Philadelphia Skin Blog A discussion of Skin and What affects your Skin

Diverse Acne and Skincare Needs in Philadelphia

2008-07-03T19:24:00.002-05:00

Skincare 101 and when to see the Doctor

Acne is a skin condition that affects almost everyone at some point in his or her life. While many people only deal with the occasional pimple, others have to contend with regular outbreaks that can cause feelings of self-consciousness and misery. Fortunately, there are many effective treatments that can minimize or even eliminate acne problems.

For some individuals, however, home treatments are not successful at treating acne and professional help is necessary. It is important to know when you should see a doctor about your acne in order to prevent long-term problems such as scarring or skin discoloration.
Hormones that lead to increased oil production are the main cause of acne. Bacteria then cause the oil to thicken and clog pores. This problem results in pimples and blackheads that are unattractive and can even be quite painful. Before consulting a doctor concerning your acne, try clearing up your skin with home treatments and remedies.

The first step in acne prevention and treatment is to use a good cleanser, washing your face no more than twice a day, once in the morning and once at night. It is important to use a good moisturizer in order to prevent skin from becoming overly dry, which will lead to increased oil production and more pimples. Once you have applied moisturizer, use an over the counter medication to treat the problem areas where outbreaks commonly occur. One of the best treatments is benzoyl peroxide lotion, which helps clear up the bacteria that causes acne.
Be cautious to use these treatments in moderation in order to avoid drying out the skin too much. Never squeeze or pick at pimples, which will only spread the acne-causing bacteria to the surrounding area and can lead to permanent scars.

If home treatments do not lead to a reduction in symptoms within two weeks, you should consult a doctor about how to best treat the problem. You should see a doctor if pimples become irritated or inflamed or if the problem worsens due to your home treatment. If either of your parents had severe acne or scarring as a result, you should consult your doctor as soon as possible. Your doctor may prescribe antibiotics that will kill the germs and bacteria that cause acne. Another commonly prescribed treatment is medicines that impact hormones amounts, leading to a reduction in the amount of oil the body produces. Your doctor may recommend other topical solutions that are stronger than those you can buy over the counter.

Before deciding on the treatment that is best for you, ask your doctor about the potential side effects of each option. Some hormonal treatments can lead to weight gain or moodiness, while topical solutions can cause skin irritation or allergic reactions. If your doctor recommends the drug Accutane, be sure to inquire about the drug's potential for psychiatric side effects such as depression or thoughts of suicide. Carefully watch for potential problems after you begin using a doctor prescribed treatment and be sure to report any undesired or unexpected results.

Acne can be more than just a minor annoyance for many people. Those with severe acne often experience depression, feelings of self-consciousness, and may avoid social situations due to embarrassment over the condition. It is important to take good care of your skin in order to minimize acne, but home treatments may not be effective for everyone. Consult a doctor for advice and treatment if home remedies are not helping, if your acne is worsening, or if you have a family history of severe acne. A professional can offer treatments that will minimize or eliminate the problem. It is vital to treat acne effectively in order to prevent long-term damage such as skin discoloration and scarring.

To Slow Down Aging: Treat All Three Layers of Skin

2008-06-27T20:36:00.003-05:00

TO SLOW DOWN AGING: TREAT ALL THE LAYERS OF THE SKIN

The skin has three different layers to it. To help slow down the aging process of the skin, all three layers of the skin need to be treated. The treatment is different for each layer because the aging process affects each layer differently. To help you understand what is the best treatment for you, read on.

The top layer of skin, the epidermis, regenerates itself every 6-8 weeks, but as we age, the natural exfoliation process of the epidermis begins to slow down. This leaves the skin appearing uneven, dryer and duller. Your skin care products don't work as well because they now have to pass through this thick layer of dead skin for them to have an affect. The best treatment for epidermal aging is microdermabasion or glycolic peels.

The middle layer of skin, the dermis, is where collagen and elastin are produced. After the age of 30, we begin producing less collagen and elastin fibers. This causes the skin to thin, and if you are fair, it may appear more red because the superficial blood vessels under the skin are more noticeable, and skin begins to sag. If you have sun damage, there is an accumulation of abnormal tissue that begins to replace collagen, causing it to further weaken. The skin begins to develop fine lines, deep wrinkles and leathery skin. The best treatment to help rebuild this layer are the fractional resurfacing lasers (the PIXEL). These lasers penetrate deeper in the dermis to build collagen and elastin. If there is more redness, the skin rejuvenation lasers can help decrease the redness. The last layer of the skin is the hypodermis, the subcutaneous fat which provides us the natural fullness seen in young faces. As the dermis thins and atrophies, gravity begins to take its effect and slowly begins to pull the subcutaneous fat down to the jawline. Our facial structure begins to slowly change. In our twenties and thirties, we had an inverted triangle with the fullest part of our face in our cheeks with a natural tight jawline. In our forties and fifties, our face becomes more square or rectangular like as the dermis thins and gravity begins to pull the fat in the cheeks down towards the jaw line. As we approach our sixties, the fat is now at the jaw line causing more of the jowling and sagging effect. The end result is that we have an upright triangle rather than the inverted triangle we started with as a young person. The treatment for this layer is the Accent laser that helps remodel the subcutaneous fat while tightening the skin.

Shanti MedSpa at The Institute for Advanced Skincare and Optimal Health can help you slow down this process with our new 3 in 1 combo: ACCENT, PIXEL, MICRODERM. This treatment procedure helps you rebuild, remodel and revitalize all three layers of the skin to truly slow down the aging process. To see if you are a candidate for this revolutionary anti-aging treatment, please call or email us today!

A Detailed discussion of Acne Treatment Options

2008-02-09T15:45:00.000-05:00

Contrary to what your mother may have told you, it’s not what you’re eating that causes acne. Acne has a strong genetic component, exacerbated by hormonal changes (most women already know this!); stress associated with school, jobs and starting families, and sometimes-poor skin care regimens. Everyone knows that acne affects teenagers, but most people do not realize that young adults in their 20´s and 30´s are more likely to develop acne than their teen counterparts.

NOT ALL ACNE IS CREATED EQUAL

There are different types of acne lesions as well as grades of acne severity. Treatment is based upon these possible combinations.

Types of acneiform lesions

· Open Comedone (aka the blackhead)

· Inflamed Papule

· Pustule (aka closed comedone)

· Painful Nodular Cysts

Doctors perform acne grading to help track improvement (or lack thereof) to therapy. Grade 1 is the mildest, with very few lesions. This continues up through grade 4, acne that has the most significant surface coverage.

When a patient presents in my office, I quickly evaluate the overall severity of the acne (the grade) and the types of lesions present. Every doctor has their favorite combinations of treatments that have been successful for their patients, so what I am about to share with you are regimens that I tend to favor. I allow 6-8 weeks for any therapy regimen to show significant (I didn’t say miraculous) improvement. If a patient does not demonstrate this, I will often change their medications. If you have been on the same medicines for a year and you are still breaking out, discuss this with your doctor!

Very mild, grade 1 acne, composed of small, superficial lesions, such as blackheads and pustules often responds well to topical therapy. My favorite prescription topical that shows consistent resolutions of blackheads continues to be Retin A .025% cream. Frequently, patients will tell me they have used Retin A in the past and have experienced quite a bit of irritation. Almost everyone can use Retin A if used properly.

I tell my patients to wait 30 minutes after washing before applying a pea-size amount of Retin A to the face. I also tell them to apply it only every other night when starting out. This minimizes the dryness. If the patient experiences anything more than some mild white flaking, they should back off to every third, fourth, or fifth nights, etc. until they can tolerate its use.

For patients with incredibly oily skin or for those who have innumerable stubborn blackheads, I have been very pleased with the Tazorac Gel that comes in 2 strengths, 0.05 and 0.01%. It is used in the same manner as Retin A or other similar derivatives.

Prescription Therapy For Acne Currently On The U.S. Market*

PILLS

Used to kill the bacteria P. acnes that causes acne flares as well as act as anti-inflammatory agents, reducing the size of acne lesions and helping prevent outbreaks altogether. Spironolactone works for those women with hormonal influences causing acne. BCPs again work at the hormonal level. Accutane works to correctly form the oil glands whose linings are improperly forming, and is the closest to a “cure” we have for acne.

· Tetracycline

· Minocycline

· Doxycyline

· Erythromycin

· Bactrim (Sulfa)

· Accutane

· Birth Control Pills (Ortho Tricyclen)

· Spironolactone

DIETARY SUPPLEMENTS

VitaMedica Healthy Skin is a nutritional supplement that provides internal skin care by enhancing the body´s natural systems for repairing, cleansing and healing. The supplement is intended as an adjunctive therapy to the topical products and/or treatments that skin care professionals recommend for acne patients.

Many topical treatments for the care of acne and inflammatory disorders of the skin are currently available. While effective, these regimens contain products that produce an action primarily on the outer layer of the skin. Although the topical approach represents the foundation of good skin care, it also makes sense to address what is going on internally. That´s because what you put inside your body may be just as important as what you apply externally.

VitaMedica Healthy Skin is indicated for patients with mild to moderate acne. The product is suitable for patients 12 years or older. This nutraceutical is ideal for individuals who do not eat a well-balanced diet on a consistent basis. Certain individuals should seek the advice of their doctor before beginning the program particularly diabetics, pregnant or lactating women. Healthy Skin Formula contains Vitamin A. If you are presently taking Accutane® (isotretinoin) for the treatment of acne, please refrain from taking HEALTHY SKIN FORMULA until the end of the treatment cycle.

TOPICALS

Topical Vitamin A Derivatives
Used to remove blackheads, dry up excess oils and smooth out bumpy acne.

· Tretinoins (Retin A, Avita)

· Tazarotene (Tazorac)

· Adapalene (Differin)

Topical Antibiotics
Used to kill of P. acnes, the bacteria responsible for flaring acne outbreaks.

· Erythromycin (Erycette, Emgel)

· Clindamycin (Cleocin T)

· Azelex

· Benzoyl Peroxide (BPO)

· Benzamycin (a combination of BPO and Erythromycin)

· Clinac BP (a combination of Clinac O.C. and Benzoyl Peroxide)

· Metronidazole (MetroGel/Lotion/Cream & Noritate)

· Plexion Lotion & Cleanser (Sulfa based)

INJECTABLES

The stray cyst can always rapidly be resolved with a small shot of steroid solution known as Kenalog (triamcinolone). The plus side to this is the rapid resolution for those "little emergency" situations like weddings, prom, etc. The draw back is that this is simply not the way to treat widespread recurrent acne. Nor is it pleasant should you experience the atypical "sink" spot where fat atrophy has taken place as a side effect from the shot. Fortunately this is unusual and fills in over several months.

