Over the years, I've gotten hundreds of questions from clients and friends alike. Here are the top five questions I get asked, most on a daily basis! I hope they can help you find some clarity.
1. What is the best thing I can do for my skin?
I get asked this question from almost all my clients and my answer is always the same: the best thing you can do for your skin is to get started on a good skincare regimen: wash, exfoliate, oil control and toner, and sunscreen. These are quite simply the basic steps of what someone should be doing on a daily basis. However, if we are looking to repair the skin from years of sun exposure, I recommend adding a corrective phase to this routine.
The severity of sun damage to your skin will dictate what products to use in the corrective phase of your skin care regimen. The products to choose from will depend on what you want to accomplish (i.e.: brighten skin, correct brown/sun spots, redness, fine lines, texture, roughness, etc.). Some of these products would be hydroquinone (HQ), retinoic/retinol acids, and Vitamin C.
There are so many skincare products on the market ranging from relatively inexpensive to high-dollar amounts; it can be hard to distinguish what to buy. If I had to choose what I can’t live without, it would be a good sunscreen, RX retinoic acid, and RX hydroquinone 4%.
The reason I choose to use this type of skincare regimen is because I have uneven skin tone from years of sun damage in my younger years. The HQ creams help to suppress the melanocyte cells that overproduce pigment in the skin. These cells appear as freckles, sunspots, and lentigos; the brown and red tone of these cells make the skin look uneven in appearance.
Generally speaking, a 30-year-old is not going to using the same skin regimen as a 60-year-old because their skin is going to be different. Older women will have had more exposure to UV rays, a decrease in hormones, a loss or decrease in elastin/collagen, and a loss of bone density. If you’re in your 20s or 30s, I am going to recommend a skin-care regimen that will preserve your skin’s collagen and elastin and prevent sun damage, which causes premature aging (wrinkles, texture irregularities, sunspots, etc.).
Vitamin C is another essential. It is an antioxidant and helps to protect against free radicals that cause premature aging. This is a product you would add in the 20s-30s age group.
Adding on retinol/retinoic acids should start in your 30s. These particular creams are meant to regenerate the skin cells more frequently to produce healthier-looking skin… it’s like exercise for your skin! And of course, sunscreen is for every age. I cannot stress enough how important sunscreen is for your skin.
Derm Diva Pro Tip
Switching up your skin regimen helps prevent your skin cells from getting used to the same exposure to products. After a while, the skin cells just don’t respond like they use to like they did at initial exposure.
Take melanocytes for example: these are the cells that produce pigment for the skin. If you expose these cells to HQ creams, the active ingredient stops these melanocytes from producing melanin. With continued exposure of this cream, however, these melanocytes will stop responding to the creams and start producing melanin again; they have become “refractory.” By switching out your skin regimens, you can prevent this refractory response of the melanocytes to the products.
2. How do I get rid of these lines on my forehead and around my eyes?
It’s very interesting how our brain perceives someone's age and mood very quickly by scanning their face. The lines in their face play a big role in that perception.
Most lines in the face are caused by constant muscle movement in our facial expressions; over time, these lines will become deeper and more pronounced. Even without this muscle movement, these lines become more noticeable. Sometimes facial lines are even formed by constantly sleeping on one side of the face!
So, the question is… how do we soften those lines? Of course I recommend a good skin regimen first and foremost, but sometimes you need a little more. Neuromodulators (like Botox, Xeomin, and Dysport) are injectables that can do amazing things to soften the look of your skin. When used in the right areas of the face, they can soften your expression beautifully and also be used for wrinkle prevention.
There is a misconception out there that, if you use a neuromodulator, you’ll look surprised all the time and won’t be able to move any muscles in your face. THIS IS SIMPLY NOT TRUE. Most people don’t even notice a well-performed neuromodulator treatment… they’ll just think you got a good night’s sleep!
3. I’m not a teenager... so why do I have acne at my age?
The truth is, you can get acne at any age… especially if you are a female.
We as females deal with hormones fluctuations throughout our lives. We have babies, we deal with stress, we deal with periods, etc. And the simple truth is acne is caused by hormones. Androgens (i.e. testosterone) stimulate sebum production, and sebum plays a vital role in acne formation.
Our skin has its own endocrine system and its own way of converting testosterone. In the skin, this conversion works in the sebaceous gland. When there is an overproduction of testosterone, the sebaceous gland starts to produce more oil/sebum. Bacteria LOVE to make baby bacteria in this oil, and when this happens a pimple is born.
