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- Anti-Aging Skin Care
Q. There are so many anti-aging skin care products out there and I hear so much conflicting information. What do I really need to use?
A. There is actually a consensus from cosmetic dermatologists about which active skin care products and ingredients actually work to slow down skin aging and make you look younger. Based on scientific studies and clinical experience, most of us would rate the importance of the major categories of antiaging skin care products in the following order:
- #1 Sunscreen
- #2 Retinoids
- #3 Alpha Hydroxy Acids
- #4 Antioxidants
- #5 Peptides
Some people will use a multi-step skin care system; some will only use one or two products a day. If you are one of the former then use at least one product in each one of the categories a day. After that, you can add one of the other smaller groups such as tissue growth factors or sirtuins. On the other hand, if you are one of the latter, then start at the top and work down until you hit your limit.
If you only use one thing—use sunscreen. Everyday sun exposure destroys collagen and elastin causing saggy wrinkled skin, brown spots, dilated blood vessels, fine lines and cross hatched wrinkles. Ultraviolet rays produce damaging free radicals that promote aging and skin cancer. Tanning beds do the same, only quicker.
Every single day, year round, apply a broad spectrum sunscreen with SPF 30 or higher to your face, neck, exposed chest, forearms and backs of hands. Look for sunscreens that have one or more of the ingredients that block the widest spectrum of both UVB and UVA: Zinc Oxide, Titanium Dioxide, Avobenzone or Mexoryl. I know you get tired of hearing this. Too bad because you are hearing it again.
The most effective topical treatment to reverse skin aging is retinoids. Prescription topical retinoids such as Refissa, Renova, Tazorac or Differin or over the counter retinol help reduce brown discoloration, pore size, fine lines and wrinkles and enhance collagen production. They also treat acne. Yes, you may have some redness and peeling at first. Your dermatologist can give you some tips on how to avoid or reduce irritation from retinoids.
Alpha hydroxy acids are botanically derived sugar acids that diminish fine lines and wrinkles by increasing collagen production and also reduce brown spots, pore size and acne. The most effective alpha hydroxy acids are glycolic acid and multi-fruit acid blends. They can be irritating to sensitive skin so only use them once a day and follow with sunscreen.
Every day your skin is damaged by free radicals released by environmental exposure to UV light, pollution, cigarette smoke and various toxins. Antioxidants contained in many fruits and plants, vitamins, or produced in the lab bind to these free radicals, rendering them harmless.
Effective vitamin antioxidants include alpha-tocopherol (Vitamin E), L-ascorbic acid (Vitamin C), retinol (Vitamin A) and niacinamide (Vitamin B3). Vitamin C should be used in an active form such as Magnesium Ascorbyl Phosphate as some forms are not active when applied to the skin.
There are numerous plant-sourced antioxidants in use today, with more on the way. Some of the most effective are: Aloe Vera, Arnica, Basil, Beta-Carotene, Bilberry, Bromelain, Chamomile, Cocoa Seed, CoffeeBerry, Curcumin (Curry), Ginkgo Biloba, Ginseng, Grape Seed, Green Tea, Lavender, Licorice, Lutein, Lycopene, Milk Thistle, Olive Oil, Peppermint, Pomegranates, Quercetin, Resveratrol, Rosemary, Soy, Swiss Green Apple Stem Cell Extract, Tea Tree Oil and Thyme.
Laboratory synthesized antioxidants include Lipoic Acid and Ubiquinone (Coenzyme Q10).
Finally, peptides are amino acids that function as messengers to tell cells to increase collagen production thereby reducing wrinkles and increasing elasticity and tone. Some also help regulate abnormal pigment. Some of the most effective are Matrixyl (Palmitoyl Pentapeptide 3 also called Pal-KTTKS), Matrixyl 3000 (Palmitoyl-Oligopeptide and Palmitoyl Tetrapeptide-7), Matrixyl Synthe' 6 (Palmitoyl Tripeptide-38), Argireline (Acetyl Hexapeptide-3), Eyeseryl (Acetyl Tetrapeptide-5) and Copper Peptide (GHK-Cu).
You need to apply skin care products every day. They might as well do some work.
- Body Skin Care
Q. What are these rough bumps on the outside of my arms? No matter how much lotion I put on they are still there.
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 usually inherited and seems to be worse in childhood, adolescence and early adulthood. It is very common.
Treatment consists of daily use of a moisturizer containing glycolic or lactic acid which dissolves the plugs and prevent them from reforming. Our Perfecting Body Moisturizer works great.
Q. What is a mineral foundation?
A. Mineral foundation or mineral powder is becoming increasingly popular, particularly among women with sensitive or acne prone skin. Available in about every form, from foundation to lipstick to mascara, it's made from minerals 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 brushes used to apply some products can cause irritation to sensitive skin or to those using "active" skin care products, so Dr. Elaine recommends using a sponge for application.
Try our very natural looking Antioxidant Mineral Powder which is applied with a sponge to reduce irritation. It is great for all skin types, including acne prone or sensitive skin.
