Category Archives: Peels

Should you use a stronger (AHA/BHA) exfoliator?

THE ANSWER IS YES AND NO. Yes if you have a stubborn condition that needs stronger and stronger treatment, and No if your condition is well controlled using the strength that you are presently using. Also No if your skin is becoming more sensitive due to the use of an alpha or beta hydroxy acid.

This is where first hand knowledge of your skin helps me in the assessment… The skin care goal is also important. If severe dry skin is impacting acne, strong sebaceous activity is creating cysts under the skin (that are not bacterial and thus not inflamed), or very pigmented (sun damaged) skin is creating uneven skin tone, then getting you to a stronger exfoliator will be ideal in most cases.

Depending on the strength of your skin, or the extent of the condition you need to correct, I may suggest starting off with an exfoliant that you use 3 nights a week for 2 weeks, then 5 nights a week for 2 weeks, then 7 nights a week. Sometimes I may even have you use it 7 nights a week at the outset. For severe acne or pigmentation issues, I may even have you use an exfoliator in the a.m. and p.m. The proviso is always that if your skin becomes too sensitive due to the use of the exfoliator, then you back off and use it 3 nights a week for a while until your skin stabilizes.

There are some people that I start off with a milder exfoliant like Clear Skin Ultra Gel (5% Glycolic + 5% Lactic + 2% Betaine Salicylate at 3.9pH) and then move up to Age Limit (5% Glycolic + 5% Lactic at a 3.5pH) and after the skin is accustomed to that level of exfoliation at 5 – 7 nights per week, then I will probably suggest moving up to Glyco-A-Gel (10% Glycolic at 3.2pH). Of course, after working on your skin, I may see that it is strong enough to start out with a more intense exfoliator. The lower the pH and the higher the concentration of Glycolic the more intensive the sensation and affect will be on the skin. In some cases I may suggest moving up to a 30% Glycolic if I feel that we need to be more aggressive because the skin issue is not responding as well as I would like it. When I have done this I have usually been able to achieve the goal that we set out to achieve. In the vast majority of cases it is foolish to shock the skin with an intensively strong exfoliant from the outset.

In some cases we will move to a strong chemical peel to create even more dramatic results, but peels have to be planned. See the post-peel home care regimen to see what a strong chemical peel involves.

As an added benefit, acid exfoliators that are less than 3.9pH are also anti-bacterial. This is ideal in youth acne where bacterial activity is one of the many factors that play a roll in the level of acne breakouts experienced.

Finally, there may be a reason to back down from intensive exfoliators to something milder. Firstly, if your skin becomes too irritated with a high % and low pH acid exfoliator. Irritated skin does not help you solve any problem because irritated skin will not repair and heal quickly or effectively. Secondly, if we achieve the goal of eliminating dry skin that is clogging pores, or if we have successfully lifted sebaceous cysts, or effectively evened out skin tone by lightening hyperpigmented areas.

Daily exfoliation is always a good idea, especially as we age, so the option of no-exfoliation is non-negotiable unless you have a severely unbalanced skin in which case I prefer that we balance and strengthen the skin before even contemplating exfoliation. Don’t ever rush things. Treat the skin gently, get it strong and healthy, and it will take care of itself.

Please check out the other posts on exfoliators in this blog.

The information provided here is not meant to diagnose or cure any medical conditions.

Resurfacing options – for smoother texture and a more even skin tone

Resurfacing options for getting rid of acne scars, brown spots (sun damage), and to look younger have changed over the years. Chemical peels (like Jessner’s) are still a viable option, but aggressive ablative lasers cause way too much down time.

According to MedEsthetics magazine of Nov/Dec 2007, the fractionated lasers (e.g. Fraxel) have become the chosen method due to the limited down time and proven results. They basically leave the epidermis intact but create zones of damage under the skin and these areas of damage cause the body to regenerate collagen and elastin so creating firmer, ‘younger’ looking skin. Ablative lasers will burn off the epidermis and thus create more damage and thus more collagen and elastin regeneration. With fractionated lasers you need multiple treatments over a course of a few months. The number of treatments depend on the condition of your skin (it could be 3 – 5 treatments spaced 4 – 6 weeks apart for example). Down time can be as little as 24hrs. Ablative leaser treatments can require a week or 2 of down time.

They can also focus fractionated laser on specific areas – like the eye area for example. Chemical peels are a good option if the cost of laser treatments is outside your budget. The best solution for deep wrinkles will be laser according to Dr Tina Alster of Washington Institute of Dermatologic Laser Surgery. Basically, injuring the skin will cause dermal remodeling. Fractionated laser can also be used successfully on the neck, chest and hands.

What I have stated here is not meant to diagnose your condition nor try and claim to cure it. Just helpful suggestions that usually create positive changes. We are all unique, and our body chemistry and genetic inheritance will often create unique skin conditions. I always hope that I can help the majority who fall in the middle between the extremes.