DRYING AGENTS

Drying agents help reduce oils and often contain ingredients to help unplug pores otherwise known as keratolytic activity. Many OTC products contain these 2 activities in addition to some antibacterial properties thanks to Benzoyl Peroxide.

· Sulfur (Sulfacet R)

*This list is not meant to be fully comprehensive.

Non Prescription Therapy Options For Acne*

· Salicylic Acid (a.k.a. Beta Hydroxy Acid)

· Glycolic Acid

· Oil-Absorbers

· Oil-Absorbing Therapeutic Masques

· Combination Products (Peter Thomas Roth Max BPO Gel 10%,

· BPO

· Drying Agents/Keratolytics

· "Scar" therapy

· Discoloration therapy

*This list is not meant to be fully comprehensive.

While there is no single perfect prescription item in the treatment of acne, I still find topical Azelex 20% Cream to be a personal favorite. This medication is great for treating small inflammatory papules and pustules, and also works well for folliculitis and "hair bumps". This product works well in conjunction with Retin A. It is applied twice daily (ideally morning and dinner time), while the Retin A is applied by itself at bedtime.

A few tips when treating acne.

· Blackheads often require some form of prescription topical vitamin A product for eradication. Several agents have been clinically proven to target a variety of factors that contribute to the formation of a blackhead while improving the appearance of pores. It can be used solo or in conjunction with a prescription regimen depending upon the severity of the problem.

· Cysts respond best to pill therapy.

· A corollary: If you’re under 13, nursing or pregnant, tetracycline based medications are off limits as they can permanently discolor the tooth enamel. If you really need oral medication, usually it’s limited to Erythromycin.

· Consistency of treatment is your best asset when trying to get results. Don’t pick, it can lead to scar formation.

· Allow at least 6-8 weeks for every new therapy to kick in before giving up on it.

· Don’t scrub your face or get facials if you’re acne prone. This simply traumatizes the glands and leads to further flare-ups.

· Keep your bangs off your forehead and your hands off your face. This deposits excess oils that can further clog pores.

· Avoid the use of heavy skin care products like cocoa butter, they will smother the skin and flare your acne.

· Don’t apply your acne creams/lotions, etc. heavily like a masque (unless it is one). There is no reason that your cream needs to be seen in order to work.

· Remove your make-up when you’re at home. Let your skin breathe!

Skin care for those who are acne prone can be enhanced by the use of high potency glycolic acids. "Medical grade" should provide at a minimum level of 8%, preferably 12% or higher. Neostrata line of acne agents contains 12% glycolic acid, can be used for removing excess oils and surface debris, thus unclogging pores. For anyone concerned about rejuvenation and acne, Neostrata has a bevy of antioxidants combined with even higher levels of glycolic acid (15% and 20%, respectively), providing an enhanced cleansing experience.

The application of a topical glycolic acid gel or lotion such as Neostrata can also be used in conjunction with other topicals such as Azelex at the same time, it helps to draw the medication in deeper and become more effective.

Many times, patients will also have a great number of inflammatory papules and/or cystic lesions. In this case, oral medication is needed in addition to topical therapy for effective resolution. The tetracycline family is the most effective. Regular tetracycline (aka sumycin), is used in doses of 500mg twice daily. Minocin is a more aggressive member of this antibiotic family. It also is much more expensive. I save this for patients who show no response to tetracycline, or patients with mostly cystic acne. Doxycycline is similar to minocycline, however, I have not had nearly the response rate to this medication as I have to Minocin so I tend to avoid its use. Erythromycin is not nearly as effective for treating acne and tends to cause significant stomach upset. I save this for patients who are younger than 13 (tetracycline products will discolor dental enamel in this age bracket) or for patients who for some reason cannot take tetracycline. If you are on Erythromycin, take it on a full stomach you’ll be more likely to tolerate it.

Regardless of which antibiotic you might be on, here are some things to keep in mind. After you’ve cleared in let’s say 8 weeks, that doesn’t mean you suddenly go off the medication like you have had a sinus infection. If you do, odds are you are going to break out again. Once I have found the best mix of medications that clears a patient, I usually keep them on the same routine for another 3 months. At that time, assuming all is well, I will start to slowly wean them off their oral prescription antibiotics if at all possible. If there is a flare, I go back to the dose before that kept them clear. Some patients come off the meds altogether (this is rare), most are able to take the medicine less frequently (timing will vary with the patient) and a few won’t be able to decrease their dosage whatsoever.

Unfortunately, I still come across many first time acne patients who have very severe cystic acne. These are the grade 4 cystic acne patients for whom aggressive treatment is required right away. Accutane has been a blessing for these patients. Accutane is a drug to be taken seriously. It is the closest drug we have to an acne "cure", however, it can have potential side effects. For this reason it is not offered to patients with mild acne. Occasionally, I will have a patient with significant non-cystic acne unresponsive to accepted aggressive therapy who may be placed on Accutane. Pregnancy must be avoided while on Accutane as well as for 1 month after discontinuing the drug due to the risk of birth defects. It is important to understand that the medication does NOT affect ovaries, eggs or sperm. Only a developing fetus is at risk. Treatment is for only 5 months and has repeatedly shown great results. While on Accutane, blood work is done for screening, every 2 weeks for the first month of use and monthly for the final 4 months of use. This is to monitor potential problems with blood counts, liver and kidney function as well as monitor triglyceride levels that can skyrocket during Accutane use.

Two product candidates in the acne pipeline under study include topical versions of oral medications that have been used to treat cystic acne. Topical Accutane is being used in Canada and Europe. I have had some patients present who have been given "home made" forms of this product which consisted of their pharmacist poking holes in the Accutane capsule and mixing it into a cream base. So far they have reported all it did was locally irritate and dry the skin without helping clear the acne lesions. It remains unclear whether a consistent formulation marketed after FDA approval would be more beneficial. Another medication called Dapsone used to be prescribed for severe cystic acne before the availability of oral Accutane. Dapsone continues to be used in dermatology mainly in the treatment of certain blistering disorders. So far I have heard very little about early study results of its topical use for acne therapy.

Foot Loose and Oil-Free

Finally, it is necessary to avoid the use of routine skin care products that might exacerbate or cause acne. Typically dermatologists try to recommend oil free products right away to their acne patients. Another term for these items is non-comedogenic. Products such as Neostrata are often recommended as appropriate for acne prone patients without the concerns of causing further acne flares. It is important not to dry out your skin in your enthusiasm to try to clear your face. It is natural to want to repeatedly use a helpful item or try one that is quite strong to help speed up the healing process. But overly dry skin or red, irritated, inflamed skin is not meant to be the end point. There are some acne patients who have normally dry or sensitive skin despite the presence of acne. If you fall into this category, try keeping the use of drying items to a minimum. Rarely, some acne patients are unable to use any topical acne therapy as it is simply too irritating and the use of pills again becomes necessary.

Too many acne sufferers go untreated far too long. Acne can have a real impact on an individual’s self esteem. Dermatologists are specially trained to treat skin diseases including acne. We have so many effective therapies that weren’t available in the 70’s when I was growing up. I can’t emphasize enough that NO ONE needs to suffer from acne. If you have acne that doesn’t respond to over the counter treatment, please check with a board certified dermatologist in your area.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Acne Geography-Treatments for Various Unique Location

2008-02-09T15:34:00.000-05:00

Despite its persistence as a facial blight, acne doesn’t necessarily respect bodily borders and confine its geographical reach to the T-zone. Despite winning the overall war against zits, you may still find yourself fighting the occasional battle on your chin, back and butt. Sticking with a good skin care routine that keeps your skin clean, but not stripped, exfoliated, but not raw, and using a topical agent such as benzoyl peroxide or salycilic acid is good practice. However, if your breakouts seem to crop up where you least expect them, a little sleuthing might help you uncover the culprit.

The zone: Jaw and chin

The culprits: your phone or resting your chin in your hand.

Dirty hands cradling your face throughout the day constantly deposit dirt and oil from your hands directly on to your face. Add to that the pressure and you’ve set the stage for a pimple. Telephones, oily from constant use and tucked against your face, create a welcome environment for acne.

The fix: Regularly swab down your home phone, cell phone, work phone, whatever phone you use, with an alcohol soaked cotton pad to cut grease and kill bacteria lingering on these heavy-use surfaces. When speaking on the phone remember not to rest your face on the receiver. Wear an excellent oil-control gel that will be there to absorb the oils, not your skin. Gel can be re-applied throughout the day - even over makeup! We can make recommendations on a gel for your problem

The zone: Hairline, scalp, forehead, and temples

The culprits: So common is this flare-up destination that it even has it’s own name: pomade acne. Many hair products designed to defy gravity and the nature of your hair to get it to mold into the desired style of the day can also clog pores and lead to acne.

The fix: If you can’t forgo using the hair product altogether, try to at least keep it from having direct contact with your skin by limiting the amount that comes into contact with your hairline and scalp. Look for brands that tout their noncomodogenic (won’t clog pores) qualities such as many water-based formulations. Keeping oily hair clean by using a good, grease-busting shampoo. Glycolic acid facial cleansers such as NeoStrata alone or combined periodically with a good facial chemical peel or microdermabrasion can go a long way to keeping skin clean. Add a dab of retinol used solo every other night to stubborn troublesome areas.

The zone: Cheeks

The culprits: Hair, hands, pillows, and makeup.

The fix: Compared to other regions of your face, cheeks generally are less prone to breakouts, so a flare up can be particularly frustrating. Luckily, a little self-discipline may be all it takes to get your complexion back in shape. If your hair is oily and regularly dragging across your cheeks, try using a shampoo formulated for oily hair and then keep your hair tied back, off of your face, to prevent transferring oil from your hair to your skin. Likewise, change your pillowcase frequently. Dirt and oil build-up on bed linens can aggravate acne.

If you are a blush or bronzer user check the label for mica. Mica is a mineral that even when ground finely for cosmetics retains its irregular shape. Its jagged edges can irritate and clog pores leading to acne. We recommend mineral oil based cosmetic line like Glo Minerals as a daily use make-up that is safe and preventative.

A dirty blush brush can harbor disturbing amounts of acne causing bacteria so remember to wash out your cosmetic brushes regularly or switch to a non-comodogenic gel or water-based formula.

Kill skin bacteria and open pores with a well-rounded acne masque such the NeoStrata antibacterial soap and moisturizer used a few nights each week.

The zone: Back and shoulders, chest

The culprit: Sweat and friction.

