Physician Skin Care
Intensive Skincare For Anti-Aging or Improvement
Your skin is constantly replenishing itself. When you are younger your skin's "turnover rate" is about every 15-18 days. When you start approaching your mid-thirties the process slows down to as much as every 28 days. The upper most layer, the epidermis, is where we shed our skin cells and reveal the newer cells that are produced in the basal layer (the bottom). Any product that is bought in the stores and make up counters at those expensive boutiques affect this layer only. The next level down is the dermis. This level contains oil glands, nerves, capillaries, your body's melanin (the cells that are responsible for your coloring and a tan) plus sweat glands that moderate your body's temperature.
The dermis also contains your natural collagen and elastin in addition to your fat and water storage. Your collagen and elastin are responsible for that springiness that gives your skin its youthful vitality. Without this, in addition to lessened sebum (oil) production and slower cell turn-over rate as you age your skin appears wrinkled and drier than when in your youth. Then, there is the basal layer which we previously spoke about. It is in the basal layer that the skin cells are produced. This is where it all starts and this is where the magical renewal process can work its wonder of providing our bodies with the ability to uncover a newer, healthier and unblemished skin!
Now, your skin not only appears aged because you grow older. Even the youngest of individuals can appear aged prematurely because of photoaging. Photoaging is the damage received due to excessive exposure to the sun. This includes indoor tanning equipment as well. The UV light exposure (more often the UVB - remember B as in "Bad", UVA as in "Aging") destroys your skin's collagen and elastin supply within the dermis. Your body reacts to the excessive UV light and a thicker layer of skin cells forms in an attempt to protect your body from the UV exposure.
Have you ever noticed how it seems that when you lay out for days in the sun, or the many sessions in a tanning bed to get that "healthy glow" you seem to lose it pretty quick? Well, the reason your tan seems to be vanishing quicker than the eye is because your skin's renewal rate actually speeds up to rid itself of the damaged cells. That's right, the more you tan the more you must tan to retain that look of having been on an island vacation.
Skin Typing: Which Category Do You Fall In
Some of you may know what your skin type is but a lot of individuals really don't know. Some of you may be washing your face with too harsh of a product for your skin type. If you have oily skin and wash it with a harsh soap or over-wash it, it may become even oilier. You skin will try to compensate for its loss of sebum (oil). If your skin is normal and you are over-washing it can seem dry and flaky. With these tips you can find your skin's true type category and treat it accordingly.
Skin-typing test: When you wake up in the morning, wash your face with a mild facial cleanser and pat dry. Do not apply ANY products (not even a toner) and wait about an hour. Press a facial tissue or those special little oil-tissues to your forehead, nose, chin and cheeks to check for excess oil.
If your skin isn't overly shiny from excess oil or too tight and dry from lack of, then you have Normal skin.
If you have an oily T-zone (forehead, nose and chin) and are normal on the cheeks, you have one of the most common skin types, Combination skin.
If your entire face (or at least a good percentage of your face) is shiny with oil or an oily residue is left on the tissue from all sections of your face you have Oily/Acne-prone skin. Those with oily skin may notice a lot of "breakouts" and this is sometimes attributed to excess hormones. This can be corrected with medications received by a dermatologist or birth control from your OBGYN or physician or simply, physician skin care.
If your skin feels tight and has flaky areas that are remedied by moisturizer application - you have Dry skin. Dry skin appears to be more wrinkled and older without moisturizer. It tends to age faster as well. Your skin retains its youthful appearance with the help of its natural moisturizer (sebum) and regular exfoliation.
If you find that your face and/or body "breaks out", produces red bumps or patches, irritable dry areas or stinging sensitive areas after applying some products or just for no reason at all, you may have Sensitive skin. Sensitive skin can make your life difficult when it comes to cosmetics, skincare or just everyday personal hygiene.
Now that you know your personal skin-typing you can better choose from the many products formulated for your personal needs. *Remember, your skin changes as the seasons do. Plus, when you get older, your skin's needs change as well. This can be confusing and you may think it to be a hassle. But, once you get a regimen down, it gets easier. The benefits far outweigh the temporary annoyance of getting accustomed to a regimen.
