Skin Care Procedures—Misc: all links so far

Skin Care Procedures

• A cautionary tale about IPL treatments (new!)

• Botox anyone? What is botox? Plus a client’s cautionary account

• Botox, “Mental Botox,” and a client’s comments

• Collagen Injections: the basics

• Derma-rolling: a few thoughts (upcoming)

• IPL & PhotoFacial treatments for hyperpigmentation, capillary issues & scarring (new!)

• Microdermabrasion Q & A + one client’s experience (and it’s not a good one!)

• Microdermabrasion—What’s all the fuss about?

• Plastic Surgery—do your homework

• Restylane—what is it and what does it do?

• SKIN PEELS—should I or shouldn’t I? (new!)

• Some thoughts about cosmetic surgery—a totally personal choice (new!)

• What are glycolic peels?

• “What is a derma roller and should I be using one?” Client questions (upcoming)

• What is laser resurfacing? (upcoming)

also see

• Medications Oral & Topical: all links so far

• Trends & Fads: all links so far

A cautionary tale about IPL treatments

The following are parts of a long email I received from someone who was not a client in my salon, but someone who was in need of help with her skin post-IPL treatments. I lost touch with this person so I don’t have a followup on how her skin is doing today, but I include her comments and my responses to help any of you who may have had unexpected and unwanted results from IPL skin treatments.

I was seeking the IPL treatment in hopes of reducing my pore size*. I was told at the office where I had the procedure performed that it could reduce pore size up to 80%. I asked about risks and the possibility of scarring and I was told there were no risks. This should have put up a very large red flag for me, but unfortunately I’m only seeing that now.

*If you read anything about IPL, reducing pore size is not really something it’s touted as doing. Perhaps laser resurfacing would have been a better choice here, but even then nothing can really reduce pore size—without the possibility of changing the skin irreparably. That the office where this lady had the procedure gave her an 80% pore reduction number makes me wonder about the credentials of this doctor and who else might be getting misinformation about the powers of IPL. And as she mentions, “no risks” should have been her first warning that something wasn’t quite right here.

I had four IPL treatments between January and April of last year. Since that time, minor breakouts I have around the time of menstruation leave depressed acne scars on my cheeks, forehead and chin, and the overall quality of my skin has deteriorated dramatically. It has lost elasticity and is now pock-marked with odd linear scarring present on my right cheek. All the changes are most pronounced on my right side.

Perhaps she sleeps on her right side. Even the pressure of sleeping on one side or the other after a skin procedure(s) could possibly cause a change in the skin there.

My dermatologist (who did not perform the procedure, an osteopathic physician** performed the IPL procedure for me) has seen the changes and agrees they are “bizarre” but as he is not a cosmetic surgeon, he doesn’t know what to do with me. He stepped up my acne treatment program in an attempt to decrease all breakouts as these are now leaving scars and told me to wait a year and see if the scars fade. They haven’t. My skin has gotten very irregular and firm, again most pronounced on the right side.

**Dare I say, this should have been the 2nd red flag for this IPL seeker. An osteopath is a great doctor to see for joint issues or maybe a problem with your spine, but why this particular physician was giving IPL treatments, in my mind, only shows up as dollars signs.

So, the long and short of it is, this “lunch-time” “no-down-time” procedure has ruined my complexion. I recognize that these changes are probably permanent, but I would like your guidance and help regarding what to do now.

Had I been told that there was any risk of scarring, I wouldn’t have had the treatment. I am very conservative generally when it comes to my skin, though I made a grave mistake in this case. Hindsight is 20/20. My dermatologist told me with the damage done, it would be a mistake to risk an invasive procedure to try to repair the damage (i.e. “resurfacing”), as I might come out worse than I went in.

If you have any recommendations I would so much appreciate it. I know these changes aren’t going to reverse, but my skin is damaged now and I need to be more attentive to it than ever.

What this lady experienced may be an anomaly. She may have had unique issues with her skin previous to IPL that made her a bad candidate for this light wave technique but the doctor went ahead anyway or simply wasn’t aware. It could be she was just unlucky and had a bad experience when many people have exceptional results with IPL. To her, none of this matters because what she went into the procedure hoping for is definitely not what she left with.

It is always disappointing to hear negative result accounts when it comes to skin care procedures since you’re going in for an opposite experience. Rather than simply spending time on how to repair her skin (you really cannot reverse the damage done), I wanted to publish this emailer’s comments in hopes that if someone reading this is contemplating IPL—or any facial procedure—you will think on it long and hard before going ahead.

I recommend she start (or continue) doing a good Basics and Extras program and focus on her sugar intake to keep the breakouts to a minimum, even though they usually happen around her period (hormone driven). I’d look for a qualified aesthetician who really knows her stuff. How can you tell? You might not be able to tell at first sight, but if someone tries to sell you on all kinds of skin care miracles, I’d look for someone else. But in a good aesthetician you may find someone who can help lead you to better techniques and even products to help with your skin issues. Scarring is a completely different animal, but if your skin is well taken care of and exudes a healthy glow, then perhaps you won’t notice the scars as much. A small consolation perhaps, but you have to start where you are and with the truth of the situation.

