Daily Skin Fix

How To Use Retinoids Without Your Face Peeling Off

As many of you know, I am a strong advocate of daily retinoid use for most patients to prevent aging and correct existing damage. There is so much proven scientific data behind them that they are still the gold standard in topical anti-aging treatment. I have been using prescription retinoids and daily sunscreen for 25 years. If you come to see me as a patient, I will likely recommend that you start one of them as part of your anti-aging skin care program. And, of course, if I recommend it, you will do it.

Retinoids are vitamin A derivatives and include over-the-counter retinol, prescription Retin-A, Renova, Refissa, Tazorac, and Differin. Originally developed for acne, they were found to also increase collagen and elastic fiber production, diminish wrinkling, improve brown discoloration, and reduce both roughness and pore size. Retinoids 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 to skin that is off the face every other night because of irritation.

The biggest drawback, and the reason people discontinue retinoids, is that early on they cause peeling and some redness, a process called retinization. The key to success is to use the right form and to use it correctly on a regular basis, not intermittently. Most people do it this way: they use the retinoid; they get dry and peel so they stop until it gets better and then start again. In the meantime the top layer of skin builds up, just in time to peel again when you restart treatment. That is the wrong way to do it. If you do it that way your skin never adjusts and you will keep peeling every time you start treatment again. If you use it regularly without starting and stopping, after about 2 months your skin will stop peeling. You may have occasional episodes of peeling after an environmental insult to the skin, but much of that can be prevented.

Most, but not all, people who have had problems using a retinoid are able to 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, but consistently. You can start with the least irritating retinoid and move up to the more irritating product. Gels are more drying and irritating than creams. Refissa and Renova are the least irritating, then Differin, then Retin A, and finally Tazorac is the most irritating. On the other hand, Tazorac gives the most improvement in pore size and acne scars. Another strategy when you are starting treatment is to mix them with moisturizer to dilute them, apply moisturizer before application (if you are having redness, itching or irritation), or after (if you are just dry). And if you have an episode of dryness and peeling later in treatment, you can always dilute them again for a few days. Our Antioxidant Enzyme Peel is great for removing the peeling skin without abrasion.

Mild stinging, redness, peeling and flaking may occur during the first several months and on occasion. This is normal, soreness and irritation are not. Anything that you use on your skin that abrades the skin will cause more redness and peeling. The most common culprits are washcloths, synthetic cotton balls, makeup brushes, or a granular exfoliant. The infomercial technique of applying mineral powder in a circular scrubbing motion with a special brush is the most common cause retinoid intolerance in my clinic.

Discontinue retinoids 5-7 days before waxing, bleaching, peels, microdermabrasion, acne surgery, hair removal, and laser treatments or you will be sorry. If you wax an area that has been treated with a retinoid, strips of skin will come off with the wax when it is ripped off. Other procedures may burn the skin if you don’t stop retinoid use prior to the procedure. That is why the instructions we give with the prescription goes over this. If you didn’t read your instructions, and have an “unfortunate accident” start with a non-fragranced moisturizer and apply it 3-4 times a day to the area where the skin was ripped off.  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.

Retinoids do make you more sensitive to the sun and you should use sunscreen every day, year round or you are just undoing what you are trying to do. We used to tell patients that they could not use retinoids if they were in the sun, but now we know that, within reason, you may use them if you use sun protection. Of course, I know you are already wearing your sunscreen every day, because you know that it is an essential part of an anti-aging skin care program.  If you are going to the beach, lake, or skiing, discontinue retinoids for a few days before exposure.

To recap:

How to reduce peeling and irritation with Refissa, Retin A, Differin, Tazorac and retinol

• Use it on a consistent schedule—every day, every other day, every third day, not on and off. Work up to every day.

• Choose a cream not a gel.

• Start with Refissa unless you have oily skin and acne. Refissa is in a moisturizing base, is stronger than Renova, and usually the easiest to tolerate. I use Refissa.

• Apply moisturizer underneath to reduce redness and irritation.

• Apply moisturizer over retinoids to reduce dryness.

• Don’t use mineral powder with a brush, use a sponge.

• Don’t use a washcloth or granular exfoliant.

• Stop retinoids 5-7 days before waxing or laser hair removal, chemical peels.

• Wear sunscreen.

Retinoids are very effective as part of your anti-aging skin rejuvenation program. It is worth working with them to be able to use them successfully.

Skin and Sin

There are sins of omission, sins of commission, and just sin.

Sins of omission, is not doing something. For hair that could be not getting enough iron intake and having hair loss as a result. For nails it might be not keeping the edges filed, and getting splits at the ends. For skin it could be not wearing sunscreen daily and using a targeted anti-aging skin care program so your skin ages faster than it needs to, or having severe acne, but not treating it, and then getting scarring.

Sins of commission are things you do that are just the result of bad decision making, that affect the skin, hair and nails, and badly. For hair it is that really unfortunate hair color, or decision to resurrect your 80’s perm. For nails it is wearing acrylics continuously, rocking the ends and super gluing the loose areas yourself. For skin it is going to the tanning bed 5 times a week.

And just sin is when you do something you know is damaging, and that serves no purpose, but you do it anyway. For hair it could be over plucking the eyebrows until you look like a silent movie star from the 1920’s. For nails it is biting them to the quick and ripping the cuticles off so that you can’t show your hands in a job interview. For skin it could be picking at that pimple 4000 times using your 15 power magnifying mirror, when you know nothing will come out of it, but you can’t stop picking. And then when it is trying to heal, picking at it again.

