On Call Articles
Retinoids: Improving Skin from the Inside Out
Wm. Philip Werschler, MD, FAAD, Dermatologist, Spokane Dermatology
Few skincare ingredients have as storied a history as retinoids. These vitamin A derivatives first found fame as a novel and effective treatment for acne in the early 1970s, until older patients found it to have aesthetic anti-aging benefits as well. As a result, Retin-A received the FDA's first anti-aging approval in the early 1990s. Today, retinoids are considered by many dermatologists to be one of the most effective topical ingredients for treating symptoms of sun damage. Found both in prescription and over-the-counter creams and gels, retinoids are available in multiple strengths and under a variety of names, including tretinoin, retinol and retinaldehyde. There are also retinoid analogues such as adapelene and tazarotene.
Scientifically speaking, all retinoids are derived from vitamin A, which plays a vital role helping our skin grow and act the way it's supposed to. Regardless of the strength, name, or brand, all retinoids are converted to retinoic acid when they are absorbed by the skin. By normalizing the skin's natural shedding process, retinoids prevent skin cells from sticking together inside of pores and hair follicles, thus preventing the formation of acne. In sun damaged and aging skin, retinoids help repair the architecture of the skin that begins to falter with time. Retinoids thin the upper layer of the epidermis (stratum corneum) where visible damage accumulates while thickening the lower layer of the epidermis and dermis, in turn increasing blood flow and collagen production within the skin. This action is referred to as a "normalization" of the growth pattern.
From an aesthetic perspective, the prevention and improvement of acne speaks for itself. But the beauty benefits can be equally as profound in mature skin. Retinoids work to speed the rate at which skin cells turn over, helping to keep fresh, healthy, younger-looking skin on the surface. Retinoids also fade the excess pigment that accumulates in the lower layer of the epidermis. Furthermore, retinoids work to improve the appearance of fine lines and wrinkles by helping the skin produce healthy collagen and elastin. The longer a patient uses retinoids, the better their skin will look, and over time retinoids deliver pink, smooth, healthy skin with even tone and texture.
Since all skins are different, some patients experience irritation when starting to use retinoids. Though over-the-counter versions are less concentrated and usually well tolerated, dermatologists often recommend applying prescription retinoids every other night until the skin adjusts. Though oilier skins tend to tolerate retinoids better, one common side effect is increased dryness, especially if too much of the cream or gel is used. But this side effect can be easily improved with a hydrating moisturizer. There is also some concern about increased sun sensitivity when using retinoids, which is why they are best applied at night and used in conjunction with sunscreen during the day.
As a dermatologist, I see patients who are concerned about visible signs of aging every day. In my practice, I often recommend SkinMedica Retinol Complex because it contains three forms of vitamin-A derived retinoids. Its unique microparticle delivery system releases the active ingredients over time, which helps minimize irritation. This one product alone enhances the skin's appearance and texture by promoting exfoliation and skin regeneration. And to protect the skin from further damage during the day, SkinMedica Environmental Defense Sunscreen SPF 50+ is a perfect complement.
No other skincare ingredient does the full spectrum of what retinoids can do. In the field of dermatology, tretinoin (the active ingredient in Retin-A) has a reputation as the granddaddy of all anti-aging products. Whether over-the-counter or prescription, all retinoids work similarly, and have anti-acne and anti-aging benefits that are unique to this class of ingredients.
Dr. Wm. Philip Werschler is the founder of Spokane Dermatology Clinic and Premier Clinical Research. He received his medical degree from George Washington University Medical Center in Washington, D.C., where he also completed his residency and fellowship in dermatology. Dr. Werschler is an Assistant Clinical Professor in Medicine/Dermatology at the University of Washington and he is affiliated with several professional societies, including the American Society for Dermatologic Surgery, the American Society of Laser Medicine and Surgery, and is a Fellow of the American Academy of Dermatology. He is also the past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.
