I use Vitamin C infusions and nutritional supplements to directly restore nutrients to the dermis. With infusion technology; for example, it is possible to deliver antioxidants, anti-inflammatory agents, hydrating chemicals, and collagen-building materials directly to the dermis. For the last two years, I have been using the infusion technique to flood the skin with high concentrations of vitamin C with excellent results that you will learn about in chapter 11.

Back to TopA DIFFERENCE YOU CAN SEE

Some improvements, such as the glow that comes from removing dead, dry skin cells and improving circulation to the skin will be noticeable immediately: Other, more dramatic changes-diminished fine lines, fading of hyperpigmented areas, increased production of collagen-will begin to appear in about five weeks. And the improvement will continue as long as you follow the program. Finally, some age-related changes are prevented entirely. Consistent use of the anti-aging supplements and sun protection means you'll never see what might have happened had you continued to ignore your skin's needs for hydration, repair, and protection.

My program has evolved over nearly three decades and encompasses five principles of skin care.

• First, the skin must be healthy: Its most important function is to serve as a barrier to hold moisture in and keep irritants, toxins, and invaders out. And it can only perform these tasks if it's healthy.
• Second, supply the skin with water inside and out and protect and repair the cell membranes so that each and every cell of the body is filled to its maximum capacity with water. Everything done for the skin is directed toward boosting its water supply.
• Third, repair any damage that has occurred as a result of the external and internal insults on a daily basis. By restoring and maintaining the skin's health, it begins to function more youthfully.
• Fourth, skin must be protected from further environmental injury as well as damage from internal forces, like stress.
• Fifth, accomplish all of the above objectives with an inclusive program of a variety of ingredients and supplements that target all the causes of aging, not just one. Everything done to and for the skin is based on a recipe of antioxidants, anti-inflammatory agents, hydrators, collagen-builders, and protectors. No single product or ingredient can do everything that has to be done to repair and rejuvenate skin.

The processes that cause aging can't be permanently stopped. But I've seen that aging of the skin can be slowed and much of the damage can be repaired. To achieve this you have to follow all the steps of the program consistently. Even the effects of a potent drug such as Retin-A, which improves fine lines and stimulates collagen production, doesn't last indefinitely. Studies have shown that the skin reverts to its pretreatment state once the drug is stopped.

Cell turnover and collagen production are ongoing physiologic processes that have to be maintained at their optimal level. I believe this can be done by continuously feeding the skin with nutrients that repair, restore, and protect it.

The cosmeceuticals and nutraceuticals that are the foundation of my anti-aging program are the results of research efforts of many scientists over the past decade. In some cases, these natural, active ingredients, such as vitamin C, are not new, but the technology is now available to incorporate them into products that are stable and pleasant to use. Some ingredients, such as hydroxy acids, have simply been rediscovered and are now in formulas that are gentle and suitable for all skin types.

Skin treatment products are now widely available that include powerful antioxidants to counter the free radicals that are partly the result of the aging process and partly the result of environmental insults. These products also include anti-inflammatory agents that soothe the skin. And finally, some are superhydrating agents that attract water to the skin and improve its ability to hold on to water.

There are supplements that restore health and vitality to the skin cells and are beneficial to all the cells of the body. After all, free radical damage doesn't just affect the skin, it affects the walls of blood vessels and lung and brain tissue. Every cell in the body is susceptible. Indeed, scientists are now learning that inflammation plays a critical role in the development of many of the diseases of aging such as diabetes, heart disease, and cancer.

Which brings us back to my basic premise for healthy skin care. Whatever you do for the health of your skin will improve the health of your body: Whatever you do for the health of your body will improve the health and appearance of your skin. My philosophy can be summed up simply: Make your skin healthy, and your body will follow.

Back to TopTHE BASICS

You're already doing some variation of basic skin care. You're washing your face every morning and night. Possibly you're doing some kind of exfoliation with a hydroxy acid, a facial scrub, or a loofah-like sponge or cloth. (Men give themselves an exfoliating treatment every time they shave.) It's likely that you're following your cleansing with a moisturizer. And, if you're smart you top this off with sun protection. But are you performing these basic steps with the least amount of damage to your skin? Inflammation, which can be caused by using irritating products, is one of the major causes of dryness and wrinkling. And are you making the most of your basic skin care regimen to infuse your skin with nutrients and natural moisturizers?

Daily skin care with products that include my basic recipe of ingredients, which you'll soon learn about, is your first defense against aging. If the barrier function of your skin is compromised in any way, it can't do its protective job.

When I talk with patients in my practice, I never assume that they already do what's best for their skin type, and I'm not going to assume that readers do either. So please don't skip the descriptions of the skin care steps, even if you think you already have the basics down pat.

Back to TopENVIRONMENTAL AGING

For decades skin researchers have made a distinction between intrinsic and extrinsic aging. Skin, like every other organ in your body, begins to age when you are about twenty as a result of internal cellular changes, many of which are genetically preprogrammed. But skin is different from other organs in that it is also exposed to external injury, mainly environmental damage by sunlight and pollution. Environmental factors also include those things we do to ourselves, such as eating poorly, drinking too much alcohol, smoking, and taking certain medications. These environmental factors cause biological changes that accelerate the natural intrinsic aging process.

