Topical Alternatives to Going Under the Knife

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Going under the knife in the name of youth requires time, money and potentially some pain. But a facelift isn’t the only option when it comes to shaving five (or even ten) years off an aging appearance. The last decade has brought major advances in topical lotions and potions for younger looking skin. But with so many choices out there, it's hard to figure out which treatment is most appropriate. To narrow down the options, we asked Charleston, SC dermatologist Todd Schlesinger, MD, for his advice on what to look for when you’re on the hunt for the fountain of youth. 

1.  Hyaluronic Acid

Hyaluronic acid (or HA) is a sugar-based molecule that’s a basic component of the skin. When you add more HA to your skin, “it serves to hydrate the skin because it draws water to itself,” says Dr. Schlesinger. After applying HA to your face, you’ll see “skin that appears more plump, radiant and smooth,” he explains. HA is most effective in hydrating the skin, but “certain forms of it have also been shown to alter the inflammatory pathways within the skin, increasing certain wound-healing activities while not affecting those pathways that might lead to harm,” he says.

HA is available in various forms such as gels, creams and lotions, where these cosmeceuticals serve to hydrate the skin while improving the texture and tone of the skin, too. “Aging skin is, by nature, drier skin because of the loss of the skin’s ability to retain moisture,” says Dr. Schlesinger. When your skin is hydrated, "it is better able to recover and respond to other agents designed to improve its function and appearance," he says.

There typically aren’t any side effects when using HA. “Depending on the vehicle (or base) that the product comes in, there could be a reaction to an ingredient now and then, but since HAs are a natural component of the skin, true allergic reactions would be rare,” explains Dr. Schlesinger. “Most reactions to skin care products can be classified as allergic or irritant, and these are more often related to preservatives, fragrances or antioxidants, rather than HAs,” he says.


When it comes to aging skin, sometimes a loss of elasticity, a drier dermis, and more fine lines and wrinkles aren’t the only obstacles your face may face. There are many types of spots that may appear as you hit your 30s and beyond, where a topical treatment may assist in fading, or destroying, the unsightly spot. One of these types of lesions, called a raised seborrheic keratosis (or SK), can now be treated topically, thanks to a FDA-approved topical solution called ESKATA® (hydrogen peroxide) topical solution, 40% (w/w).

ESKATA is a topical treatment for raised SKs, which can appear as “stuck-on brown or tan lesions that may show up on the face or neck,” says Dr. Schlesinger. This treatment “is a concentrated hydrogen peroxide solution that is supplied in a unique applicator designed to soak raised SKs thoroughly with solution,” he explains. “The hydrogen peroxide forms bubbles within and around the lesions, which essentially dissolves them,” he says.

“The most common adverse reactions in the studies leading to its approval were redness, stinging, swelling, scaling, crusting and itching. When applied, ESKATA can cause the treated SK to turn white temporarily” says Dr. Schlesinger. 

3.  Retinol

A tried-and-true anti-ager, retinol “is a form of vitamin A and is essential for the correct functioning of the top layer of skin cells,” says Dr. Schlesinger. Retinol improves smoothness, texture, and evens coloration of the skin, “and its related compounds are quite effective at reversing the sign and symptoms associated with aged or sun-damaged skin,” he says.

You can find the vitamin A-derived ingredient in “prescriptions (like Retin-A), office-dispense skincare products, or over-the-counter regimens,” he says. Some of the most common side effects of using a retinol are irritation, dryness, stinging, redness, burning and itching, but “retinol, and its closely related cousin, retinaldehyde, are considered the less irritating versions of vitamin A compounds used on the skin,” says Dr. Schlesinger.

While Dr. Schlesinger sings his praises for each of these anti-aging ingredients and topicals, he always stresses the importance of sunscreen in preventing signs of aging on all his clients. “Sunscreen is vital in protecting the skin from the known harmful effects of ultraviolet radiation,” he says.

Important Safety Information and Approved Use

ESKATA® can cause serious side effects, including:

·  Eye problems.  Eye problems can happen if ESKATA® (hydrogen peroxide) topical solution, 40% (w/w) gets into your eyes, including: ulcers or small holes in your eyes, scarring, redness, irritation, eyelid swelling, severe eye pain, and permanent eye injury, including blindness.

·  If ESKATA accidentally gets into your eyes, your healthcare provider will tell you to flush them well with water for 15 to 30 minutes.  Your healthcare provider may send you to another healthcare provider if needed.

·  Local skin reactions.  Skin reactions have happened in and around the treatment area after application of ESKATA. Severe skin reactions can include: breakdown of the outer layer of the skin (erosion), ulcers, blisters and scarring. Tell your healthcare provider if you have any skin reactions during treatment with ESKATA.

The most common side effects of ESKATA include: itching, stinging, crusting, swelling, redness and scaling.

Your healthcare provider will not apply another treatment of ESKATA if your treated area is still irritated from the previous treatment.

Tell your healthcare provider right away if ESKATA gets into your eyes, mouth or nose during application.  ESKATA is for topical use on the skin only, and is not for use in your eyes, mouth or vagina.

These are not all the possible side effects of ESKATA.

Approved Use for ESKATA

ESKATA is a prescription medicine used to treat seborrheic keratoses that are raised.

ESKATA is for use as an in-office treatment. ESKATA is applied by your healthcare provider and is not for use at home.

You are encouraged to report negative side effects of prescription drugs to the FDA. Contact Aclaris Therapeutics, Inc. at 1-833-ACLARIS or 1-833-225-2747 or FDA at 1-800-FDA-1088 or

Please click here for full Patient Information for ESKATA.

ESKATA is a registered trademark of Aclaris Therapeutics, Inc. PP-ESK-US-0411 08-2018.