Adult Acne Treatments with Anti-Aging Benefits
Barbara Schell, M.D, Cosmetic Surgeon and Dermatologist, Ageless
As any aesthetic physician knows, acne can be an issue for patients ranging from their 20s through their 60s. But in contrast to teenage acne, adult acne poses unique challenges in terms of treatment due to differences between teenage and adult skin.
Regardless of age, all acne is caused by hormonal fluctuations. For teens, acne appears as hormones begin to surge and stimulate the oil glands. In adult women, acne outbreaks are associated with the hormonal changes associated with monthly menstrual cycles and the onset of menopause, which also impact oil production within the sebaceous glands.
Stress is another significant cause of acne, especially in adults. Work stress, financial pressure, and family obligations all contribute to the release of adrenal gland hormones, which prompt the oil glands to secrete more oil. With more oil present, P. acnes bacteria can thrive, inflammation sets in, and acne becomes problematic.
The main difference between teenage and adult acne is in the skin itself. The oilier nature of teenage skin makes it more tolerant of acne treatments that can be too drying for more mature skin. When adults with acne are concerned about visible signs of aging as well, adding hydration to the skin is a primary goal, and this makes some acne treatments inappropriate.
The ideal acne treatment with anti-aging benefits is a combination of alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs). These acids improve acne symptoms by melting the bonds between skin cells, allowing them to gently slough off instead of clogging the pores. In terms of anti-aging, AHAs and BHAs are wonderful for improving excess pigment, fine lines and wrinkles while they stimulate new epidermal cells, thicken the skin and make the skin look more youthful. SkinMedica’s 15% AHA/BHA Cream features the optimal concentration of these acids in a moisturizing base, making it ideal for adult acne sufferers.
Salicylic acid is another common anti-acne ingredient with anti-aging benefits. Found in SkinMedica’s Purifying Foaming Wash and Purifying Toner, salicylic acid works well for adult acne because it removes excess oil from the skin and gently exfoliates without being too drying. Adult acne sufferers with oily skin can usually tolerate a benzoyl peroxide product to reduce bacteria and absorb excess sebum, and SkinMedica Acne Treatment Lotion utilizes an advanced microparticle delivery system that enhances absorption while minimizing irritation.
Skincare products are often the first line of defense against acne at any age, but more stubborn cases may require additional treatments. Regular chemical peels have both an acne-clearing and anti-aging effect, and SkinMedica offers an array of in-office peel products that range from superficial to deep. For more cystic, inflamed acne, oral antibiotics, spironolactone and Accutane are extremely effective for skin clearing, but the appropriate treatment depends on the patient.
Every patient needs to know the importance of diligent sun protection, but it’s even more imperative for anyone who is exfoliating regularly or using anti-acne ingredients since they can cause an increased sensitivity to the sun. SkinMedica Environmental Defense Sunscreen SPF 50+ helps prevent sun-induced signs of aging with superior UVA and UVB protection, and its oil-free base will not exacerbate acne.
Dr. Barbara Schell is a double board-certified physician, certified by the American Board of Cosmetic Surgery and the American Board of Dermatology. She is in private practice in Seattle, Washington, and is the Founder, President and Medical Director of Ageless, The Center for Rejuvenation. Dr. Schell graduated with Highest Honors from Indiana University School of Medicine. She did her general surgery training at Indiana University Medical Center, and her dermatology training at the prestigious Baylor College of Medicine in Houston. She then completed a fellowship in cosmetic surgery at the Stough Plastic Surgery Center.
Chemical Peels Offer Minimally-Invasive Solution to Facial Rejuvenation for All Skin Types
Daniel Levy, M.D., Cosmetic Dermatologist, The Spa at PRO Sports Club
The words "chemical peel" could make those unfamiliar with the procedure's benefits anxious; however, chemical peels are really just a form of exfoliation, a minimally-invasive and essential component of facial rejuvenation. Chemical peels optimize skin health and are beneficial for all skin types, skin colors and ages.
Peels help remove damaged outer layers allowing a fresh, new layer of skin cells to naturally emerge. This results in both a renewing and therapeutic experience for the patient. If this renewal process could be achieved for every organ in the body, imagine how amazing we would feel!