What Is Intensive Skincare For Anti-Aging or Improvement?
Physician Skin care is of course the a great course of action for those who have skin and complexion woes and who do not respond successfully to over the counter formulations. Some individuals may need increased exfoliation to remove several layers of skin either all at once with deep chemical peels or through gradual chemical-induced exfoliation via products such as Retin A or alpha hydroxy acids. There are options which use manual exfoliation such as microdermabrasion or dermabrasion, as well. There are even more invasive measures which use laser light (laser resurfacing) to remove several layers of skin instantly.
Your Options In Skin Care
There are so many options for skin care that it would be impossible for us to mention them all. New products hit the market every day - some good, some not so good. Some are really great products that are definitely worth your time. We are going to cover several product categories and summarize the most frequently used lines with products suitable for all pocket books. Many of these you will recognize from your corner pharmacy whereas some are only available by prescription from your physician. Depending upon your needs, brands which arte less in strength may be all you need. Please consult with a qualified skin technician or physician for more information.
For product summaries, please click the hyperlinked product brand or types below for more information.
Retinoids
Retinol I
Retinol II
THA
Over The Counter (OTC) Lotions, Creams & Serums
There are many product which claim to reduce the appearance of wrinkles we will cover the higher quality products that are available without a prescription. Some are available at your local pharmacy, some from your Dermatologist or Plastic Surgeon.
Retinol I:
Retinols are considered a Cosmetic, these products are available over the counter (OTC). These are low level Retin- A (Tretinoin) creams. There are pharmacy brands such as:
L'Oreal Line Eraser
RoC
Neutrogena Healthy Skin
but there are also products available from a Dermatologist or Plastic Surgeon. Patients who have trouble with Renova and Retin- A can use Retinols with less if any irritation. They will cause peeling but do not usually cause cracking and bleeding as Retin-A creams due when they react with moisture from the corners of the mouth or eyes.
Hydroxy Acid Peels
Hydroxy Acid peels are usually very mild but can can sever damage when used full strength. You may find that you can receive Alpha Hydroxy peels from your aesthetician or Dermatologist for a generally reasonable price. Of course you may purchase product with Alpha Hydroxy Acids from your local pharmacy, Beauty Store or Grocery store which penetrate superficially. It depends upon the esired results or complaints being addressed.
Hydroxy Acid peels aren't exactly "peels" per se, but they do ause a reaction in your skin that makes you peel a few days later. They increase cell turnover rate and thicken the dermis as well as correct hyperpigmentation or texture problems. Of course the amount of improvement depends on the strength or number of treatments you have. The ones that you can get in a spa by an aethetician are not as strong as you can get by a Dermatologist or Plastic Surgeon's office but either one of the latter will . Normally, my esthetician charges just $5.US extra for a glycolic treatment on top of her normal $65.US fee for a European facial. If you aren't accustomed to it or don't know what to expect, I think 'sting' would be too harsh a word, rather it is irritating. *Ladies: I don't recommend any type of glycolic or similar treatment when you are nearing your menstrual cycle, your skin tends to be more sensitive around these times and you will be climbing the walls.)
Alpha Hydroxy Acids (AHA):
Water soluble, these products such as 8% Glycolic acid cream can help remove hyperpigmentations and help with photo damage, thickening of the dermal collagen and increase cellular turnover. It shows the same type of improvements in other treatments but offer no neoangiogenesis (blood vessel formation) so that telangiectasias are not increased or inflamed. Includes Lactic Acids. Higher concentrations work better, of course. Low PH causes irritation, irritation represents stimulus BUT one needs to change strengths. You must determine if your physician knows the difference about high concentration, high free acid concentration and low ph - irritation is symptomatic of it working. Although extreme irritation should be avoided.
BetaHydroxy Acids (BHA):
(Salicylic Acids most common); lipid soluble. It is an exfoliant, an anti-inflammatory (acetylsalicylic acid - aspirin family), a comedolytic (de-clogging agent for pores). It is in many products. There are BHAs in Oil of Olay's Age Defying Series, Pond's Prevent/Correct Neutrogena has products with BHA's and are recommend by Dermatologists.