If you are reading this and thinking about changing something with the skin on your face, once it’s done—most likely it’s done and there usually is no going back. Be clear about your intentions as well as what and more importantly why you are seeking a change. In the case of this person, reducing pore size is next to impossible. The skin just doesn’t shrink like that, in fact enlarged pores only get more pronounced as we age.

Don’t set yourself up to say hindsight is 20/20. Perhaps foresight will compel you to wait and see and do more research on a particular procedure. Over time, you might find you don’t even want to make the change that you did just a year ago. No matter what you decide to do: be care-filled and cautious and do your homework and research—please!

For more information, see:

• The Basics 1-2-3 Program for proper skin care
• IPL & PhotoFacial treatments for hyperpigmentation, capillary issues & scarring
• “8 Secrets Your Aesthetician [perhaps] Won’t Tell You” BUT I WILL!!! There is a section about scarring in this article

IPL & PhotoFacial treatments for hyperpigmentation, capillary issues & scarring

In your book you say there isn’t anything that can be done about broken capillaries, but I had successful laser sessions a year ago that erased most of them from my face.

This email came from a client of mine. She actually had IPL treatments, which are a bit different than laser therapy. Indeed, she had severe couperose (broken capillaries), predominately in her cheek and nose area. She did achieve remarkable results from having her capillaries treated with IPL. It took several sessions, but over 70% of the damage was eliminated.

Intense Pulsed Light (IPL) can be an effective treatment for mild or severe couperose, rosacea, or just getting rid of those pesky capillaries that have been hanging around on your face for so long. I have many clients who have had success with this procedure and are now enjoying less redness in their skin. One of the benefits of this treatment versus some of the older laser versions is it can treat tiny broken capillaries as well as redness deep within the skin where abnormal vessels are found, which is especially good for rosacea sufferers. Because IPL helps to alleviate the flushing associated with rosacea, treatments can really have a long-term effect.

IPL is also effective for getting rid of hyperpigmentation, making your skin tone even and free from pigmentation spots. Because sun exposure is what caused this condition in the first place, you will be instructed to be very aggressive with your sun protection program; it will not be just temporary care, but diligent sun protection for the rest of your life.

Although I don’t believe in before and after pictures in most circumstances, in several articles discussing IPL for redness, the before and after pictures speak volumes for this procedure’s efficacy. These photos give a clear view of the patient’s skin prior to IPL, which looks like skin with medium to severe capillary damage. Afterward, there is at least a 60% reduction in redness—the capillaries have disappeared. I have also seen these results in several of my clients.

Usually you will first go through a consultation with your dermatologist or a physician’s assistant in the office. They will go over your needs and wants as well as procedural information. Then you will find out about cost. IPL is not cheap. On average, each treatment is anywhere from $700 to $1,200, and you have at least five treatments in a series. However, if you are suffering from severe hyperpigmentation, rosacea, or just capillary damage, and you are willing to truly commit to aggressively protecting your skin (especially your face) from sun exposure, then IPL may be the miracle you have been searching for.

Your skin may be red for a day or two, but (if you have rosacea) it was red already, so it may not look very different after the treatment. Once the redness subsides, what you should be left with is less redness and an overall improved condition.

Depending on your pain tolerance and the normal procedure at the doctor’s office, you may have a topical anesthetic applied to the skin being treated. This is not a painless procedure, but the effects can last a long time, making it worth the small amount of discomfort you may experience.

I had a wonderful treatment called PhotoFacial™ that really helped to eliminate acne scars I’ve had for years as well as hyperpigmentation from when I was pregnant. It’s a bit uncomfortable, like a rubberband snap, but tolerable—and worth it! I had a series of 5 treatments, each one was about 2-3 weeks apart.

PhotoFacial (developed by Dr. Patrick Bitter, Sr.) is yet another name for IPL therapy; FotoFacial™ and EpiLight™ are a few more. No matter the name, if hyperpigmentation, rosacea, broken capillaries, or perhaps even acne scars are a concern, investigate IPL and see if it works for you.

Laser as well as light therapy are analogous to computers; the technology is advancing and expanding so rapidly that the techniques and machines used today may be obsolete tomorrow. As with all procedures, please get more than one opinion, and do your homework. When it comes to your face, you want someone who has a lot of experience and a great reputation working with IPL.

As with any and all procedures you are seeking, ask around for referrals. Once you have a few names, talk to someone in each doctor’s office. It’s doubtful you will get to speak with the doctor until you pay for a consultation, but sometimes you can get a feel for the office by the people who are working there. You always want to find a professional who has a lot of experience doing these treatments and using the machines, not a doctor who is just beginning to do this procedure.

For an example of someone who had a bad experience with IPL, see the article below. I think it’s smart to read the good and the bad and make your decision from there. As you’ll read, this client was probably not a good candidate for this procedure, but the doctor went ahead and performed it anyway.

For more information, see:

• A cautionary tale about IPL treatments
• Hyperpigmentation: A few Q & As
• Do you have Rosacea?

Some thoughts about cosmetic surgery—a totally personal choice

I found this great quote by writer Judith Krantz in a wonderful little book of quotes called, Age doesn’t matter unless you’re a cheese: Wisdom from Our Elders by Kathryn and Ross Petras:

“A woman I graduated from college with told me plastic surgery was vulgar, that lines were a sign of character, that it’s beautiful to age. I said bull. Character is internal. If you want to present yourself to the world with a face-lift, why the hell not?” 