The fix: Wear workout clothes, especially sports bras, that breathe and wick sweat away from the skin, and aren’t binding or abrading to the skin, both of which can promote an acne-positive environment. Make sure to shower after sweating with a cleanser that will lift grime away from the skin such as Murad Activating Body Scrub and change into clean, dry clothes that aren’t tight fitting.

If you find that you’re breaking out along your bra-strap line, on the shoulder where you carry your handbag, or shoulders that take the weight of your backpack, rethink those items (i.e. use a handbag or tote instead of a shoulder bag) to reduce what is called acne mechanica. This pressure-induced acne can also show up on the chins of violin players and where sports equipment chaffes (like bike helmets).

If you are experiencing acne on your back, Murad allows you to treat this hard to reach area. If after controlling the acute and chronic acne formation, microdermabrasion, chemical peel or pixel laser are all options for eliminating acne scarring, pitting and discoloration.

The zone: Lip line

The culprit: Pore clogging lip balms/lipstick/lip gloss. All those concoctions that make your lips feel slick and silky can also leave you broken out.

The fix: Switch to formulations that don’t have the high concentrations of waxes and petroleum. A Lip Plumping Pencil is a great option; apply to lip line and fill-in. Don´t forget to remove lipstick residue at the end of the day.

The zone: Your, uh, bum

The culprit: Tight clothes that don’t breathe and tough behind skin that doesn’t slough off pore clogging dead skin cells.

The fix: First, ditch tight pants and undergarments, including tights and stockings, for garb which gives skin a little space and a chance to breathe. Then, invest in an exfoliant and use it regularly. Medicated scrub is an ideal way to keep pores "down there" clean and fresh, but remember, that this is delicate skin; don´t over do it!

Health Benefits of Brown Rice

2008-02-08T20:43:00.000-05:00

White rice begins as brown rice. Once the outer coating of rice bran is hulled off, however, not a lot of nutrients remain. A thousand years ago, Chinese physicians discovered that eating only refined white rice, devoid of the B vitamins in the bran, led to beriberi, a deficeincy in thiamine (B1). Modern research has identified a wealth of nutrients in the bran coating of brown rice. It is remarkably effective in lowereing high blood sugar and therefore serves as an excellent food for diabetics.

Rice bran contains more than seventy antioxidants, including the well known aging fighters vitamin E, glutathione peroxidase, superoxide dismutase, coenzyme Q-10, proanthocyanidins, and inositol hexaphosphate. It is no wonder that rural farmers in Asia, who eat brown rice because white rice is too expensive, live longer and develop fewer health problems than their city dwelling counterparts, who eat mostly white rice.

Biologic Replaces Ointments & Surgery to Stop Aging

2007-06-18T15:14:00.000-05:00

Biologic Replaces Ointments & Surgery to Stop Aging

Sun Smart Cities-Where does Philadelphia rank?

2007-06-16T14:49:00.000-05:00

So you think your city got on the list for "sun smart cities", think again. The American Academy of Dermatology released its first-ever ranking of 32 "sun smart" cities and a few states. Washington, D.C. leads the list and Chicago is in last place.
More than 3,300 adults in those areas completed the AAD's online survey, "Rays: Your Grade," in February.
Survey topics included participants' history of sun exposure and their knowledge about tanning, sunburns, skin cancer, and sun protection.
The AAD's rankings are based on the responses of residents in each location. Here is the AAD's list. Locations that tied received the same number.
1. Washington, D.C.
2. New York
3. Miami
4. Tampa, Fla.
5. Los Angeles
6. Dallas
7. Salt Lake City
8. San Francisco
9. Idaho
9. Atlanta
9. Philadelphia
12. Phoenix
13. Portland, Ore.
14. Vermont
15. Providence, R.I.
15. Baltimore
15. Boston
18. Hartford, Conn.
18. Riverside, Calif.
20. Houston
21. New Hampshire
21. Denver
21. St. Louis
24. Cincinnati
24. San Diego
26. Detroit
27. Cleveland
27. Minneapolis
29. Seattle
30. Pittsburgh
31. Maine
32. Chicago
Other poll results include:
Nearly 3 in 4 participants feel that people look more attractive with a tan. Nearly 4 out of 5 participants are concerned about skin cancer. Nearly two-thirds of participants got a tan last year. Half of participants were sunburned at least once last year. Most participants (71 percent) don't use sunscreen on an average day.
Curious about the quiz? You can take it yourself on the AAD's Web site http://www.aad.org/

Pixel Laser- One Device for Multiple Solutions

2007-06-09T22:22:00.000-05:00

Seema Patel MD, MPH The Institute for Advanced Skincare and Optimal Health

the Harmony Pixel Laser?
The Harmony Pixel Erbium Laser is the latest FDA-approved laser designed to improve the skin’s surface and texture by stimulating the production of collagen. This safe and effective treatment represents the best of both worlds for skin resurfacing. It combines the proven effectiveness of an ablative approach with the patient comfort level and convenience of a non-ablative approach.

Why is it different from other laser treatments?
The Harmony Pixel Laser delivers results similar to ablative lasers (lasers that resurface the skin) but without the side effects which can include significant irritation as the skin heals. The Harmony Pixel also can be used on many more body parts such as the face, neck, chest, arms and hands, a much wider scope than the traditional technologies.

What conditions will the PIXEL help to improve?
The Harmony Pixel Laser is used to treat wrinkles, scars, superficial skin lesions and is effective for skin resurfacing.
What can patients expect following treatment?
Patients will find the skin around the treatment area feeling firmer with a smoother surface texture. They will not need pain medication and can return to work immediately after the treatment.

Patients will experience little to no discomfort following treatment with the Harmony Pixel Laser. During treatment, patients may feel subtle warmth as the laser pulses the skin. They also may feel as if they have a mild sunburn for a few hours following the procedure. Make-up can be applied immediately afterward.
Is there any down time?

There is little to no down time following treatment with the Harmony Pixel Laser, though redness may be seen for a few hours to a few days. Patients may also experience mild flaking as the skin exfoliates for one to two days, as well. Full recovery is typically five days.
How many treatments are required?

Skin resurfacing with the Harmony Pixel Laser is gradual with complete results being typically seen after three to five sessions at two to four week intervals.

Since this is an Erbium laser, patients with more moisture in their skin experience more sensation and greater results in fewer treatments. Therefore, a patient with dry skin may require more treatments.

2007-06-09T13:43:00.000-05:00

Get the Facts; Not Fiction Behind Anti-Aging Products and Their Active IngredientsActivate the Anti-Aging Process

The aging process begins when we enter the world and the effects of aging are evident in our bodies through out our lives. Beginning in our 20's, the signs of aging start to become noticeable. Genetically programmed chronologic aging causes changes in collagen and elastin, the connective tissues that supply firmness and elasticity to the skin. The genetic program of individuals is different, so the loss of skin firmness and elasticity occurs at different rates and different times in one individual as compared to another. As skin becomes less elastic, it also becomes drier and underlying fat padding begins to disappear. With the loss of underlying support by fat padding and connective tissues, the skin begins to sag; it appears less supple and wrinkles form.
Although wrinkles, lines and age spots are formed by the natural effects of getting older, one way to prevent them from appearing early on in life is to avoid direct sunlight and use sunscreens with SPFs 15 or higher. And, although most of us have some form of sun-damaged skin, there are ways to regain healthy, smooth skin. After many years of research, scientists, dermatologists and plastic surgeons have discovered that a variety of natural ingredients and vitamin extracts significantly help slow down and even reverse the signs of aging skin. These ingredients are now found in many physician developed and physician recommended anti-aging skin care products, which are specified below.

Vitamin A (Retinol) - Topical Vitamin A has been suggested to help build collagen fibers within the skin in addition to its more superficial exfoliating property. This is the basis for its use in minimizing the appearance of fine wrinkle lines. Vitamin A or Retinol is the main ingredient found in TYK Young Again, M.D. Forte, DDF and SkinScience products.

Vitamin C - Vitamin C or ascorbic acid acts as an antioxidant and is considered vital in wound healing because it aids in stabilizing collagen. When applied topically, vitamin C can reduce fine lines and wrinkles and may lessen the severity of sunburns. This healing ingredient is found in SkinCeuticals, Cellex C and Obagi Cffectives skin care products.

Vitamin E - Vitamin E is another antioxidant that shows to have anti-inflammatory effects on the skin. When applied topically, vitamin E has been shown to improve moisturization, softness and smoothness and also provides modest photo protection. Vitamin E is found in Cellex C, Exuviance and MD Forte products.

Alpha Hydroxy Acids (AHAs) - AHAs are designed to smooth fine lines and surface wrinkles, to improve skin texture and tone, to unblock and cleanse pores, to improve oily skin or acne, and to improve skin condition in general. AHAs are the main ingredients found in MD Forte, TYK Young Again, Super Skin and SkinScience products.Glycolic Acid - Glycolic acid is the most active and beneficial of the Alpha-Hydroxy-Acids (AHAs) in skin care. Once inside the cells, the acid triggers new formations of collagen to plump cells and the ground substances in the skin to reduce wrinkles on the skin's surface. Glycolic acid is proven to be very effective in the treatment of acne as well as in cosmetic uses. Glycolic acid is found in products by Gly Derm, MD Forte, Z. Bigatti and Super Skin.

Idebenone -Idebenone is the synthetic variant of the natural compund ubiquinone. Both powerful antioxidants, idebenone and ubiquinone shield skin from environmental damge, improve the appearance of fine lines and wrinkles, reduce dryness and smoothe skin texture.

N-6 furfuryladenine (kinetin) - The nature-identical plant growth factor, furfuryladenine, retards the aging of plant cells as well as in vitro human skin fibroblasts. This natural, anti-aging ingredient has been proven to reduce wrinkles and fine lines and is exclusively found in Kinerase creams and lotions. This is a proven alternative for people with sensitive skin or people who are sensitive to products containing Retinol and Vitamin C.

Copper Peptides - Copper Peptides are the latest scientific breakthrough in skin rejuvenation. Copper has been found to naturally firm the skin, enhance elasticity, and reduce fine lines and wrinkles. Copper is the main ingredient in products by Neova and Osmotics.

Pal-KTTKS - Pal-KTTKS is an effective ingredient for reducing fine lines and wrinkles. It's found to promote a smoother, younger complexion quickly, without with out expensive and painful chemical peels, surgery or injections. This patented peptide solution is found in StriVectin-SD.