A chemical peel has dual cosmetic and medical benefits. Cosmetically, skin renewal improves pore size, hyperpigmentation and fine lines. Medically, a chemical peel can improve acne, benign keratoses and actinic keratoses. I recommend chemical peels to those who want a more rapid improvement than a topical product could provide, and who don't have time for laser treatments.
Chemical peels offer various benefits depending on skin type and desired result. Light peeling agents such as alpha hydroxyl acids (AHAs)—glycolic, lactic or fruit acid, and Beta hydroxyl acids (BHAs)—salicylic acid are milder acids, induce a faster sloughing of the cells in the epidermis. Deeper peels are achieved with tricholoroacetic acid (TCA) and carbolic acid (phenol) and stimulate renewal in the dermis, the collagen-rich layer of the skin. Dermal regeneration can take weeks to months. The epidermis, however, heals in a few days giving the skin an improved appearance, more even skin color, smoother texture and a healthier glow. Specifically, chemical peels offer the following benefits:
- Decreased fine lines, especially under the eyes and mouth
- Improvement of mild scarring and certain types of acne
- Reduction of skin discoloration, such as sun spots, age spots, freckles and blotchiness
In addition to chemical peels, skin peeling can be achieved by the following two methods, each recommended based on skin type and the desired result:
- Laser peeling performed with an ablative laser. CO2 has long been the golden standard for laser-generated peeling. The newest fractionated lasers produce a medium to deep peel with skin shedding that lasts 3-5 days, and promotes new collagen production and long-term skin rejuvenation.
- Pharmacological peeling using retinoids—a class of compounds derived from vitamin A.
Ideally, chemical peels are incorporated into a good skin care regimen. I recommend chemical peel patients use a combination of SkinMedica® skin care products starting with the Sensitive Skin Cleanser, ideal for post-procedure or inflamed skin, followed by the TNS Recovery Complex®, a potent solution containing human growth factors that help to enhance skin tone and texture.
For moisturizing, I suggest SkinMedica's TNS Ceramide Treatment Cream™ containing the TNS® growth factor blend and peptides to help restore skin's moisture balance while hydrating the driest post-procedure skin. For a patient needing a lighter moisturizer, I suggest SkinMedica's Ultra Sheer Moisturizer, an oil-free formula to hydrate skin with vitamins C and E to protect against free radical damage.
I always recommend patients use daily sun protection to protect their delicate skin from damaging UV rays. Following a medium or deep peel, routine SPF use is not sufficient. It is essential to avoid direct sun exposure for at least four weeks to minimize the stimulation of melanin-producing cells in the nascent layer of skin. Direct sun exposure during this period increases the risk of hyperpigmentation and uneven pigmentation in the new skin.
Consult your dermatologist for a thorough skin care evaluation to determine the best peel for your skin.
Daniel Levy is a medical dermatologist at The Spa at PRO Sports Club in Bellevue, WA. Levy is a Washington State native and alumnus of the University of Washington (UW). After graduating from UW, Levy completed his graduate medical education and residency in dermatology in New York City. Levy's training includes a year of general and trauma surgery at the University of Southern California in Santa Barbara, a wound healing fellowship at the University of Miami and a clinical fellowship at Duke University.
On Call with Dr. Koch
The Iowa-based plastic surgeon discusses the importance of utilizing a skin care regimen to maintain beautiful skin post facial surgery.
Deciding to undergo facial plastic surgery is an investment; however, investing in a skin care regimen prior to and after facial surgery is equally as important to preserving the goal that was achieved.
Incorporating a skin care regimen before or after any facial reconstructive surgery will help to speed the recovery process and enhance the results of the surgery while maintaining healthy, youthful looking skin for the long term.
Facial surgeries help to tighten and lift the skin, while specially formulated skin care solutions can help smooth skin's texture, even tone and produce a glowing effect on the skin. I even recommend that my younger patients start a skin care regimen now to preserve the look that surgery will accomplish and to help slow the effects of aging over time.