I love this quote because, for me, it really says a lot. I agree with the woman Ms. Krantz is talking about. I do believe that aging can be a beautiful thing if we let it. And I do believe, for myself (and I know I am not alone) that lines are the manifestation of the accumulation of life—a life well lived. I also agree with Ms. Krantz when she says if you choose to get cosmetic surgery, or any type of procedure, that is purely and unequivocally your decision and in fact your right. I don’t think we should judge others for what they decide to do with their appearance. But perhaps we can learn from it. And this goes both ways.

Cosmetic surgery is purely an individual decision. Many of my clients probably think that I am totally against it, and that is not true. As I tell anyone considering such procedures, I will drive them to and from the hospital if they don’t have a ride. And I am serious! I do believe, because I have strong opinions about surgery, that people are afraid to fill me in on their decisions.

I have even had some clients “disappear” and never return to my office. Later I find out a client has had a procedure, and I guess she didn’t want my judgment. On the contrary, anyone who has come to my office after plastic surgery can tell you, I am fascinated! I want to know all about it—whether the client is happy with their decision, and because I have seen my client’s skin prior to the surgery, it is so interesting to see their face and skin afterwards. For me it is all just information, and I try not to judge anyone for doing what they need to do.

But some people, in my opinion, are chasing after a dream—a dream of youth and looking young forever. This is where I stand on my soapbox and hope that if you’re going to get surgery that you also do inner work as well. Inner work to make sure you aren’t trying to fix the unfixable with a cosmetic procedure. The unfixable meaning a view of yourself that is unrealistic, a self condemning view that no surgeon’s knife will be able to fix or heal.

Everyone has surgery for their own reasons. I just want to make sure that all the options have been looked at before someone forever changes their appearance. And in the end, everyone is going to do what they want to do anyway, so who cares what I or anybody else thinks! I am nearing 60 now and still I am fascinated with the changes taking place (and there are definitely changes taking place!), but I can confidently say I can’t see changing anything, not right now anyway. However you certainly don’t need my approval and if you really feel the need to do a cosmetic procedure and you feel good about your decision then go for it!

There are a few very important points that cannot be excluded from any discussion about plastic surgery. The first and most important thing to find out about is credentials. You must know who your doctor is and what kind of doctor he or she is. There are many people who have “M.D.” behind their names, but are they well-versed (and certified) to do cosmetic surgery? Please read the article on plastic surgery listed below to get further information on this most important topic.

Second, have you gone to several doctors (yes, this takes time) to get several different opinions about your potential changes? Personality as well as skill level are important to match up with a doctor who is going to be essentially cutting on your body. I hope you invest enough time to discover the perfect doctor for you. They may not be who your best friend chose, but if the fit feels right to you, then so be it.

In closing, I have a little quiz for you. Let’s say surgery was not an option. I know it is, obviously, but just for one moment, let’s say surgery is not an option. Then what would you do? What would you do differently to take care of your skin, your body, and your total self that you aren’t doing now? Would you slow down or limit your sun exposure? Eat better and drink more water? Spend more time on rituals to stimulate your health rather than break it down? Would you be more accepting of yourself because you’d have to be? Remember, for this one moment there is no cosmetic surgery available. What would you do differently? I think it’s an interesting question to explore.

In the end nothing really matters—not really. We live our lives the best we can and I think, at least this is true for me, we search out happiness in every corner and down every road we can find it. There are many roads to choose from and many different paths we take in life. So be well, enjoy your life and feel good about yourself always.

For more information, see:

• Plastic Surgery—do your homework
• Skin Care Procedures—Misc: all links so far
• MYTH: Aging is bad

SKIN PEELS—should I or shouldn’t I?

The term peel is thrown around a lot these days. What it usually refers to is an acid or other caustic substance that is applied to the skin of the face. Acids decompose cells, so having a peel helps to remove several layers of dead cells on the surface of the skin. How many layers depends on the strength of the peel. This strength also determines how much of a benefit or detriment the effects of the peel will have on your skin.

I am not fond of strong acid peels. Most glycolic peels given in facials are 20%-40% or even higher. The stronger the peel, the more dilation of the capillaries. So the stronger the peel, the more potential harm can befall the capillaries. When it comes to caring for the skin, moderation will usually bring about the best results.

Are chemical peels good?

It’s not a matter of whether a chemical peel is good or not, but whether you need a chemical peel. And more importantly, are you a good candidate for this type of procedure? The strong phenol peels of the past are still used today, but there are many other ways to either reduce wrinkles or lighten pigmentation that are far less traumatizing to the face than chemical peels. Chemical peels, unlike glycolic peels, have long-term effects, whether for the good of your skin or not.

I would exercise extreme caution if you are about to embark on a chemical peel. You may be trading one thing for another. You may be ridding yourself of some of the life experience you have accumulated on your face, which we call wrinkles, but in the process you may gain permanent sensitivity, problems with hyperpigmentation, or something else that is irreversible.