Of course, there is a lot of overlap, as when you don’t do something, and it is bad decision making, and it really serves no purpose but you do it anyway. Like not wearing sunscreen on your face, neck, forearms and hands every day. Yes, it does take 20 seconds to do. As opposed to the 5 minutes it takes to apply a heavy foundation to cover up the effects of sun damage. Clear cut categories of sin are sometimes in the eye of the beholder. And some of my “skin sins” are really other sins that affect your skin, but as my grandmother used to say to me: “Little missy, don’t try to talk your way out of this one, I am on to you. Just admit you are wrong, say you are sorry, and don’t do it again.” And as usual, she was right. So without further ado, here are my top 10 Skin Sins.

Top 10 Skin Sins

1. Unprotected Sun Exposure. You knew it would be #1. I am not going to go into my usual tirade about the aging and damaging effects of the sun, except to say—daily sun exposure is one of the top 2 most aging things you can do to your skin, and causes skin cancer. It causes discoloration, broken blood vessels, wrinkles, large pores, loss of elasticity and that stiff, yellow cross hatched skin that is characteristic of chronic sun exposure. You know this, so put on your sunscreen every day.
2. Smoking. Do I really have to say this? Smoking reduces blood flow in the skin, exposes you to direct toxin exposure on the skin and in the blood. And, if that’s not bad enough, the facial expressions repeated over and over etch lines in the skin. It is the other sin in the top two most aging things you can do to your skin. Whatever you do– don’t do 1 and 2 together. The effects of chronic sun exposure in smokers are much more damaging than either one alone. The results aren’t pretty.
3. Procrastination. I see this frequently. Young people in their twenties and early thirties are more worried about hair style, eye shadow, and outfit than they are about the health of their skin. That’s because they are young, and by and large have good skin. And then in their thirties and early forties they are raising a family, busy at work. Mornings are too rushed to apply sun screen, and evenings never end so active skin care is not applied. Then all of a sudden at 45, they have an “OMG what has happened to my face” moment. And end up in my office. All of the easy stuff to slow down aging of the skin work best when you do them while your skin is still good. And they are not really complicated—sun screen every day, a retinoid (tretinoin, retinol etc.) every night, a peptide lotion and a combo botanical and fruit acid serum once a day. Add a little Botox when those frown lines start showing and a little dermal filler for smile lines and you are good. Yes, those things help later too, but it is always easier to prevent than try to fix the damage.
4. Following every fad. There are patients who jump from doctor to doctor and back again. They try this new procedure, that new skin care ingredient they read about. Some may be appropriate for them, some are not and some are bogus. But they never stick with anything long enough to see the results they could see if they picked one doctor, committed to a treatment plan and then followed through.
5. Ignoring your teeth. We all lose bone structure in our face as we age. When we do there is less structure to the eyebrows, cheeks, around the mouth and at the jawline. Soft tissues and skin sag when there is less underlying structure. Tooth loss leads to loss of supporting bone structure around the mouth. Teeth wear down and become discolored over time. The result is a collapsed mouth without enough underlying structure to fill out the skin. So take care of your teeth. You need them.
6. Yo-yo weight fluctuations. The weight goes on. The weight comes off. The weight goes back on again. Repeat. Skin is pretty elastic, up to a point, when you are young, but it loses elasticity over time. At any age, too many episodes of weight gain and stretching, or too large of weight gain and skin loses its ability to shrink back. The result is sagging skin on the face, and sagging and stretch marks on the body.
7. Picking, picking, picking. One of my pet peeves. So much so I wrote a whole series on why you should step away from the magnifying mirror before someone gets hurt.
8. Accentuating asymmetry with bad eyebrows. Another of my pet peeves. Eyebrows frame your eyes and balance your face. Symmetry is the hallmark of a young face. We all get more asymmetrical over time but funky eyebrow shape accentuates it. The biggest mistakes are tweezing the brow too thin, tweezing the center margin too far outward and starting the arch too far centrally giving a comma shaped eyebrow. Hold a pencil parallel to the outside corner of your nostril through the inside corner of your eye to your eyebrow. Only tweeze center of this line. Rotate the pencil through the outside corner of your eye to your eyebrow. This is where your eyebrow should end. Rotate through the outside edge of the colored part of the eye to the brow. This is where you arch. Do it right and it will make a big difference.
9. Wearing heavy, mismatched foundation. Heavy foundation actually makes texture abnormalities like large pores, lines and wrinkles look worse. It can cover red discoloration. So lighten up on the foundation. It you want to fill in some of the texture abnormalities like lines and pores, and then use silicon based translucent foundation primer, followed by a lighter liquid foundation or mineral powder applied with a sponge.
10. Rushing around, doing too much and not getting enough sleep. During sleep many of the body’s natural repair mechanisms are more active including those that repair your skin. Sleep deprivation leads to both decreased levels of some beneficial hormones and less time to repair damage. Missing sleep for one night makes you look bad the next day and missing sleep on a routine basis can affect your appearance long term. So let everyone else do some of the work and go to bed.

It takes little or no money to correct these 10 skin sins. Just consistency and a little determination. So follow my grandmother’s “advice”—admit you are wrong, tell your skin you are sorry, and don’t do it again.

 

I Hate Melasma:
How to Prevent and Treat Melasma

Finally, the last installment in the Out Damn Spot, Out, Out, I Say series on brown spots on the face, what they are and how to get rid of them. We have discussed brown spots from sun damage, raised brown age or liver spots, brown spots after acne, cosmetic skin procedures or injury. So now, Lady Macbeth, we go on to the bane of the cosmetic dermatologist’s existence, melasma.

