Another year, another wrinkle; inevitably you wonder how much money you can afford to throw at the problem you see in the mirror every morning.
L'Oréal's advertising slogan, "Because You're Worth It", has seeped into the national consciousness. Youthful, glowing skin has a price tag that's well into three figures - if you care about yourself, that is.
Of course, we all know that the promise of a miracle in a pot of cream, however expensive, is unrealistic. Experts point to the "coincidence" that astronomical "cosmaceutical" prices have followed the visible success of today's invasive treatments, with sales pitches claiming that products are "better than Botox" or "achieving the same results as a peel".
The latest scientific study to debunk beauty-counter prices comes from Consumer Reports, the US version of Which? Scientists used a "high-tech optical device" to monitor changes in wrinkle depth and skin roughness achieved by 10 of the best-selling anti-ageing creams on a group of women, aged 30 to 70, over 12 weeks. As the team reported in the January issue of its magazine, the price of products was unrelated to efficacy.
The best performer was one of the cheapest: at £16 for 30ml, Olay Regenerist achieved slightly better results than its more expensive rivals. The La Prairie Cellular range, costing up to £229 for a 30ml pot, was among the least effective, as was StriVectin-SD, costing £67 for a 6oz tube. Other luxury products such as Lancôme Renergie and Roc Retin-Ox were also less effective than Olay.
The message, however, was unequivocal: you may be worth it, but most anti-ageing face creams aren't. "Even the best creams reduced the average depth of wrinkles by less than 10 per cent, a magnitude of change that was barely visible to the naked eye," according to Consumer Reports.
Such reports, however, are unlikely to dent the profits of the multi-million-pound industry. It's not just vain hope: what Jennifer Aniston calls "the science bit" convincingly persuades us to spend money on making the most of our largest organ.
The upmarket botanical beauty company, Sisley, claims that it took 20 years to develop Essential Day Care Anti-Ageing Shield (£152 for 50ml). We may decide to take this with a pinch of a salt - along with its "unique combination" of apple skin, sesame and rice extracts. But palmitoyl pentapeptide, the protein molecule that is claimed to achieve "dramatic results without the celebrity price-tag" in Olay Regenerist, has a good evidence base. Creams containing Vitamins A, C and E all have substantial scientific basis as do AHA products, which work like a gentler version of Retin-A. Some women swear that hormones keep them looking young - and a handful of studies even underpin claims for copper and Q10 as important ingredients.
Credible research has also been devoted to ensuring that these ingredients hit the spot: peeling away roughness and age spots, and stimulating rejuvenating collagen and elastin. So why are clinical trials of products containing these ingredients consistently disappointing?
Partly the reason is that wrinkles are like scar tissue: once they're formed, as a result of non-elastic skin being stretched and then hardening into furrows, they can only be removed by surgery. There are numerous ways to reduce the appearance of wrinkles, however - depending on the problem. But treatments that work are not on sale in beauty counters. "For a start, creams that are strong enough to make a difference are also likely to have side effects," explains Michelle Irving, director of Cheshire Image Clinic in Chester. "Companies cannot take the risk that their products will cause reddening or irritation and so they sell products with low levels of active ingredients."
Product ranges from companies such as Environ, NeoStrata, Dermalogica and SkinCeuticals are only available from cosmetic clinics, staffed by therapists with either a medical or nursing qualification or the proven skills and expertise to provide tailored advice that takes account of medical history.
Irving is a registered nurse and a member of the steering committee of the Royal College of Nursing's Aesthetic Nurses' Forum, an organisation set up three years ago to achieve minimum standards of expertise, training and safety in cosmetic medicine - and which already has 300 qualified members. "I have patients, not customers," she says. "They're healthy patients but they need just as much individualised attention and follow-up as people on ordinary drugs." Sally Penfold, education manager of the International Dermal Institute, which also trains beauty therapists, says there is little point in getting anti-ageing treatments without a thorough examination of the face under a magnifying lamp.
"The therapist needs to know about any dryness, secretions or rough patches before deciding which creams will help," she says. "Touching the skin all over the face is the best way to diagnose problems. Yet a beauty counter assistant with no training has to make confident a diagnosis by glancing at someone who is often wearing full make-up."