Green Tea Extract - Green tea's anti-inflammatory and anti-growth qualities are found in many skin care products designed to reduce the appearance of puffiness, wrinkles, fine lines and large pores. Green Tea is found in the Dr. Brandt skin care line, Z. Bigatti and Gly Derm products.

TNS - The biotechnology of the skin's natural healing process has arrived with the first tissue repairing complex containing growth factors found in normal, healthy skin. Unlike anything else currently on the market, TNS is the next level of skin rejuvenation that delivers dramatic results, for smoother, softer, younger looking skin. TNS is found in SkinMedica's TNS Recovery Complex.

Many customers ask which anti-aging product is best and we always respond by saying that there is no "best" product. Since every individual's skin is different, the results of using anti-aging products will be different as well. We recommend that you consult with a skin care professional prior to use of any new skin care product to determine your skin type, skin condition and possible sensitivities to active ingredients. Your skin care professional may recommend specific products, or you can try a few on your own based on your consultation. If you are not happy with the first product you try, try another one. It's important that you choose a product and skin care regimen that makes you feel 100% comfortable with the look and feel of your skin.

Customers also inquire about when they should expect to see results from using anti-aging products. Again, we respond by saying that results will be different for each individual, generally due to the condition of one's skin prior to use. However, across the board, we say not to expect a miracle, as there is no anti-aging product on the market that provides overnight results. Whether you are trying to reduce the appearance of fine lines, wrinkles, dark circles, puffiness or age spots, the process is gradual and takes anywhere from 4 to 8 weeks depending on the severity of your problem areas. After allowing the products time to take effect as well as following product directions, you can be sure to notice significant improvement in the appearance of your skin.

To see the quickest results, you will have to undergo professional cosmetics procedures. While procedures such as laser treatments, injections and dermabrasion produce the fastest, most noticeable improvements, they are all are somewhat painful or uncomfortable and very costly. In addition, pre and post treatment plans are required to achieve maximum results, which consist of using skin care products, that are also proven to be safe, effective, painless and less expensive alternatives to professional cosmetic procedures.

Please note that with the use of any new skin care product, it is highly possible that your skin will react to the ingredients. You may experience irritation, redness, dryness or a mild breakout, which should only last for the first 3-5 days of use. If you experience any of these reactions for a longer period of time, please discontinue use and consult a skin care professional. It is also recommended that prior to using any new skin care product to consult with a skin care professional. www.optimalhealthtoday.com

Botox Alternatives-The Real Story

2007-06-09T12:34:00.000-05:00

Seema Patel MD, MPH Director The Institute for Advanced Skincare

Botox Alternatives... Wrinkle Creams... Alpha-Hydroxy Serums... Wrinkle Defense Systems...
Which products provide noticeable and lasting results?
Which products are top performers at rejuvenating your skin?
How effective is the product you use?

The topical wrinkle reducing product market is exploding. It generated over $1 Billion in sales in 2004, with that number expected to double by 2006. You do not have to look far to hear about these types of products. There is huge interest in this market and advertisements can be found everywhere, from TV, to radio, newspapers and magazines. While the majority of these products are marketed to female consumers, surprisingly, our research indicates that men account for approximately 25% of this market. It seems that women are no longer the only gender searching for the fountain of youth.

Treatments and products once only provided by dermatologists are now accessible to consumers. There are over 200 products currently marketed to remedy the signs of aging, from Botox alternatives to alpha-hydroxy serums and wrinkle relaxers. These products range in cost from under $10 to over $300 per ounce. How does the consumer determine which products are effective? How does the consumer determine which product is right for them?

In this article we offer our readers a comprehensive list of anti-wrinkle products based on our evaluations. We reviewed the over 200 products currently available for the treatment of wrinkles. Our assessment included review of the following product attributes: long term effectiveness for wrinkle reduction; instant reduction of fine lines and wrinkles; antioxidant protective properties delaying skin cell aging; skin renewal and collagen stimulating properties; and skin smoothing and firming properties. Based on the outcome of our evaluation of these product attributes we ranked each product accordingly.

Our list is presented in descending order based upon the cumulative score of product attributes. You may not see the product you use, or are interested in using, on this list as it did not rank in the top 25. Our list is dynamic in that we are constantly reexamining and updating our rankings due to the availability of new products.

During our research, the skin care specialists we consulted provided useful tips that contribute to achieving and maintaining younger looking skin, including the following:
• Be certain to consistently apply the product(s) you choose in accordance with its directions for use;• Pay special attention to your neck and hands while applying the product(s) you choose, as these areas reflect your age;• Always use sunscreen with a Sun Protection Factor (SPF) of at least 15;• Drink at least eight glasses of water a day to stay well hydrated;• Avoid excessive intake of caffeinated and alcoholic beverages, as they may contribute to dehydration and exacerbate the appearance of fine lines and wrinkles; and• Be sure to get adequate rest every day.

Learn more About wrinkle reducing Agents.

Aging and Black Skin

2007-03-12T20:37:00.000-05:00

As we age, our bodies begin to change. We begin to notice more wrinkles and fine lines. In our skin, collagen and elastin fibers that provide us with the firm, youthful look begin to weaken with time. The skin begins to lose its natural fat and that causes the skin to appear looser, more laxed, and less plump. Gravity also tends to pull the skin down further, worsening the skin sag. Skin can age more rapidly due to repeated sun exposure as well as smoking.

Many African Americans appear about 10 years younger than their stated age. This is due in large part to the extra melanin in the skin that protects the skin from the harmful UV sun rays. The more melanin one has, the more skin protection they receive. Thus, the lighter the complexion is, the greater the propensity is to age. Furthermore, less African Americans sun bathe or use tanning booths in comparison to Caucasians.

African American skin needs UV protection just as much as white skin does. You need to protect yourself from both UVA and UVB rays. UVB protection comes from SPF and UVA comes from a physical barrier such as zinc oxide and titanium dioxide. These now come micronized that they do not leave dark skin looking grey as in the past! What most people do not know is that UVA is very powerful and can penetrate through windows and is given off by fluorescent lighting, thus being indoors in your office, you are still exposed to UVA rays! Protect yourself daily and more frequently when you are out in the sun.

As African American skin ages, the biggest concerns are loss of volume (a more gaunt face), saggy skin, discoloration, and wrinkles. The loss of volume is seen because we lose our natural fat that is in our skin. Look at your pictures from your thirties and compare them to your pictures now in your fifties and sixties. The people who lose the most volume are the people who had thin faces to begin with. They treatment for this is fillers such as Juvaderm (the only filler approved for people of color) and sculptra to provide volume back to the face. It is very effective and can last 6-12 months.

The patient’s who have a more round face, may experience more sagging around the jaw line as gravity begins to pull the skin down. Using the laser tightening and resurfacing techniques can help if it is not bad, but if severe, surgery may be the only option.

Discoloration comes from sun damage that has occurred over the years. If you are lighter, you might have freckles which are a sign of sun damage, or if you are darker, you may just have patches or spots of unevenness. I tend to see more darker skin on the forehead and chin with lighter skin around the eyes and the cheek/nose area. This unevenness in skin color is also a sign of sun damage. Depending on how bad the discoloration is, treatments will vary. Topical treatments with hydroquinone 4%, a lightening gel and Retin-A, will work well for more superficial and milder forms of sun damage. For more severe sun damage, peels to lasers may be your answer. The best t thing is to see your expert and learn more about your skin and its specific needs.

Ethnic Skin: African/African American Skin

2007-03-12T20:28:00.000-05:00

At Shanti Medical Spa & Wellness Center, we care for a variety of different people from around the US and the world. What I would like to discuss in this blog is the most common concerns that I see and hear from my African American/African patients. This does not cover the multitudes of skin conditions experienced in the world, but the most common ones seen in our clients. But before I go on to discuss this, I would like to say this category of skin, African American covers a very wide array of people. The skin hues can vary from very fair to very dark. What our clients experience, will vary depending on their genetics, their environmental exposures, and lifestyle.

In our African-American/African patients, their top three concerns are:
1. Acne
2. Discoloration or brown spots-acne scarring, melasma, freckles, etc
3. Unwanted Hair

Acne can occur in anyone and in any part of the body. Acne occurs due to inflammation in the sebaceous glands of the skin. Acne can look like brown bumps, pus bumps, large deep cyst or nodules. Inflammation occurs on the skin due to hormonal changes, friction, sweating, and stress. Taking care of the inside is just as important as taking care of the outside. So, first take a look at the common things we do: if you where hats, does your acne follow a pattern around your hat, does your hair or your hair products cause inflammation, do you see more acne where your cell phone touches your face?

Does what you eat cause acne? All the large studies in the US show no correlation to food, however what I find in my wellness program is how important nutrition or the lack of good nutrition can affect internal and external health. The majority of African Americans/Africans can not digest milk because they are lactose intolerant. Removing dairy from their diet can help clear the skin. I use elimination diets often in my clinic to help people improve well being. Processed foods cause inflammation within the body and I feel that it also causes inflammation on the face. Do your body good, and try to decrease the junk food and soda! Eating a well balanced diet rich in fruits, vegetables, whole grains, and good sources of protein and lots of water will take you far!

For African Americans, acne is sometimes related to hair follicles causing angry “hair bumps” anywhere on the body that experiences a hair removal process such as shaving, depilatories, or waxing. What aggravates my patients even more is that the scar that the acne leaves behind last even longer than the acne itself!

What I recommend for hair bumps, whether this occurs in men or women, is salicylic gel or solution. The area that is prone to hair bumps tends to be in need of greater exfoliation than other areas. Salicyclic gels/solution help the skin exfoliate faster and serve as a deterrent to new acne outbreaks in that area. I recommend to both men and women to use the gel if they get occasional break outs on the face, the neck, and even the bikini line. I like the solution if it is more severe. The side effects of salicylic acids is skin dryness, seen more with the solution. Also using Retinols in the area affected can reduce scarring over time.

What I like for treatments is chemical peels for mild acne and hair bumps. Chemical peels are natural fruit juices that have become acidic and cause the skin to exfoliate faster, reducing the outbreaks and scarring over time and can be used anywhere on the body. For more severe acne, I feel laser therapy is a better alternative. We offer two types of laser treatments: the blue light for just acne and the resurfacing laser for patients who have acne as well as scarring. Both can be used on all skin types and colors. I do recommend a lightening gel for two weeks prior to your laser treatment.