I hate melasma. I really hate melasma. What is that you say? “That is a bit harsh Dr. Elaine, hating on a skin disease.” True. But here is why I hate melasma: I have had it. I treat it. It is really difficult to treat. It is really difficult to treat because the factors that cause it are very hard to modify. The factors are hard to modify because they are factors that are part of life: sun exposure, hormones, and skin type. Add to that the fact that the medications that we use are really hard to get right now. Often the treatments we use to treat it cause inflammation, and inflammation worsens melasma. The women who get it often have more natural pigment, which makes them more likely to pigment with treatments for melasma. Melasma is very persistent and sneaky, it often responds to treatment, but waits patiently for a tiny sliver of opportunity to start up again. Then it does, and both patients and cosmetic dermatologists get frustrated. And that is why I hate melasma.

To recap, here is what you see with melasma:

• In the mirror:  Large dark flat patches of discoloration, usually symmetrical, over cheeks, jawline, fore head and above the upper lip. It is often more obvious in low light settings, such as at sunset. It responds almost instantly to any sun exposure. It is hard to cover up with makeup.

• Diagnosis: Melasma or “mask of pregnancy,” is caused by a combination of hormones, predominantly estrogen from pregnancy or birth control pills, and sun exposure. Once it starts, melasma tends to reoccur very easily with minimal amounts of sun exposure, even if the hormonal trigger is removed. I divide melasma into two types: “relatively easy” and “hard.” The difference is dependent on how deep in the skin the pigmentation is found, and whether both the hormonal stimulation and sun exposure can be reduced. Deeper pigment is always harder to improve.

• Treatment: Involves both removing the triggers, and using creams and procedures to reduce existing pigment. Daily, year round, broad spectrum sun protection and avoidance of sun exposure is absolutely essential. Reducing hormonal triggers is often a challenge as pregnancy eventually ends, but often the need for birth control continues. Even if the hormonal trigger is removed, the melasma remains “turned on” and even tiny amounts of sunlight cause it to reoccur. Treatment at home with skin lighteners, prescription skin bleaches, retinoid creams, and sunscreen, combined with in-office chemical peels or SilkPeel microdermabrasion are tried first.  “Relatively easy” melasma usually responds fairly well to this treatment. For more resistant cases, Intense Pulsed Light, laser, and deeper chemical peels under the supervision of a dermatologist experienced in treatment of pigment, are considered. Results are varied, and these procedures may actually make pigment worse.

• Ease of treatment: Difficult-very difficult.

Melasma is almost exclusively a skin disorder in women, though very occasionally it occurs in men. It is caused by a combination of estrogen, and to a lesser extent, progesterone, hormones, found in birth control pills or devices, naturally occurring during pregnancy or just the hormones made by the body, in combination with sun exposure. It shows up as dark patches of brown pigmentation most commonly on the sides of the face, the forehead, above the upper lip, on the chin, and on the sides of the neck.  Mild melasma appears as small faint brown splotches, but more severe melasma surfaces as patches of light brown skin pigmentation. There is a genetic susceptibility to melasma, and it is more common in women with skin that pigments easily. It is especially common in women with Asian, Hispanic or African American skin type. There are more active pigment producing cells called melanocytes, and the melanocytes are more easily triggered to produce melanin. The excess melanin is stimulated most significantly by sun exposure, but also by heat, and anything that irritates the skin like facial scrubs, brushes, irritating skin creams, medications or treatments. Once melasma is triggered on, even minimal amounts of sun exposure will cause it to darken or return after successful treatment. It is more apparent during and after periods of sun exposure and less obvious in the winter months.

Melasma can occur at either the surface level (superficial melasma) or in the deeper layers of skin (dermal or deep melasma), giving it more of a spread-out appearance. One way to determine whether your melasma is superficial or deep is to stretch the skin. If you stretch out the brown patch and it appears lighter than when the skin is not stretched, then the hyperpigmentation is superficial. If it’s darker when stretched than it is when not stretched, then the pigmentation is deeper.

I pigment moderately easily, and had a decade or so dealing with melasma. It is often in a pattern, which is why it is also called the “mask of pregnancy” and I had a delightful set of horns above my eyebrows and a brown pigment moustache. Melasma drives women crazy, and is incredibly frustrating. I was no exception. Usually it finally burns out, and mine did.

There are two reasons that melasma is so hard to treat. The first reason melasma is so hard to treat is because even minor amounts of sun exposure can darken or reactivate it. It is hard to avoid all sun exposure, especially in women in the age group most commonly affected, 25-40, who may have children with outdoor activities. The other reason is that estrogen and progesterone hormones go along with being female. And women in that age group are faced with the decision to either be on birth control pills, or be pregnant, both of which are triggers.

There is no single treatment that works for all melasma patients; therefore, we develop an individualized treatment plan for each patient. Combination therapy usually is needed and recommended. Because the melanocytes are easily irritated, and when irritated they produce more pigment, we avoid aggressive treatments that may lead to more pigmentation, white blotches, or scarring. Treatment options range from topical bleaching and prescription medications to techniques such as IPL, chemical peels and microdermabrasion as well as lasers and light sources. We plan a stepwise approach to treatment beginning with home treatment, stepping up to office procedures as needed if results to home treatment are unsuccessful. If office procedures are needed, they should only be performed by cosmetic dermatologists with extensive experience in treating pigment problems.

