The eyelids are one of the most common places for skin cancer and the first place we see the signs of aging. Skin cancer in this area is especially dangerous and hard to detect. Luckily, there are products that can protect the delicate skin around the eye.
The eyelids are very susceptible to skin cancer and the aging effects of UV exposure. About 10% of skin cancers occur on the eyelids, which is kind of shocking when you consider that the face/head accounts for less than 5% of the total body surface area. There are many additional concerning factors regarding skin cancers on the eyelid. There is a significant risk for tissue damage to nearby vital ocular structures and even blindness. Tumors in this area can also spread into the nasal and orbital cavities (the area behind the eye). Let not forget that the skin of the eyelid serves to protect the eye and when that skin has to be removed we are presented with a host of issues such as preventing infection and reconstruction of the eyelid is very difficult. Early detection can be challenging because these tumors tend to grow inward toward the deeper layers of the skin and bone, before they are seen on surface of the skin. The appearance of this type of cancer varies and looks different than other types of skin cancers, making detection even more difficult. Reoccurrence of skin cancer on the eyelid is among the highest. It is important to take measures to prevent skin cancer, and become an established patient of a good dermatologist before you think you need one.
As if cancer was not enough, photo-aging of the eyelid is another concern. Photo-aging is a term used to describe sun damage and premature aging caused by UV exposure. Consider that the skin is a direct reflection of health and that sun damaged skin is not healthy skin. Photo-aging goes beyond vanity, it really is about skin that is not functioning properly or at a healthy state.Sun damaged skin will have lowered immunity against infection and impaired wound healing ability. Furthermore, UV rays age skin cells, damage DNA, break down collagen, elastin and damage pigment producing melanocytes. All of this equals unhealthy skin that is thin, lax (loose), with lines wrinkles and skin discoloration. There are products and treatments that can be done to improve these issues, but it will take time, money, and a little work.
Prevent the damage and reduce risk of cancer
The first line of defense is a broad spectrum sunscreen SPF 30 or more. The eyes and the skin around the eyes are sensitive to chemicals in sunscreen so you should look for a physical sunscreen, meaning the only two active ingredients are Titanium dioxide and Zinc oxide. I like Physical Eye UV Defense SPF 50 by Skin Ceuticals, it is a non-migrating, high protection sunscreen designed specifically for the upper and lower eyelids. This is a pure physical sunscreen that you apply like and eye cream. The formula is tinted to enhance tone, however it will nor provide coverage like a cosmetic. I like to say it’s tinted for a man. It blends right in and doesn’t settle into fine lines or make your eye area appear dry/cakey. the ceramics in it will nourish the skin, but I still recommend using your usual eye cream first then SPF.
For additional protection I recommend using a topical product with vitamin-C, every morning. While sunscreens absorb or reflect out UV radiation, antioxidants such as vitamin-C neutralize the UV rays. Photoprotective topical antioxidants work by the inhibiting the UV-induced biochemical changes that lead to photoageing and DNA mutations.
Studies show that sunglasses do help protect eyes from UV damage, however some UV light can still get to the eye area, depending on the type and style of sunglasses. Look for sunglasses with UVA/UVB protection and remember that sunglasses do not eliminate the need for sunscreen.
The Eyelids: Highly Susceptible to Skin Cancer / Skin Cancer Foundation
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The eyes are the focal pointe of the face and one of the first places we start to age. A professional chemical peel to treat the skin around the eyes, may be just what the doctor ordered.
A Medium Depth Peel will..
- Treat skin laxity, fine lines, “stretchable” wrinkles and scars.
- Improve skin texture, reducing roughness
- Treat hyper-pigmentation Brown spots and Melasma
- Tighten large pores
- Increase collagen and skin density
The skin around the eyes is thin and with age begins to show fine lines and take on a crepey texture. Treating the delicate skin around the eye can be tricky. Lasers can damage the eye, so this limits how we treat this area. Laser resurfacing can be done, if special laser eye shields are placed inside the eye. Chemical peels are another option for treating the skin around the eye, and when done by a skilled professional can be done up to the lash line.
Chemical peels that penetrate to the appropriate depth in the skin, can improve texture and tighten skin. A TCA peel that penetrates beyond the papillary dermis, just to the Immediate Reticular Dermis (IRD) will provide skin tightening effect, this is called a Medium Depth Peel. I am choosing not to mention the strength of TCA used, because I read too many horror stories online about people who attempted to do a professional peel at home. Skin care professionals are trained on how to determine where we are working in the skin, this is a medical grade peel and should be done by an experienced professional.
Aging Skin and Chemical Peel Intervention
Skin care professionals often talk about “skin cell turn over”. Skin cell turnover is the process of a new skin cell being produced, working it’s way up to the surface and replacing old skin cells which have been sloughed away. In young healthy skin this process takes about 6 weeks, however aging and sun damage slow this process. Chemical peels increase skin cell turnover, which in turn improves skin texture.
The production of growth factors, collagen, elastin and hylaraunic acid all slow with age, so the goal in anti-aging is to preserve and increase the production all of these things. Collagen is a protein that gives skin it’s volume strength and structure, while elastin is what gives skin it’s elasticity or ability to snap back. Hyaluronic acid is a key molecule involved in skin moisture, as it binds and retains water. Hyaluronic acid is also needed to bind collagen to elastin. When we do chemical peels and laser treatments that penetrate beyond the skins epidermis, we are benefitting from the skins own wound healing ability to up regulate growth factors and stimulate the production of collagen, elastin and hyluranic acid. The result is a thicker dermis, smoother surface and skin tightening.