For discoloration or brown spots, we first have to understand what causes them. Most of my patients complain of discoloration from acne marks, scarring from bug bites, scratches, freckles from sun damage, as well as hormonal changes that cause sections of the skin to become dark, called melasma. Melasma typically occurs in pregnancy or after due to the hormonal changes. The treatment for discoloration really depends on how long it has been there and how extensive it is. The milder it is and the less time it has been there, the more likely it is to respond to topical medications/creams. The best treatments for this are Hydroquinone 4% and Retinols. Hydroquinone is a lightening gel that causes the skin to blend to its natural color. No, you will not look like Michael Jackson, but rather the inside color of your forearm. This is your natural skin color because very few people have exposed that area to sunlight intentionally. Retinols help the skin exfoliate faster lightening hyperpigmented areas. You must use these two for 12 weeks to notice a difference.

If the discoloration has been there for awhile, it will probably be more effectively treated with lasers or peels. I use peels for more milder and superficial pigmentation and lasers for discoloration that has been there for some time. Topical medications do not work well for brown spots that have been there for years. They may reduce some spots but not all the way. I like the fractional ablation or laser resurfacing treatment the best. It does have some down time of two-three days of redness and peeling, but penetrates deep within the skin to build new collagen and elastin over damaged areas. As with all lasers, it is best to be on a lightening agent for a few weeks before undergoing laser treatment.

Unwanted hair is another top concern. Like all people, very few of us want to be hairy and the thought of just not having to shave, appeals to all of us. Some specific concerns I have seen in my patients is that many people can not shave do to ingrown hairs, folliculitis or hair bumps. This can cause more scarring for them. Thus, laser hair removal is a great solution for people who have this problem. Another common medical condition I see that causes excess hair growth in women, is poly-cystic ovarian syndrome. Poly cystic ovarian syndrome causes irregular periods, weight gain, insulin resistance, acne and unwanted hair growth. I remove the unwanted hair with laser hair removal while modulating their hormones to permanently keep them hairless is very effective.

I will be talking about African American skin and aging. Aging and wrinkles are a whole new topic and the fastest growing segment of cosmetic medicine users are African Americans. We want to break the myth that “Blacks don’t Crack”. They can and do but usually never to the same extent as their lighter skin counterparts and usually about 10 years later. Stay tuned!

Ethnic Skin: South Asian

2007-03-12T20:25:00.000-05:00

South Asians make up one quarter of the world’s population. The skin tones vary from very light to very dark, with many of us falling in the mid range, which we refer to as the color of “Wheat”. Being South Asian, I treat many other South Asians. What are the most common concerns I see in my patients at Shanti Medical Spa & Wellness center are unwanted hair, discoloration, and acne. This of course does not cover the wide array of skin conditions experienced in our community, but are the most common ones I see everyday.

For many South Asians, we have the genetic predisposition to have more hair than other people in the world. Our hair is thicker, coarser, and denser. There is no part of our bodies that is not affected by this! Almost 70% of the laser hair removal done today is done on South Asians even though we make up less than 2% of the population in the US. The love and desire to be hairless is insatiable in our community. It is best to start earlier rather than later. The reason is the hair that has been waxed, tweezed, and threaded responds slower to the laser than hair that is “virginal” to hair removing techniques. What hair removal techniques due to the hair follicle is it makes it crooked from the constant trauma and thus, when the laser light hits it, the whole hair follicle is not penetrated, which extends the hair removal process even longer. The earliest one can start is two years after a young teenage girl has had her period. For young teenage boys, they can start after 16, since most have started growing by then. If for whatever reason, one has not experienced pubertal changes, I do not recommend proceeding with hair removal. The body will go through a change during this time, and it is important to wait and see what happens.

When you choose a laser hair removal place, go to a reputable place that has had training working on South Asian skin. Many places literally train staff overnight and let them loose on unsuspecting clients. I think the hardest area to treat on my women patient’s is their lip area because it tends to be lighter and finer hair. It usually responds less than areas that have thick and coarser hair. Remember, because we have more hair than most people do, it will take us longer to respond to any hair removal technique than other people. Don’t worry, laser hair removal is great. I have done my whole body!

South Asians also suffer from acne just like the rest of the world. I do think that some of the acne is due to the excess hair we suffer from. I like to do a multi-faceted approach for my South Asian patients. I usually begin acne treatments along with hair removal to get the best treatments. Depending on the severity of acne, the treatments will vary. Please refer to the previous blog on what causes acne and acne treatments for more information.

For mild acne, topical treatments and peels work well. For more severe acne, laser treatments will probably help more. Talk to your local expert to see what a better treatment option is for you.

Discoloration is a common concern in the South Asian community. You can have discoloration from acne, bug bites, scratches, picking, hormonal changes, and just from aging. Treatment once again varies on how much discoloration one has and how long it has been there. For patients who just don’t want to do anything but use topical creams, I love the OBAGI line for South Asians. I use it and all the women in my family use it. It is an amazing line that helps with acne, brown spots, and slows down the aging process as well! Go to obagi.com to learn more!

For patients who have more severe discoloration, peels or lasers are better options. If the scarring has been there for years, the lasers will work better because they penetrate deeper and thus are more effective. I use the Pixel, our resurfacing laser on many South Asian patients. It is an amazing treatment that improves skin tone, texture, evenness and it even fills in soft lines and wrinkles! I love this laser for myself and my patients. To learn about South Asian skin and aging, stay tuned!

Is there a Wrinkle Cure?

2007-02-18T21:20:00.001-05:00

When I do a skin care consult, the most common concern people want to improve upon is wrinkles, wrinkles, and wrinkles. Wrinkles are associated with aging. No one wants to look older and wrinkles are definitely not attractive. The problem is that just about every product and brand claims to have something to prevent wrinkles and most of the time, only minimal changes are seen and maintained. Is there a wrinkle cure?

Well to understand wrinkles, let's talk in brief about why and how they occur. One reason why we wrinkle is that as we age, certain genes become turned off spontaneously, thereby causing us to form wrinkles. The genes that are turned off are the ones that produce collagen. The second phenomena is the constant exposure to free radicals. As described in a previous blog, free radicals are cells that are unstable and cause a vicious cycle of destruction when they try to become stable. We are exposed to free radicals every where. It comes from the air, solar radiation, ozone, and pollutants. Normal cell metabolism also cause free radicals to form. It is the accumulation of these free radicals that causes us to age. And lastly, there are natural decreased levels of anti-oxidants in the skin that decrease our ability to fight off the free radicals and accelerate the aging process.

There are two types of skin aging: Intrinsic Aging and Photoaging. In Intrinsic Aging, the natural collagen production will decrease by 1% per year throughout the adult life span. What we see is reduced collagen formation at the nuclear and cellular level. This produces the chronological changes we see with age. In Intrinsic aging the skin appears dry, dull, pale with fine wrinkles. There is some laxity to it and it is prone to benign skin growths. With Photogaing, this is aging related to sun exposure. The UV radiation causes direct damage to the DNA of the skin cell damaging its ability to repair itself as well as reproduce normal skin cells. It greatly reduces the body's ability to form collagen and repair collagen, and lastly, there is a very large amount of free radicals accumulating that worsen everything I just mentioned. The more sun damage there is, the reduced ability the body has to repair itself, leading to more damage and more wrinkles. It is a vicious cycle. The skin with photoaging has very coarse, deep wrinkles, a leathery look, dry, and mottled appearance. It also is suspect to precancer and cancer lesions of all types.

Two other things can cause skin to age faster are smoking and reduced hormone levels. Smoking accelerates the formation of free radicals and works synergistically with sun damage to cause wrinkles. Reduced hormone levels occur in both men and women as they age. We begin to lose critical hormones after 30 by 1-3% per year. This loss of hormones causes a decrease in collagen and elastin production which causes us to age even more. For women, the decrease in collagen production after menopause is 2.5% per year, which is more than 1% as seen with intrinsic aging. That is why in our center, we talk about hormone optimization as being part of the skin care program. Patients who don't want to do that, end up spending more money and see less change per treatment. My patients who do the wellness with the advanced skin care, have the best results because we can heal from the inside out and the outside in.

So, to stop wrinkles, you must use sunblock and vitamin C topical. Sunblock which has both UVA and UVB protection should be used everyday to prevent solar radiation exposure. Vitamin C serum is important to use as a topical anti-oxidant to reduce the formation of free radicals.

For patients who have wrinkling, I add Retinols which if used over time (for one year) will correct intrinsic damage done to the skin. OBAGI is a great skin care line to use for those with both deep and fine lines.

The other items I recommend are treatments. Patients with fine lines can see changes with both peels and laser skin rejuvenation. Laser skin rejuvenation involves an Intense Pulse Light (IPL) which penetrates the skin about 20-25 microns deep to improve skin tone, texture, and soften fine lines. This IPL treatment reorganizes damaged collagen and elastin but does not cause new collagen and elastin production. Most patients typically need about 5-6 treatments to obtain maximum improvements. They will need a touch up every three to four months.

Peels can help as well but are not as dramatic mostly because superficial peels penetrate only about 5-12 microns deep in the skin. The skin damage is usually 100's of microns deep in the skin. Peels are a great starting point for young people who want to prevent wrinkles, but for my more mature clients, I think the skin rejuvenation is better. The more deeper peels, are generally losing favor due to the down time of 5-10 days. Most of my clients work and that is not something they want to do or can afford to do. We don't even offer it in our centers because we have other laser treatments that work even better without the down time.

For patients with deeper lines or a lot of fine lines, I use our fractional ablative laser, the PIXEL. This is the newest technology to improve skin with minimum down time. The PIXEL uses the same Erbium laser that was used in the past with ablative lasers (the lasers used to peel off your whole skin and made you look like Freddie Kruger for a few weeks. The new skin would be regenerated over time improving appearance) However the down time associated the old lasers was too much and were falling out of favor. This new fractional ablation is great. We can have about 30-150 microns deep penetration in skin with each treatment and causes the formation of new collagen and elastin. This is what fills in the wrinkles resulting in a more even, health look. There is about two days of looking sun burned and two more days of some mild peeling but nothing to stop you from going to work with each Pixel treatment. Most people need about 3-6 treatments for optimal results and then maintenance every 6-12 months. It works for wrinkles, sun damage, melasma, scars, acne, and just overall appearance in skin tone and texture. It

The Pixel's counterpart is the Fraxel. The fraxel uses the same fractional ablation technology but the physician has to buy a whole new system for it (which means to the consumer, a more expensive procedure), a blue dye is placed over the skin to see where it has gone, and is more painful than the Pixel. I think as a consumer you should check out both but for cost and effectiveness, the Pixel is better.

The other things you can do to help reduce wrinkles is the skin tightening laser. Most people use this for the laxity around the jawline and turkey neck. This laser uses infrared technology to heat up the dermis to pull closer the stretched out collagen and elastin fibers, resulting in a tighter firmer look. Most clients need about 4 treatments once per month for optimal results and then a maintenance treatment once every six months.

