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Aesthetics Practice Today

Peeling After a Peel
October 22, 2013 3:32 PM by Kimberly Cray
Frequently Asked Aesthetics Question: I didn't peel after a chemical peel. Is this normal?

A common misconception in aesthetics is that you must peel after a "chemical peel." I hear this all the time and this is just not so. There are many types and strengths of chemical peels. The term "peel" actually refers to a multitude of products that are available to qualified providers at a medical grade concentration. The term "peel" does not imply that you will peel, should peel or need to peel. 

Superficial peels, such as glycolic acids and salicylic acids, may induce little to no peeling. This does not mean that the peel was not performed properly. This means that the peeling agent is superficial (think little down time, less pain, etc.) and working microscopically to induce positive changes in the skin. 

These peels are excellent before an event when a patient wants a glow and little down time. Especially when performed in a series (every 2 to 4 weeks depending on the type), these peels can achieve great results.    

Deeper peels, such as TCA (Trichloroacetic Acid) peels, are much more likely to cause peeling or significant sloughing of the skin. Depending on the percentage and the contact time, skin after this peel tends to darken or crust before the skin is fully exfoliated off.

Not all skin types are a candidate for this depth of a peel because of potential adverse reactions (hypo or hyper pigmentation, etc). This depth of a peel also comes with more discomfort (think "burning sensation"); however, most patients tolerate these peels well with the use of a hand held fan.

While the name may imply otherwise, a chemical peel may or may not cause physical peeling of the skin to occur. If the proper peel and technique are used on an individual patient, the results should be noticeable regardless of any actual "peeling." The most important things to consider are what agent is going on your skin and what it will do for your skin.

What are your favorite peels? Did you peel after the treatment? In my next post, I will discuss some of my Go-To Peeling Agents.

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Don’t Leave the Toner Behind
October 15, 2013 1:07 PM by Mina Grasso
Most patients prefer simplicity in their skin care routine. Unless the benefits of toners are explained to the patient, toners are usually the first product in a skin care system to be cut out. 

Patients new to skin care associate toners with over-the-counter acne astringents that are stripping and drying. Various ingredients are used for specific skin conditions. The following are just of the few benefits of using a toner.

  1. Additional cleansing: Soap or certain cleansers as well as the water used to rinse after cleansing can leave a residue on the face. This residue can clog pores and cause breakouts.
  2. Reduce surface oil or shine: Toners are formulated for different skin types. Acne prone patients or those with oily skin can benefit from a toner containing salicylic acid. Some patients feel their pores seem tighter using this type of toner.
  3. Antibacterial properties: Some products have various ingredients that are known to reduce bacteria on the surface of the skin.
  4. Hydrating properties: Humectants can add hydration and suppleness to the skin. Some hydrating ingredients can be found in acne toners as well.
  5. UVA/UVB protection: Vitamin C and E are ingredients that help reduce unwanted skin pigmentation and damage related to sun exposure.
  6. Anti-Aging properties: Products such as Retinol Palmitate (a form of Vitamin A) can be converted to retinoic acid, can be found in some toners and can stimulate new cell tissue and can be moisturizing.
  7. Anti-Inflammatory: Vitamin C, Ginseng Root and Chamomile Extract are just a few ingredients found in some toners that have anti-inflammatory properties. 

Once patients experience the benefits of a toner suited to their skin condition, the toner is usually the product they miss the most when they run out.

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A New Capacity for Repair and Regeneration
October 8, 2013 2:03 PM by Kimberly Cray
As part of the body's capacity to heal itself, platelets and other components in human blood migrate to a site of injury. Platelets are known to release a variety of factors that respond to tissue injury, where they initiate and promote healing. By concentrating platelets at the site of injury, the body's own natural capacity for healing can be stimulated. 

Selphyl is a unique system that taps into this capacity. The Selphyl system contains a fibrin matrix to effectively capture the body's own platelets. Through this process platelets are stabilized and protected, allowing the sustained release of growth factors to promote growth of new tissue, blood vessels, and collagen.

The treatment takes place in a single office visit. A small amount of a patient's own blood is drawn into a vacuum collection tube containing a cell separator gel. We typically collect two vials of blood. The tubes are then placed into a centrifuge and spun for six minutes to separate the blood. The platelets and plasma are then transferred in a closed system to a second vacuum tube containing a small amount of calcium chloride solution. The material is then injected, serving as a three dimensional scaffold to maintain the platelets at the site of injection.    