What to expect
The day of the peel is considered day 1. On days 1 and 2 your skin looks okay, but it may look dry and slightly older. By day 3 skin begins to look dark or bronze, this will vary depending on your natural skin color, skin discolorations and depth of peel. Skin usually begins to peel on day 4 and is usually done by day 5. After the skin has peeled of it may be pink for a couple days. The healing process does vary for each person. Healthy skin will always recover more quickly with less inflammation.
During the peeling process you will need to follow the post peel instructions given to you by your skin care professional. This usually includes using a gentle cleanser, a hydrocortisone cream and mild moisturizer. An occlusive ointment such as Vasoline or Aquaphor may be recommended. It is VERY important to not pick or pull off the skin, let it peel in its own time! (seriously… don’t do it) You should also avoid sweating during the pealing phase, because it will create sweat beads under the skin that will cause it to peel of prematurely and thats bad. The skin should be protected with a totally physical sunscreen, I like Physical Eye UV Defense SPF 50 by Skin Ceuticals.
After the old skin has peeled off, it instantly looks and feels smother. The collagen production will continue to increase and the skin will continue to feel tighter. To keep the skin renewal process un regulated and functioning more similar to young skin, I usually recommend having around 4 TCA chemical peels around the eye area per year. Treatments should be scheduled over 6 weeks apart.
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Throughout my career in medical aesthetics, Pseudofolliculitis and ingrown hair has been a common concern. Often times it’s men who mistake the condition for acne, other times it’s someone who has had an infection and a doctor recommended they get laser hair removal. The bad news is, that it can be more serious than you might think. The good news is, it can be treated!
What is Pseudofolliculitis?
Pseudofolliculitis commonly known as “razor bumps” or “ingrown hair” is an inflammatory condition in the skin and hair follicle caused by shaving, waxing and ingrown hairs. Pseudofolliculitis can occur anywhere on the body hair grows, however it most commonly occurs on a mans beard and for women on the bikini and underarm area. It tends to be more common in those with curly or coarse hair.
There are two types of Pseudofolliculitis, extrafollicular and transfollicular. Extrafollicular pseudofolliculitis or “razor bumps” occur when curly hair grows back into a hair follicle. Transfollicular pseudofolliculitis or “ingrown hairs” occur when the hair never leaves the follicle, this can happen if the hair grows at an angle. The hair keratin causes inflammation in the skin, usually seen as pustules that look similar to acne.
Concerns and complications associated with Pseudofolliculitis?
Pseudofolliculitis can be painful, embarrassing but more concerning is that it can lead to scars, secondary infection or become abscessed. You may not think that an ingrown hair is a big deal, but it has been associated with secondary infections. When there is damage to the skin, it becomes more susceptible to bacteria such as Staphylococcus. It is not unusual for an ingrown hair to become infected with “staph” or become abscessed. In extreme cases, if left untreated staph can lead to a very serious blood infection known as sepsis. These infections can spread and be contagious. If you suspect an infection, you need to seek medical attention.
Laser hair removal remains the best treatment option for Pseudofolliculitis. A series of treatments will be needed, generally spaced 4-6 weeks apart. Another option is to quit shaving, waxing or tweezing and let the hair grow, but if that doesn’t work for you there are some things you can try. When shaving, start with cleansing the area with an exfoliating cleanser that has glycolic acid or some type of an AHA. I also recommend the Clarisonic cleansing brush, which will help to lift the hair. Before you shave place a steamed towel over the area, being careful not to burn your self. For sanitary reasons, I prefer a new razor. Avoid shaving too close, do not stretch the skin or shave against the direction of growth. If you have pustules, you may also be prescribed a topical antibiotic.
Chemical peels and skin care products that contain chemical exfoliant can help with skin discolorations and help to prevent hair from becoming ingrown. - ” the reducing properties of glycolic acid may reduce sulfhydryl bonds in the hair shaft, resulting in straighter hair growth, and thereby may potentially reduce the chance for re-entry of the hair shaft into the epidermis. Salicylic acid peels offer exfoliation and lightening in cases complicated by PIH. Reduced numbers of PFB lesions have been observed with both glycolic acid and salicylic acid peels.” Expert Rev Dermatol. 2009;4(6):595 Dermatologic Conditions in Men of African Ancestry by Marcelyn K Coley, Andrew F Alexis
Laser hair removal for skin of color, is challenging, but possible. If you have dark skin, be sure to find a laser technician that is also a skin specialist and has experience treating your skin type. Your specialist may recommend preconditioning the area prior to having laser treatment, it is important to comply with all instructions. We make these recommendations to prevent you from getting a burn. They may also suggest doing a test spot first to see how you respond to the laser treatment.
Treating the scars
Pigmented scars are the most common and can be treated consecutively with laser hair removal treatments. Pigmented scars can usually be treated with prescription strength skin care products, and chemical peels. Depressed scars require a deep treatment such micro-needling, fractional laser resurfacing or dermabrasion. It is best to treat depressed or raised scars when the condition is controlled. Keloid scars are very complicated and need to be diagnosed and treated by a dermatologist. I want to specify that keloid scars need to be diagnosed by a dermatologist, because raised scars are sometimes confused with keloid scars.
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The free-radical theory of aging (FRTA) states that organisms age because cells accumulate free radical damage over time. You may believe that you are getting enough antioxidants via diet, you may be wrong. As I learn more about the benefits of resveratrol, I am convinced that a nightly application of an effective topical resveratrol product needs to be a part of everyones skin care regimen.
What is Resveratrol?
Resveratrol is a botanical antioxidant with diverse biologic effects important to anti-aging. Resveratrol is a natural polyphenolic antioxidant found in over 70 plants, including berries peanuts and grapes. It protects plants from stress, UV light and certain fungal infections. You may have also heard that red wine is a good source of resvertrol, this is because it is in the skin of the grapes and as the grapes ferment the concentration of resveratrol increases.