Combination Hydroxy Acids (CHA):
Equal concentrations of AHA and BHA. These are not recommended as mixing of the two different pH's cause the delivery of only one product at the right pH and the other at a lesser strength. This is a marketing ploy - don't fall for it.
Triple Hydroxy Acids (THA):
Lactic, malic citric, glycolic acids, usually has three of the aforementioned acids. It is another marketing ploy. Another not to fall for.
Topical Vitamin C:
(Ascorbyl Palmitate) First it was thought that the molecules were not small enough to penetrate but it DOES penetrate, but very irregular and unstable. Different sizes do not work on different people. Many arguments have arisen due to this fact and quite frankly some molecules work differently in you or I. Yet, how do we know? The benefits of a correctly absorbed molecule can stay in the tissues for up to 3 days and is considered an anti-oxidant and benefits the skin my seeking out and destroying free radicals. Unfortunately you may have to go through hundreds of dollars to figure out which works for you.
Topical Vitamin E:
(Tocopheryl Acetate) Considered an antioxidant and has anti cancer and anti sunburn properties but can cause contact dermatitis and possible worsened scar healing.
Topical Vitamin A:
(Retinyl Palmitate) Such as Retinol Products but specifically Vitamin A in OTC creams/lotions such as, well just about every night cream. One such product is a product I use but not for its Vitamin A content but more for its Niacin/Niacinamide - BeautyControl SPA Organic Enzyme Masque with Niacin and Niacinamide (which dilates your superficial capillaries) to bring oxygen rich blood to the surface of the skin. You will appear flushed after use of a Niacinamide/Niacin containing product. This particular product contains Retinyl Palmitate as well as papaya and pineapple enzymes and pineapple-derived Bromelain.
Niacin/Niacinamides/Niacinamates:
As I said, I use products with these additives to flush my facial skin. These products deliver increased oxygen to the skin, increase circulation and help transport toxins from the epidermis. I find that I break out less with use of this masque. Although sensitive skins beware it can irritate and sometimes make your skin feel itchy in addition to the normal sensation of heat due to the flushing. Niacinamides are making their way to Dermatologists office more now.
Enzymes:
The enzymes (protein complexes) dissolve the horny layer (stratum corneum) They are not an irritating product and only "digest" the dead skin layer. They stimulate cell turnover and allow other products to penetrate better into the skin. Papaya and Pineapple are the most common. They are unfortunately unstable and can't be kept fresh for long.
Prescription or Physician Supplied Skin Care
These are more expensive but more effective. Some can be found on the web, or eBay - some you just have to get from your doc.
Kinerase (N6-Furfuryladenine 0.1%) (KEYEN-er-ace or KINN-er-ace)
"Scientifically Proven Results: In clinical studies conducted by a dermatology department at the University of California, Irvine, Kinerase™ was shown to help improve the signs of photoaging. After 24 weeks of treatment, physicians saw improvement in 100% of Kinerase™ patients. Improvement was seen in roughness, blotchiness, and fine wrinkles.
Kinerase™ Leaves Skin With a Smoother Look and Feel: Kinerase™ provides moisturizing qualities that outshine and outlast other moisturizing products you may be using. While some of these products may temporarily lessen the appearance of fine lines through improved hydration, that effect disappears a few hours after application. Kinerase™ enables the skin to retain more moisture, leaving it with a softer, smoother feel.
Kinerase™ is not an Acid and Won't Burn Like One: Unlike many other skin care products, Kinerase™ is non-acidic and won't burn or irritate your skin. In fact, patients using Kinerase™ in clinical studies experienced virtually no side effects."
(**Also available online through numerous sites)
Click Here to visit the Kinerase Site - ICN Pharmaceuticals, Inc.
All information was taken from The ICN Pharmaceuticals, Inc. site and all restrictions of the use of this information, in any form, applies. I have included the above for general informational purposes only and receive no funds from any company.
My opinion of it: It's okay - I mean it's great for mature, drier skins, but if you have oily skin then it may increase break outs. Sorry. It isn't the miracle cream they think it is. I'd rather Retin A or Retinols. But if I am really gonna spend the money - mild peels. Which cost less in the long run.