Because of the difficulty in reducing pigment, the ongoing hormonal issues, and the tendency for melasma to reoccur we discuss in detail the lengthy treatment times and commitment needed to success­fully treat melasma to help manage unrealistic expec­tations. We also discuss the importance of and strong commitment to the sun protection program that is central to treatment. But even in the face of our hormones and our lifestyle, we soldier on and treat it the best we can with realistic expectations for improve­ment. And here is what we do:

Home Treatment:

• Daily Sun Protection: Is absolutely essential for successful melasma treatment and should start early and continue throughout treatment and also after melasma has improved to help prevent reoccurrence. Exposure to UV radiation and even visible light activates melanocytes and causes melanin to deposit in the skin. Sun protection with a broad spectrum sunscreen which covers both UVB and UVA with a SPF of 30 or greater used every single day, year round, and reapplied every 2 hours during sun exposure is essential. And that goes for all skin types, even patients with darker skin types who do not routinely use sun protection. But you have to remember that no sunscreen will block out all UV rays, so you cannot put on sunscreen in the morning and go out all day. Patients must limit time in the sun, and wear a hat whenever possible if sun exposure cannot be avoided. As a matter of fact, it is so important, that if you are not willing to modify your sun exposure, stop reading and go play on Facebook. 

• None of the other treatments may be used during pregnancy. If you are pregnant and at risk for melasma, start immediately to protect your skin from sun exposure to prevent melasma. If you are pregnant and have melasma, scrupulous sun exposure will help keep melasma from becoming more established.

• Prescription Hydroquinone (HQ) skin bleach: Hydroquinone is skin bleach that has been used for years. It inhibits the enzyme tyrosinase which is essential in pigment production. It comes in an over the counter 2% concentration, and stronger and more effective 4% prescription concentration. It is effective for approximately 20 weeks of treatment, then the skin becomes used to it, and effectiveness decreases. If used longer than 4-5 months, rarely an irreversible darkening of pigment occurs, especially in patients with darker skin types. It is usually applied twice daily and should be applied to the entire face because bull’s-eye areas of discolor­ation can develop from localized or spot treatments. Unfortunately it is irritating to the skin and if irritation occurs it can actually cause darkening of pigment. It has been very helpful in the treatment of pigment problems, but has recently come under fire from consumer groups and the FDA because of safety testing concerns. The most effective of the prescription forms, in my opinion, was Tri-Luma cream, which is a combination of HQ, a topical steroid, and tretinoin. It can only be used for 2 months at a time because the topical steroid component can cause dilated blood vessels and thinning of the skin if used longer. Currently it is not being produced, and has been unavailable for the last year. Intermittently other prescription HQ products are available, and then they disappear. HQ at 4% concentration is a prescription product, and recently the FDA has been cracking down on products available without prescription that contain 4% HQ. Time will tell if HQ will be banned by the FDA, approved by the FDA, and if so, will a company produce it. After about three to four months, the body increases tyrosinase production and overrides the effects of HQ. Because of this, HQ is used is a pulsed manner, usually 4 months on, 2 months off, to allow it to work again. HQ cannot be used in pregnancy.

• Prescription retinoid creams such as Retin-A, Retin-A Micro, Refissa, Renova, Differin, and Tazorac: Topical HQ often is combined with a topical retinoid, such as tretinoin, which exfoliates the skin and allows for the ingredient to penetrate properly.  Unfortunately, they can be irritating, and irritation increases pigment. So they need to be used cautiously. Retinoid irritation can be reduced by titrating the dosage, changing the dosage to alternate days, and diluting the tretinoin with a moisturizer base. Creams or micro sponge formulations are much easier to tolerate than gels. The key is to have your face completely dry before you put it on at night, and use it on a regular basis, not intermittently. When your face is damp you absorb more and it is more irritating. You can apply it every other night or even every third night to start and work up. If you are having irritation, apply an oil free moisturizer first then the retinoid.

• Over the counter Retinol: The prescription retinoids discussed above are forms of retinoic acid, and are stronger than retinol. Non- prescription, over the counter retinol can be helpful in melasma treatment as long as it doesn’t cause irritation.

• Mequinol such as Solage solution (mequinol 2% and tretinoin 0.01%): If HQ causes the patient too much irritation, a deriva­tive alternative is mequinol.

• Over the counter or natural skin lighteners: include aloesin, arbutin, azelaic acid, bearberry extract, dimethylmethoxy chroman palmitate (Chromabright), ferulic acid, kojic acid, lactic acid, licorice root, lignin peroxidase, mulberry bark extract, N-acetylglucosamine, niacinamide, soy protein, various peptides, and vitamin C especially magnesium ascorbyl phosphate or L-ascorbic acid. These lighteners have various actions including inhibiting the pigment producing enzyme tyrosinase, dispersing pigment, and exfoliating pigment. They can be used for extended periods of time and can be used with other lightening ingredients to speed up the process.

• Every dermatologist and skin care company has their favorite combination. Our Antioxidant Skin Lightener contains aloesin, licorice root, bearberry, niacinamide, the form of active vitamin C magnesium ascorbyl phosphate, (Melfade-J) and dimethylmethoxy chroman palmitate (Chromabright). We use it with our Correcting Serums containing glycolic and salicylic acids, fruit acids, aloesin, and our Antioxidant Enzyme Peel containing papaya to exfoliate abnormal pigment.

Office Treatment:

Office treatments are used if topical creams don’t give enough improvement and to speed results. They must be done very carefully or they can cause increased pigmentation, especially in patients with darker skin types. They should be done very carefully, and by a physician who is experienced in treating pigment problems and skin of color, in other words by a cosmetic dermatologist.