Resveratrol is impressive because it has a dual antioxidant capacity, not only is it an exogenous antioxidant it also works to up regulate endogenous antioxidants. This means that not only does resveratrol scavenge free radicals from the environment, it also works to increase the production of the bodies own “endogenous” antioxidants
Benefits of Resveratrol
- Dual antioxidant capacity
- Preserve collagen
- Reduce skin inflammation
- Helps with skin discoloration (tyrosinase inhibitor)
- Inhibits non-melanoma skin cancer formation, when applied topically
- Positive effect on extrinsic and intrinsic skin aging
- Works synergistically with antioxidants such as vitamin E
- Increased epidermal and dermal skin density ( with topical Resveratrol BE )
- Increased Elasticity ( with topical Resveratrol BE )
Intrinsic and Extrinsic: What you need to know about free radicals
A free radical is any unstable atom or molecule that is missing an electron. They stabilize by steeling an electron from another molecule, which then becomes becomes another free radical, creating a chain reaction. Free radicals can be intrinsic (natural) or extrinsic (environmental). Extrinsic free radicals (from your environment) can be ingested, inhaled or absorbed into the body. UV rays, air pollution, tobacco smoke, herbicides, and pesticides are all forms of free radicals. Intrinsic free radicals (natural) occur constantly when our body produces free radicals as by-products of a basic metabolic process called oxidation. Immune cells will also release free radicals in order to fight invading viruses and bacteria.
Exogenous and Endogenous: What you need to know about antioxidants
Exogenous antioxidants are obtained from an outside source such as diet or topical applications, compared to Endogenous antioxidants which are made by the body. The body makes five types of endogenous antioxidants: superoxide dismatuse (SOD), alpha lipoic acid (ALA), coenzyme Q10 (CoQ10), catalase and glutathione peroxidase. The body is incapable of producing enough endogenous antioxidants to combat free radicals on their own, so it is essential to get additional (exogenous) antioxidants through diet. We can increase exogenous antioxidants by eating a healthy diet, but this does not exactly increase endogenous antioxidants. Unfortunately, as we age the body produces less endogenous antioxidants. Evidence suggests that a decrease in endogenous antioxidants plays a role in both extrinsic (environmental) and intrinsic (natural) aging, leading to premature aging. So…this is where resvertrol comes in to play. Resveratrol helps to up regulate endogenous antioxidants, including superoxide dismatuse (SOD), catalase and glutathione.
Skin aging is effected by the depletion of naturally occurring (endogenous) antioxidants. Another driving factor in skin aging is ROS (reactive oxygen species), which can result from environmental insults such as sun exposure as well as the disturbances in mitochondrial function. Increased ROS can directly damage cell membranes, proteins, DNA as well as turning on the cellular and molecular mechanisms that accelerate aging. This means a break down of collagen, less collagen production and increased inflammation. Studies show that resveratrol down regulates this process, helping to preserve collagen and reduce skin inflammation.
Learn More “Topical Antioxidants”
Topical Resveratrol: Benefits and Challenges
Orally ingested resveratrol is rapidly metabolized, leaving only a small fraction to reach tissues. Resveratrol ingested via diet or supplements is not the most effective way to deliver it to the skin, topical applications are more promising. Topical resveratrol is applied directly to the targeted area allowing skin tissue to attain a therapeutic concentration.
The first challenge with topical resveratrol is that it is photosensitive, so it must be protected by a broad-spectrum sunblock or used exclusively at night. The second challenge is that it has a low water solubility, making it hard to get high concentrations of pure resveratrol in a topical solution. This explains why most topical products have less than 1% of pure resveratrol. Finally, the transport of resveratrol to the skin is limited by the type of vehicle used. It is essential that the resveratrol be able to escape from its vehicle and be able to penetrate the initial barrier.
Renowned for their topical antioxidant serums, it is no surprise that Skin Ceuticals would overcome the obstacles of topical resveratrol. Skin Ceuticals has created “Resveratrol BE” with a maximized concentration of 1% pure stabilized resveratrol in a synergistic formulation with 0.5% baicalin and vitamin E for enhanced efficacy. Skin Ceuticals advanced research labs have formulated the resveratrol in a delivery system of hydrotopes which allow the resveratrol to penetrate the skin.
How To Use Topical Resveratrol
Remember resveratrol works synergistically with other antioxidants and it is degraded by UV rays. I recommended that in the morning you apply a topical antioxidant such as CE Ferulic along with broad spectrum sunblock. Apply topical Resveratrol BE at night before any moisturizer or creams. If you use tretinoin (Retin-A), apply the tretinoin first then the resveratrol.
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Reference “Resveratrol: A Unique Antioxidant Offering a Multi-Mechanistic Approach for Treating Aging Skin”
Journal Of Drugs In Dermatology, December 2013. Volume 12. Issue 12
The Challenge of Skin Care Products
As skin care professionals, a large part of our job involves searching for skin care products that are effective and then searching for new ways to help those products to work better. The bennefits of a product can look great on paper, but if it does not penetrate effectively then it loses a lot of the benefit. The main function of skin is to act as a barrier, meaning to keep things out. This barrier function makes it challenging to get skin care products to penetrate enough to be effective. Many topical creams merely sit on the surface of the skin before evaporating away.
While researching new ways to deliver skin medications, bioscientists made an amazing discovery—ultrasound waves uniquely increase the effectiveness of applying topical ingredients to the skin. Ultrasound waves work by creating a path to deliver key ingredients to the skin. In short ultrasound waves help create a path for better product penetration, which means skin care products will work more effectively, giving you better results.