Skin lightening/Dealing with hyperpigmentation/brown spots/solar lentigos/sun damage

Brown spots come with age…yes…but most are due to sun damage. Not just direct sun damage – incidental sun damage too – like walking your dog in the morning, picking up food at lunch time, driving to and from anywhere (near and far) etc etc. You are NEVER truly out of UV rays from the sun – no matter how hard you wish to believe that you are. The proof is in the sun damage you develop – and then must deal with.

Pigmentation can also come from hormonal issues in women (melasma), acne (post-inflammatory pigmentation), genetic disorders, photo-sensitivity due to medications….

And then there is pigmentation from your skin not breaking down cell material properly when cells die off (or are killed off by safety mechanisms in the body). This issue has no real solution as yet. The big brown spot on my left cheek is proof of this.

According to the March/April 2010 edition of MedEsthetics, doctors invariably attack pigmentation issues with strong ingredients like Hydroquinone and retinoids (Retin-A and all similar products). Both of these product ingredients are irritating to the skin and often can not be tolerated by patients – who wants red/irritated/flaky skin?

As stated in the article “many individuals with uneven pigmentation also have sensitive skin, so it is important to ease into any treatment regimen”. Strengthening and balancing the skin is my #1 goal, so let’s do that before you embark on any expensive medical treatments.

Medical treatments for fair skin tones with light to moderate sun damage includes IPL and other stronger laser resurfacing treatments. Unfortunately doctors usually prescribe strong detergent cleansers and hydroquinone products post laser treatments so your skin will definitely be red/irritated/uncomfortable for quite some time.

Medical treatments for dark skin tones include the same harsh detergent cleansers and other barrier damaging ingredients in moisturizers, coupled with retinoids. I like glycolic acid serums  and retinaldehydes in treating darker skin – it takes longer but will not create potential hypopigmentation issues (light spots). I agree with some of the doctors that a Jessner peel is a good solution of light skin tones as well as some darker skin tones. Come in for a consultation and we can decide if you are a good candidate for a strong peel. Specialized peels are an option at Blue Turtle Spa. I prefer to consult with you on a peel first, and if your skin is suitable we can set up an appointment. You will need to review the post-peel home care regimen because a peel is a commitment that you must plan for…

The essential aspect of any pigment lightening treatment is the  repair and rejuvenation that occurs after the initial procedure. Help the skin get stronger with antioxidants (like the antioxidant vitaserum ), hydration gels (like the Hale Dermist HA ), and repair stimulating beta glucans and glycoproteins (as in the aloCell Gel ). Ongoing lightening in the home care regimen will include a nightly application of glycolic acid serums (like Glyco-A-Gel or Age Limit ) as well as a retinaldehyde (Vit A) serum (like Renew or Calm ). ALWAYS wear a mineral sunscreen (>10% minerals) EVERYDAY – otherwise your quest to lighten dark spots will all be wasted as the sun (UVA and UVB – whether direct or incidental) will always cause pigmentation issues to reappear.

Hydroquinone is approved by the FDA as a skin lightener. It does works. I can get you a high % Glycolic acid and 2% Hydroquinone mix for strong skin, and a high % Lactic acid and 2% Hydroquinone mix for less strong skin. Both have a distinctive ‘sting’ when applied to the skin. Some people may be able to use it nightly – others only 3 x per week. You have to scale back on it’s use if you are getting irritated skin (always a possibility with frequent use of products like this). Often the pigmented area will turn quite dark within a week or 2 but this will peel off and leave the area lighter – or even without the pigmentation if it is not too deep… I never recommend strong acids and hydroquinone for rosacea or weak/unbalanced skin.

Alternatives to hydroquinone are available – though they tend to work a little slower – so these are fine as long as you are not impatient about getting results. Arbutin from Bearberry extract is a natural form of Hydoquinone, Azelaic acid from almonds, Kojic acid – another natural form of Hudroquinone, Licorice and mulberry extracts also show lightening effects. Vitamin C also has skin lightening abilities (as well as being a great antioxidant) but there are many forms of Vit C, the one that penetrates the skin barrier the best is tetrahexyldecyl ascorbate – found in the Triple C E formula . Peptides are also a growing area of skin lightening ingredients.

The most important aspect of using any skin lightening ingredients is how well they can absorb into the skin. Many poorly formulated products will just sit on the skin and do not penetrate to where they will be effective. The quantity of the ingredient in the product is also critical to the level of success you can expect. Using an exfoliator like glycolic acid (in Glyco-A-Gel or Age Limit) together with any skin lightening ingredients will be the most effective.