Topical Retinoids:
The first drugs that increased neoangiogenesis (blood vessel formation) therefore increasing vascularity, cell turnover, dermal thickening, etc. In a hand basket - the first wrinkle eliminator. Can cause more telangiectasias to form. Persons with telangiectasias should stay away from retinoid topicals.
Retinol II: (aka baby Retin A) Medicus
Affirm is one brand, in 3 strengths, 1X 2X and 3X. This are less irritating but still stronger than OTC Retinol formulas.
Retin A
aka Tretinoin. It is the only FDA approved photo damage treatment lotion/cream. Retin A is the strong stuff, Retin A Micro time released (I use Micro), whereas the Renova is the emollient based and can be too heavy for some and cause break outs.
Renova:
Vitamin A Aldehyde. This product is Tretinoin 0.05% in an emollient based cream and not as harsh as the Retin A. Hence, less effective than Retin A, more effective than Retinol. The product gets converted into a small amount of Retin A.
Retin A Micro:
o.1% Tretinoin in microsphere form. It is a strong drug BUT in time release formula so very little irritation is seen where normally patients would experience irritation. I am using this now. And it is doing WONDERS to my skin. My skin looks, younger, healthier, smoother, all of the above. I am using it with the Obagi NuDerm system. I highly recommend it!!! It is even reducing the appearance of fine lines (although it appears worse at first due to the drying nature of the products) as well as fading my freckles!
Avita: (brand)
Tretinoin in a less irritating formula.
Refinity Peel:
15% lactic acid (AHA) product with cosmederm- 7 and a 70% glycolic peel with .06 pH and cosmederm-7. This product increases the cellular turnover rate, helps with hyperpigmentation and corrects skin mottling. Irritation can be moderate - individualistic. (by Collagen Corp)
Cosmederm (strontium nitrate):
This product prohibits epidermolysis (blister formation), irritation blocker. It is added to other products (AHAs) to reduce the stinging, burning by 70% and erythemia (redness) by 30%.
Beta-Lift by Medicus:
B-Lift X (salicylic acid peel). May cause exfoliation , peeling skin, slight pinkness for a few days. Medicus markets a peel per pack kit, that includes enough product for 1 peel with complete instructions for both patient and physician.
PolyHydroxy Acids (PHA):
(Neostrata is one brand) These are larger molculed acids that in theory are supposed to decrease the dermal penetration so as not to irritate the skin. Has not really shown any more than a 6% difference in reactivity. Not worth the time if it is more expensive.
Alpha-Lipoic Acid:
Perricone has this patented, It is an anti-oxidant that is both water and lipid soluble. It does penetrate the skin even into the subcutaneous area. 3% has shown wrinkle reduction. BUT! not enough to prove this claim. If you have the opportunity to try it I would be interested in any feedback.
Topical Hormone Therapy (THT):
Studies showed that topical applications of 0.03 Estriol or 0.01 Estradiol for 6 months have shown decreases in ore size and wrinkle depth by 60%, an increase in collagen/elastin firmness and water content in the tissues. Unfortunately it is showing an increase in prolactin [: a protein hormone of the anterior lobe of the pituitary gland that induces and maintains lactation in the postpartum mammalian female --called also luteotropic hormone, luteotropin, mammotropin] percentage as well. I wouldn't mess around with these.
Copper (Copper Peptide):
(Neova is one brand) Copper Peptide Complexes can increase fibroblast stimulation, hence collagen formation. I will be reevaluating this product. The update is coming soon. Please visit ProCyte.com for information. I am slowly reviewing these products by ProCyte so please check back. So far, so GREAT!
Neova Calming Green Tea Serum
Neova Intensive Blemish Treatment
Squalane AF
Neova Day Therapy:
Neova Night Therapy
Neova Eye Therapy
Ti-Silc Sunblock 45
Ti-Tan Sunless Tanner
Hydroquinone ("bleaching" agent):
This is the standard bleaching product that can can prohibit your melanin production. 4% used to be thought to be the best and irritation would erupt in higher strengths. This has been proven as not so and strengths up to 10% are routinely formulated for patients. Although Hydroquinone is used by itself, it can be mixed with others such as...
arbusome
azelaic acid
glycomelanin
kojic acid
licorice extract
melawhite
...for increased effectiveness. These products are frequently used before and after Laser surgery or dermabrasion or intense Pulsed Light (IPL) treatments. Especially in ethnic patients.