Ultrasound itself isn’t new, we use a professional ultrasound device in our clinic for several different therapies. Until recently however, ultrasound devices were only available for use in medical offices, but now there is an ultrasound device called JeNu that can be use at home. JeNu is a home skin care device that combines the power of gentle ultrasound wave technology with effective skin care products.
It is a small hand held ultrasound wand that is used to help improve product penetration, up to 12 times better penetration. JeNu also comes with a lip and eye product that use breakthrough technology to hydrate and plumps lips as well as minimizes the appearance of crow’s feet and refines skin texture around eyes. (The lip serum is my new obsession -LOVE it!)
Aside from the amazing results I have enjoyed with my skin, I have to add that I love the sleek design. The wand is fairly small and the charger plugs directly into the wall, rather than taking up space on your counter. The JeNU Active-Youth Pro Skincare System is available exclusively thru skin professionals.
Video: How it Works
Professional Tip / Before You Start
JeNu recommends using the ultrasound wand only with JeNu products. I personally use the ultrasound with additional skin care products, as do my clients. It is important to understand that as it increases product penetration it will likely potentiate active ingredients, although this is basically the desired effect it may also increase the skins reaction to product. If you want to use your JeNu device with other products, I recommend that you first consult with a skin care professional that is familiar with both JeNu and the product you intend to use. I would advise against using it with anything very active such as Retin-A, retinol, salicylic or glycolic acid.
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Photofacial is one of the most popular treatments for skin rejuvenation and with good reason. Photofacial can treat a variety of skin conditions including skin discolorations and redness, but with all the different light devices and treatment names being used there is a lot of confusion about this versatile treatment.
What can be treated with IPL.
Photofacial uses Intense Pulsed Light (IPL), which is well absorbed by chromophores that have color such as melanin and hemoglobin (think red and brown). It works best for brown spots and vascular skin conditions. IPL treatments can help stimulate collagen production, can kill acne causing bacteria and some IPL devices can also be used for hair removal.
The most common conditions treated with IPL include:
- Broken capillaries
- Flushing/ Facial redness
- Sun damage/Age spots
- Brown Spots
What is in a name?
Photofacial is a photo rejuvenation treatment that uses Intense Pulsed Light (IPL) technology. Photofacial is known by many different names with a variety of spellings including: PhotoFacial, Fotofacial, FotoFacial RF, Photo-Rejuvenation, Photoderm, BBL or simply IPL. These are essentially all the same thing, however some names may be trademarked, associated with a specific device or a developed treatment protocol. Dr. Patrick Bitter, Sr. developed the procedure PotoFacialSM in 1988 and Dr. Bitter Jr., is the developer of the FotoFacial™ and PhotoFacial™. BBL is Sciton’s trademarked name for their IPL machine, which is said to be the most powerful IPL device. You do not need to be overly concerned with the name being used to describe an IPL treatment, instead focus more on the device being used and the experience of the technician performing the treatment.
What device should be used for a Photofacial?
Photofacial is a treatment and the devices used is Intense Pulsed Light (IPL). Some people will use an LED device and call it a Photofacial, however this is not a true Photofacial. LED devices are commonly use in spas, they have lower energy and do not produce intense light.
Due to the increasing popularity of Laser and IPL treatments and the growing industry there has been an explosion of new devices on the market. Many of the new devices are less effective. As Laser Technicians we look for a device that gives us more precise control. IPL treatment settings do not work by simply turning a dial up or down. We control things such as the pulses, pulse duration, the amount of joules used and cut off filters. Devices that use a larger selection of cut-off filters are more effective because they allow for treatment of vascular and pigment lesions at different depths. In the authors opinion the best IPL devises are Scitons BBL and the Lumenis One/M22.
How many treatments are needed?
The first treatment will generally provide significant correction, however for best results a series of treatments are recommended. The exact number of treatments will vary depending on the condition being treated, the desired patient results, how the skin responds and how compliant you are with pre and post skin care. A very generic protocol would be a series of 5 treatments scheduled 3 weeks apart, however it is better to work on a plan that is designed specifically for your skin and your lifestyle.
What to expect after a Photofacial (IPL/ BBL).
There generally isn’t any down time with Photofacial, however if you have a lot of sun damage you may not look great for a week or two. Immediately after your treatment your skin will be a little pink and slightly warm. It is normal for it to feel like a mild sunburn, windburn or razor burn, but if you experience an excessive or lingering heat you should communicate this to your technician.
If you have brown spots they will darken up and gradually flake off over the next two weeks. Freckles tend to look darker, skin with a lot of discoloration may look “peppered” before it flakes off. If you have treated non-facial skin such as neck, chest, hands or arms it may take three weeks and some spots may take even longer. You may be able to speed up the process with a microdermabrasion 7-10 days after your treatment. Swelling and redness may also occur, you can apply cold packs to help with swelling and some people find an over the counter antihistamine helpful.
It may feel hot. If the skin does not cool down quickly after treatment it is very important that you go home and apply cold cloths until it is no longer hot. Take a large, clean bowl fill it with ice, add water and put clean washcloth in the bowl. Ring out excess water and apply cold cloth to treated area. When the cloth is no longer cold, trade it out for a cold one. Continue to do this until the area is no longer hot (this could take hours).
How can I improve the results of my Photofacial treatment?
The most important thing you can do is follow all pre and post care instructions, this includes not tanning, avoiding heat immediately post treatment and using the recommended topical skin care. If you are treating skin discolorations you will most likely need a skin care regimen that includes tretinoin and 4% hydroquinone. If you are treating rosacea you will need a topical vitamin-C. Everyone will need an approved sun protection with Zinc Oxide, the SPF should be over 30.