There is virtually no risk of allergic reaction since Selphyl does not contain any synthetic or animal products. The procedure takes place in about thirty minutes. Immediate results can be noted, however true results are seen in around two to three weeks and as collagen is stimulated thereafter, around 8 weeks or so. The results are long lasting, with claims of up to 2 years. 

Do you have experience with this system or one similar? I'd love to hear your thoughts. From my experience, I find it to be a great option for those hesitant in having synthetic fillers or neurotoxins. Not only will patients see results, but they may feel more comfortable in choosing a more "natural" treatment. For patients new to aesthetics, this could be a great gateway treatment that leads them to consider more aesthetic options.       

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Male-Centric Aesthetics on an Upward Trend
October 1, 2013 9:23 AM by Mina Grasso
Although the percentage of total aesthetic procedures performed on men is still under 10%, it has increased more than 100% since 1997.

The most common surgical procedures sought by men include liposuction, rhinoplasty and eyelid surgery. Laser hair removal, noninvasive body sculpting, neurotoxins and dermal fillers are the preferred nonsurgical options. 

Male-centric aesthetics is becoming more socially acceptable not only in the gay population, but also the younger population with more interest in fitness, staying in shape and looking good. Most of our male patients are younger than 50, with many starting in their teens for acne treatment. Men in their 20s or 30s usually seek treatment for acne scars, hair or tattoo removal. 

The baby boomers are slower to seek aesthetic procedures. They are usually encouraged or dragged in by partners who seek to embrace the concept of aging well and looking youthful. If they are in a competitive job market, they tend to be more accepting and desire to look less tired and want to refresh their appearance.

Advances in laser technology in body sculpting, hair removal, hair restoration and implantation, acne and acne scar as well as general laser skin rejuvenation have driven the interest among men. The vast Internet resources have allowed men, who tend to be more private about their aesthetic interests, do their research on procedures that appeal to them.

It takes a little more effort to get men in the door, but once they start to experience the benefits of the various aesthetic treatments, they tend to be more regular at scheduling their appointments than women are.

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Correcting a Gummy Smile
September 24, 2013 1:31 PM by Kimberly Cray

One morning one of my co-workers walked past me and smiled. Something about her looked different. It was something subtle. I couldn't put my figure on it, but her smile was brighter than ever. 

Well, it turns out that the previous week my co-worker had Botox injections for a television segment my supervising physician had an appearance on. The topic was "correcting a gummy smile." 

A "gummy" or "gingival" smile is a term used to describe a smile in which there is a show of the anterior gingiva above the teeth when smiling. A smile tends to be more "gummy" for many reasons, such as the size and shape of our lips, gums and teeth, as well as the muscles that are involved in raising the upper lip when smiling. 

As in her case, a gummy smile can be successfully treated with a low dose of a neuromodulator, such as Botox or Dysport. Placed in the proper muscle(s), the injection will help to reduce the gums from showing.  

The three lip elevator muscles converge on the area lateral to the nasal ala, so this location tends to be the most common injection site for this purpose. In the case of my co-worker, and many other patients, the results were incredible. All of this was achieved with a very small amount of Botox (5 units total). 

The effect of Botox/Dysport can take several days, or even up to a week or two, for full results. Once the full results are evident, the upper lip will not rise as high when smiling and will reduce the amount of the gum that is visible. 

Keep in mind, injecting the lower face in this region could affect your singing or playing of a wind instrument, using a straw or spoon, etc., so this treatment is not for everyone. The treatment should also be performed very conservative for this reason. Such injections should only be performed by an experienced provider. 

Neuromodulators, such as Botox and Dysport, are not permanent solutions and typically last between 3-4 months. Surgical correction would be a more permanent treatment, however may seem quite drastic to patients who only have a mild condition. 

I'm still in awe of how much this simple technique changed the smile of my co-worker. We have always thought she was a beauty, but she had always disliked the look of her smile and now is happy to smile with confidence. 

Sometimes the most subtle aesthetic touches are the ones that get noticed the most. Having someone say "you look great- what did you do?" is truly one of the greatest compliments we can strive for in aesthetics! 

If you truly have a gummy smile, Botox is not the definitive treatment for you. Although it may be temporary, it could distort your smile slightly and create some asymmetry while you are at rest.

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Radiant, Sun-Kissed Glow
September 18, 2013 3:53 PM by Mina Grasso
Early this summer I was on a mission to find a body bronzer or camouflage makeup for my patients to help them feel more confident about their legs prior to treatment of unsightly veins or for those suffering from prolonged brown staining after treatment.