For patients, who want to try injectables, there are lots of options. Botox is used for lines in motion whether they are on the forehead (your worry lines), the glabella (the frown lines you get when you get mad; also called the 11's), the crow's feet area (the smile lines around your eyes), the smoker lines around the lips, and for depressed mouths. It is a small injection done over these areas using Botulinum A. This weakens the muscle so it can not move but still allows for normal facial movements. It last about 3-6 months. My patients tell me that when they do the PIXEL and Botox, the Botox last longer.

For lines at rest, we use fillers. The most common fillers are Restylane and Juvaderm. Both are made from Hylauronic acid and both last about 6 months. The difference from the two is more what the individual physician and patient feels, thus far. Juvaderm is newer and less information is out on it in the United States. It came from Europe and has an excellent track record there. It uses slightly more hylauronic acid then Restylane and feels softer when applied. It is also the first filler approved for People Of Color. Restylane has a long track record of working well with minimum side effects. It does last about 6 months in average, and most patients require some block to be used before it can be injected. I use both and I prefer Juvaderm because it is easier for me to apply and less painful. I will have to see anecdotal which one last longer!

For the longer fillers, there is Sculptra and Radiesse. Sculptra was approved for HIV lipodystrophy (the thinning of the face from fat loss that is seen in HIV patients) but is now cosmetically used for aging on our thin, hollowed out faces. It is suppose to last about 1-2 years. Radiesse is the longer filler like Restylane and Juvaderm which is suppose to last 1-2 years. I recommend it only to my patients that love the way they look with the Juvaderm or Restylane since it is so long lasting. Patients do complain that it feels hard but not enough to stop anyone from getting it done.

As you can see there are lots of options for wrinkles. To find out which is the best for you, it is best to speak with a professional. Remember, skin care products and healing from the inside are just as important as healing from the outside!

The Most Important Skin Care Products

2007-02-06T22:20:00.000-05:00

I meet and see a lot of different patients and each one is looking for that perfect product that will take care of everything. Well, the truth is, that perfect product does not exist, but rather a lot of great complementary products can be used to achieve good results. New skin care products keep coming on to the market but the most important ones that have been shown to make a difference in the literature over and over again, and these products have remained the same. Sure, you can try whatever is new and upcoming, but if you just want to know what the basics are, read on.

Skin care products work if they can change the skin surface or inside of the skin cell. The skin is in a constant state of renewal. A new skin cell forms deep in the dermis and slowly moves up to the skin surface over 6-8 weeks, to slough off. What happens as we age is that the percentage of skin that is renewing and sloughing off, diminishes. Young children (about 10 or so) have beautiful luminescent skin because everything is renewing and exfoliating at 100% like it should. As we age, the exfoliation process slows down, causing the skin to look duller, more uneven, and older. Skin that has problems with it, can also have a disruption in the renewing or exfoliation process exacerbating the skin condition. So at 30 years of age, the percentage of skin that is renewing and or exfoliating drops to about 70%, at 40 this is about 60% or lower; thus causing the skin to look older.

To help the skin look healthier and younger, the skin needs to be exfoliated. Many of my patients are using over the counter products to do this. The most popular items reported by my patients are the St. Ives Apricot Scrub, facials, and the hardest thing used was a scrubbing brush. Unfortunately these may not be the best products because exfoliation is dependent on depth of penetration. These are rather superficial and will not cause true skin changes. The young patient using a scrubbing brush can be injuring her skin even further and causing more damage. I believe in using skin care products that penetrate a little deeper and can cause the skin to rejuvenate as well. These two products have been on the market for some time and work well. They are alpha hydroxy acids and Retinols.

Alpha hydroxy acids are made from edible fruits and vegetables that when fermented become acidic, causing the skin to exfoliate. They are found in many over the counter products under the label AHA. AHA's help with exfoliation and skin rejuvenation thereby reducing fine lines, brown and red spots, even out skin tones, as well as help reduce acne. Some patients will not be able to tolerate them because they have very sensitive skin and it will irritate when applied. Typically, this resolves after a few weeks, but for those patients, it may be more useful to use the next generation of these products which is poly hydroxy acids. They are slightly bigger molecules and penetrate the skin slower, thus are more gentle for that sensitive skin.

What is the difference between over the counter AHA's, the salon grade, and the physician grade products? The difference is in the concentration of the AHA. The higher the grade of AHA, the more pure it is and thus more effective it is. The physician grade is about the same price as the salon grade so do yourself a favor, and buy something that works! You do have to use AHA's for awhile to see a difference and it is great for all ages and even pregnant women!

The next exfoliant is Retinols. This can be Retin-A, Renova, Tazorac, Tretinoin, etc. This is a much stronger product than the AHA because it is more penetrating. It is a great product to use because if you use it over time, greater than one year, it actually intrinisically repairs the skin cell that was damaged with the sun and age, thereby reducing wrinkles, fine lines, brown/red spots, acne, and scarring. Studies show that long term use of Retin-A at 0.1% will reduce the incidence of skin cancer!

The problem with Retin-A is the side effects of peeling and redness. This can be overcome by using a lower strength of retin-a, using an alternative breakdown product, or mixing it with a blender than will soften the delivery of Retin-A. For people who are very sensitive, I recommend starting with 0.025% cream and slowly building up to 0.05%. The goal is to be able to use 0.1% because this is what helps reduce skin cancer formation. The breakdown products such as retinaldehyde are more gentle on the skin and do not cause as much irritation and redness. The blender product is something that works synergistically with Retin-A to penetrate the skin without the same amount of redness. Retin-A should not be used by pregnant and lactating women.

The third product is Vitamin C. Vitamin C is the only product that prevents wrinkles (that's right, I said prevents wrinkles) and brightens the skin. Vitamin C stabilizes free radicals. Free radicals are cells that have become unstable due to a loss of an electron. (Do you remember in physics class how you learned that electrons and protons need to always be together in an atom, otherwise it becomes unstable? The free radical is an atom that has lost an electron). This unstable cell wants to become stable so it steals an electron from the next cell. The next cell now is unstable, and steals and electron from another cell and so on and so on. What Vitamin C does, is it comes by and donates the missing part to stabilize the cell. Vitamin C does not become unstable because it can intrinsically repair itself. Another question patients ask me is if their oral Vitamin C will be enough for them. No, because there is not enough skin penetration unless you did 25 Vitamin C pills daily.

The fourth type of product that helps the skin is lightening gels. These can be hydroquinone, Kojic acid, soy, licorice, etc. They all suppress the melanocytes (the cells that produce pigment) thus there are less darkened areas. Hydroquinone is the strongest of them all but the one that is the most controversial. THe FDA recently banned hydroquinone 2% that was commonly found in over the counter products like Porcelana, Esoterica, Black Opal.

This came after some controversial research showed an increase in cancer in laboratory rodents. This has not been shown in humans. Furthermore, across the world, it is difficult to find for these reasons but also because it was not regulated, patients were bathing in such high doses of 10-20% hydroquinone. (the strongest dose in the US is 4% found in prescription skin creams). At such high levels, patients experienced something called Ochronosis-graying of the skin and reflex darkening of the skin. Unfortunately this came from using such large concentrations for long periods of time. I typically provide a 4% hydroquinone for about 4-6 months and then use as needed. I still use hydroquinone with all the controversy because nothing else seems to work as well. I use hydroquinone in conjunction with other items such as the vitamin c to brighten the skin and retin-a to exfoliate the skin so you need less of hydroquinone then if you used it on your own.

The last item that is important is a total sun block. There are three types of sun rays: UVA, UVB, and UVC. UVC we are thus far protected because of the ozone layer. Once that is gone, we will need protection from that. UVB is a weaker sun ray and does not penetrate through glass. UVB causes sun damage and skin cancer. We are protected from it by using SPF. Using a SPF 15 is great because it will provide you great coverage without adding more chemicals to the skin. However, SPF does not protect you against UVA. UVA has both long and short rays and need to be blocked by using a physical barrier such as zinc, titanium and parasol. The new one on the market is by L'Oreal that has avobenzene.

I realize that this is a lot of information but be smart about what you are using and know what works and what doesn't. Most of these are very complementary to one another and many of my patients use a little of everything so they get less side effects from each product. So use the right products to help you maintain great skin!

Spots and Scars-What to do?

2007-02-01T12:06:00.000-05:00

Most people can relate to spots and scars which can occur anywhere on the body. Spots and scars are due to any injury on the skin. It can be from acne, sun damage, an infection (such as a boil, severe dry skin from eczema, psoriasis), skin conditions that causes ulcerations and patches, bug bites, ingrown hairs, picking at the skin, etc. There are so many reasons I can't list them all but you get the picture. The skin got hurt and it left a mark. This happens because when the skin is injured, cells that provide color in our skin the melanocytes become too active and lay down extra pigment. If you have very fair skin, it will look red to light brown. If you have more olive to light brown complexion, it will look light to dark brown. If you have more brown to black skin, it will look more brown to black but darker than your normal skin color always. The medical terminology for this is post inflammatory hyper pigmentation (PIH).

It is important to understand what caused the spot or scar in the first place to understand what treatment is the best. The most important thing to do is stop the injury from occurring in the first place. If it is from acne, we need to treat the acne. For more information on that refer to the acne blog. If it is dry skin or ulcerations, the cause of this needs to addressed and the skin needs to be intact before any other treatment can be started. The most common cause for spots is usually from sun damage and from acne scarring.

What I do for this is start on good skin care products. We need to use products that will exfoliate the skin and lighten the spots/scars. Two items that will exfoliate the skin are alpha hydroxy acids and retinols. The skin cycle which is the renewal of new skin that matures and comes up to the surface of the skin to be sloughed off is 6 weeks long. As we age, the percentage of skin that turns over or exfoliates every cycle begins to diminish. When we are young, most of our skin exfoliates every 6 weeks leaving healthy, glowy skin. As we begin to age or if we have skin problems, this process slows down leaving more dull, irritated skin.

Alpha hydroxy products expedite the exfoliation process to keep the skin looking healthier and younger. Retinols penetrate deeper to exfoliate and if used for over one year with consistency, can actually correct any damaged DNA to leave the skin looking radiant. It does take one year of use at 0.1% strength to achieve this. The typical prescription is for 0.025% or 0.05% only. In fact, studies on transplant patients show a reduction in skin cancer using retinols at high strengths, so I am a firm believer in using Retinols for not only problem skin, but for wrinkle correction and prevention as well as for the prevention of skin cancer. (No, it will not protect you if you continue to be a sun worshipper!) . Using exfoliation products will cause lightening of the spots/scars over time. This does take about 6-9 months to see the results with products alone. Retin-A is contra-indicated in pregnant and breast feeding women.