IPL treatments can be combined with other technologies for enhanced results. I will often use a vascular laser in my treatments for treating broken blood vessels or add Radiofrequency (RF) for skin tightening. Other possabilities include blue light for acne, laser resurfacing and laser hair removal. A microdermabrasion may be done prior to treatment to cause vaso diolation which can enhance results of an IPL treatment for those with facial reddness.
If you really want to increase your results you may want to do a PhotoDynamic Therapy (PDT) treatment. PhotoDynamic Therapy uses Levulan (aminolevulinic acid) also known as ALA to photosensitize the skin prior to a photofacial Adding Levulan results in a higher level of correction of freckles, sunspots, skin discolorations, broken blood vessels and redness. You will also have the added benefit of an aggressive acne treatment and treating Actinic keratosis (AK’s).
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If you are considering laser hair removal, you should know how many treatments you will truly need, and what type of a financial investment you will be making. I want to explain how many treatments you may need and why, so that you can make a more informed decision before you invest in laser hair removal.
I have people come in to our clinic after they have had a series of laser hair removal treatments at another clinic, and they are disappointed because they think it didn’t work. The problem is that many laser technicians will over promise and under deliver. The common misconception is that you will only need (let’s say 5) treatments. I don’t care what “they” tell you, this is almost never true! Don’t be surprised if you are told that “they” have the most effective laser on the planet and they can give you better results with only a few treatments. Maybe you will be told that you are perfect candidate, so you will need less than other people. If you buy this, I have a bridge to sell you. I do think that some technologies are more effective than others, however, even with the best technique and most effective equipment, you will still need several treatments. Even if you are the most ideal candidate in the entire world, you will still need several treatments.
Growth Cycle of Hair
Hair follicles go through a cycle of activity commonly refered to as the hair growth cycle. Each active hair follicle will continuously cycle through three phase of growth ( anagen, catagen and telogen). It is also important to understand that each hair follicle acts independently, so not all of the hair is in the same stage of growth at the same time. This is why it is necessary to have a series of laser hair removal treatments, scheduled at specific intervals.
Anagen Stage- Active Growing Stage
Catagen Stage – A Brief Transitional Stage
Telogen Stage – Resting Stage ( hair sheds at end of telogen stage)
With laser hair removal we are most concerned with hair in the anagen stage, because this is when the hair is at it’s maximum depth. The laser energy is absorbed by the melanin or water in the hair and we need to deliver the energy to the maximum depth of the follicle. This means that hair in the catagen or telogen stages of growth may singe and fall out with treatment, but they are not at thier maximum size or depth so they will likely grow back. So…. to reiterate, hair that is in the anagen stage of growth responds the best to laser hair removal.
The length of each cycle will depend on the region of the body, it will also vary from person-to-person and from time-to- time. Unfortunatly, in most areas the number of telogen hairs out number the amount of anagen hairs. For example the axillae (under arm) area is estimated to have about 70% of the hair in a telogen stage and the telogen stage in this area typically lasts for about 3 months. Again, this is not an exact science because there are several variables with the growth of hair and each idividual hair acts indepentaly. This means that the best you can hope for in this area is about 20% reduction per treatment and if by some sort of miracle your personal cycle of hair growth corasponds perfectly with your scheduled treatments you can complete your hair removal process with 5 treatments. However… you probably have a better chance of getting struck by lightining.
We all are born with a certain amount of hair follicals which do not increase with age, however the activity of the follicles do increase. We all have many, many potential hair follicles. Potential follicals are dormant hair follicles that are not active (currently producing a hair), but have the ability to produce a hair if stimulated by the appropriate hormone. Trust me when I tell you that you will likely see new hairs pop up in areas that you have never had them before. This is important to understand because laser hair removal only effects hair follicles that have a hair in the follicle at the time of treatment. Laser hair removal treatments can not prevent potential follicals from having the ability to produce a hair in the future. This is another reason that everyone needs to plan on having maintanance treatments after the intial series of treatments.
How Many Hair Removal Treatments Will I Need?
An initial series of treatments are necessary and occasional maintenance treatments are almost always needed after the initial series. For facial areas, you should expect to do an initial series of 12 treatments (once a month for a year). For body areas, you should expect to do an initial series of 8 treatments (scheduled about 6-8 weeks apart over a year).
There is no way to predict exactly how many maintenance treatments you will need. Some people need one every year or so, while others require several treatments for several years. This is due mostly to genetics and hormones, however other factors include technique, technology, and patient compliance. There are some things you can do to help improve your results. Keep your treatments on the appropriate schedule, avoid tanning, search for an experienced laser technician and a reputable clinic that is known to use better equipment. Do not wax, tweeze, or remove the hair from the follicle before or between treatments. If you have excessive hair growth, you should consult with your doctor to address any medial conditions that may contribute to hair growth.
Questions you should ask before you pay
Who will be performing your treatment?
Will you always see the same person or will you have somebody new each time? Do they have the appropriate certification and training, how long have they been doing laser hair removal and how long have they been at that specific clinic ?
Who is the medical director?
Are you having treatment in a medical practice or a med spa ? What are the credentials of the medical director ? Is it a Nurse, Dermatologist, Plastic Surgeon, Chiropractor, Dentist, Veterinarian? Is the medical director on site? How often are they in the office and are they available to see you if you experience a complication?
What is available for pain management?
Yes, laser hair removal hurts. The good news is that we can do things to help. Usually, we will apply a topical numbing cream before treatment, and in our clinic we use a proprietary formula that is extremely effective. I have a few other tricks that I will not share.
How much will it cost?