Spray tans and self-tanners applied at home do a fairly good job. However, issues that patients often have are that they have an area of dryness, more sun damage or sun spots. These areas are highlighted, absorbing more of the tanning product, and it makes them look spotted. 

Some of these products last for several days, but unfortunately, it comes off unevenly. Streaking can occur during applications if not applied quickly. In addition, some patients are allergic to the self-tanning ingredients.

Gleam Body Radiance is a makeup for face and body that is a moisturizer at the same time. It covers up minor flaws and provides warm golden hues with four shades that are universal that can enhance, illuminate and compliment all skin types, making it simple for our staff that are not makeup artists to use.

A celebrity make-up artist who led and developed ABC's show "Dancing with the Stars" created this product. She had the tedious job of covering bruises and covering uneven wear of spray tans.

She developed the line to create a product that would help to nourish dry skin while providing a golden glow. Because it was originally developed for TV, she wanted her product to draw in the light, not reflect it and reduce an ashy appearance. Gleam has warm golden hues and is mixed with crushed pearls that create the glow.

Gleam Body Radiance is water safe for the face and body. Infused with vitamin E, aloe, calpurian, brown seaweed extracts and tea extracts, it will keep skin nourished and looking its best. It is water based and will not clog pores. It washes off with soap and water or a baby wipe. If product is transferred to clothing, it easily washes off.

With Gleam Body Radiance we can provide body skin care to our patients while helping them cover up spider veins, brown staining after procedure, minor flaws or bruising and have the sun-kissed Hawaiian tan glow just like the celebrities.

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Tired of Looking Tired?
September 3, 2013 3:29 PM by Mina Grasso

People in society today, including teenagers, are becoming more health and fitness conscious. As individuals become more selective with their dietary intake with reduced calories, and they become more fit, they have less body fat.

Unfortunately they lose fat volume in their face, which creates an older, more tired appearance. These people are often mistaken for looking tired and older when in reality they feel pretty energetic and youthful.

Weight loss usually results in a person's face looking tired. This pattern of volume loss is also consistent with the natural aging process. The aging process involves loss of bone and muscle as well as fat. Under the eyes "dark circles" appear.

The hallowing creates a shadow that appears dark. These "dark circles" caused by volume loss can be remedied by replacing the volume with tissue fillers.

Restylane, a hyaluronic acid, is the most popular tissue filler that is used under the eyes to replace volume. It is non-animal based, and allergy skin testing is not required. The results are immediate. In 20 minutes, a patient can appear more refreshed and look 10 or more years younger.

There is minimal to no downtime. The risk of bruising is significantly reduced using a blunt cannula. The blunt cannula can also reduce the risk of tissue necrosis due to injection of the hyaluronic acid into a blood vessel.

This office procedure is well tolerated, and patients are usually presentable after treatment. They can resume regular activities immediately. Mild to moderate swelling may occur the following one to two mornings after the procedure.

Volume replacement to treat the "Tired Look" creates a natural, more refreshed and rested appearance. Patients say that when friends or family see them, they usually give them a second look and ask if they lost weight or changed hairstyle or color.They cannot pin point what the difference is they see, but complimentary comments are of looking refreshed. 

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Getting Your Feet Wet in Aesthetics
August 27, 2013 4:36 PM by Kimberly Cray
In aesthetics, like other medical specialties, experience and practice are invaluable. It is a highly procedure-driven field and therefore excellence really comes with time, exposure and most importantly with hands-on experience. It is a self-discovery of sorts, if you will. 

Whether you are just starting out or are a seasoned professional, there are always new treatments on the horizon to learn. No one starts off perfectly with a new treatment and no two providers likely perform any given treatment exactly the same. 

It is easy to get comfortable using the treatments and techniques we have readily available. However, medicine is always evolving and always being at the forefront of the latest technology benefits us. Doing demonstrations of new products is a great way to learn more and attending conferences which discuss, and often have live demonstrations of procedures, will also get us exposed to new modalities. 

It is easy to become busy with our professional and personal lives, but we must always take the time to talk to other professionals and use them for guidance or direction if we want to grow. Also, we must make sure to read our medical and aesthetics journals for useful clinical information, studies and helpful hints. 

Aesthetics really is an artistic field. It can be fun and fulfilling to correct something that has for a long time affected a patient. But at the same token, it can be overwhelming to know and master so many things. 

Remember, you didn't learn to ride a bike overnight. There may have even been training wheels involved -- and we should always remember this as we continue to grow in the field of aesthetic medicine.    

