May 7, 2010 -- Americans spend billions of dollars every year on products promising to smooth out wrinkles and restore the glow of youth to skin, but are they actually getting a bang for their buck? Though the labels promise to fill in wrinkles and reverse the signs of age, dermatologists warn that most of the time, you're just buying "hope in a jar."
In recent years, cosmetics have gone high-tech, with many brands proudly advertising engineered formulas that are "scientifically proven" and names that sound more like pharmaceuticals than face cream, giving rise to the hybrid term "cosmeceuticals".
The problem, dermatologists say, is that cosmetics by their very definition are not medicine. They are not held to the same regulatory or scientific standards as pharmaceuticals.
What's more, if a product could actually change "the structure or function" of the skin cells, it would have to be considered a drug by the FDA, and then of course, it couldn't be made available without a prescription, says Dr. Darrell Rigel, clinical professor of Dermatology at New York University.
So, short of a trip to the plastic surgeon, what are shoppers concerned about their skin to do?
Botox injections and prescription anti-wrinkle creams, such as those containing retin-A, are proven to work, but if you want to keep it over the counter (and within your budget), there are ways to navigate the anti-aging product lines with modest results, dermatologists say.
ABCNews.com asked dermatologists to weigh in on how to navigate the anti-aging market.
Fine (Product) Lines: Are They Working, or Just Working You Over?
Unfortunately, there just isn't a lot of "great science" behind most over-the-counter skin products, says Dr. Ellen Marmur, chief of dermatologic and cosmetic surgery at the Mount Sinai Medical Center and author of "Simple Beauty."
"Great science" here describes the kind of testing that medicines have to go through -- usually requiring a randomized clinical trial in which the product is tested against a placebo.
"Often the studies are just surveys of people using the product," Rigel says, "and you could give people sugar water and some people will still report that they think that it makes them look better."
Another issue is that anti-wrinkle creams will often seem effective at first, but they are actually damaging the skin.
"Over-the-counter products tend to have lots of ingredients," says Dr. Robert Grant, plastic surgeon-in-chief at New York-Presbyterian Hospital. "If you slather 25 to 30 chemicals on the skin, you're going to gain some degree of inflammation and irritation which makes the skin swell slightly, plumping it up and making your wrinkles look temporarily less visible."
You get the same effect from a bee sting, or rubbing the skin with cayenne pepper, says Rigel -- which of course are things he does not recommend.
"Of course, long-term inflammation of the skin is also damaging to the skin and causes more wrinkles in the end," Grant says, making these temporary fixes a bit of a flop.
When it comes to miracle-workers such as gamma-Aminobutyric acid, which purport to mimic Botox in slightly paralyzing muscles of the face, dermatologists say there is "absolutely no science" to support that wrinkle-buster. The same goes for applying collagen to the skin, or eating it in cake, as has become the vogue in Japan.
Fortunately, not everything over-the-counter is bunk, dermatologists say -- a few ingredients can soften fine lines when used over time.
Rx-Less Wrinkle Rehab
Antioxidants and Retinol, a derivative of vitamin A, can have modest effects over time, says Dr. Jessie Cheung, assistant professor of dermatology at the New York University Langone Medical Center.
Retinol is similar to the retinoic acid that is used in prescription-strength wrinkle creams, but it is less potent and hence less harsh on the skin, leading to less irritation and over-drying than is experienced with the prescription version, she says.
"When you use retinol, it's a long-term commitment, however," she says. "It may take six months to see any difference."
Antioxidants help prevent future wrinkles by combating free radicals (which damage skin as we age), but it can be difficult to get stable versions of antioxidants like the popular vitamin C, E, and coffee berry.
"Vitamin C has been hugely popular as an antioxidant, but by nature they are unstable and [in most forms] it breaks down once it's exposed to the air," Cheung says, and Grant suggests an etherized (stabilized) vitamin C.
Acid exfoliants, such as alpha- and beta-hydroxy, also serve as temporary skin brighteners by removing dead skin cells on the surface of the face, says Grant, but they won't help with wrinkles.
While looking for retinol, acid exfoliants and antioxidants in a product can help you make savvier decisions, buyer beware, dermatologists say, because listing these ingredients on the package doesn't mean that they will actually be absorbed by the skin.
"Just because [the ingredient] does something in a test tube, that doesn't mean it will work on the skin or stay stable once in the jar," Cheung says.
"You need to understand," Marmur adds, "the function of the skin is not to absorb, but to keep things out. You wouldn't want to go swimming and puff up with water." Things might change the surface texture temporarily, she says, but to penetrate deeper, and have any real change in the skin, is difficult with a topical product.
An SPF in Time Saves Lines
There is one over-the-counter anti-wrinkle cream that dermatologists said always made a difference, and it only costs a few bucks.
Yep, you guessed it: sun block.
"Sun protection is the number one thing for anti-aging," Cheung says, as well as not smoking.
"The best cure is to not get them in the first place," Rigel agrees. "So wear an UV-protected sun block when out in the sun and don't squint or frown a lot."
And don't spend $250 an ounce on something that has no science behind it, he adds, and don't expect miracles: "if you're fifty, nothing is going to make you look like your eighteen, especially if you're getting it over the counter."