I have seen the difference in my patients who use SkinMedica's clinically proven anti-aging skin care solutions.
We hear positive feedback from patients regarding the texture, ease of usage and results associated with the SkinMedica products. We've seen a quicker recovery time with peels and other procedures when patients use the Ablative Post Procedure Kit and TNS Recovery Complex.
The Ablative Post-Procedure Kit is formulated to help optimize the results from deep chemical peels, CO2 and fractionated CO2 laser resurfacing treatments. The kit contains skin care solutions that help the skin throughout the healing process, complimenting the results of facial procedures. The TNS Recovery Complex pairs antioxidants with other elements found naturally in the skin, helping to reduce the appearance of fine lines and wrinkles while improving skin's elasticity and texture—an essential post-operative skincare product.
Once the skin and incision sites are completely healed, my patients are given a complimentary spa facial and a comprehensive skin care consultation to determine which SkinMedica products are best suited to meet their goals.
Our office chose to become exclusive to SkinMedica because it is a superior skincare line based on advanced ingredient technology and continual scientific research.
Dr. Brenton Koch of Koch Facial Plastic Surgery in Des Moines, Iowa is board certified by the American Board of Facial Plastic and Reconstructive Surgery as well as the American Board of Otolaryngology-Head and Neck Surgery. He has earned the designation of Fellow in the American College of Surgeons. Dr. Koch specializes in facial plastic and reconstructive surgery including facelifts, rhinoplasty, blepharoplasty (eyelid surgery), Botox, Juvederm and Radiesse.
On Call with Dr. Roberts
The Los Angeles based dermatologist and official dermatologist for the judges and contestants on the past season finale of ABC's Dancing With the Stars shares how you can prepare your skin for a big event.
The pressure to look our best before a special event can wreak havoc on our skin - often resulting in embarrassing blemishes and dull, tired-looking skin. Stress causes the body to increase production of the stress hormone "cortisol" which causes the skin's oil glands to kick into overdrive, increasing oil production that can cause stress-related acne - even in those who don't normally suffer from acne. Not only does stress increase oil production, but it can also drain the skin of water that acts as a protective barrier, inhibiting the skin's ability to repair itself from damage.
SkinMedica's beauty experts have designed a quick-fix skincare regimen to repair stressed skin in less time.
If the event is a week away, follow all three steps for flawless skin. The night before the event follow Steps 2 and 3, and if you are looking for an instant beauty boost the day of the event, follow Step 3:
Step 1: One week before the event:
- Start with a gentle, non-invasive chemical peel treatment, such as SkinMedica's Illuminize Peel, the week before the special event to improve skin's clarity and give your complexion a healthy, radiant glow with no downtime or visible peeling.
- If you have developed stress-related acne, use SkinMedica's Acne System, which consists of an Acne Treatment Foaming Wash, Acne Treatment Toner and Acne Treatment Lotion to accelerate healing, control breakouts and absorb excess oil.
- For a quick and dramatic enhancement of your overall skin condition, as well as providing your skin with long-term improvement, use SkinMedica's TNS Essential Serum. This ultimate serum combines the power of growth factors with potent antioxidants, peptides, skin smoothing and lightening agents that transform the skin. In addition, the TNS Essential Serum produces a filling effect by infusing the skin with Hyaluronic Filling Spheres together with a wrinkle relaxer, a peptide that relaxes muscles and temporarily eases fine lines.
- Use a sun block with an SPF 30 or higher to maintain improvement and prevent ultra-violet (UV) damage.
Step 2: The night before the event:
- Wash with SkinMedica's Facial Cleanser followed by a mild facial exfoliant such as SkinMedica's Skin Polisher. The Skin Polisher contains soft, ultra-fine jojoba spheres that gently lift dead cells from the skin's surface without over-exfoliating or stripping away moisture, polishing the skin to perfection and preparing it for proper moisturization and hydration.
- Follow with a moisturizer that is appropriate for your skin type. For example, SkinMedica's Ultra Sheer Moisturizer, a light solution that infuses skin with panthenol and antioxidants for a healthy-looking complexion.