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Stretch Marks
August 20, 2013 2:35 PM by Mina Grasso
Stretch marks are caused by rapid physical stretching of the skin in a condition where elastic fibers due to genetics or hormonal influence. Stretch marks develop in a variety of circumstances including pregnancy, weight gain, adolescents with rapid growth spurts, and weightlifters bulking up (usually on the arms). Men and women can get stretch marks in several areas including the abdomen, thighs, hips, breasts, upper arms or back. Depending on skin type and the cause, stretchmarks can appear pink, red, purple, reddish brown, light or dark brown. 

Various prescription and over-the-counter topical solutions have been recommended over the years with little to very mild improvement used alone. The following are just a few:

  1. Wheat germ oil
  2. Glycolic acid
  3. Vitamin C
  4. Peptides
  5. Retinoids

Light and laser devices have given patients more hope. Initially, treatment was known to be only successful when treatment was initiated while stretch marks were red or purple, but new laser technology has made it possible to improve the appearance of stretch marks in their white or silvery phase many years old.

Microdermabrasion and chemical peels have been used for years with minimal results. Vascular lasers such as the pulse dye laser and intense pulsed light have been effective in reducing redness or purple appearance of stretch marks. 

Fractionated lasers such as fractional CO2 have now proven to be effective in improving the appearance of older, silver or white entrenched stretch marks. Deep fractional micro laser beams vaporize a fraction of the skin leaving surrounding skin intact which allows for minimal downtime with reduced risks compared to traditional CO2 lasers. New collagen is produced in the treated areas resulting in improved elasticity and collagen fiber strength.

Radiofrequency using Viora Refit protocol is something we have found to be surprisingly effective in improving the appearance of new and old stretch marks. Radiofrequency heats the tissue and stimulates contraction and shortening of the collagen fiber bundles causing the skin to appear tighter and improves the appearance of the stretch marks. 

Multiple treatments possibly using different modalities and topical solutions will be required. The most important part of treating patients with stretch marks is setting realistic expectations on results and cost.

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Immediate and Real Results with Radiesse
August 14, 2013 12:40 PM by Kimberly Cray
We all know aging is a part of life and in many regards, aging is quite fabulous. I mean, does anyone really want to go back to their high school days? Pimples, bus stops, getting teased for the outfits we were wearing. I know I personally would be happy if I never had to look at (or hear about) a yearbook again.

While emotionally and physically we mature, learn, grow, fall in love, make new friends ... before we know it, we start to see our skin maturing and looking older. We may like ourselves better, but we start looking at our skin differently. We experience our skin becoming dull, less vibrant and less youthful. Collagen, elastin and hyaluronic acid become less plentiful, resulting in facial lines, wrinkles and skin laxity.  

I've been working in aesthetics for many years now, but it wasn't until recently that I turned thirty. To my teenage cousin I am ancient, to my eighty-something year old patient I am a baby. One thing is for sure, I finally understand why aesthetic offices are so busy. We love growing up, but we really don't love the idea of aging.

I see treatments that work to help facial rejuvenation and treatments that just have false promises. In many cases, to erase lines and folds we must replace lost structure with volume. This is not something accomplished overnight with a facial or a fancy spa day. I have seen this accomplished though, pretty instantaneously, with fillers. 

One in particular that I am gaining more experience with is Radiesse. In the case of Radiesse, the filler offers immediate and lasting volume. Radiesse is a filler, or facial volumizer, composed of calcium hydroxylapatite. Like other fillers, Radiesse acts as a scaffold under the skin, providing structure and stimulating natural collagen to grow. This collagen production continues for several months, which extends even beyond the initial effect of Radiesse. 

Over time the gel is absorbed and the body metabolizes the CaHA microspheres leaving behind only your own natural collagen. Results are natural and long lasting - clinically proven to last a year or more in many patients.

It is a great choice for building up cheekbones nicely; volumizing deeper nasolabial folds; augmenting chins and nasal regions. It gives a really nice lifting effect - especially when patients want filler in the nasolabial area only and you can show them that by addressing the mid face it will improve the lower face without a single injection there.    

Simply put, this filler can truly rejuvenate your entire face with one simple in-office procedure. I like my patients and I really like happy patients with incredible results. We are seeing both with Radiesse.

Do you work with this filler? What other filler or treatments do you do in combination? We are using it in conjunction with many of the HAs (for more superficial lines/voluminzing) and it works beautifully. I would love your feedback.