• Chemical Peels: A series of in-office light chemical peels can improve discoloration by peeling off the top layer of pigmented skin cells, and allowing better penetration of other surface treatments. Glycolic acid peels are most commonly used but others include salicylic acid, superficial trichloracetic acid, lactic acid, tretinoin, 14% HQ, and resorcinol peels. They are best when used with home retinoids, prescription hydroquinone or other skin lighteners. Skin may be red, dry and flaky for up to 5 days.

• Intense Pulsed Light (IPL): A series of 3-5 Intense Pulsed Light treatments (IPL, Photofacial, or Photorejuvenation) at a lower intensity than is used to improve sun damage induced dilated blood vessels and age spots can be helpful.

• Particle Free Precision Microdermabrasion/Dermal Infusion such as SilkPeel: SilkPeel particle-free microdermabrasion uses a treatment tip to exfoliate the skin accompanied by application of the skin brightening peptide Decapeptide-12 (Lumixyl) at controlled intensity. It removes surface pigment, and allows better penetration of prescribed home skin treatments. A plus is that there is no redness or flaking after treatment.

• LED Treatments: GentleWaves LED Photomodulation uses a painless light emitting diode treatment and is used to reduce inflammation with other melasma treatments.

• Nonablative Laser Treatments: The Q switched 1064-nm Nd:YAG laser and the fractional lasers Fraxel Restore and Mosaic may be used in patients who don’t respond well to the treatments above or who also desire improvements in mild to moderate wrinkles, large pores, surface irregularities, or acne scarring.

• Ablative Lasers: Multiple treatment sessions with the Pearl 2790-nm Er:YSGG laser combined with IPL and topical treatments in carefully controlled protocols may be used in carefully chosen patients with skin types I-IV if melasma does not respond to other measures.

Sometimes things that seem that they should be easy are not. This is one of those times. With diligence and time melasma can be significantly improved or resolved. But I still hate melasma.

Holiday Sale: 20% Off Botox, Juvederm and Skin Care

Join Dr Elaine Cook and staff at Advanced Skin Treatment Center, 2609 Wolflin Village, Amarillo to celebrate the start of the Holiday Season with an Open House on Thursday, November 17 from 8am to 8pm in conjunction with the annual Wolflin Village celebration. This is a sale you won’t want to miss!

In addition to offering 20% off on all Dr. Elaine’s® Advanced Skin Treatment Skin Care, we have reserved the entire day for patients wanting Botox® and Juvederm® treatments at 20% off! It doesn’t get much better than that. Most people want to look their best around friends and relatives during the holidays especially for holiday photos. With this special, you can ‘Lose Ten Years in Ten Minutes’ and save 20%!

Relax the wrinkles between your eye brows, across your forehead and the crows feet outside the eye area with Botox. With Juvedermyou can plump up the ‘parenthesis’ wrinkles between your nose and the outside corners of your mouth, plump up your lips and fill in the areas below the outside edges of your mouth to give your face a more youthful look. Whether you’re a veteran to these procedures or want to try them for the first time, you should call today to schedule your appointment because we expect the slots to fill up quickly!

Botox and Juvederm first come, first serve, by appointment only. Call 806-358-1117  or email us at skincare@skintreatment.com today to schedule your appointment.

 

Fraxel and IPL BOGO Free Sale

Back by popular demand, we are once again offering our Fraxel and IPL BOGO Sale. During the months of October and November, with the purchase of either or both Fraxel or IPL treatments, with each treatment you get a second site treatment of the same procedure of equal or lesser value FREE! If you purchase a Fraxel for your face, you will get a free treatment for your eyelids or neck. If you purchase an IPL treatment for your face, you get a free treatment for your neck. Both the primary and the free second site treatment must be completed at the same time. You have until April 1, 2012 to complete your procedure in order to qualify for the free treatment, and you can purchase more than one Fraxel or IPL BOGO, as long as they are completed by April 1, 2012.

Fraxel Laser treats fine lines, wrinkles, sun and aging related texture changes, pigmentation, spots and acne scars and reduces pore size. Eyelid Fraxel Laser treatment improves lines and crepiness on eyelids.

IPL Intense Pulsed Light Treatment improves sun damage, unsightly brown pigmentation and facial veins and also reduces the blushing and flushing of Rosacea.

Both are IPL and Fraxel are extremely popular. Fall is a great time to do your procedure, as you will need to be sun protected during your treatment series. Call us at 806-358-1117 or 800-417-SKIN for more information or to schedule your treatment.

Take advantage of this great offer! It’s a great deal. Don’t miss out or I’ll say “I told you so”.

So you want to be a junior dermatologist?

Women pick at skin lesions, growths, cysts and spots. It is hard wired into our DNA. The first rule in medicine is to know what you know, know what you don’t know, and know that you know the difference.

So junior dermatologist, let’s take a pre-test.

 

 

 

Dr. Elaine’s “So you think you can dermatology?” Quiz

What is a good reason to pick at a skin spot?

1. It is there
2. It hurts
3. I really think I can get it better
4. Makeup makes it look worse
5. I have a date tonight
6. I am stressed

How many times should I try to pick at something before I give up?

1. One
2. Three
3. Ten
4. Thirty-seven
5. Four Hundred
6. Never give up

What is a good indicator that a pimple will respond to picking by getting better?

1. I want it to be gone
2. It is deep and painful
3. It is red
4. I can see pus at the top
5. It is draining
6. I have a date tonight

What is a good indicator that a pimple will respond to picking by getting worse?