- Dark Circles and Bags Under Eyes
Q. How can I get rid of dark circles and bags under the eyes?
A. The problem with dark circles and under eye bags is that they make you look tired, sad, and older than you are. Dark circles may be hereditary pigment. Collagen and elastic fiber loss from factors such as: aging, sun damage, environmental toxins, smoking and estrogen loss make the skin thinner and saggy. Increased visibility of veins through thinned skin contributes to dark circles. As skin becomes loose and thins, under eye bags result when the naturally occurring fat pad under the eye drops. Allergies with chronic rubbing of itchy, watery eyes may contribute to swelling and eventually to stretched out and wrinkled skin.
Prevention and treatment options include cosmetics to disguise discoloration and wrinkles, skin care ingredients that have an effect on the skin, prescription medications, non-surgical aesthetic procedures and surgery.
Cosmetics that help disguise discoloration and wrinkles:
- A yellow based concealer, one shade lighter than your natural skin color counteracts bluish dark circles.
- Foundation or eye treatment with light reflective particles will bounce light to optically soften the indentation around the under eye bag.
Home treatment help reduce swelling and puffiness under the eyes:
- Cold gel eyelid mask kept in refrigerator and applied for 10-15 minutes will reduce puffiness.
- Cold damp black tea bags contain tannin and if applied for 10-15 minutes help reduce the swelling by reducing inflammation. Also caffeine draws water from the skin helping deflate puffiness.
- Enzymes contained in chilled cucumber slices reduce tissue inflammation but may cause irritation and rash.
- Urban legend treatment with Preparation H applied for 15 minutes has a vasoconstrictor effect but it is temporary and can cause irritation.
Home medications for under eye bags and swelling:
- Oral antihistamines such as Benadryl or Claritin help control swelling from allergies or hay fever.
- Retinoids include over-the-counter retinol, and prescription tretinoin creams Renova and Refissa. Over time they help reduce pigment, wrinkles and increase collagen production tightening the under eye bag.
- Prescription Hydroquinone can help with dark pigment but is often too irritating .
Skin care for dark circles and under eye bags:
Antioxidants, peptides, vitamin C, and retinol increase collagen, tighten, and reduce pigment. Some of most useful peptides are Matrixyl Synthe' 6, Matrixyl 3000, and Eyeseryl. Botanical skin lightener's bearberry, arbutin and licorice, and niacinamide (vitamin B3) are usually well tolerated. Daily sunscreen helps prevent collagen breakdown and pigment darkening.
Three skin care products that can help treat dark circles and under eye bags:
Total Eye Renewal is a professional eye treatment 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.
Line Diminisher + with Retinol, the anti-aging peptide Matrixyl Synthe' 6, and Swiss Green Apple Stem Cell Extract visibly reduces the appearance of lines and wrinkles. Antioxidant Vitamins, Green Tea Extract and Echinacea defend against environmental free radical damage. Hyaluronic Acid, Cucumber, Glycerin, Allantoin and Aloe Vera smooth and balance moisture.
Antioxidant Skin Lightener with natural skin lighteners Licorice, Bearberry and Vitamin B3 Niacinamide combined with antioxidant Green Tea evens skin tone and reduces abnormal pigment. Active Vitamin C Magnesium Ascorbyl Phosphate (Melfade-J) and Chromabright brighten skin. Willow Bark exfoliates age spots. Aloe Vera soothes while Allantoin and Glycerin balance moisture without clogging pores.
And always use sunscreen daily to prevent further collagen and elastic tissue breakdown.
Non-surgical aesthetic treatments for under eye bags:
- Thermage radiofrequency tissue tightening to tighten bags.
- Restylane dermal filler injections to soften hollowing and deep under eye wrinkles.
- GentleWaves LED light treatment to increase collagen.
Surgical treatment involves surgical removal and tightening of excess skin and fat.
Q. I Used Tazorac Cream and had my face waxed. It tore my skin off! What can I do?
A. Sorry to hear about your problem. It is actually fairly common.
We have information for our patients on our skin care usage instructions: "Discontinue the retinoids: Refissa, Renova, Retin-A, Differin, or Tazorac to affected area 1 week before waxing or bleaching, or before other procedures as directed."
Why do we say this? Because if you don't discontinue them and then you wax, when they pull the wax off, your skin will come off with it. This will also happen if you are on isotretinoin (Accutane and generics) for severe acne. Anyone who waxes any part of your body should ask if you are using a retinoid, or taking isotretinoin.
If they don't ask, and you forgot to tell them you will get strips of skin ripped off. Start with a non-fragranced moisturizer and apply it 3-4 times a day. I like Aquaphor, or Cetaphil cream. Don't put any toner, or active skin care products (glycolic acid, salicylic acid etc.) on it until it has healed. Don't scrub or pick. As soon as the skin has healed, (pink, not open, crusted or oozing) wear broad spectrum UVA/UVB sunscreen with an SPF of 20 or higher every single day, whether you normally do or not. Avoid sun exposure over the next several months to help keep the area from darkening over time.
