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

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.

The Most Important Skin Care Products

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?

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

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?

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

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.