Step #3: The morning of the event:
- Wash with SkinMedica's Facial Cleanser, and follow with Skin Polisher, a gentle facial exfoliant (do not use Skin Polisher if you used it a night before).
- Apply a hydrating facial masque, for example, SkinMedica's TNS Hydrating Masque, and let it sit for 10 minutes (take this time to relax and relieve some stress). Occlusion forces the moisture into the skin and promotes deeper hydration, which also leads to better penetration of other important active ingredients. In addition to infusing the skin with vital hydration, the Hydrating Masque helps nourish, plump and firm the skin. As an added benefit of using the Masque, makeup will glide on smoother and look more even.
- Apply appropriate moisturizer for your skin type, such as SkinMedica's Ultra Sheer Moisturizer.
- Then use the SkinMedica TNS Line Refine around the mouth, eyes and crow's feet where fine lines tend to appear. TNS Line Refine creates a rapid filling and smoothing action that visibly reduces the appearance of fine lines and wrinkles.
Follow this simple routine and your skin will look spectacular for the big event.
Dr. Heather J. Roberts, a board certified dermatologist in Los Angeles, CA, was the official dermatologist for the judges and contestants on the season finale of ABC's Dancing With the Stars. She has also been featured regularly on KTLA, Fox, CBS, ABC, the History Channel, Telemundo, the Los Angeles Times, Savoir and Teen Vogue Magazines.
On Call with Dr. Taub
The Chicago area dermatologist discusses sun damage and ways to treat it.
Photoaging refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiation. Sun freckles (also known as liver spots, although they have nothing to do with the liver), irregular pigmentation and dilated blood vessels (often referred to as "broken" blood vessels) are some examples. Other examples of photoaging include fine lines and laxity from the loss of elastic fibers and healthy collagen.
To understand the difference between photoaged vs non-photoaged skin, look no further than your arms and chin. Notice how the inside surface of your upper arm is lighter in tone? Compare this to the outside of your arm where you can see the sun's staining effect. Similarly, you can see these effects on your neck if you look in a mirror. Given enough sun exposure to the surrounding areas, there will be a subtle and even "V" outlined below your chin where the skin has been shielded from the sun by your chin. The mottled pigmentation of the sides of the neck is missing because your chin acts as a sunbrella.
Your best weapon in the treatment of photoaging is of course prevention through good sun protection. There"s also a variety of ways to reverse signs photoaging, including topical treatments such as vitamin A derivatives, alpha hydroxy acids, vitamin C preparations, plant and botanical derivatives, antioxidants, growth factors and peptides. Chemical peels and microdermabrasions are also options worth looking into, as well as laser surgery and radiofrequency devices which help correct sun freckles, dilated blood vessels and wrinkles. Botox, collagen, hyaluronic acid and fat injections can help with certain lines of expression and loss of facial fullness. And new non-invasive tightening devices have come to the forefront to "replace" face-lifts.
Speak with your dermatologist to find out which treatments are best for you.
Dr. Amy Taub is a board-certified dermatologist who founded Advanced Dermatology, Skinfo® Specialty Skincare Boutique and SKINQRI in Lincolnshire, Illinois.
On Call with Dr. Nikolaidis
The Austin-based dermatologist discusses post-procedure care.
Optimal care during the recovery of a procedure allows for better post-procedure results. Post-procedure skin requires special care in order to minimize negative reactions and heal quickly. It is imperative for providers to optimize the healing during this phase.
One of the ways I do this is by recommending SkinMedica's TNS products following surgeries and laser procedures. These products have a unique human growth factor solution that plays a crucial role in skin tissue growth and repair. TNS Recovery Complex is recommended as a spot treatment for areas such as post-liposuction canula marks, and as a complete treatment for the face and neck following laser procedures and facial surgeries. TNS Body Mist is typically recommended for patients that have treated larger areas of the body such as legs, arms, or the stomach.
