Physician Referral Online

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of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

Request an appointment
We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.

For the 12th year in a row, Yale-New Haven has been highly ranked by U.S. News & World Report for its programs in gynecology.

Variety of options for sun damage

Lines, wrinkles, uneven pigmentation and age spots—these are the signs of aging on our skin and most of them are a direct result of exposure to the sun. Photoaging of the skin is a common problem. Anyone who is exposed to sun gets it; and the more sun exposure, the more damage.

There are some things you can do to improve that damage, but the best thing is to prevent further damage by wearing sunscreen every day, winter and summer, with a minimum SPF of 15.

Cigarette smoking also contributes to aging effects by the biochemical changes it brings about in skin tissues. Chemicals inhaled from cigarette smoke constrict tiny blood vessels in the skin, reducing the oxygen and nutrient supply to delicate facial tissues. Blood-vessel constriction lasts at least an hour after a cigarette has been snuffed out. Over many years of smoking, the oxygen and nutrient deficiencies cause skin to wrinkle prematurely and lose elasticity. So, here’s another reason to stop smoking.

Retinoids
If you already have sun damage, there are ways you can improve how your skin looks. The results of this latest study of tazarotene cream are similar to those of other retinoids. Extensive studies have been done of Retin-A and Renova, and the results, as in this study, indicate a statistical benefit in terms of improving fine wrinkling, irregular pigmentation and coarse texture.

It is unrealistic to expect dramatic changes, however. The improvement is usually relatively subtle, but noticeable in the double-blind studies that have been conducted.

Many patients do experience some irritation, redness, dryness or flaking when beginning a regimen of retinoids. A small percentage of patients find the irritation serious enough to cause them to discontinue the products, but most find that these symptoms abate within a few weeks.

Retinoids work by sloughing off the dead outer layers of the skin, exposing the skin underneath and promoting the growth of collagen, which thickens the skin fibers that preserve moisture. By removing dead surface cells that become harder to shed as we age, and by thinning and flattening the outer layer of skin, retinoids give skin that much-valued “rosy glow.”

Other options for photoaged skin?

OTC products
Hundreds of over-the-counter (OTC) preparations are advertised as having anti-aging benefits. They vary in price from reasonable to very expensive. Many of these products may be effective moisturizers, but none has any proven benefit to sun-damaged skin.

AHAs
Also widely hyped are alpha hydroxy acids (AHAs). They’re less irritating than the retinoids, but they don’t penetrate as deeply. Be aware that it's the prescription creams that have been found effective. The small amount of AHAs in over-the-counter moisturizers and facial treatments may not make much difference to your skin.

Stronger solutions can have a significant impact, but they must be administered by a physician. At concentrations of 30 percent and higher, glycolic acid is known to increase collagen production and skin elasticity and to thicken the epidermis.

Laser skin resurfacing
New-age lasers burn off top skin layers in lined areas and injure the dermis so collagen will reform. Healing takes a week or more; redness persists for weeks to months. The newer “laser facial” or “photo-facial” procedures bypass the skin surface and go straight to the dermis, where they’re said to encourage collagen production, but this can take months. Laser skin resurfacing is expensive and long-term studies on the outcomes of laser work are not available.

Microdermabrasion
This popular procedure is essentially a mild sanding of the skin’s surface, a kind of mechanical acid peel with a bit of vacuum effect. Some patients report good results after multiple treatments. It has been shown to be effective for post-acne scarring.

Injected fillers
These substances, most often collagen or fat, are injected directly into the wrinkle to plump up creased and sunken areas of the face. The effect is temporary, and some people can have allergic reactions.

Chemical peels
Peels tighten the skin by promoting growth of collagen and elastin; they also remove fine lines and wrinkles. The stronger the acid used, the more dramatic the improvement. Mild peels cause the outer layer of skin to slough off in two to three days. Medium-strength peels create enough crusting, scaling and oozing to remove deeper scars and wrinkles, but they’ll keep you out of circulation for a week to 10 days. Deep phenol peels can eliminate major sun damage and wrinkles, but the patient is out of commission for a couple of weeks, and the resulting redness takes months to fade.

If you’re considering any of these treatments, be sure to consult with a medical specialist and fully understand the risks as well the benefits you may realistically expect.

Dr. Savin is a dermatologist and founder of the Savin Center in New Haven. He is an attending physician at Yale-New Haven Hospital and a clinical professor of dermatology at the Yale University School of Medicine.