A TCA peel (using trichloracetic acid) is just another name for a type of commonly used chemical peel. I have a client who decided to do a full-on change to her aging skin. She got a TCA peel, liposuction on her cheeks, and fat implants in her lips. Doing so much at once can be overwhelming to say the least, and perhaps even dangerous at the worst. Infections can arise with any procedure, and you certainly don’t want to develop an infection within the delicate tissues of your facial skin. She got through the procedures without incident, but she did regret doing so much at one time.

Obagi® is an entire product line that also has a strong TCA peel as part of a skin care program. Here is an email from a client of mine who went on Obagi, had the peel, and had some good results along with some sensitivities from the products.

I had great success with Obagi. It really helped my hyperpigmentation. I can’t say that it helped my breakouts, partly because of my skin care habits (I sometimes pick at the pimples) and partly because my eating habits go from good to bad. I also know my sugar intake has something to do with the skin problems I still experience.

I am rarely in the sun anymore, where I was prior to using these products. Not being in the sun makes a big difference with my pigmentation. The sun makes my brown spots come out quickly, even with limited exposure.

Keeping your skin out of the sun will always keep hyperpigmentation away. It will keep all pigmentation from presenting itself. For most of us, staying indoors and out of the sun is simply not practical. But if you have pigmentation issues and it really bothers you, staying out of the sun may be your only option. Then again, perhaps you can just relax into the hyperpigmentation and enjoy life outside—still protected, but knowing the sun will continue to cause pigmentation issues for you.

Here are comments from another client: 

I think Obagi is very helpful, but I don’t know how long I can keep using the treatments. I am on the maintenance program, so I use Retin-A and a product called Blender (a bleaching cream) and Exfoderm [these are both Obagi products] two times a week. The other days I am trying to use a more natural product line.

I don’t want to use Obagi every day anymore. My opinion is that it is great for temporary use. Long-term, your skin can become very sensitive, and I don’t think that is a good thing. 

After having a TCA peel, there are no guarantees on how sensitive your skin will be. This client is also using Retin-A, which in and of itself can be irritating to many people, along with a bleaching cream that has chemicals in it that may irritate, and an exfoliation product that may add to her sensitivities.

Remember, you can’t solve internal problems with external changes. Seeing fewer wrinkles when you look in the mirror may be the surface objective when you get a procedure. Just make sure that how you feel about yourself—as a person, not a body—is not the motivation for these external changes.

For more information, see:

• Some thoughts about cosmetic surgery—a totally personal choice
• Skin Care Procedures—Misc: all links so far
• Trends & Fads: all links so far

Plastic Surgery—do your homework

What is plastic surgery?

Plastic or cosmetic surgery is defined as an operation that reconstructs an aspect of your body into a new and different form. The term plastic comes from the Greek word plastikos meaning to mold or give form to. Cosmetic surgery is elective, nonessential surgery. These are operations you choose to undergo to correct, add to, or reduce aspects of yourself that you are dissatisfied with.

There are two main things I have to say about cosmetic surgery. First, get more than one opinion. Many books recommend getting at least three opinions before you let someone cut on your face (or body). Next, I highly recommend consulting a nutritionist, even if your plastic surgeon doesn’t suggest you do so, to get a good vitamin and mineral program started before you have surgery. This will give you a better chance of recovery and possibly lessen scarring.

I have seen a lot of plastic surgery in my practice. Many clients ask who I would recommend as a good plastic surgeon. I explain it is not only the choice of surgeon that affects the outcome of surgery; it is first and foremost your body and how well it repairs itself. Do you tend to scar easily, or do you recover from wounds rapidly without noticeable scarring? Everyone’s body heals differently. How healthy you are and how you heal will greatly affect how good your surgery will look.

Finding a skilled surgeon (an artist) is the second part to the “best outcome” equation. Get referrals from friends and go to several doctors before you decide on “the one.” Make sure the doctors you see are members of the American Board of Plastic Surgery. This is not to be confused with the American Board of Cosmetic Surgery.

According to Arthur W. Perry, M.D., in his book Are You Considering Cosmetic Surgery, “The American Board of Cosmetic Surgery is a self-designated board. Its membership is open to doctors who practice cosmetic surgery but do not necessarily have the qualifications for membership in the American Board of Plastic Surgery.” There are many doctors performing plastic surgery who are not members of this prestigious society. I have heard over and over again that this is the first criteria you want to look for in a doctor for cosmetic surgery. (Perry’s book is older, but a good one nonetheless.)

For most procedures you will be under general anesthesia. My recommendation would be to make sure your body is in tip-top shape so you will be strong and healthy and have the best chance for optimum recovery. This area of pre-op and post-op nutrition is rarely if ever addressed. Sometimes in life you have to take matters into your own hands. In this instance, I recommend you do so. Why not go the extra mile if it could mean a better experience and recovery from surgery?

Deciding to have plastic surgery isn’t a good thing or a bad thing, it is simply personal preference. As I’ve written in many of my anti-aging/aging with grace articles, if you continually notice a so-called flaw—day after day—it inevitably begs to be changed. Many times this is the case with wanting plastic surgery. You see something “wrong” with your face and feel compelled to change it. Plastic surgery will certainly do the job. Please please—do your homework!