Once diagnosed, a good therapist will take a long-term, holistic view of treatment. "We would very rarely start someone on a full-strength cream," says Marie Duckett, co-director of Fiona & Marie Aesthetics in Harley Street. "People want to get the strongest treatment straight away. But it can be far more effective to start off on a mild dose and gradually work upwards. We encourage people to call up if they're worried and to come back regularly, so that we keep an eye on their skin," she says.
While beauty therapists are widely seen as catering for the super-rich, this doesn't necessarily apply when it comes to dispensing creams. Go and see Duckett at her Harley Street practice, staffed by two qualified nurses, and the chances are you'll pay substantially less than at an Oxford Street department store. "We offer a free half-hour initial consultation and most people leave with a bag of samples to try out to make sure you're using the right cream."
Once identified, a combination of facial cleansers and creams are likely to leave plenty of change from £100. Her advice is to stick to the simplest products if you want to buy over-the-counter. But an appointment with an expert is a must for anyone with delicate, sun-damaged or problem skin or who just wants to make sure their skin is as good as it can be.
Behind the labels
Found in: Olay Regenerist, £16. Strivectin SD, £120 for 6oz
These short-chain amino acids are small enough to be able to penetrate the epidermis and can be synthesized to perform specific functions such as stimulating the healing process and turning on the fibroblasts responsible for producing collagen and elastin. "There are a lot of different types of peptides, all of which have different impact," says Sally Penfold. "They are expensive, so don't expect much from a low-cost product." If you're going for over-the-counter, go for simple, says Marie Duckett. "Olay is unlikely to do any harm. It's pleasant to use though it's unlikely to change the skin's structure."
* FRUIT ACIDS OR ALPHA-HYDROXY ACIDS (AHAs)
Found in: NeoStrata Smoothing Cream (Glycolic Formulation) £35
Glycolic acid improves the smoothness and feel of the skin. At effective levels, they need to be dispensed by a physician because they can cause irritation. "Over-the-counter creams containing AHAs are not particularly effective," says Irving.
Found in: SkinCeuticals CE Ferulic. Crème de la Mer, Clinique CX
Vitamins C and E products can counteract sun damage and promote rejuvenation. "To us, it makes far more sense to build up the skin with effective antioxidants than to strip it down with Retin-A products or AHAs," says Duckett. Vitamins in over-the-counter products are often unstable, however, and are unlikely to penetrate the skin effectively. Crème de la Mer is too rich for most skins, says Duckett. "Because of the price, an element of Emperor's New Clothes can creep in. Women feel that they look better because they've paid so much for a pot of cream."
* COENZYME Q10
Found in: Nivea Visage Anti-wrinkle Q10 Plus Night Cream, £5.99
Coenzyme Q10 is a vitamin-like substance thought to have antioxidant free radical-quenching properties. "There is some evidence that in products such as Eucerin or Nivea, it can help in skin protection," says Dr Lowe.
Found in: ROC Retinox Correction, Sisley Global Anti-Age
This Vitamin A derivative, used since the Sixties to treat acne, is also a beauty treatment. In high doses, it causes dryness and flaking. Lower-strength creams can reverse skin ageing, says Dr Lowe "by increasing cell production, shedding dark pigment and increasing collagen formation".
What really works?
* Use a sunscreen every day. "The biggest cause of skin ageing is free radical damage caused by exposure to UV rays," says Sally Penfold, of the International Dermal Institute. "Best to use a sunscreen that also works as a moisturiser."
* Avoid white sugar, chocolate, sweets and processed food - this prevents acne, which ages the skin.
* Avoid crash dieting - wrinkles can be caused by a loss of supportive fat under the skin. "Even popular diets such as the Atkins can have this effect by producing rapid weight loss," says dermatologist Dr Nick Lowe in his book Away With Wrinkles (Kyle Cathie, £14.99)
* Reduce intake of saturated and trans fats: instead eat regular, moderate amounts of oily varities of fish, which help to mop up free radicals and reduce the rate at which skin ages, according to Dr Lowe. Also, consume more essential fatty acids, found in oils, nuts and cereals.
* Exfoliation will help the skin to appear smoother and fresher, but there's no need to buy special products. Anything mildly abrasive, such as a warm flannel, will help to slough away dead skin cells.
* Include in your diet plenty of slow-release complex carbohydrates, a wide range of fresh fruit and veg as well as protein, "which plays a vital role in the formation of collagen and elastin".
* Cut out smoking and reduce alcohol and stress.
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