If you are considering a laser or surgery treatment, make sure you consult with your physician about finding the right post-procedural products available for your unique needs and circumstances.
Dr. Nikolaidis practices at Westlake Dermatology & Cosmetic Surgery in Austin, Texas.
On Call with Dr. Atkin
The Del Mar dermatologist discusses Thermage
Thermage is a non-invasive treatment that applies radiofrequency energy to the skin. It works by heating the deeper dermis and subcutaneous layers to tighten existing collagen and tissue and stimulate new collagen production.
Thermage products permit me to lift, tighten and contour in a way that nothing else currently can. Just one session is all it takes to see significant results in my patients. And best of all, there is NO down time.
It's commonly used on the face to smooth out wrinkles and renew facial contours. It's also an excellent solution for cellulite and to lift and contour trouble spots around the body - such as knees, upper arms, and the abdomen.
Because Thermage is non-invasive, it can easily be combined with other treatments such as Botox, Fraxel treatments, and liposuction.
We tell patients that they may desire another Thermage treatment in two to five years to further tighten the skin, not because they've lost the benefit, but because they continue to age after the treatment.
Consult with your dermatologist or plastic surgeon to determine if Thermage is right for you.
Dr. Deborah Atkin practices at Dermatology & Laser of Del Mar.
On Call with Dr. Moradi
The renowned plastic surgeon discusses noninvasive procedures.
As a facial plastic surgeon my expertise lies in facelifts, although I feel fortunate to practice at a time when there are many noninvasive procedures available to rejuvenate the face.
The aging baby boomer population has ignited the innovation of newer and less invasive procedures so that one can continue to look young without having to take any time off of work.
As the number of invasive facial procedures has continued to decline gradually, the number of non-invasive procedures has risen exponentially. Skin care, Botox and fillers are now the corner stone of facial rejuvenation.
Botox is the most common cosmetic procedure performed in the United States today. Botox is a highly purified protein injected in specific facial muscles, causing them to weaken which in turn leads to softening of wrinkles and lines. Botox has many different applications, including the lifting of sagging eyebrows and neck bands.
Fillers are used to reduce or eliminate deep wrinkles and lines and reestablish a youthful facial volume. Some of the most common areas for fillers include the laugh lines, lips, cheeks, temples and lower eyelids. It's exciting to see the use of fillers grow.
In this economy patients are less likely to be able to afford larger facial surgeries that require taking many days off of work at a higher cost. In my opinion, more and more patients will continue to gravitate toward less invasive procedures such as skin care, Botox and fillers. In 2008 our practice experienced a surge in the sales of SkinMedica skin care with TNS Essential Serum™ being the most popular product.
My advice to patients is to research the different treatments that are available and consult a qualified physician to explore your options.
Dr. Amir Moradi specializes in facial plastic surgery and practices at the Face Beautiful Plastic and Cosmetic Surgery Center in Vista, California.
On Call with Hema Sundaram, M.D.
The Washington, D.C. cosmetic surgeon and laser expert shares her thoughts.
Chemical peeling has been around for eons, and nose jobs and fat injections were happening even a century ago. What's different now is that we have more efficient technology for making ourselves over, and this gives us better and safer results with less recovery time.
The media often portray cosmetic surgery negatively and depict those who've had it as victims. But, in almost a decade and a half as a cosmetic surgeon, I've seen time and time again that cosmetic surgery for the right reason can actually be uplifting and empowering.
To me, the right reason is to balance how you look with how you feel, so that what you reflect outwardly is an accurate representation of who you are inside. Many men and women find that this inner-outer balance, which is so easy when they are young, is lost with age. You look in the mirror and may not even recognize the image staring back at you.
Today's minimally invasive procedures such as the Vitalize Peel®and Illuminize Peel™ allow you to reclaim your inner-outer balance effortlessly. You can look in the mirror and once again see the "real you" looking back - an image that reflects the timeless beauty that dwells within you at any age.
-- Hema Sundaram, M.D.; author of Face Value: The Truth About Beauty and a Guilt-Free Guide to Finding It
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