1. I want it to be gone
2. It is deep and painful
3. It is red
4. I can see pus at the top
5. It is draining
6. I have a date tonight

I am deep enough in the skin to cause scarring when I see?

1. Redness
2. Pus
3. Blood
4. Muscle
5. China
6. 4 or 5
7. 3, 4, or 5

What things should I not pick at?

1. Red bump filled with pus
2. Deep tender pimple that I feel but can’t see
3. Little white beads under the skin
4. Moles
5. The spot I have been picking at for 6 months
6. Growths
7. 2 and 4
8. 2, 4, 5, and 6

When should I pull the flaky crust off?

1. This instant
2. When I want it gone so my makeup will go on smoothly
3. When I can rip it off with tweezers and get good, fresh blood
4. When the edges are lifted but the center is still stuck down
5. When it completely lifts off by itself
6. Never

What is the best way to remove those little white beads under the skin?

1. Apply Retin-A 37 times over 24 hours
2. Squeeze them until they pop through the skin like “Aliens”
3. Scrape them off with a fingernail
4. Prick the top with a clean, sharp straight pen and squeeze gently.  Once
5. Do a reverse osmosis high colonic

 What are the possible complications from picking?

1. Scarring
2. Permanent pigmentation changes
3. Infection
4. Delaying treatment of a skin cancer
5. Continual harassment from my husband
6. All of the above

How do I know I am picking too much?

1. When I have to use medical makeup meant to cover birthmarks and severe burn scars
2. When I spot the Intervention production crew talking to my husband
3. I keep a 10x magnifying mirror and tweezers at my side 24/7/356
4. I keep picking when I know there no chance that it will help
5. When Dr. Elaine tells me so
6. All of the above

 When should I stop playing junior dermatologist and see a real one?

1. When I see scarring
2. When I see increased redness, pain, bleeding, or pigment
3. When it is not getting better within one week
4. For any brown, black, growing, bleeding, or tender growth or persistent sore
5. Any growth that I am not absolutely sure is not skin cancer
6. When I want the best result possible
7. All of the above

 

Answers: Give yourself one point for each correct answer

1. 3
2. 2
3. 4
4. 5
5. 6
6. 8
7. 5
8. 4
9. 6
10. 6
11. 7

Score

1-3     Surrender your magnifying mirror, tweezers, and surgical instruments

4-6     Return to Google Medical School

7-9     You may proceed, but you are on academic probation

10-11   Apprentice junior dermatologist–proceed

12      Grab your white coat and join me in clinic

Note: maximum score is 11

Next: Review of test answers

 

Do you have a license for that thing?

I was recently talking with a patient whose face had markedly improved since her last visit. When I asked her what had changed she said, “You were right, and I finally took your advice. That made all the difference.” Gratified that my clinical skills had once again been validated, I asked her which specific and wonderful piece of advice she had taken, since I give quite a bit of wonderful advice.

“I had my husband hide my magnifying mirror.”

So here we are at yet another of my pet peeves—magnifying mirrors.  Specifically, magnifying mirrors that are owned and operated by women who also own several pair of devilishly sharp tweezers, assorted safety and straight pins (cleaned with alcohol of course!), and their very own monogrammed comedome extractor  (pimple popper) complete  with loop on one end and scalpel  blade on the other.

Before my gentlemen readers get too smug, at least the women don’t tell me “I didn’t know what that growth on my arm was, but it was bugging me, so I just took out my pocket knife and cut it off. See this scab right here? What do you think it was doc? You don’t think it was something serious do you?” To which I answer “I don’t have a clue.”

When women have a magnifying mirror, at-home surgical instruments, and the stubbornness of a mule, bad things can happen.  

For instance:

• Eyebrow shape becomes very peculiar, with the eyebrow starting centrally too far apart over the pupil, and the natural arch obliterated.
• Milia, those small white balls under the surface of the skin that the nurses and I remove through tiny pricks in the skin with sterile instruments, are excavated through incisions in the skin that most doctors would close with stitches.
• Hair on the chin is plucked, in-grows, is dug out with tweezers and needle, tweezed, in-grows again.  The cycle is repeated until permanent brown and red pigmentation, and scarring occur. And then the hair, ingrown skin, red and brown discoloration, and scar are picked again. Repeat.
• Pimples are popped and picked at before they are ready. Even when the picker knows they are not ready. Because they are there, and they are gross.  So they must be picked, mustn’t they? Of course if one squeeze doesn’t remove the pimple and all signs of its existence, then 200 squeezes must be applied. Because that will make it disappear without a trace. By morning.
• Scabs, flakes of skin, acne pimples that are trying valiantly to heal, are picked off every morning because the dry flaky top looks unsightly with makeup accentuating it. Unfortunately, the trauma of picking at it causes the lesion to make more protective flakey skin and scab, to thicken and pigment. It is in effect saying “please stop so I can heal.” Usually no one listens, and the cycle can literally go on for years.

Sarcasm aside, I commonly see women (and I hate to be sexist, but it is almost exclusively women, unless meth is involved) who have caused permanent and unnecessary scars to themselves by picking.

Am I any better? No. As my husband once said to me “I think you went into dermatology just so you could pick legally.” Partially true.  But be that as it may, I am a licensed and trained professional who knows what the lesion is, how to remove it, how much I can destroy without a permanent scar, and when to stop. Even if I don’t always do it.

