Ask Dr Elaine

A: Dark circles may be hereditary pigment and is more common in those of Middle Eastern, Mediterranean, East Indian ancestry. Thin skin and collagen loss from aging, sun damage, smoking and lack of estrogen make the skin more translucent and saggy. Increased number or visibility of veins also contributes to dark circles. Allergies and chronic rubbing of itchy, watery eyes darken the skin. Finally there is shadowing-- when the fat pad just under the eye and above the cheek bone drops or thins and leaves a dark shadow.

Under eye bags are often from gravity on under eye fat pads causing the pad to drop and become a “bag”. Thin skin from aging, sun damage, smoking and lack of estrogen cause the skin to be loose and lets the fat pad descend. Allergies may cause puffiness.

You can camouflage dark circles with yellow based concealers. Eye products with light reflective particles bounce light to soften dark circles.

Treatment creams for dark circles and under eye bags involve a combination of therapies:

Antioxidants stimulate dermal fibroblast activity helping firm and tone. Vitamin C thickens skin to decrease visibility of underlying tissue and lighten pigment.

Retinoids such as Retinol, Renova®, Refissa® and Retin A ® increase collagen to tighten the skin and reduce pigment.

Peptides are amino acid messengers which tell fibroblasts to increase collagen production thickening and tightening the skin to form a “girdle” for the bag. Useful peptides for under eye bags and dark circles are Matrixyl® 3000 (Palmitoyl-Oligopeptide and Palmitoyl Tetrapeptide-7), Matrixyl® (Palmitoyl pentapeptide 3 also called Pal kttks), Argirilene® (Acetyl Hexapeptide-3). Eyeseryl® (Acetyl Tetrapeptide-5) has been developed specifically for under eye bags.

Hydroquinone or kojic acid skin bleaches may be helpful but often causes irritation. Bearberry is a natural botanical that contains Arbutin a glycosylated benzoquinone which inhibits tyrosinase, prevents melanin pigment formation and is well tolerated.

Oral antihistamines such as Benadryl® or Claritin® and are helpful if allergies are a culprit.

Eyes by Thermage® radiofrequency tissue tightening specifically for the eye area.

Fraxel® Eyes fractional laser resurfacing for the eye area reduces lines and tighten skin.

Juvederm® hyaluronic acid filler injections soften hollowing under the eyes.

GentleWaves® non invasive LED treatment to increase collagen and soften fine lines.

Surgical treatment, Blepharoplasty, involves surgical removal and tightening of excess skin and fat.

For emergency home treatment after a late or sleepless night a refrigerated gel eyelid mask applied in the morning will help reduce swelling. Cold Black Tea bags contain tannins which reduce swelling by decreasing inflammation and caffeine draws water from the skin helping deflate puffiness.

A traditional spa treatment, chilled sliced cucumbers contain enzymes that reduce tissue inflammation but may cause irritation and rash.

Urban legend treatment with Preparation H® applied for 15 minutes has a temporarily constricts tiny blood vessels but also can cause irritation.

Dr Elaine´s® Advanced Skin Treatment Total Eye Renewal with Eyeseryl® (Acetyl Tetrapeptide-5) to correct puffiness, Melfade®-J (Magnesium Ascorbyl Phosphate and Bearberry Extract) to brighten dark circles and Matrixyl® 3000 (Palmitoyl-Oligopeptide and Palmitoyl Tetrapeptide-7) to reduce fine lines. Ginseng and light reflective particles give a young rested look.

A: Acne scars when the acne or inflammation is deep enough in the skin to cause a scar or after aggressive picking at acne. Scars occur because of the healing process and can be raised, depressed, or at skin level.

Pigment changes after acne may be either darker or lighter spots and are a result of increased or decreased melanin (the pigment that gives your skin color) or iron from red blood cells. Post inflammatory redness occurs from red blood cells in the skin, or dilated blood vessels. These are not true scars and often disappear without treatment over time. Various bleaches, and other surface creams as well as Intense Pulsed Light (IPL®) treatment can help resolve the discoloration. Clear Skin Serum, Antioxidant Skin Lightener and Oil Free Moisturizer help to both prevent acne and reduce redness and pigmentation.

True acne scars are more difficult to treat. For the mildest cases we use a combination of the medication tazarotene (Tazorac® cream) with a treatment series of Silk Peel®. The most effective and our preferred choice of treatment for acne scars is Fraxel® Laser. Depressed scars may be injected with Juvederm®, and steroids injected into some raised scars.

Because treating acne scars is a challenge, it is important to treat acne early and effectively.

A: Although Dermatologists have long maintained that diet does not play a significant role in acne, new evidence indicates that diet may worsen acne in certain patients who are genetically predisposed.