I also use lightening creams/gel and Vitamin C. Lightening Gels/Creams are from Hydroquinone 4%, which is prescription strength to use two times daily to the affected area. If it is really bad, wait five minutes and reapply it in 5 minutes to get optimal results. Most people will need 3 months to see optimal results. Hydroquinone is contra-indicated in pregnant and breast feeding women.

I love using Vitamin C serum to brighten the skin and it helps prevent wrinkles! It is the only product out there that will do that. Vitamin C must be at the right pH, right molecular structure, and a clear serum for it to work well. There are many products that claim to do a great job but have no studies behind it. Skinceuticals and Obagi have great Vitamin C serums. I like Obagi better because you can use it on the eyes. The eyes are where everyone starts to age and for many of us, this is where dark circles from chronic sleep deprivation, genetics, etc begin. Vitamin C does not make these circles go away, but can soften and blend the color closer to your natural skin tone. I use Vitamin C daily around the eyes and 3 times per week to the full face. My patients always ask me if their oral Vitamin C will work. If you took 25 pills of 500mg of Vitamin C a day then maybe but the one to two pills that people take will not do it. Vitamin C stops free radicals from causing destruction to the skin. The skin does super saturate with it so you do not need to use it everyday, but many people do because they love the way their skin looks. It does take about 3 months to see good results with this as well.

For the treatments of spots and scars, it will depend on how long they have been there, are they indentations or pick marks deep in the skin, and any other conditions you may have. The longer they have been there, the deeper they are. If you have some superficial spots that have been there less than a few months, high strength chemical peels and aggressive medical dermabrasion may work for the face. For the rest of the body, I usually recommend lasers and microderm treatments because the skin is usually thicker and does not respond as quickly.

To understand how deep things are, let me tell you that for acne scarring and pits, that scar mark is about 800microns deep in the skin. The best laser out there penetrates about 150microns so that is why repeated treatments are necessary. Think about an indentation in the skin as a big pot hole in the skin. This pot hole is usually treated in three ways. It can be filled with something temporarily, the skin around it can come down so it looks less noticeable, or it can be filled with new collagen and elastin to be a more permanent solution.

To fill the scar, we can use a filler such as Restylane, Juvaderm, Radiesse or Sculptra. The first two last about 6 months and the latter two, last 1-2 years. You will need to return back to get this filled regularly just like the pot hole does every year. Option two is a resurfacing laser. This is a procedure that requires sedation and down time for a week to 3 weeks depending on how deep they went. The resurfacing laser removes all of the skin and lets new skin grow back. To go back to the pot hole analogy, the whole road around the pot hole got taken off and then it was slowly filled. It does not always fix the very deep scars because they do not get filled. It is rather the skin around it came down so it looks less obvious. The third option is a fractional resurfacing. This uses similar technology as the latter but there is only a weekend of down time and it actually fills the pot hole with new collagen and elastin. It does take time to get optimal results because the marks are deep.

For patients with spots secondary to sun damage-using an intense pulse light or the fractional resurfacing laser are two great options. Once again, the difference is how long has it been there and how deep is it. The deeper it is, the more treatments it requires and the better you will do with the one that penetrates deeper in the skin-the fractional resurfacing laser is my choice.

For scars that come from trauma-bug bites, boils, dry skin, etc, the resurfacing laser is our best treatment. But once again, using the skin care products is complementary to this and it will take time.

Spots and scars are a long topic and cover a lot of different problems. This I hope will at least provide you with some preliminary background to help you understand the choices out there and also to differentiate what people are just trying to sell to you. I really think a lot of my patients with bad scarring will try anything but not everything will work. The best thing to do is do your homework, go and talk to the specialist, see what they offer, see what results they have gotten, and have them answer all of your questions! Make an informed decision and give it a try. I really do think these treatments help soften and blend down spots and scare but people just have such unrealistic expectations of what will happen. It is important to understand that you will not achieve perfection as much as an improvement. [

Acne: Treatment Options

2007-01-24T20:31:00.000-05:00

Acne treatment varies depending on the severity and skin type.

Mild acne is defined as involving less than 1/4 of the face with some pustules, papules, and black and whiteheads. Generally, these patients can obtain a decent response using mild over the counter products such as Benzoyl peroxide 5-10% to control outbreaks. Usually, by the time I see patients, they have already tried it, failed it, and are on Pro-Active! Pro-active works on mild acne but does not seem to work for more severe cases and or causes too much dryness.

For mild acne, I personally like to use the Neostrata Antibacterial cleanser for acne. It is a physician grade product sold in doctor's offices and now in some CVS drug stores. It is an alpha hydroxy product so it causes the skin to exfoliate faster, reducing acne outbreaks with time. I also prefer salicylic gel or solution to benzoyl peroxide. Salicylic products help "thin" the skin by removing any dead skin cells and sebum around the hair follicles, thus making it harder for pustules and comedones to form. I use this because I had a lot of facial hair that worsened my acne. After my laser hair removal, I use it for the occasional outbreak. I also use it on men around their beard line and women for their bikini line if they suffer from acne or ingrown hairs there. Please note that salicylic is contra-indicated in pregnancy!

Most of my acneic patients don't want to use moisturizers because they feel it will worsen their acne. Moisturizers are important to keep the skin's immune barrier working, which will prevent further skin damage. From over the counter, mild products again like neutrogena, Cetaphil, and Purpose are good. In my center, the two products I use for my mild acneic patients are alpha and poly hydroxy moisturizers. Both of them cause the skin to exfoliate while hydrating. The difference is that the alpha hydroxy is a smaller molecule and penetrates the skin faster, thus causing more irritation in the beginning. This irritation subsides after a few weeks. I use the polyhydroxy products on my more sensitive patients whereas for my oily skin patients, I use the alpha hydroxy products. For super sensitive skin, Avene makes Diacneal cleanser and moisturizer for acne which are great.

Treatments for mild acne can include chemical peels and microdermabrasions. Use chemical peels (glycolic peels that help exfoliate the skin faster) for active acne and microderm, a mechanical exfoliation for acne scars and maintenance of great, glowy skin. Both are relatively mild treatments and there is no down time with it! It is great for maintenance as well as for acne!

For moderate acne, which involves at least 1/2 to up to 3/4's of the face, treatment needs to start early to prevent scarring. For my Caucasian patients, they will complain of pink, red, and brown marks on their face, while my people of color (Asians, Latinos, African Americans) will complain of dark brown to black marks on their face. For many of my patients, these marks can last for 1-2 years if not longer and that is what frustrates them (and me!)

The most important thing is to control the acne using both skin care products and skin treatments to stop the acne and improve on the scarring. I start patients on good skin care products as discussed in the mild acne treatment, add a few additional items, and start on treatments. Using good skin care products is a must because you do not want to start an expensive treatment and not be able to maintain the results using clinically ineffective products from the drug store!

For moderate acne, a good cleanser, salicyclic acid acne treatment, moisturizer that is an alpha hydroxy acid, and SPF are a must. I also add hydroquinone and Retinols. I like to use hydroquinone, a skin lightening cream to reduce the formation of dark marks as well as the existing ones. In this country we use Hydroquinone 2-4% to stop the melanocytes, the cells that cause pigment from being overactive. No, you do not become lighter and look like Michael Jackson, but your skin will lighten to your natural color which is like the inside color of your forearm (take a look, that's your normal skin color).

In many countries, they do not use Hydroquinone because of a reported increase in cancers. We have not seen it in this country and thus, the FDA allows only physicians to use these products. Kojic Acid is another lightener which I will often use together to enhance the action or separately for patients who do not want to use hydroquinone. Use the Hydroquinone once or twice a day on the full face. For the stubborn spots, reapply it on the spots after 5 minutes for more effect.

Retinols are great to help the skin exfoliate faster. When the skin exfoliates faster, you help prevent acne from forming and help lighten scars. The best one's are prescriptions such as Retin-A, Tazorac, Retin-A micro, Renova, etc. Retin-A (the generic is Tretanoin) causes a lot of dryness and peeling because it forces the skin to exfoliate faster. If this gets to be too much, you can use it every other day or try adding a "blender" to it to make it less irritating. A blender product I use is from a wonderful skincare line called OBAGI. You blend the two products together and it allows for a smoother, gentler delivery of RetinA with less side effects. I also like to use the Avene Retrinal, a break down product of Retin-A so it is less irritating and gets you great results (cheaper too!)

For procedures to treat moderate acne, you have several options of peels to lasers. The treatments vary due to the depth of penetration in the skin. The deeper it penetrates the skin, the more expensive the treatment becomes because it leads to better results faster.

For patients on a more strict budget, a series of peels at higher strength is a good beginning. It will not take care of deep scarring. Progressive Peels are can penetrate about 5-12 microns deep in the skin and will work for more superficial acne, but not for that deep cystic acne. I use Neostrata Chemical Peels because they are made from natural sugar cane juice that is acidic allowing it to penetrate the skin and cause it to exfoliate faster. The reason this is important is that as we age or if we have problem skin, the exfoliation process that occurs naturally in our skin every six weeks, slows down. So less and less skin exfoliates, leading to more problem skin, a thicker layer of dead skin on top making products useless after a few weeks (just because it can not penetrate through).

When we do peels, we can remove that superficial dead skin, and penetrate a little deeper to where the acne is. And, no, you will not look like Samantha from Sex in the City (she had a peel and was lobster red for a day). Our peels are superficial progressive peels that are physician grade but gentle. Peels done at the salon/spa and at home are very mild even though they may say 50% glycolic. They can not use a true acid because they are not medical professionals and thus, their peels are buffered. Be a smart shopper and get a real peel with a physician!

A better option for moderate acne is using ALA and an intense pulse light treatment because it penetrates deeper (about 20-25microns deep). ALA is amino levulinic acid which has been shown to dry up the sebaceous glands to stop acne from forming (this is how accutane works without the same side effects). It needs a series of treatments and generally provides good results. People may need a touch up after the series of treatments are done to maintain their results. The ALA is applied to the skin for one hour and then an intense pulse light laser is used to "activate" the ALA. You may be sunburned looking for a few days. Repeat treatments occur every four weeks. I am not to impressed with just using the blue light acne laser treatment. I have not seen great results with it. Most of my patients state that they would not do it again, and thus, I do not offer it as a sole treatment, but only in conjunction with the ALA. Darker complexions can do the ALA and the blue light without concern. If you are going to do the ALA and the skin rejuvenation, I recommend that you use hydroquinone 4% for about 4 weeks in advance to minimize any risk of hyperpigmentation. Darker skin is more likely to get injured by the laser light due to the extra melanin. Using hydroquinone one month in advance will reduce this risk. Many places don't even bother, but since I am of Indian descent and have been burned in the past by "other laser places" I highly recommend it. Why take a chance...this is your face!