Kojic Acid is available over the counter in weaker strengths, from your aesthetician or through your physician - it is a natural agent capable of blocking melanin production without the stigma of Hydroquinone use. They are either made from one or two sources (or a combination of both): ester of kojic acid from certain Japanese mushrooms or asafetida extract [also known as Asafoetida, Devil's dung, giant fennel and gum asafetida, (Ferula assa-foetida syn F. foetida)] which is native to Afghanistan.
Lustra Bleach (brand name, BLEACHING agent):
(Medicus) 4% Hydroquinone, 4% Glycolic and emollient. It is richer and is less reactive and drying. It is used as standard Hydroquinone.
Proteque (name brand):
1% hydrocortisone. Is a protectant to help diffuse inflammation of other products. Newer product that I haven't seen yet. Contains silicone and honey suckle extract as well.
Are You a Candidate for This Type of Skincare?
Usually there is always a product for each individual, however - do you truly need physician skincare? If you have tried just about every product or combination of products on the general commercial market, visited many aestheticians with no luck, perhaps it's time to get serious about your skin care. You should look into paying a visit to a dermatologist or plastic surgeon for custom skin care options.
What to Expect at Your Consultation
After checking a several physicians' backgrounds and credentials, you will make an appointment for a consultation. You will meet with these surgeons/dermatologists/aestheticians (depending) and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc. - this is very important. You really should consider smoking cessation as this can significantly decrease healing for more invasive procedures. Visit the Medication & Supplements List for more information. Also smoking can significantly affect vascularity and contribute to poor skin complexion and condition.
You will discuss your complaints and concerns and discuss the various techniques, the amount that can be corrected, etc. He or she should discuss the risks associated with hyperpigmentation removal procedures with you, as well.
If you would like more information on Consultations or a list of questions to ask your surgeon please visit the Consultation Help Page. If you should choose to book or reserve a surgery date for a more invasive treatment you will usually give a deposit to hold your surgery date. Most times if you cancel a few days beforehand, this amount is non-refundable. After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...
Preparing for Your Treatment
You should be given a pre-operative information packet that explains everything you should do and know before your treatment date. If your regimen calls for home care and application, this will be explained to you during your initial treatment consultation or whenever you receive your products.
Recovery & Perseverance
Great skin isn't uncovered overnight. Great skin takes time - generally a lot of time. Be patient and be realistic in your expectations as exfoliation takes many days if you wish to have no down time from immediate exfoliation measures (laser resurfacing, dermabrasion, deep chemical peels, salibrasion, etc.). If you don't mind the downtime than consider the more invasive options which carry with it more risks but faster benefits.
Many treatments - especially home care regimens - leave you red and peeling and even worse off than you were original, at first. Perseverance will get you where you want to be. Just remember this. Many patient stop because the benefits are uncovered and they are left with distaste for these treatments - often never going back and finishing. Please trust us, there is a silver lining if you stick with it.
Risks & Complications of These Products
The risks, complications & contraindications vary significantly and is highly dependent upon the treatment chosen.
For Chemical Peels:
If you have oral herpes. You MUST gain the approval of your primary physician and seek a prescription for oral acyclovir - one brand name is Zovirax®. This is very important! Zovirax® can significantly decrease your chances of a break out. If you have a break out during your healing period, it can spread to your entire face and result in severe and permanent scarring.
Be careful of crusting or excessive weeping. In AHA peels you may think this is normal but there is a borderline appearances that you must watch out for. Ask your skin care specialist for specifics regarding what to look for. If for a typical AHA peel, you should feel and look normal within 3-4 days. For deeper peels your downtime may take weeks and then months for complete recovery.
If you experience painful areas of the face, contact your surgeon or skin care specialist immediately - ESPECIALLY if you are prone to cold sores. Blisters that form will need to be reported immediately!