Caffeine containing foods and drinks such as coffee, colas, and chocolate, have long been associated with worsening of acne in some individuals. Now the question has been raised if milk products, or a diet high in processed foods, may worsen acne. Although there is little scientific evidence for this at present, some investigators are studying this possibility.

Most patients who restrict their diet find little or no improvement, however some do see an improvement, and of course we can all benefit from more healthful eating habits.

A: Physicians who are experienced in treatment of spider veins on the leg most often use Sclerotherapy (injection of a solution into the vein) as it usually the most effective with the least number of treatments, and with the least discomfort. Although laser treatment can be effective for treatment of spider veins on the leg, it is more painful and less effective than sclerotherapy.

Intense Pulsed Light (IPL®) uses a pulse of light to heat up and seal off small veins on the face. It also reduces overall redness, flushing and rosacea.

A: Acne in women has a strong hormonal influence. Oral contraceptives, or birth control pills, are often helpful. However BCP’s alone may not completely control acne. Ortho Tri-Cyclen® and Estrostep® are FDA approved for the treatment of acne. I think that Yasmin® is the most effective, and has the added benefit that women usually do not gain weight. Yaz® seems to work for some women. The risks of certain medical conditions such as stroke are higher in oral contraceptive users so discuss it with your Gynecologist or Family Physician.

A: Rosacea is usually correctly diagnosed by experienced dermatologists. The characteristic findings include redness, dilated blood vessels, bumps, pustules, skin thickening, and oil gland growths. Patients with sun induced dilated blood vessels, acne, perioral dermatitis, sensitive skin, and lupus may sometimes be incorrectly diagnosed with rosacea.

A: Mineral makeup is increasingly popular, particularly among women with sensitive or acne prone skin. It’s made from minerals taken from the earth, such as titanium dioxide and iron and zinc oxides, rather than synthetic ingredients. The advantages: no artificial colors, fragrances, or ingredients; plus, mineral products have a natural SPF. The downside, however, is that they’re intensely pigmented, which may make them harder to apply. The brushes used to apply some products can cause irritation to sensitive skin, those with acne or to those using “active” skin care products which is why our Antioxidant Mineral Powders and Mineral Glowsare used with a sponge.

A: Self-tanning lotions are safe to use in all areas but tend to cause an exaggerated darkening in the areas of thickened skin such as elbows, knees, calves, and heels. Exfoliate those areas prior to treatment with a physical exfoliant or lotion containing glycolic or lactic acid, such as Perfecting Hand and Body Moisturizer. Applying lotion before application also reduces the darkening. Self-tanners may be used on the face but avoid getting it into eyes or mouth. Don't breath in the aerosol is a spray is used.

A: Two procedures offering rapid improvement with minimal downtime are BOTOX® Cosmetic and Juvederm®.

For movement related wrinkles in between your eyes, forehead, or crow’s feet, or if you want a nonsurgical brow lift, BOTOX® Cosmetic is the treatment of choice.

If you have moderate wrinkling around the lips, smile lines, or at the corners of the mouth, or would like increased lip or cheek volume, Juvederm® is appropriate.

Utilizing both BOTOX® Cosmetic in the upper face and Juvederm® in the lower face offers complete rejuvenation. Results of both are complete by 2 weeks after treatment.

A: If it sounds too good to be true, it often is. While there are many surface cream treatments that lessen skin redness, there is no cream that decreases small broken capillaries, called telangiectasia. Fortunately, however, facial telangiectasia responds well to Intense Pulsed Light (IPL®) treatment.

A: Hydroquinone has been used effectively for many years, both in over the counter (OTC) products with a strength of 2% or less, and higher strength by prescription. Recently questions have been raised regarding the safety of hydroquinone based on rodent studies. Currently there is no evidence that hydroquinone is carcinogenic in humans.

There is also the rare condition, called onchronosis; in which skin darkens if a high concentration of hydroquinone is used for a prolonged period of time.

The FDA is considering restricting the sale of hydroquinone containing skin bleaching products for prescription sale only.

Bleaching creams tend to lose effectiveness if used continuously for many months at a time. Therefore both to monitor progress and reduce the risk of side effects we evaluate patients on a regular basis and prescribe intermittent rest periods from treatment.

Dr Elaine has developed Antioxidant Skin Lightener as a non-HQ alternative bleach for abnormal pigment and dark areas occuring after acne or other skin conditions.

A: Those are usually keratosis pilaris (KP), hard cores of shed skin cells that plug the hair follicles. They are most commonly found on the outside of the upper arms, on the front of the thighs, and on the lower cheeks. Often rough, they sometimes become red inflamed bumps or pustules.

Keratosis Pilaris is very common, often inherited and worse in childhood, adolescence and early adulthood.

Treatment is daily use of a moisturizer containing glycolic or lactic acid, such as our Perfecting Hand and Body Moisturizer, which dissolves the plugs and prevent them from reforming.