Just as a side note: Whenever you need to have a cancerous growth removed from your face, I recommend going to a plastic surgeon. They will almost always do a better job aesthetically with any incisions that need to be made and therefore your chances of having a “good” scar on your face improves dramatically.  

For more information, see:

• Some thoughts about cosmetic surgery—a totally personal choice
• Trends & fads in skin care
• Radiance—what makes a woman radiant
• Ageless Beauty—Part I

Botox, “Mental Botox,” and a client’s comments

Botox® is a very popular anti-aging treatment. It is one of the least harmful procedures, but alas, it is also temporary. Only your inner core belief about life and the aging process is something that can hold its shape unchanged over time.

Botox isn’t technically wrinkle removal; consider it wrinkle postponement. Botox doesn’t truly erase wrinkles; it paralyzes the muscles at the site of injection, prohibiting movement during expressions. Once the toxin is absorbed and removed from the muscle, your ability to express will return, and so will the wrinkles.

Some of you will obviously choose Botox. But where does it really get you in the end? And do we know about the possible long-term detrimental effects of using this toxin over and over again in particular muscles of the face? The answer is no—at this point there are no long-term studies on botulism’s effect long-term. Botox was approved for use in the facial area by the FDA in 2002.

Mental Botox. What I’m introducing is a way to begin being consciously aware of how you are creating your lines and wrinkles through your repetitive and unconscious facial expressions. If you decide to get Botox injections, it will prohibit facial movements but will do nothing to teach you to control your unconscious expressions. Once the Botox wears off, you will be right back where you started, albeit a few months further away from deepening the lines.

I’m beginning to form lines between my brows. The only reason these lines are forming is from crunching up my face from squinting in the bright sun or when I’m worried or upset—oh, and I’m almost 55. Nevertheless it is something I am creating (the wrinkle); nothing else is causing it.

Mental Botox is this: I have simply, over time, learned to direct my conscious awareness to my facial expressions. Sometimes I don’t realize I am making wrinkle-producing expressions immediately, but now when I do become aware that I am, I relax that part of my face so the line will cease to increase. Sometimes I put my finger up there and massage the skin a little bit to help the muscles relax.

Because I am getting older and because skin changes as we age, these lines will end up forming on some level even with this Mental Botox application. However, I can certainly delay their coming and decrease their depth by learning to relax those muscles. This way I am in control of my destiny, and I don’t have to pay hundreds of dollars every few months for a Botox injection. And Mental Botox can be used for the rest of my life. It also enables me to make expressions, which are something that is a part of everyday communication and something lost with Botox.

I believe you can consciously direct yourself away from bad behaviors and habits as well as into new and improved habits. For example, I have not only used this self-programing for when I’m wrinkling my face, but also for when I am grinding my teeth. I now wake myself up when I am grinding my teeth, whereas before I would just wake up in the morning with a jaw ache from grinding all night. I simply told myself to become consciously aware of the grinding and to wake up when it was happening. Although it may sound impossible, it actually works. It’s just a matter of determination, setting a goal, and prioritizing its achievement.

They say we only use a very small percentage of our brain’s capacity. You have the resources within you to make changes, large and small, within your own life and body. Why not give Mental Botox a try? You have nothing to lose and maybe better body awareness to gain.

I had a bit of Botox around my eyes two weeks ago. I’ve been very afraid of that treatment but caved in. I have to say, it has made quite a difference. I just pray that it is safe! What are your thoughts on Botox?

I have said that if I had to get an anti-aging procedure (emphasis on had to), I would most likely choose Botox. To me, it seems the least invasive as well as the least problematic. And the results are temporary, so if it doesn’t do what you want it to do, you aren’t stuck with the results. But for now I will continue to go along using my mind to help me with aging. Yes, I mean using Mental Botox, but more so I mean I will continue to work on developing a healthy attitude of acceptance vs. resistance to the most natural process in our lives and our bodies—the aging process.

For more information, see:

• Trends & fads in skin care
• Botox anyone? What is botox? Plus a client’s cautionary account
• AGING Gracefully: all links so far

Restylane—what is it and what does it do?

I'm not a fan of before and after photos, these included

https://en.wikipedia.org/wiki/Restylane

Restylane® is an injectable (wrinkle) filler that received FDA approval at the end of 2003. It is made from hyaluronic acid; hyaluronic acid is an amino acid (a protein) found naturally in our own skin. It is suggested that Restylane is going to take over for collagen as the number one choice for plumping up depressions in the skin, aka wrinkles. Unlike collagen, which has an animal origin, hyaluronic acid is made in the chemistry lab, alleviating the possibility of allergic reaction like with animal-derived collagen.

The results of a single injection can last anywhere from six months to even an entire year. Prices will vary according to whom you go to and what they are charging, but the basic cost per syringe is around $500. Collagen, on the other hand, costs about the same but only lasts half as long.

As far as I am concerned, the jury is still out on this latest and greatest “miracle” to remove the life and lines that are on your face. I’m in my 50s and am resistant to changing what is now the progression of my own aging process. I suppose it's the scientist in me that wants to see how I will age—naturally; I want to see how the lines show up and increase, how gray my hair will get, and what I will look like—untouched—at 60, 70, and even 80 years of age.