Many med spas have tricky packages or “plans”. Find out how many treatments are included in your package and how you are expected to pay. Do you need to pay for a full package all up front, or can you make payments? How much will additional treatments cost after your initial series? Is there a discount? Do you need to buy another package or can you pay as you go? If you are offered some sort of contract or membership, be careful, and be sure to read between the lines! You should also be warned that it is not uncommon for a med-spa to go out of business, and not tell clients or employees. You may show up one day with the doors locked, and, if you prepaid for a package, you can kiss your money good-bye.
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Hydroquinone has been the gold standard for treating hyperpigmentation for over 50 years, but some confusion about hydroquinone has developed over the past few years. Common rumors include, hydroquinone has been banned or that it causes cancer. A lot of information found on the internet misrepresents hydroquinone by omitting some of the facts related to Hydroquinone studies and the FDA’s proposed rule.
I personally use hydroquinone on my skin to treat melasma and hyperpigmentation. I love what hydroquinone does for my skin and I have not been able to duplicate the results with other skin lighteners, however health is always going to outweigh the benefit of beautiful skin. I certainly would not want to use anything that is unsafe, furthermore I consider my self an advocate for my clients. It is important that my clients feel confidant in my knowledge of skin care and even more important that they trust that I always have their best interest in mind. I have spent a lot of time educating my self on hydroquinone and I aim to clarify some of the confusion.
What is Hydroquinone
Hydroquinone is an active ingredient used in topical creams and cosmetics as a depigmenting agent to treat skin discoloration such as melasma. Topical skin lightening creams containing Hydroquinone first became available in the United States in 1955. Hydroquinone has been described as a ubiquitous chemical, meaning it is something that we are exposed to as part of our daily life. Hydroquinone occurs in some plants as free hydroquinone or as arbutin. Arbutin (glucosylated hydroquinone) is found in the leaves and fruits of many plants that are used for food and bacteria in the intestines can transform it into hydroquinone. Hydroquinone and Arbutin can be found in foods such as cranberries, blueberries, pears, beans, broccoli, onions tea, coffee, beer, red wine, all-wheat bread and cereals (concentration may exceed 1%). Hydroquinone also has a number of other uses, it is used as an antioxidant for rubber, a reducing agent for photographic developing solutions, a stabalizer in paints and varnishes. It is also found in hair dyes and nail polish. The list goes on and on.
Does Hydroquinone Cause Cancer
Hydroquinone has been available as active ingredient for over 50 years and there have not been any reported cases of hydroquinone induced cancer in humans. There is also no evidence in human clinical studies to suggest that Hydroquinone could cause cancer in humans. It is suggested that additional studies are needed.
What about the Rats? I have heard and read many times that hydroquinone causes cancer in rats, so I decided to read the study and reviews myself. The 2 year gavage study with hydroquinone, showed some Rats with end stage CPN developed cancer. The problem is that you need to read the full report and it’s reviews before you develop a conclusion. CPN is a renal disease that affects various strain of rats, but has no counterpart in humans. In a 2007 review, McGregor concluded that hydroquinone is carcinogenic only in the context of end-stage CPN, which is not relevant in humans. There is some debate over using rats in carcinogenicity studies, as test results may not be relevant to humans. It should be noted that certain strain of rats are prone to spontaneously develop tumors.
Does Hydroquinone Cause Ochronosis
There are two types of ochronosis, endogenous and exogenous. It is only exogenous ochronosis which can be induced by the topical application of compounds including hydroquinone as well as antimalarias, mercury, resorcinol and phenol. Exogenous ochronosis is a fairly rare type of dermatitis that needs to be diagnosed by a dermatologist. It is not known exactly how hydroquinone induces ochronosis but suggested factors include: sun exposre, long term use of hydroquinone, high concentrations of hydroquinone, other active derivatives and penetrating vehicles such as t-butyl alcohol, mercuric compounds, resorcinol and hydroalcoholic lotion. Exogenous ochronosis is believed to be a progressive disorder that likely develops over several years.
Was Hydroquinone Banned
No, hydroquinone was not “banned” in the US. Hydroquinone is available in concentrations of 2% or less over the counter (OTC), and concentrations over 2% (typically 4%) are available in prescription strength in the United States.
To simply say Hydroquinone has been “banned” in other countries is something of a misrepresentation. First, we need to acknowledge that hydroquinone is an active ingredient available in prescription strength and over the counter (OTC) strength. I am not aware of any ban or proposed ban on prescription strength hydroquinone in any country. The confusion seems to come from the change in availability of over the counter (OTC) hydroquinone. In Japan and Australia hydroquinone is no longer available in cosmetics OTC (over the counter), it is only available as a prescription based ingredient.
As part of a review of OTC products, the FDA published a proposed rule in 2006 to consider the withdraw of the 1982 rule that recommended hydroquinone be GRASE, because of evidence indicating that hydroquinone may act as a carcinogen in rats and mice after oral administration. It is argued that this is not relevant in humans, so the proposed rule recommended additional studies should be conducted to determine if there is a risk to humans. The FDA has yet to make a final ruling, but until then it’s still believed that hydroquinone should remain available as an OTC (over the counter) drug product.
I have considered the facts, studies, reviews and opinions of medical professionals and have concluded that I will continue to use hydroquinone. I would not be concerned if my mom, best friend, husband or children were using hydroquinone. I feel very confidant in the efficacy and safety of hydroquinone. I will continue review and consider any new information and I will modify this post if my opinion changes.
I have read hundreds of pages of studies, reviews, letters and other published literature on the subject of hydroquinone. I am not able to share everything I have learned, but I focused on some of the main points. I have included links to resources that are available on line, I encourage anyone who is concerned about hydroquinone to do thier own homework. I also recommend consulting with your doctor.
If you are using hydroquinone, be sure to use a broad spectrum sunblock and give your skin a resting period from hydroquinone. For example: 3 months on and 3 months off.