It's been estimated that 80 to 90 percent of the visible signs of aging are caused by environmental injury, and that the remaining 20 percent are due to internal aging factors that we once thought to be beyond our influence. I've done an exhaustive search of the literature and haven't been able to find the source of this famously high percentage, but I do think it's safe to assume that much of the damage we see as aging is the result of injury from the outside-that is, overexposure to the sun and pollutants in the atmosphere.

When I was in medical school, my dermatology professor taught us to understand the difference between extrinsic and intrinsic aging by saying, "Just look at the back’s of your hands. What you see is the result of external; or extrinsic, aging. Now look at the inside of your wrist. The changes you see there are the result of intrinsic aging."

Where I differ from the party line on extrinsic and intrinsic aging is that I don't believe in a simple division into inside and outside factors. Rather I believe these destructive forces are mutually dependent. Everything in the external environment has some impact on how the body ages internally. And the body's diminished ability to cope with injury affects its vulnerability to external injury.

In fact, in 1993 I was one of the first people to talk about "environmental aging." By that term I meant aging that results from the combination of external injury and compromised internal cellular functions. I believe we have the ability to slow environmental aging, and that sun protection on the outside of our skin isn't our only weapon.

Of course, protecting the skin from the most serious environmental insult--overexposure to sunlight--can begin immediately with proper use of sunscreen. But the skin's defenses can also be boosted internally, by taking an antioxidant supplement, such as pomegranate extract. In chapter 9, you will learn how ellagic acid, one of the key active ingredients in pomegranate extract, works internally to increase the sun protection factor (SPF) of your topical sunscreen by 25 percent.

Back to TopREJUVENATION

The core component of the program is improving your skin's internal environment so that it can function at its very best. As a result, the visible signs of aging will fade, but the main purpose is to give your skin a healthy environment so that it can heal itself. This program is not based on a single component but on a combination of anti-aging steps:

• It hydrates skin cells with water-attracting and water holding molecules.
• It disarms free radicals with specific antioxidants before they can damage skin structures.
• It reduces inflammation with skin soothers, which also curtail free radical production.
• It repairs damage to connective tissue with amino acids, minerals, vitamins, and other nutrients.
• It provides key nutrients, such as fatty acids, to repair damaged cell membranes and prevents water loss.

Some of the nutrients and botanicals you'll be learning about are taken internally every day: Some are applied to your skin's surface at least twice a day: And some require weekly or monthly treatments.

Back to TopSTAYING ON THE PROGRAM

Patients and Murad Spa clients tell me that the program quickly, becomes part of the everyday routine. The hardest steps, I'm told, are taking time out to relax every day and the weekly facial treatment. We seem to be a nation of doers, and doing nothing for just fifteen minutes while the vitamin C infusion seeps in, or practicing deep breathing exercises, is very difficult. When people tell me this step is so difficult, it tells me a great deal about why their skin appears dull, old, and etched with worry lines. People who can't stop for fifteen minutes a week to care for themselves are under enormous stress. And from what I'm told by my patients, many of you are in this situation.

What you are going to learn how to do in the pages that follow is to accomplish six anti-aging skin care objectives: increasing the water content of the skin cells and hydrating the top layer of dead skin cells

• increasing the rate of skin cell turnover
• flooding the skin inside and out with nutrients that counter free radical damage and inflammation
• providing the skin inside and out with the building materials needed to repair and maintain collagen and elastin fibers
• bolstering the cell membranes with fatty acids, lecithin, phosphatidylcholine, and choline
• protecting the skin inside and out from ultraviolet radiation, the major aging accelerator, and pollution

Back to TopA SAMPLE PROGRAM

Sarah, a forty-six-year-old department store executive, came to me because she was considering a face-lift. She had recently started a new job and couldn't take the time off that's needed for a complete recovery for at least two years. Sarah was adamant about not letting anyone know she'd had surgery, and so wanted to postpone the operation until she could take "a trip to Europe.” At least that was the alibi she planned to use.

Sarah wanted to know what I could do to soften her wrinkles, firm her neckline, and fade the dark blotches along her jaw line. She wanted to look as good as she could until she could have a face-lift.

Sarah's skin was typical of many women who have not yet gone through menopause. Although her cheeks were a little dry, the skin was supple and moist along her forehead and down the center of her nose and chin. Occasionally, just before her period, she would get a pimple or two, but she had never been troubled with acne. She had been a serious sun worshiper until a tiny skin cancer alerted her to the dangers of tanning.

Sarah was so determined to look her best that she followed the program for normal/combination skin religiously. She even gave herself the weekly vitamin C infusion treatment.

Sarah has been on the program for over a year and she hasn’t made a final decision about the face-lift, but she’s wavering. “Now I really am considering taking a trip to Europe. Taking a month off to enjoy Italy will be healthier for me than having surgery. Besides, now that my blotches are gone and I don’t have so many lines around my eyes, I think I can postpone a face-lift for a couple more years.”