Perhaps at some point I will partake in some of the anti-aging products and procedures that I am currently saying no to. I give myself the leeway to change my mind, knowing that I might just keep traveling on the very same path I am on now. Time will tell.

For more information, see:

• Trends & fads in skin care
• Collagen Injections: the basics
• AGING Gracefully: all links so far

Collagen Injections: the basics

What are collagen injections? 

This is a procedure where bovine collagen, taken from cowhide, is injected into the furrows of deep lines and wrinkles of the face. The most commonly injected areas are the nasolabial lines (laugh lines), fine lines around the lips and corners of the mouth, and the vertical lines between the eyebrows (worry lines).

The collagen acts like a filler to plump up the depression caused by a wrinkle, making the line (wrinkle) temporarily disappear. The actual procedure will cause redness in the injected area along with temporary bruising and a bit of swelling. These minor reactions will usually go away within the first 24 hours.

In all of the literature written about collagen injections, two main points are repeated. First, collagen injections are a quick and easy “fix.” This procedure will give you the fastest results with a minimum of complications. However, it also is a very short-lived fix, and you have to be reinjected frequently to continue the results.

The price of collagen varies from doctor to doctor, but the cost of one syringeful starts at around $500. Since you have to constantly repeat this procedure to maintain the benefits, collagen treatments can get quite costly. Three to nine months is the life span of collagen injected into the skin. It is reabsorbed at varying speeds, but as much as 30% is reabsorbed within the first three months after the injection.

In addition to the high cost, there is another problem—the potential for allergic reactions. Around 3% of the general public is allergic to bovine collagen. I’ve read that if you have an intolerance to beef and other bovine products, you will most likely have a reaction to cow collagen. Therefore, before having collagen injected for cosmetic purposes, you will always be tested for allergic reactions. Usually the collagen test is in the forearm, and sometimes it’s behind the hairline, on the scalp. A second, follow-up test is standard practice with many doctors—just in case you have a delayed reaction to the first test. This precaution is taken because experiencing an allergic reaction to collagen would be disastrous!

If you are allergic to cowhide collagen or you just don’t want the bovine experience, you can use your body’s own collagen, which is called autologous collagen. Surgery is required to obtain this type of collagen, usually from the upper thighs or buttocks. The potential problem is that if you continue to get regular treatments with autologous collagen, more of your collagen will need to be donated. This requires more surgery to transplant, then more injections into your wrinkles. In the long run, is it worth all the trouble?

Collagen injections should only be administered by a licensed doctor, usually a dermatologist or plastic surgeon. You want to make sure to find a doctor who does a lot of these injections. Accuracy is imperative for proper results.

For more information on “anti-aging” procedures, see:

• Trends & fads in skin care
• What are glycolic peels?
• Botox anyone? What is botox? Plus a client’s cautionary account

Botox anyone? What is botox? Plus a client’s cautionary account

What is Botox? 

I call this “Magic Poison.” And essentially, that is exactly what Botox is. It is actually the botulism bacterium (botulism toxin) that is injected into specific areas of the face, usually the forehead and between the eyebrows along with other areas. The poison renders the surrounding muscles paralyzed. Once the site is injected and the muscles are paralyzed, you are unable to express or move that area of your face. Without daily and constant expressing, lines do not furrow into the skin. So Botox, by paralyzing the muscles, indirectly helps to reduce the deepening of wrinkles. It lasts four to six months and has to be reinjected to continue the benefits.

Botox has been used for years to help stop eye tics and other medical maladies. Around the 1990s it was “discovered” for its antiaging, cosmetic benefits. It was approved by the FDA for cosmetic use (between the brows specifically) in 2002. It is only administered by a licensed doctor, either a dermatologist or a plastic surgeon.

One client’s story. Recently I had sent my client Barbara to see her dermatologist about a mole I was concerned about. She is 47 years old and has beautiful skin that has very few lines. Barbara truly has the skin of a woman in her mid-30s. During her last facial, she told me about her trip to the dermatologist. Luckily the mole wasn’t anything to worry about, but I found what happened later on somewhat disturbing.

The dermatologist asked Barbara to frown in order to furrow her brow, and she gladly obliged. He proceeded to tell her he could inject her “worry lines” (lines that form between the eyebrows) with Botox. Ask anyone to form a line of expression, and guess what you’ll get? A line of expression—a wrinkle. So there she was, feeling like something was wrong with her face, and the solution was being conveniently presented to her in the form of a quick-fix injection. It was such a blatant, bold-faced way to make her feel ill at ease and to endorse the sale of his services. Plus his comments were unsolicited. She was going in to get a mole checked, not to inquire about anti-aging procedures. Even if Barbara had deep worry lines, I still wouldn’t defend this ploy by her dermatologist.

My point in retelling this story is to instill an air of caution in you if and when you find yourself in a similar circumstance. Don’t fall prey to someone else’s opinion of how you should look, especially when the opinion-giver stands to gain $300-$500 for one injection of Botox (or any other corrective procedure). Remember the saying “Let the buyer beware!” 

Getting Botox injections is a personal choice. As an aesthetician, I don't encourage or discourage anti-aging procedures per se, but I do feel Botox is one of the least “harmful” things to do to alter your appearance if that is what you’re looking to do. Far be it from me to tell anyone what to do with their face—except of course when it comes to cleansing, toning, and hydrating: The Basics for healthy skin.