Magnifying mirrors should be available by prescription only.  Or at least any magnifying mirror over 3x power. If I can’t see a lesion on exam with my 3x power magnifying glasses, it is not there. Instead, be like my patients who have had cataract surgery, except in reverse. They say “I never had all of these spots on my face until I had cataract surgery.  It gave me spots. “I tell them, gently of course, “No you did, and I have seen them on your face for the last 10 years.  It is just after your cataract surgery, you can see them too.” If you are prevented from seeing it in your 10x magnifying mirror, it will magically disappear.

So step away from the magnifying mirror ma’am, before someone gets hurt.

Next: if you must pick, do it like a dermatologist. Even though my lawyer is sitting at my shoulder trying to shake some sense into me.

Patient Appreciation Week Sale

All Dr Elaine’s Skin Care 20-30% Off
+ Free Shipping

So don’t miss out on our Patient Appreciation Week Sale. All Dr. Elaine’s skin care is 20-30% off, and of course, our everyday free USPS Priority Mail shipping. The sale ends Sunday July 17th at midnight CST.

If you have never tried our fabulous skin care, now is the time. And if you are already a fan, thank you.

Dr Elaines’s Advanced Skin Treatment is a dermatologist (and guess who that might be?) developed clinical skin care line that combines anti-aging cosmeceuticals with proven natural botanicals. Cosmeceuticals are cosmetics that have effects on the skin. The main groups are the peptides, antioxidants, growth factors, and vitamins. They improve fine lines, roughness, blotchy pigment, loss of elasticity, dullness, acne, and stimulate collagen production. Our botanicals are plant derived compounds that are used for their antioxidant, anti-inflammatory, exfoliant, moisture balancing, and collagen stimulating properties.

We offer specialized skin care products for acne, anti-aging, skin pigment lightening, sensitive skin, rosacea and hair and body. Clinical skin care is both a preventative anti-aging strategy and a repair strategy for skin that needs help. It is your everyday health program for your skin, and the foundation of an anti-aging program. Your skin is smoother with a healthy glow, reduction in appearance of lines, wrinkles, acne blemishes and brown discoloration.

If you have never been to our web site SkinTreatment.com here is where you can find what you need: Patient Appreciation Sale Dr Elaine’s Skin Care on Sale 20-30% Off including all skin care on sale through Sunday July 17th, midnight CST. If you know what you need, or are shopping for skin care after our Patient Appreciation Week Sale, these sections are always available, which show our current special offers: All Acne Skin Care on Sale– all of the special offers for our acne skin care, including sets at a discount All Anti-Aging Skin Care on Sale–all of the special offers for our anti-aging, and lightening skin care including sets at a discount All Skin Care Sets on Sale–all discounts on skin care sets or kits All Skin Care on Sale–everything–all skin care that is on sale

If you already use Dr. Elaine’s skin care, take advantage of this great sale to stock up. If you are considering trying it, this is a great opportunity.

A little paint and spackle can work wonders, but all the makeup in the world can’t make bad skin look good.

It is by far and away better to have good skin, than good makeup. With that in mind here are Dr Elaine’s top 10 rules for wearing cosmetics:

1. Heavy foundation may cover a pimple, but it makes you look older, and harder. A million times better to have good skin, and wear little or no foundation. So I put my time, energy and money on my skin.

2. There should be evidence to the naked eye that there is live human skin under your foundation. Ditto for blush.

3.  Concealer on pimples or marks plug up pores and cause breakouts later. Don’t just kick the can down the road.

4. Most women need some lip color, either their natural color if they are lucky, or with a lip color product if they are not. But lip color should always approximate a color that is seen, somewhere, in live humans. Bubblegum Pink and Bright Maroon are not in that group.

5. Corollary–blush color, if used, should also approximate a color that actually occurs in live humans. Fuchsia and Burnt Orange are not in that group.

5. If you use lip liner, it should be subtle enough that you don’t look like you are playing dress up with Mommy’s lipstick.

6. For everyday, eye shadow should not include the color family robin’s egg blue. For nights and special occasions eye shadow and eye cosmetics can be more dramatic and artificial. That is because in those situations eye shadow is subconsciously classified as “decoration” closer to jewelry, while lip color, cheek color, and foundation remain subconsciously classified as “natural beauty.”

7. Foundation on oily skin often turns more orange as the day progresses. Choose accordingly.

8. Don’t buy cosmetics based on friendship with the company rep, unless the cosmetics are really right for you.

9. Spend the most money on getting the perfect, natural looking foundation. That is the trickiest for cosmetic companies to do right. Mascara absolutely, lip color often, and eye shadow a fair amount of the time are just as good from the drug store as the expensive brands.

10. Try very hard to find the “sweet spot” with your makeup and cosmetics. The sweet spot is in between wearing no makeup at all and looking like you just got out of the hospital but are still ill, and wearing so much makeup that you could make some extra money while waiting at the bus stop to pick up the kids. The “sweet spot” is where you look natural, polished and beautiful.

Next: How I look natural, polished and beautiful every day.

 

Your skin can’t take a joke–so don’t tell it one

Hair and nails forgive and forget. But skin is something else again. It doesn’t forgive and it doesn’t forget. So, I do take care of my skin, and pretty well too. And I have for a long time. That is because skin holds a grudge. If you don’t take care of it , it goes bad on you, and at least some of the damage is irreversible. You can fry your hair, color it blue, lose it from going off birth control pills or after pregnancy and it recovers. Hair just says “whatever, and it grows out just fine. And the kind of hair problems that are really frustrating are not from anything that you do, they just happen, like alopecia areata, and the scarring hair loss diseases.  You can have chipped and damaged nails from working in the garden, you can abuse your nails from wearing acrylics and, within reason, they can recover. Unless you damage the matrix or the nail bed, then you gotta pay. But your skin remembers every unkind thing you ever said about it, did to it, or didn’t do to it (like protect it from sun damage). It really can’t take a joke.