There have been reports of counterfeit beauty products and illegally imported skin care products containing mercury. I strongly discourage purchasing skin bleaching creams on-line.
Nomination Profile /Hydroquinone [CAS 123-31-9] Supporting Information for Toxicological Evaluation by the National Toxicology Program /21 May 2009 / Prepared by U.S. Food & Drug Administration Department of Health and Human Services
Hydroquinone: An Evaluation of the Human Risks from its Carcinogenic and Mutagenic Properties / Critical Reviews in Toxicology 2007, Vol. 37, No. 10 , Pages 887-914 / Douglas McGregor /Toxicity Evaluation Consultants, Aberdour, Scotland, United Kingdom / Toxicity Evaluation Consultants, 38 Shore Road, Aberdour, KY30TU, Scotland, UK
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Pay attention! I am about to share the ultimate beauty secret, the secret to anti-aging.
The desire to stay young and beautiful is a natural part of the human psyche and we are apparently willing to pay big bucks to achieve it. Americans spend billions of dollars each year on anti-aging products and services in a desperate search of the fountain of youth. Each new product we try offers a new opportunity to look younger, but they often prove to be nothing more than disappointment in a bottle. So… how can we avoid disappointment and achieve real results? The answer lies with a comprehensive approach. To understand the benefits of a comprehensive approach you should first try to grasp some of the basics of the aging face. After all, if we do not understand the aging process how can we know how to prevent or correct it?
What is a comprehensive approach to aesthetics in relation to the aging face?
Comprehensive Aesthetics uses a variety of treatments and products to cover a large scope of issues associated with the aging face. Aging occurs on many levels of the face, including the bone structure, muscular level, fat or volume distribution and finally the dermal and epidermal levels of the skin. To achieve the most ideal results it is necessary to address the affects of aging at each level, in order to do this a variety of treatments are needed. We also can not ignore the effects of lifestyle and general health, as both play a major factor in aging.
Aesthetic Professionals and Interdisciplinary Collaboration
Aesthetics is a branch of philosophy or science pertaining to the nature of art and beauty and aesthetic professionals are those whom are specially trained in the art of beauty. Utilizing a full team of medical aesthetic professionals, including a Plastic Surgeon, Dermatologist, Nurse Injector, Estheticians and Certified Laser Technicians, we are able to take advantage of interdisciplinary collaboration. Each professional possess a special set of skills that contributes to a truly comprehensive approach toward an attractive, youthful face.
Bone adds to the volume of the face and provides structural support to the other layers of facial tissue and skin. As we age there is a significant loss of facial bone which contributes to biometric volume loss. The bones that define your nose, and upper jaw and brow bone recede and the bones of the eye socket gradually widen. The jawbone also recedes and becomes less defined, reducing the angle of the lower jaw. Even the skull shrinks with age, further adding to excess facial skin. The loss of structural support creates noticeable changes in the other layers of tissue, simply put – when the bones that define your face recede your skin begins to droop and sag.
Bad news ladies, we begin to see bone loss as early as our 40′s, where men may not notice bone loss until their mid 60′s. This leads me to speculate that our complicated hormones may play a factor in bone density. As we age bone density can decrease, leading to diseases such as osteoporosis. Your doctor can help you monitor and address issues of bone density loss. Maintaining a healthy diet with enough calcium vitamin D and magnesium can also help prevent bone density loss.
Once bone loss has occurred you can take action with aesthetic treatments. Injectable fillers such as Sculptra can add volume and support for a more youthful and defined face. Sculptra is injected below the surface of the skin to correct the effects of fat loss and natural age-related bone loss. A plastic surgeon can strategically place fat into the face or use facial implants to make up for bone loss.
Below the facial skin and fat, is muscle. The muscle and connective tissue add support to the overlying fat and skin of the face. As our face ages the ligaments stretch and the supporting system begins to elongate causing the face to droop or sag. When the face is sagging due to muscle, this is usually the time for surgical intervention. During a facelift the underlining muscles and tissues are lifted. If you are not ready for surgery, you may consider Ultherapy which does work at the top of the muscle (SMAS) and gives a non surgical lift. Keeping in mind that a non-surgical treatment will always provide a non-surgical result. Ultherapy will not remove excess skin or reposition fat pads, but it will provide a modest lift. Ultherapy is perfect for early intervention and probably as good as it gets without surgery.
Muscle contraction can also cause lines and wrinkles. The muscles we use to make expressions become etched in our face over time, this is most noticeable with the vertical lines between our brows commonly referred to as frown lines, as well as crows feet around the eyes and the lines across our forehead. At first these lines are only noticeable with facial movement, but with out preventative action they are constantly visible even without movement (wrinkles at rest). Botox or Dysport injections are used to treat the lines and wrinkles caused by muscle contraction. It is a good idea to consider these types of treatments early on to prevent the lines from becoming “permanent”. Once the lines and wrinkles have become permanently etched into the skin, fillers may be used to lift the area along with laser resurfacing to smooth the skin or in some more severe cases surgery may be recommended.
Fat and Volume Distribution
A youthful face has the right amount of fat in the right places. As we age some areas of the face loose fat while others gain fat. The areas of fat also become farther apart and the fat pads appear as separate structures rather than a smooth continuous layer.