For more information, see:

• To age or not to age: Is that the question?
• Trends & fads in skin care 
• MYTH: Aging is bad
• The Basics 1-2-3 Program for proper skin care

What are glycolic peels?—with an update

A glycolic acid peel is what I consider a strong peel. Strong peels, using glycolic or other alpha hydroxy acids, will decompose surface cells. Strong peels create deep exfoliation. Deep exfoliation diminishes the appearance of lines, therefore, it stands to reason deeper peels should make you look younger. Because of this promise, many people will seek out the strongest peels available. Stronger peels can deliver a quick fix, but this fast-track mentality never brings just the desired results. There is always a consequence.

Glycolic acid causes the capillaries to dilate, which brings more blood to the area. Blood carries oxygen and other nutrients to feed and nourish the skin cells. So far, so good. But glycolic acid can also weaken the capillaries. The hot sensation you feel with the application of glycolic acid is the intense dilation of your capillaries coupled with the acid that is decomposing dead cells. It is this excessive dilating that creates a consequence that far outweighs any oxygenating and exfoliating benefits you may receive.

Because capillaries are naturally weak, strong dilating can cause capillary damage or couperose. Couperose is a condition that rarely improves but easily worsens with age, abuse in the sun, alcohol, smoking, and in my opinion, strong acid peels. So unfortunately, and you may not hear about this part, these strong peels, although exfoliating many dead cells, tend to be detrimental to the susceptible capillaries, possibly causing permanent redness.

My professional experience with glycolic peels is this. When I lived in Los Angeles (1990-1992), I worked for Dr. Murad’s wife at her salon, A Sense of Self in Brentwood. As you may know, Howard Murad developed the glycolic product: Murad. The reason I was working at this salon was because it also sold Yonka products, and at that point in my career, I had worked with Yonka for more than 5 years and wouldn’t have worked for a salon that didn't include my favorite product line.

I had access to different strengths of glycolic peels and was expected to perform them on the clients. Having experimented with the peels on my own skin, I found them to be less effective than the industry makes them out to be. I also noticed that the small amount of couperose I had on my cheeks became more prominent. The peels did smooth the surface of my skin, but at what cost? One more thing—the glycolic acid really burned!

So I was being instructed to do glycolic peels, which when requested, I did; but the results I noticed were quite disturbing. In addition to the positive exfoliating benefits that were occurring, most of my clients who received these peels had a noticeable increase in the redness or couperose in their skin. This was not good news. Subsequently, I found myself explaining these results to the clients, who all opted not to have glycolic treatments anymore. In place of the peels, I suggested receiving the Yonka facial (that has two exfoliation processes, but neither one is so strong as to cause capillary issues) and consistent exfoliation with at-home products that were sold in the salon (Yonka’s gommage).

The conclusion to this story is that after many months of working for the Murads, I was “let go” from my position at the salon. I wasn’t their model aesthetician, although I did create a lot of Yonka revenue. I wasn’t adhering to their desire for me to give glycolic peels to clients coming in. I simply couldn’t. The salon and I were no longer a good fit. And of course I realize, for my employers, I was not the kind of employee they were looking for. I moved on to another salon that carried Yonka and was no worse for the wear. I learned a lot, although in my heart I already knew strong peels were not going to be in my future, personally or professionally.

Glycolic peels usually come in a series of six treatments. What is magical about six? My guess would be money and not so much a technical result. Many times the series is given in one-week increments. My belief is that if you had a good facial once a week for six weeks, your skin would look just as fabulous, if not more so, and without any detrimental results like when using harsh acid peels.

I relate our outer dead skin to fingernails; both are made up of dead tissue. When you cut your nails, you don’t go further than the white part, otherwise you will cause an injury. And even if you did go a little gung-ho, in time the nail will grow back. The same hold true for your skin. You can eliminate many layers—even too many—at any given time and eventually the dead skin will return. Strong acid peels are like taking off too much of your fingernail. Don’t worry, the skin will continue to come up to the surface and shed off; there is no permanent exfoliation benefit from getting peels. But what about the capillaries? The only permanent result from glycolic peels is the potential for capillary issues you may not have had prior to getting peels.

I am not a proponent of glycolic peels. I realize they are popular, but once again I find myself going against the grain. If you take care of your skin consistently and take advantage of professional facials, you can achieve in the long-term the benefits of short-term acid peels without incurring any of the potential damage.

Quick fixes—in skin care—rarely ever work.

UPDATE: 1/2016

Although I generally don’t post reader comments on my blog pages, I still receive them to moderate. Recently someone named Jackie left the following comment regarding this glycolic peel article:

Unfortunately most businesses are about the bottom line, which in this case means selling peels despite all costs. I’ve done them at home myself and didn’t find them to be so bad. Besides, I read that the redness is just temporary anyway.

Glycolic peels are given in facial (and dermatologist’s) salons. The percentage of glycolic acid is going to vary in salon settings, but for at-home use, you will not be able to find high-percentage glycolic (or any) acid for “peels” or even in standard skin care products. Only professionals will be able to acquire percentages of these acids in the concentration I am discussing in this article.

