Skin - Hands on
by Brian P. Maloney, M.D.

Keep it fresh
April showers bring May flowers. And we're almost there, just one more month to go! Reflecting on this age-old saying prompts me to discuss skin hydration.

Although we generally take water for granted, the droughts in the southeastern and southwestern United States have made many people sensitive to the important value of water in our daily lives. Many communities are having water trucked in as lawns turn brown and shrubs shrivel up.

Indeed, humans cannot live without water. Our bodies are made up of almost two thirds water. And our brains, 75 percent, no matter what our hair color!

Water, water everywhere
Every time we breathe, we are using water. The nose humidifies the air that we breathe in. Our blood is mostly water, carrying nutrients to all areas of our bodies. The blood also carries waste products to our kidneys and liver, where they are removed.
Daily, our bodies lose on average 2.5 liters of water. Sources vary on how much water one needs on a daily basis, but probably somewhere between six to eight, eight ounce glasses a day. The rest is provided in our food.
When exercising water intake should increase. It is important to try to stay ahead of your water loss through sweating. Once you are thirsty your body is experiencing the first levels of dehydration.
Does it matter what you drink? I grew up drinking tap water and yet I do not glow at night or have two heads. I find the bottled water craze very interesting. Recently information was released that several bottled water companies were using tap water in its out-of-the-pipe condition or possibly altering it slightly. Some other companies were drilling wells and selling the water as spring water.

Experts seem to agree that water is the best choice to replace your water losses. Whether you choose bottled water or tap is up to you and your budget, but drinking bottled water is not environmentally friendly because of the amount of petroleum by-products used in production of the plastic bottles.

Be aware of your clients' needs
As we age our bodies begin to change. The amount of muscle in our bodies generally decreases and our fat stores tend to increase. This is one of the many reasons why weight lifting combined with an aerobic exercise program is one of the most important anti-aging activities that someone can do.

Our kidneys have a harder time dealing with sodium over time. For most of us this means there is less water in our bodies, and our bodies become even slower at alerting us when we are dehydrated.

Evaluate dehydration, radiance
As a skin care specialist it is important for you to be able to assess the hydration state of your client. Dehydrated skin will be more sensitive as the protective barrier function is decreased.

Diagnosing the condition of the skin allows you to fine tune your treatment plan. Since the skin's water content varies with each season and the patient's medical and exercise condition, one should carefully evaluate the water content of the skin prior to providing any skin treatment.

When evaluating skin hydration one should look at two features, skin dehydration and skin radiance.
Skin dehydration refers to tight, dull skin, often with many fine lines. If you pinch the skin on the back of the hands it does not snap back quickly. This may be a component of dry skin, which generally involves a decrease in oil production as well.
Asking the patient how long the skin condition has been going on may help to differentiate dry skin from dehydrated skin. I find it helpful to also ask them about any medications they are taking, since many medications - especially some high blood pressure meds usually called water pills - may dehydrate the skin.

Skin radiance is the other term commonly used when evaluating the level of hydration of the skin. Radiance refers to the ability of the skin to reflect light. In the treatment room one would be looking to see if the skin has a glow or luster. When treating dehydrated skin one should ask about the amount of water the client consumes on a daily basis. I generally recommend room temperature water. At one time it was recommended to drink cold water to have your body burn calories to warm it. This is not true. However, the coldness may slow the body's inner functions.

A few words of advice: avoid straws, as they can create lip lines.

External factors
We could not live without air conditioners in the southern United States during the summer. However they work by removing water from the air and then cooling it. The end result is a dry environment. Airplanes and hotels are also very dry environments. If you are treating dry skin, using a humidifier during treatments may help.

We generally take our skin for granted thinking it can handle everything with which it comes in contact. We should think of our skin as a delicate fabric. It is important to protect it from the wind and harsh cold. Long, hot showers can strip the skin of oils, which help to hold water within the skin.

A healthy diet is necessary to maintain healthy skin. It seems we live in a time when we look to supplements to meet our body's needs as opposed to focusing on eating a healthy diet.

For those who think there is a supplement for every condition you may just be right with skin hydration. Taking lutein and its associated molecule zeaxanthin by mouth and applying it to the skin has been shown to increase skin hydration by 60 percent. For those of you that still believe in healthy diets, lutein is found in dark green leafy vegetables, broccoli, corn and egg yolks.

Brian P. Maloney, M.D., F.A.C.S., is a nationally recognized facial plastic surgeon whose clients include celebrities and sports figures from around the world. Director of The Maloney Center in Atlanta, Dr. Maloney appears on the Discovery Channel and is often asked to conduct research studies on improvements in surgical techniques. For more information go to www.maloneycenter.com or call 770.804.0007.

Dr. Brian P. Maloney
Facial Plastic Surgeon
Atlanta, GA