Fat provides support and volume in the face, as we age this valuable fat begins to decrees. Fat loss creates overall volume loss which contributes to folds, lines and wrinkles. The signs of volume loss can be noticed as early as our 30′s and becomes more significant in our 50′s. As we lose fat in our mid face, we begin to notice things like sunken or flat cheeks, heavy lines and folds around the mouth. Volume loss can also be seen around the temples, near the brow bone and under the eyes. When volume is lost under the eyes, it creates a hollow look and dark circles. Injectables such as Sculptra, Juvederm and Restylane can be used to replace volume to the face. Fat injections can also be used to replace or add volume. Fat transfer or fat injections is a process in which a plastic surgeon removes fat from one area of the body and places it in another. ( How wonderful is that? )
Fat accumulation is often seen under the chin and along the jawline creating an undefined jawline and the dreaded jowls. Bags under the eyes are also the result of fat accumulating in the wrong area. A plastic surgeon can perform a blepharoplasty to remove the fat bags under the eyes. The jowls and fat along the jawline can be corrected with a facelift as fat pads are repositioned, but if you are not ready for surgery fillers can be strategically injected to help contour the jawline. If you opt for fillers over surgery you may consider adding Ultherapy for a modest lift.
During a facelift the underlining muscles and tissues are lifted, fat pads are repositioned, fat bags may be removed from under the eyes and volume may be added with fat injections as needed and excess skin is removed.
The surface layer of the skin is generally the first place we begin to notice the effects of aging, most of us begin to notice the effects of aging on our skin in our 30′s. As we age our skin has a reduction in collagen production, elastin, hyaluronic acid and skin cell turnover begins to slow. Uneven melanin production and distribution causes dark spots and skin discolorations. We begin to notice more broken capillaries, changes in skin texture, thickness, elasticity and moisture. When we are treating these issues in the skin we must first consider what skin functions are involve and what layer of the skin the problem begins.
The skin can be divided up into three basic layers Epidermis, Dermis and the Subcutaneous Layer (fat). When we talk about skin we are generally referring to the Epidermis and Dermis. The Epidermis is the top layer of the skin and the Dermis is the deeper layer.
Skin cell turnover in the Epidermis
The skin is constantly in a cycle of growth. The cycle of a skin cell is about six weeks, this is the time it takes for a new skin cell to rise to the surface of the skin and naturally slough off. As we age this process slows down and the dead skin cells begin to accumulate at the surface. When this happens the skin will have a dull appearance, rough texture, dark spots will become more dense and appear darker, and lines and wrinkles become more prominent. In addition to all of this, accumulation of skin cells can clog pores causing them to appear larger and lead to acne blemishes. The slowing of skin cell turnover begins in our 30′s, which is a good time to consider a medical based skin care regimen. Tretinoin (Retin-A), Laser and Chemical peels can stimulate skin cell turn over.
As the skin cell turn over rate slows so does wound healing. After an injury the skin takes longer to reepithelialize, meaning the top most layer of skin (Stratum Corneum) is not quickly replaced. This is why many Doctors and Estheticians recommend preconditioning your skin before surgery or skin treatments.
Collagen is important to youthful skin, but as we age collagen production slows down. Loss of collagen causes the dermal layer of skin to thin and reduces the skins ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). This leads to the domino effect, as loss of elastin causes laxity in the skin and reduced hyaluronic acid which cause skin to be dryer, less supple and thinner.
Professional chemical peels, laser and IPL treatments can help to stimulate collagen production. Beyond professional treatments, a skin care program that includes continuous use of Tretinoin (Retin-A), topical vitamin -C and full spectrum sunscreen will help with collagen production. Tretinoin (Retin-A) is an effective way to stimulate collagen synthesis. Sun exposure degrades collagen so it is essential to use a good sunblock daily. Vitamin C is nessacerry to produce collagen and it protects skin from both UVA and UVB, by neutralizing the UV rays.
A melanocyte is the cell that produces melanin (pigment), the melanin dispersed to keratinocytes, giving skin it’s color. As we age the cycle of melanin production and distribution becomes irregular.
As we age there is a reduction in the number of melanocytes. After age 30 the number of melanocytes decline about 6-8% every ten years. As the number of melanocytes decrease skin will become lighter, less even and white spots or patches (hypopigmentation) can be seen.
Browns spots and patches such as melasma, sunspots, age spots and freckles are known as hyperpigmentation. When a melanocyte produces more than normal amounts of melanin the result is hyperpigmentation. Furthermore the melanocyte doesn’t disperse the melanin evenly, so it is presented as dark spots or patches. Hormones and sun exposure are factors in even skin color.
There are many professional skin treatments that address hyperpigmentation, including chemical peels and Photofacial (IPL) treatments, however daily skin care is most important. Daily sun protection is necessary, this is not optional! Products containing hydroquinone suppresses tyrosinase, the enzyme involved in creating melanin. Botanical (plant based) lighteners can also help to suppresses tyrosinase, however alone are less effective than hydroquinone. Tretinoin (Retin-A) will help with the distribution of melanin.
As we age the structural wall of the capillaries (tiny blood vessels) break down which results in broken capillaries. Flushing, redness and broken capillaries are treated with Photofacial (IPL) and laser treatments. Vitamin C can also help to strengthen capillary walls, I recommend a healthy diet with enough vitamin-C and a topical vitamin -C serum. A sunblock with Zinc oxide can further help by blocking some of the heat that causes blood vessels to dilate.
Lifestyle and Health
Our skin is a direct reflection of our health. All the skin care products and treatments in the world can only do so much, it is up to you to be proactive in maintaining your health.
- Work with your physician to maintain your health.
- Maintain a healthy diet with plenty of fruits and vegetables.
- Exercise contributes to a healthy body and hormone levels.
- Sun protection will go a long way to save your skin.
- If you smoke, quit!
- Limit alcohol consumption
- Drink plenty of water
- Get enough sleep
- Try to reduce stress (get a massage, take up yoga, relax)
- Hormones play a role in the aging process. Ask your doctor to monitor your hormone levels and discuss treatment options.
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