So here is what I do. And I do it every day and every night, without fail. And yes, I use my own line of skin care products, Dr Elaine’s Advanced Skin Treatment, almost exclusively. After all, I developed them, and they are full of both high quality botanicals, marine actives, other natural actives with specific purpose, and various cosmeceuticals including alpha and beta hydroxy-acids, peptides, antioxidants, and vitamins. Since I developed them exactly the way I wanted them, this should  be no surprise to anyone.

My morning routine–First I get up, reluctantly, then:

1. Three days a week I use Dr Elaine’s Antioxidant Enzyme Peel (1 oz 38.99). You have to use it when your skin is completely dry. So I do it the very first thing, I don’t wash my hands or face, and I apply it in a very thin layer. Key word is “very thin” and then I let it sit 30 seconds with my hands in the air, without rinsing them, until the peel liquefies. Next I rub in a circular motion and exfoliate the dead skin. Then I rinse with clear water. I love this product because the papaya, grape seed, and willow extracts in it gently exfoliate without granular particles with the end result that my face reflects light well and glows, but it still allows me to use the retinoid Refissa without the increased irritation of a granular exfoliant.
2. Since I have normal-dry skin, I wash with our Facial Cleansing Lotion (6.7 oz $26.99), using my fingers only, never a washcloth. I love this cleanser–it has glycolic acid to exfoliate, it cleanses well, removes make up and the combined group of natural botanical oils leaves my skin soft and smooth rather than uncomfortably tight.
3. Then I follow with our Gentle Toner (6.7 oz $26.99) applied with a 100% cotton ball. Since I have a tendency to get eczema, and use a fairly potent retinoid every night, I need to reduce the tiny microscopic abrasions that I would get from a synthetic “cotton” pad. I don’t need a drying type of toner, so I use this one that is not drying.
4. Then Dr Elaine’s Correcting Serum (1 oz  $59.99) 2-3 pumps for my entire face and neck. The two things that I feel should be used every day as a basic program, other than sunscreen, is either an alpha hydroxy acid or fruit acid, and a retinoid. Our Correcting Serum has both 8% glycolic acid and a multiple fruit acid complex to exfoliate and promote collagen production, and hyaluronic acid to plump wrinkles and balance moisture.
5. Next I apply Dr Elaine’s Line Diminisher (1 oz $89.99). The peptides Acetyl Hexapeptide-3 and Palmitoyl-Pentapeptide 3 combined with hyaluronic acid help minimize fine lines, and antioxidant green tea calms irritation.
6. Then our Facial Moisturizing Cream ($41.99) in the winter or when I am extra dry or my skin is irritated, or our Hydrating Cream ($39.99) if it is summer or less dry weather. Moisturizers like the Facial Moisturizing Cream that are fragrance free are best if your skin has a tendency to irritation and you are using retinoids like Refissa.
7. Then I apply our Total Eye Renewal (0.5 oz $65.99) to my entire face. Yes, I know it says eyes, and I do use it on eyes,  but also on my face,  because the 3 peptides are very good, it has active Vitamin C, bunches of active botanical antioxidants and I really like the silky smooth effect from the shea butter and silicone base.
8. Then I apply DCL Super Sheer Sunscreen SPF 50 (2.5 oz $24.99) to  my face, neck, chest, forearms and backs of my hands every single day, year round, without fail. I really like this sunscreen because it covers a really broad spectrum of UV, and it is so light weight you don’t even know you have it on.

At  night, no matter how tired I am:

1. Dr Elaine’s Facial Cleansing Lotion
2. Refissa (by prescription $145) to face, neck, upper chest. I apply Refissa to back of hands and forearms every other or every third night.
3. Dr Elaine’s Total Eye Renewal ($65.99) around my eyes after Refissa.
4. Brush on Latisse to the base of the eyelashes (by Allergan–prescription $120 a 3 ml bottle) to grow eyelashes and make them darker–but I only apply it every other night or the lashes get too long and thick. That also cuts the cost, as a bottle will then go 2-3 months.
5. Dr Elaine’s Lip Therapy ($5.99) right before bed so my lips don’t get too dried out.

For Body:

1. Dr Elaine’s Calming Body Wash (12 oz $15.99) in shower which helps my dry skin.
2. Dr Elaine’s Smoothing Body Moisturizer (12 oz $37.99) every night. I am atopic, so my skin is sensitive and rashes easily. That means if I don’t apply moisturizer to my entire body I will itch all night and since I don’t want to do that I just go ahead and use body moisturizer every night. I love the scent, and also the powdery smooth feeling.
3. Then I put our Perfecting Hand and Body Moisturizer (12 oz $36.99) on my feet and heels right before bed. The glycolic acid and fruit oils, soften and repair thickened skin and cracks, and the Evening Primrose oil reduces irritation.
4. If I have been lazy and my heels are really bad I will use Ureacin-20 (4 oz $26.99)on them for a couple of nights. It works really well for thickened calloused heels, but leaves a thin white film on them, so I don’t do it in the daytime.
5. For a little color, in the summer or if I am going on vacation I will use Jergen’s Sunless Tanner ($7.99) for medium to tan skin (just means it has more DHA in it and I get color quicker) or Clarins Self Tanning Instant Gel (4.4 oz)

And that’s how I do my own skin care. I take care of my skin, and I don’t tell it any jokes.

Next: how I do cosmetics