There are several ways to combat acne depending on the severity. I recommend conservative treatments as a first line of attack; however, I believe in treating the patient, not just the acne. I ask questions like: How much does your acne bother you? Do you avoid doing things that you normally would do because you’re embarrassed about your skin? I want to know how aggressive to get in their treatment, and this depends upon the degree to which the acne is impacting their lives.
Acne can be a very difficult topic to talk about for some individuals because of the negative emotions associated with it. I tailor the acne plan to each individual… there is no “one size fits all” treatment.
A conservative treatment can consist of therapies like acne washes. Most acne facial cleansers have a component of salicylic acid (SA) and/or benzoyl peroxide (BPO). Percentages of these active ingredients can vary, but I recommend a product with 2% SA and 5% BPO. Rotating through different cleansers will help to keep the bacteria from building up a resistance to the products. Monday through Friday I recommend using the BPO wash and Saturday and Sunday using the SA cleanser.
Isotretinoin, more commonly known by its former trade name of Accutane, is another medication I recommend to certain clients. While it is typically reserved for severe cystic acne, I do occasionally recommend it for milder forms of acne. Like I said previously, I don’t just treat the problem, I treat the individual, and whether or not I recommend Accutane will depend upon how much their acne bothers them.
Accutane is vitamin A-based, not an antibiotic as many people imagine. It works by shutting down oil production; without oil, bacteria cannot reproduce. The prevailing theory in the field is that Accutane causes a trigger reset of the sebaceous oil glands.
Accutane is the only medication out there that comes the closest to being a cure for acne; however, there are some side effects to this medication you should be aware of. The top one is DRY LIPS. It is not an exaggeration to say that on Accutane your lips can become miserably dry.
Joint pain can sometimes occur on Accutane, too, but that typically goes away in the first or second month of treatment. Accutane can also cause some mood changes, so I always inform patients of that potential side effect and then we stay in communication to monitor whether they are having any sad or suicidal thoughts. This is rare, however, and most individuals won’t have any side effects aside from the extremely dry lips.
The course of treatment for Accutane is typically 4-6 months depending on the severity of the acne. Can acne come back after treatment? Yes, it certainly can, and the bad news is that, because women’s hormones change throughout their life, recurring acne is more common in women than men.
Treating the hormones associated with causing acne is also an option: oral contraceptives and spironolactone are the two most common medications. This treatment has been shown to work well for some women, but because of the risks involved with modifying hormones, this should be seen as a last resort.
4. What is the best lotion for dry skin?
Well, first things first: creams are much more hydrating than lotions. You can usually identify creams because they typically come in a tub container versus a pump bottle. Fragrance-free creams are going to be a better choice because of the possibility of allergies to fragrances. That being said, I’m not gonna lie… I occasionally use the nice-smelling body lotion from Bath and Body Works!
As for my recommendations, I love Cerave creams for the body. I also like the Cerave Itch Relief Moisturizing Cream for the trunk area because I sometimes get itchy there.
For my face, I’m pretty picky. When I get dry/flaky from using too much Tretinoin/retinols, I tend to use more ointment-based products. I recently found a product I love called Anfisa Lilou Regenerating Balm, a waxless balm that is full of natural organic ingredients. It is my go-to product when I’m feeling dry.
5. Can’t I just do a chemical or laser peel to help my skin look better?
The answer is yes! However, in order to get the best results for the money you will spend on lasers and chemical peels, it is best to pretreat your skin with a good skincare regimen for at least 6 weeks prior to any laser/chemical peels.
Again, the severity of the damage to your skin will dictate the type of pretreatment I will recommend prior to a chemical or laser peel.
For mild skin damage I will recommend at least 4-6 weeks of a consistent routine of wash, exfoliate, oil control/toner, and sunscreen.
For moderate to severe skin damage, I will recommend with the same pretreatment regimen as the mild skin damage routine, but add HQ 4% and Tretinoin 0.1% for 6 weeks prior to the procedure.
Outcomes of chemical and laser peels are much improved with pretreatment of skin.
Well that’s it! I hope you’ve found some answers. If you have any questions about any of this, please let me know in the comments! And don’t forget to LIKE Derm Diva Pro on Facebook and subscribe to my Instagram feed.