Wrinkle erasing – the medical solutions

The primary cause of wrinkles is sun damage, but genetics and how you live your life play a substantial role as well. Teenagers and young adults can reduce their potential for severe wrinkling later on in life by wearing a mineral sunscreen everyday, and take care of their skin and body by eating well.

Age happens to everyone and everything on this planet. If you have done major damage and genetics are not on your side, either accept it or pay big bucks to make changes. The dramatic changes can only come from medical procedures.  Here are some of your potential costs based on the national average based on a Wall Street Journal report of Oct 12, 2010 on page D1…

Frown lines between eyes (Botulinum toxin A – e.g. Botox) $397
Crow’s Feet at the sides of eyes (Botulinum toxin A – e.g. Botox) $397
Smile Lines and Sunken Cheeks (Dermal fillers like Restylane, Juvederm, Radiesse, Sculptra…) $467 – $1253
Loose Jowls (facelift) $6881
Dark Sunken Eyes (fat grafting or specialized fillers) $1797
Sagging Eyelids (Blepharoplasty eyelid lift) $2717
Sagging Brow (Forehead lift) $3276
Sun Spots (laser resurfacing) $1030 – $2424. An alternative is a chemical peel. At a medical facility it is $719, at Blue Turtle Spa a chemical peel is $150 so you can get 4 of them for less than 1 a medical facility…

Dr. Gregory Nikolaidis, a dermatologist and cosmetic surgeon from Austin TX is reported in the Sep/Oct 2010 issue of MedEsthetics that filling the tear trough and sunken eye area is  one that he specializes in and avoiding the veins in the area is critical to preventing bruising that may take a while to disappear. He also feels that under-correcting is better than over-correcting the area. Excess Juvederm can last for up to a year – so over-correcting will require a further procedure using Vitrase to break it down. He feels that 1 syringe of Juvederm XTC in the periorbital region is sufficient. The patient should return 4 – 5 months after first treatment and then every year or two as needed.

Post-Peel Home Care Regimen

Post Peel Home Care Regimen

This is the average for most skin types. The timeline may vary slightly in each person.

Overall parameters for skin peels:
No direct sun exposure 7 days before peel treatment date.
No direct sun exposure 7 days after peel treatment date.
Have the time to ’embrace’ the peel with a more relaxed lifestyle
Good diet will ensure stronger and better skin after the peel (5 fruits and 5 vegetables everyday….just basic healthy eating…)
Best timing for skin peels is late Fall, Winter and early Spring (less potential for the skin to get hot and sweaty)…

During the 7 day post peel period:

DO NOT PICK AT THE SKIN PEELING OFF. Leave it to fall off naturally otherwise you can induce unsightly scarring.
NO HEAT (No sauna, steam rooms, hot tubs etc)
NO SUN (stay in the shade even though you are wearing a sunscreen)
NO SWIMMING (chlorine is too harsh on chemically treated or peeled skin)
NO SWEATY EXERCISES (sweating will irritate the skin – let it heal first)
NO FURTHER EXFOLIATION (no scrubs, rough cloths, loofa, any other form of exfoliant)

The following is based on a FULL-JESSNER peel. For a ‘LITE-JESSNER’ peel
the timeline below will generally be reduced by 1 day in each

Day 1 and 2
The skin will be tight
* Wash the skin with cool or tepid water only AM and PM.
*Apply no skin care products other than a mineral based sunscreen in the AM (Zinc and Titanium based as per TIZO3). Wipe off with Kleenex before washing.

Day 3 through 5
The main “peeling” days.
The skin will start exfoliating. some people will peel in large flakes of skin, others may just have a fine granular peel (one that you can feel as being rough under the touch rather than visibly exfoliating). It may be localized in some areas only. Everybody’s skin reacts differently so don’t have set expectations….
*Cleanse with a gentle cleanser for sensitive skin (as per Dr Schwab Sensitive Cleanser) using cool or tepid water AM and PM
*Apply soothing and healing gel as per aloCel Gel AM and PM (this will soothe the new skin being exposed after the peel and stimulate stronger cell development)
*Apply a mineral based sunscreen in the AM (Zinc and Titanium based as per TIZO3)

Day 6 and 7
The new, soft skin will be slightly pink in many people…and maybe still a bit irritated (depending on the strength of the skin in the first place).
*Cleanse with a gentle cleanser for sensitive skin (as per Dr Schwab Sensitive Cleanser) using cool or tepid water AM and PM
*Apply soothing and healing gel as per aloCel Gel AM and PM (this will soothe the new skin being exposed after the peel and stimulate stronger cell development)
* Apply moisturizer where needed (Stress Recovery lotion is ideal for skin that is prone to breakouts)
* Apply eye care products
*Apply a mineral based sunscreen in the AM (Zinc and Titanium based as per TIZO3)

Day 8 onwards
Return to your regular home care regimen