Another option and my favorite is the Pixel resurfacing laser. This is a true laser treatment (not an intense pulse light) that can penetrate deep into the skin (about 30-150 microns! That is the deepest you can go without needing sedation!). How it works is that it causes new collagen and elastin to be made and dessicating any current acne. You do need several treatments every 4-6 weeks apart to get optimal results. There is down time of looking sunburned with dry peeling skin for a few days. For patients with more moderate to severe acne, it may cause "new acne" because the treatment will bring up whatever is going on under the skin up to surface. This does not mean it is not working but rather its its penetrating deep into the skin, making differences. Acne can start about 2-6 weeks under the skin before it shows up on the skin surface. A normal skin cycle is about 6-8 weeks long. When we do any skin treatments, we expedite the exfoliation process, causing the skin to turnover faster, thus, if you had some new acne forming underneath, it will come up to the surface. Don't worry, the next treatment will take care of it. And once again, for my patients with darker complexions, I believe that using hydroquinone 4% 2-4 weeks in advance will provide optimal results.

For more severe acne, you need treatments ASAP. These patients have scars for their acne already and what we want to do, is prevent new scarring and help with the old scarring. I only recommend the laser treatments because we need deep penetration. I usually do a combination treatment with some ALA and intense pulse light followed by the Pixel. Because you will be getting treatments, we keep you on our mild Avene or Neostrata cleansers to help your skin heal and prevent new outbreaks. These patients need about 6 treatments of the Pixel or some combination with the the ALA and Pixel. The reason you need so many, is that the skin is very damaged and needs more treatment. After the treatments are finished, you must stay on good products to maintain what you just did! I use our Neostrata line or for another wonderful product line called OBAGI. This is the cadillac of skin care lines! This is what the plastic surgeons use after a face lift and many derms after all treatments are done. It can be used on all skin types and all ages except for women planning on having kids in the next six months because it does use both Retin-A and hydroquinone which are both contra-indicated in pregnancy.

Acne is a frustrating skin condition that requires a multi-faceted approach. While doing these skin treatments, I usually ask my clients to look at their diet and regular activities. I see alot of recurrent acne where people hold their phone to their face. Invest in Blue Tooth technology or an ear piece! Clean your phone often! Also, after working out, wash your skin. This is when it is prone to everything. And stop touching your face! That is a bad habit many of my acneic clients have that needs to slowly changed.

Most studies state that diet is not related to your acne. I feel that there are plenty of things that can make it worse. For people who are very sensitive to hormones, meat and dairy are loaded with hormones given to the animals to grow quickly. Try organic dairy products or just move to soy products and try free range meats (this is meat from animals that were not fed artificial feed that is loaded with bad fats and hormones). I firmly believe less soda is better for the body because it keeps sugar levels lower and the body in general does better when the sugar levels are lower. So avoid the junk food (hence the name-JUNK)

For women on birth control, there are birth control pills that are better for your acne such as Yasmin and Ortho Tri Cyclen lo. Use those instead of the others.

Also, if you have alot of facial hair, really think about laser hair removal. It will help your acne out tremendously! The best thing to do for acne, is come in and have someone take a look at your skin and get you on a skin care program that works for you!

Acne: What Causes it?

2007-01-23T19:54:00.000-05:00

More than 85% of Americans suffered from acne sometime in their life. It can occur anywhere on the body but typically affects the face, neck, chest, shoulders, and back. Acne affects all ages with the teenage years being the most common. However, the disease is not restricted to any age group. Acne is very frustrating for my patients. They are just surprised that it just never goes away! Acne left untreated can cause scarring which for most of us last, for a very long time.

Acne is caused by inflammation in the sebaceous glands. The different terms that doctors use, describe the different types of inflammation.

1. Comedones (aka blackheads and whiteheads) is a sebaceous follicle plugged with sebum (a thick gelatinous oily substance produced by your skin), dead cells from inside the sebaceous follicle, tiny hairs, and or bacteria. When comedones are open, they appear black and hence are known as "blackheads". This is not dirt but oxidized material inside of the skin. Closed comedones are commonly called a whiteheads; They are skin colored or look like an inflamed white "bump" in the skin. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a skin care specialist under sterile conditions. Facials are NOT sterile conditions. I discourage my estheticians from extractions because it usually causes more scarring. If it comes up easily with a treatment, then I let them do it. I have many patients who come in and want an agressive exfoliation of their followed by deep extractions. I do not recommend this at all because the tissue is injured by squeezing or picking and can become infected with more bacteria, worsening the situation.

2. A Macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present, it looks like the person has very red, irritated skin. This is seen with acne and even my rosacea patients.

3. A Papule is a small, solid bump, slightly elevated above the surface of the skin. A group of very small papules and microcomedones may be almost invisible but have a "sandpaper" feel to the touch. A papule is caused by local skin inflammation.

4. A Pustule aka pus bumps, zits-are small, easily broken bumps containing pus. A pustule that forms over a sebaceous follicle usually has hair in the center. Acne pustules that heal without progressing to cystic form usually leave minimum scars as long as patients don't pick at them. The problem is most of my patients love to break these ugly pus bumps worsening the condition and more likely to cause scarring. I know I have done it and I take care of skin everyday, so I know all of you have done it as well!

5. A Nodule-is a solid, large bump that lies deep within the skin. Patients state it is like a big zit that never comes to a head, its deep inside and really painful. Because they are deep, they are more likely to scar. Nodules need aggressive treatment due to their propensity to scar.

6. A Cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, and tends to be more severely inflamed, extending deeper into the skin. It usually is quite painful, and there is great liklihood for scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic.

Ok, now that you know all the different types of acne. You are still wondering why it even occurs. Acne, regardless of the form you suffer from, occurs due to inflammation. What causes the inflammation? One of the most common reasons is hormonal fluctuations in the body. This is why teenagers are the most commonly afflicted due to the sudden shift in hormones. Women are usually pestered long after this because of the monthly menstrual cycle, pregnancy, or menopause. Women can get it for other reasons such as stress, friction (whether you talk on that cell all day long, keep touching your face, wear caps or clothes that cause more friction against your skin) are all culprits.

Men can be afflicted for different reasons. Yes, it can be due to hormones, but friction (from baseball caps and cell phones), sweating (especially for back acne), and body hair can be potential causes of acne. Remember pustules have hair in the center. So if you have more hair on your body or face, you may be more likely to get acne. (And yes, there are people who are "hairy" but don't have acne. I find that my acneic patients who do laser hair removal get a tremendous improvement in their acne). Clean your cell phone often and try whenever possible to be wireless or with a headpiece.

Other causes of acne are stress. How stress effects your skin is that it suppresses your immune system, thus the normal skin defenses you have are not as strong, predisposing you to acne. And usually, people when they are stressed, do not take care of themselves as well, do not eat or sleep as well, and usually start touching their face or hair in a nervous habit, which all contributes to worsening their acne.

All the literature states diet is not a cause of acne, but what I tell my patients is that, if you find that eating or drinking certain types of foods or liquids, worsens your acne, avoid it. I have seen plenty of people who have acne due to milk, nut, and wheat allergies. Studies look at large populations for changes but can not look at individual responses to allergens or other ongoing problems. I strongly believe in eating a well balanced diet, drinking 2 liters of water a day to keep the body cleansed and detoxified. Skin is an external manifestation of the internal balance. I often due elimination diets on patients to help acne and overall health. Typically, the person who is coming in for uncontrolled acne, also has many other issues in their life that are not being addressed. All of these are contributing to their acne. Most dermatologist do not have time nor the desire to address these "other complaints" and thus the studies are not set up to evaluate for these issues. So these are the causes of acne, coming up next are the treatments for acne.

The Connection between Inner Health and Outer Beauty

2007-01-07T20:50:00.000-05:00

As a primary care physician for the past 13 years, I have seen and heard just about everything. As the family doctor, I am given the responsibility to help my patients live better and stay healthy, but what has happened with managed care, is I have less and less time to spend with each person. I have five minutes, may be 10 minutes max to see someone, which is barely enough time to address their top concern, so the things that I believe can make the most difference in your life-wellness and prevention are never addressed.

I have become so dismayed with the whole process, that I have opened up a medical spa and wellness center to deliver the the philosophy I believe in: The integration of inner health and outer beauty. Your skin is a manifestation of what is happening internally. To treat skin well, both the inner and outer aspects need to be addressed. This blog is to help you understand the various skin conditions, the treatments available, as well as how your inner health can be affecting your outer beauty. Furthermore, different skin types have different concerns that need to be addressed and treated accordingly.

One of the most important things that I have learned in medicine is to make things simple. The more simply it is stated, the better people understand it and are more likely to understand how to take care for it. This is by no means to make anyone feel disrespected, but I just think doctors are so caught up in the technical lingo that they have forgetten how to explain things to people.

So, to begin with skin health, the most common reasons people come in to our center are for acne, spots, scars, saggy skin, wrinkles, and unwanted hair. (Wouldn't it be great if we could just get rid of all of these problems?) These skin concerns can be grouped into different categories that offer various treatment options depending on the severity of the condition. Severity is defined by
1. Mild-affecting 1/4th of the face or less
2. Moderate-affecting 1/2 of the the face
3. Severe-affecting more than 1/2 of the face

The five categories are:
1. Acne-there are different types and can affect the body anywhere, which we will discuss in the future.

2. Red skin-this includes rosacea, sensitive & dry red skin, "erythematous skin"-just a fancy term for people who have no skin problem
but just alot of red undertones and easy flushing, psoriasis, broken capillaries

3. Brown discoloration-from scarring, acne, melasma, sun damage,
age related changes to include the most common causes of brown spots and patches

4. Wrinkles-whether they are fine or deep, caused by movement or
are always present;the treatment will vary.

5. Other-are all other things that cause lumps, bumps, and
concerns. After we evaluate these, these can be treated or referred on for
further treatment.

I will break down each of these categories in more detail so you can learn more about them as well as the different treatment options. Yes, people can have multiple combinations of problems together as well! There are many other problems out there but I just wanted to discuss the most common concerns that I address daily and what can be done from them.