Hyperpigmentations (excessive coloration) and hypopigmentation (lack of pigmentation) can be problematic of misdiagnosed skin types, failure to reveal any skin problems or ethnicity and improper post-peel care. Infection is uncommon but possible so keep an eye out for redness and pain.
Scarring is a problem if the above is experienced so please adhere to your post-peel instructions to decrease your chances of long term or permanent, visible signs of damage.
For Microdermabrasion:
There are not many risks associated with microdermabrasion if you are a "healthy" adult, but enough to mention for those of you with skin or medical conditions. If the medical grade machines are used at high power it carries potential risks of hyperpigmentation, perforation, bleeding, and infection. Infection can also be a risk if the machines are not sterile. Many components of these machines are meant to be sterilized, autoclaved or changed out with a new disposable piece. Any and all pieces that come into contact with your skin should be able to be sterilized or changed out. Furthermore, it was brought up by a doctor in an article on Medscape, that there could be possible harm from the inhalation of the aluminum in the Al2O3 crystals, also known as Corundum.
*Also, you should NOT have a microdermabrasion treatment on the affected area if you have the following:
Undiagnosed lesions
Recent herpes outbreaks
Warts
Active, weeping acne (stages 3-4)
Active Rosacea
Unstable diabetes
Auto-immune system disorders
Some patients hyperpigment post-op. Lower pressures are used on follow-up treatments for these individuals.
*source for the immediate above, Medscape Medical Journal (1999)
For Melanin Blocking-type Formulations:
Risks can be irritation, permanent hypopigmentation, increased hyperpigmentations if you do not use sun block during this time. Ochronosis (black speckles or discolorations) if high strengths are used for long periods of time - especially in patients with ethnic backgrounds, or naturally darker skin.
Surgical Alternatives & Their Risks, Complications & Contraindications
For Laser Resurfacing:
There are minor risks and complications involved with Laser Skin Resurfacing which include but are not limited to prolonged hyperpigmentation. In 5-10% of patients, darkening or brown discoloration will occur requiring bleaching creams. This will generally resolved the discoloration in 2-3 months. Prolonged redness occurs in 3-5% of patients and this delays the fading to normal color by about 2 months.
There may be more intense burns associated with laser resurfacing. Take care in choosing your surgeon wisely. A specialist should be sought as the surgeon who is not experienced with the technique and light "touch" could very well burn you rather deeply, making matters worse.
If you have oral herpes. You MUST gain the approval of your primary physician and seek a prescription for oral acyclovir - one brand name is Zovirax®. This is very important! Zovirax® can significantly decrease your chances of a break out. If you have a break out during your healing period, it can spread to your entire face and result in severe and permanent scarring.
Patients with olive skin, brown skin or black skin (ethnic skin tones) may be at risk for pigmentation changes (hypo-/hyper- pigmentation) no matter what type of resurfacing method is recommended. Your surgeon should evaluate your skin characteristics and family history before making any diagnosis for treatment.
*Warning: Patients having used Accutane in the past 12-18 months, those who are prone to abnormal scarring or Keloids and those with frequent skin eruptions such as psoriasis, eczema and herpes may not be good candidates for Laser Skin Resurfacing. Consult with your doctor for more on this subject.
For Intense Pulsed Light:
Although rare, blistering or slight bleeding is possible as is hypo- or hyper-pigmentation (lightened or darkened areas of skin). If pigmentation problems occur, it may be anywhere from 3-12 months before normal skin tome returns. This is especially so with hypo-pigmentation (lack of color). Be aware that some patients may experience permanent skin pigmentation changes. Scarring is possible although it too is a rare occurrence.
Where To Get Products
You can either get your products at your surgeons or clinical aestheticians, or buy them online after you find out what it is that you need. Shop around for good prices, for quality products - just be sure that you know which product is right for your problem and skin type.
Products include Kinerase, Cellex-C, AllerDerm, Babor, Bio-Genetic, Cetaphil, Cosmoderm, Glyderm, Exuviance by Neostrata, Maderma, Procyte and more!
References
Rubin, Mark, G. M.D. - Lasky Clinic Beverly Hills, CA Pharmacology and Use on Contemporary Skin Care Agents (Lecture)