Regarding redness: Any redness produced for whatever reason is usually undesirable. But as Jackie says, the redness does go away. This might be true for her skin with whatever glycolic treatment she is using at home, although she said she read about this temporary effect but did she experience this herself? The redness produced by strong glycolic peels in a treatment setting is the type of redness that will probably not go away—not completely anyway.

For more information, see:

• SKIN PEELS—should I or shouldn’t I?
• Couperose Skin explained
• What are AHAs? Miracle ingredients or not?

 

Microdermabrasion Q & A + one client’s experience (and it’s not a good one!)

This procedure should be termed microepidermabrasion. Micro means very small or involving minute quantities or variations; derma refers to the dermis or inner layers of the skin, but in the case of microdermabrasion it is—hopefully—only affecting the epidermis or outer skin; abrasion means to wear away by friction, through abrading.

I would like to know how you feel about microdermabrasion. I am 35 years old and fine lines are starting to show, especially around my mouth (smile lines) and forehead. Do you think products would work just as well? The procedure is quite costly, $900 for 6 treatments. I’m trying to decide if it’s worth it or not. Any information would be greatly appreciated.

Microdermabrasion is expensive, yet it is a superficial exfoliation of the outer skin. Anything more than that would not be allowed to be performed by a mere aesthetician. It can help to reduce the appearance of the fine lines, but not the actual lines themselves. Keeping your skin regularly exfoliated at home can help you achieve similar benefits as microdermabrasion at a fraction of the cost.

I asked this reader if she exfoliated at home, and her answer was no. She had tried Retin-A, but it burned her skin and made it peel, so she stopped using it. She wasn’t actively exfoliating (vs. passive exfoliation like AHAs or Retin-A) on a regular basis—or at all. She wanted to stop wearing foundation but was having a hard time getting used to not wearing it.

I would recommend exfoliating at home first before you invest in microdermabrasion. This way you can find out the benefits of regular dead skin removal, which reveals soft, supple skin underneath.

I know many people enjoy the benefits of microdermabrasion, but I also have heard stories—firsthand accounts—from some of my clients about negative experiences with this procedure. Following are a few client’s stories.

Gowri’s microderm story. I came into the facial room to see my client who hails from India. Gowri has beautiful light brown skin, and like many darker skinned people, she has some trouble with hyperpigmentation. She went to investigate microdermabrasion to see what all the fuss was about and had an unfortunate experience.

Apparently the aesthetician working on Gowri’s skin was a little overzealous in wanting to get rid of her dead skin. There was a pimple in the middle of Gowri’s forehead, a spot that had been there for a while, and it resisted leaving (clearing).

Perhaps in an attempt to “get rid of” the blemish, the aesthetician must have kept the microdermabrasion machine on that spot for a long time because what she actually did was create a hole in my client’s skin! I couldn’t believe it! Not only was there a visible hole, but since Gowri is from India, she is prone to post-inflammatory hyperpigmentation. This shows up as dark brown spots at the site of inflammation or infection. In Gowri’s case, she had a medium-sized dark spot at the site of this hole left by the microdermabrasion treatment. 

Over time the skin healed, and because Gowri was diligent about sunscreen and covering her face in the sun, the dark spot went away as well. Both of these processes took some time, but I am happy to report her skin looks great. Needless to say, Gowri won’t be getting any more microdermabrasion treatments.

Another client of mine who likes to experiment with new and different procedures tried microdermabrasion. She said it actually hurt, and now she has red patches on her cheeks from the treatment. I have been giving her facials for over 10 years, and her skin is very delicate and sensitive. She is not a good candidate for any kind of abrasive procedures or products; no wonder she didn’t enjoy microdermabrasion.

I have had one microdermabrasion experience. I asked the aesthetician to only exfoliate one half of my face (left or right side). Although she didn’t know I, too, was an aesthetician, I’m sure she found my request quite odd. I told her (and this is true) that I wanted to be able to see and feel the difference from the microdermed side and the side without the procedure.

My experience, although limited, is this: My skin on the side that received the microdermabrasion felt very sensitive for several days after the facial. Honestly, I couldn’t feel any appreciable difference in texture from one side to the other. But the sensitivity the exfoliated side felt was enough to keep me from having this procedure done again. My skin, by the way, is not what I would describe as sensitive.

Microdermabrasion isn’t for everyone. I encourage all my clients to experiment and see what works best for them. Microdermabrasion isn’t—or shouldn’t be—any more than superficial exfoliation, so it should be a safe procedure. However, any treatment given by someone who is unqualified could turn out to be disastrous, so be sure if you do get microdermabrasion you are going to someone who knows about skin and all the possible effects of this procedure—not just the benefits.

Microdermabrasion is fairly commonplace in many facials today and it is also a safe procedure (unless you have an aesthetician who doesn’t understand skin or how to use the machine). I still think microdermabrasion is too expensive for what you get. Doing your at-home exfoliation (especially utilizing Yonka’s gommage) can, in my opinion, give you similar results without compromising the health of your skin or your wallet.

For more information, see:

• What is Post-Inflammatory Hyperpigmentation?
• What IS Gommage?
• Microdermabrasion—What’s all the fuss about?