Patients with any amount of natural pigment in their skin may experience either darkening, or lightening of the pigment in the area after healing. Often this will resolve by itself over a couple of months if you protect the area from sun exposure but if not, see your dermatologist who can prescribe a 4% Hydroquinone bleaching cream and talk to you about light chemical peels or microdermabrasion to help resolve the pigment problem.
Q. I used Retin-A for wrinkles and spots and it tore my face up. What can I do?
A. Retinoids include over-the-counter retinol, and the prescription Vitamin A derivatives Retin-A, Renova, Refissa, Tazorac, and Differin. Originally used for acne, retinoids increase collagen and elastic fiber production diminishing wrinkling, improve brown discoloration, and reduce both roughness and pore size.
Retinoids make you more sensitive to the sun and should be used with daily sunscreen. We used to tell patients not to use them if they were in the sun, but now we know that, within reason, you may use them as long as you use good sun protection. If you are going to the beach, lake, or skiing, discontinue them for a few days before exposure. They shouldn't be used by pregnant or nursing mothers.
The biggest drawback, and the reason people discontinue them, is that they are irritating to the skin. I have been using prescription retinoids and daily sunscreen for 25 years. The key is to use the right form and to use it correctly on a regular basis, not intermittently. If you get dry and red, stop until it gets better and then you start again, the top layer of skin peels then reforms and peels again. Most, but not all, people who have had problems using it can use it successfully if they do it the right way.
I often start patients off every other or every third night and work up to every night. You can start with the least irritating and move up to the more irritating product. Also, you can either mix them with moisturizer, apply moisturizer before application (if you are having redness, itching or irritation), or after (if you are just dry).
It can be applied to the face, neck, back of hands and forearms as these areas also show aging changes from chronic sun exposure. Apply a pea size amount to each area on completely dry skin in the evening. Most people can only apply it off the face every other night because of irritation. Use sunscreen to these areas every morning. You need both.
Mild stinging, redness, peeling and flaking may occur during the first several months and on occasion. This is normal, soreness and irritation are not. To reduce irritation, do not use a washcloth, facial cloth, synthetic cotton balls, makeup brushes, or a granular exfoliant. .
Discontinue use 5 days before waxing, bleaching, peels, microdermabrasion, acne surgery, hair removal, and laser treatments as directed. If you wax an area that has been treated with a retinoid, your skin will come off with the wax when it is ripped off. Other procedures may burn the skin if you don't pause retinoid use.
I am a strong advocate of daily retinoid use for most patients desiring to prevent aging or correct existing damage. There is so much proven scientific data behind them that they are still the gold standard in topical anti-aging treatment. Daily, year round, sunscreen use is essential or you are just undoing what you are trying to do. If you start early on a home preventative anti-aging program you will have to do less later on and you will look better both today and tomorrow. It is never too late to start as you will see improvement. Stick with it.
Q. So how can I use a retinoid without problems?
A. Retinoids include over-the-counter retinol, and prescription Renova, Refissa and Retin A (tretinoin); Tazorac and Differin. Here are the instructions I give our patients:
How to Use Retin A, Tazorac, Differin, Renova and Refissa:
Refissa and Renova (tretinoin emollient cream) — Apply a pea size amount to face after cleansing and toning in the evening. Skin must be completely dry before application. A pea size amount of tretinoin may be applied to neck, back of hands, and forearms every night or every other night, as tolerated.
Tazorac, Retin A Micro, and Differin— Apply a pea size amount to entire affected area on face (not as a spot treatment) after cleansing and toning every night. May also be used on chest and back if recommended. Avoid eyelids and lips. Oil Free Moisturizer or your other recommended moisturizer may be used as needed to reduce dryness. May be applied every other night if needed to reduce irritation. Females: Do not use if you are pregnant, attempting pregnancy, or are breast feeding.
Mild stinging, mild redness and mild peeling and flaking may occur during the first several weeks and on occasion when using Refissa, Renova, Retin-A, Differin or Tazorac. This is normal. If you are experiencing mild irritation, apply Oil Free Moisturizer before you apply using Refissa, Renova, Retin-A, Differin or Tazorac. If your skin is dry but not irritated, apply Oil Free Moisturizer after you apply Refissa, Renova, Retin-A, Differin or Tazorac. If reaction is more than mild, discontinue those products temporarily and contact us for instructions. Dr. Elaine's Antioxidant Enzyme Peel may be used in the morning to remove dry flakes.
Also discontinue these products to affected area 1 week before waxing or bleaching, or before other procedures as directed.
Flaking is normal, soreness and irritation are not.
Do not use a washcloth, Clarisonic or other facial skin care brush, Buff-Puffs, mesh scrubs, daily facial cleansing cloths, mineral powder brush or granular exfoliants on face.
Q. Is it safe to put self-tanner all over the body or are there areas you should stay away from?
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. These areas should be exfoliated prior to treatment, either with a physical exfoliant or with a lotion containing glycolic and/or lactic acid, such as Perfecting Body Moisturizer. Applying lotion before application also reduces the darkening in these areas. When applying self-tanners the face may be treated while avoiding application in the eyes or mouth. Individuals who apply these lotions via a spray technique should also avoid breathing in the aerosol.