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Wrinkled Knee Skin
August 7, 2013 1:57 PM by Mina Grasso
You spend hours in the gym doing cardio, firming, toning, but what do you see in the mirror as you grab another set of weights? Loose, wrinkled, rippling skin over the tops of your knees. Our skin undergoes several changes as we age. It becomes thinner, drier and less elastic with the collagen breakdown. Wrinkles and loose sagging skin become more apparent with time. What can we do to get that skin to snap back?

Various non-invasive technologies that are well tolerated and require no downtime can help stimulate collagen production and skin tightening. The following are popular options:

Laser Rejuvenation

  • Laser Genesis
  • Coolbreeze/Cooltouch Laser

Radiofrequency - Causes collagen fibers to shorten, contract and tighten

  • Thermage
  • Viora Refit

Alternatives to light and laser procedures that we have incorporated in our practice are micro-needling with dermapen, which can be enhanced with Platelet Rich Plasma - PRP (Vampire Facelift).        

Cosmeceutical and prescription skin care products used on a regular basis that have been proven to be effective to reverse the signs of aging on the face can be used on the knees as well. Prevention with SPF 30-50 containing zinc oxide should be on the top of the list. 

I usually recommend antioxidants, human growth factors and retinoids followed by moisturizers with ingredients that aid the skin in retaining moisture. In some cases, some patients do well with adding hyaluronic acid tissue fillers or a bio-activator such as Sculptra.

Patience is required when treating wrinkled, rippled skin over the knees. It doesn't happen overnight.  It takes about 3 months of "skin fitness" to see any improvement.

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Pushing Products is Bad Business
August 1, 2013 2:06 PM by Kimberly Cray
It has happened to me before when I am on the other side of the counter: providers pushing products. I was recently at a well-known spa, at a very well-known and international hotel. I received a facial with nice smelling, elegant products. Since I take care of my skin with medical grade products, I don't feel the need to do frequent facials or extractions. But everyone loves to get pampered and relax every once in a while, right?

So after the completion of the facial, I was brought to the front desk to check out. The woman there proceeded to show me products, of which I loved to look at, but had no intention of buying.  

I read the ingredients and asked what and why the products were recommended (she neglected to tell me this prior). After a half-hearted answer, I told her I would not be taking anything today. She insisted that the products are what I need after the facial for best results. Only when I stated that I worked in dermatology did she actually decide to ring me up.

The point of my story is that we should always remember that educating patients on products, especially in the medical setting, is much more important than "selling." Pushing products is just bad business.  

Now, if I was a regular at this spa and on a great skin care routine, I might stock up on their products from time to time. However, in this case, the products weren't even necessary based on the products I listed as currently using. It is one thing to show a patient something or recommend a particular type of product, but pushing is unprofessional and unnecessary. Always remember what it feels like to be on the other side of the counter.
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Caution: Intense Pulsed Light Ahead
July 23, 2013 11:15 AM by Mina Grasso
Intense Pulsed Light (IPL) treatments are one of the first treatments that were introduced to the fast growing aesthetic market. IPL is used for photorejuvenation and hair removal. A newer term used is Broad Band Light (BBL), which is virtually the same type of technology. These procedures are probably the most popular treatments in aesthetic practices today. 

Intense Pulsed Light is a very safe tool when used appropriately, but patient selection is crucial. The risk of burns is higher with darker skin types, location off-the-face and exposure to natural outdoor or indoor UV exposure. 

Summer time presents as one of the most dangerous seasons to perform photorejuvenation (IPL) treatments. It's usually a frantic bride-to-be just a few weeks prior to her wedding who presents to our clinic with a foot print pattern of redness and blistering on her face, chest or arms. 

Surprisingly, most of the cases I have seen are Fitzpatrick skin type II-III when the settings used were too aggressive and not enough attention was spent on recent sun exposure history. Oftentimes the practitioner may ask about the recent sun exposure but may have not specifically inquired about tanning bed exposure.

Patients are so familiar with IPL that they have presented to our clinic with the settings that were used on them at another clinic and request a higher setting to be used. Beware of these patients.

The settings on IPL devices can vary greatly. Newer devices have added safety features of various cooling methods. If a patient was treated with an IPL with cooling then goes to another clinic that may have an older device without cooling, a disaster can occur if the same settings are used.

Patient selection is the most important thing to pay attention to in avoiding intense burns with these devices. Anyone with recent sun exposure should automatically be disqualified to have IPL treatment for photorejuvenation or hair removal.

Realistic expectations must be set. Patients need to understand that a series of treatments is required for optimal results. Don't try to be a hero, especially if your patient is getting married in a month.

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Fielding Patients’ Cosmetic Interest
July 19, 2013 1:12 PM by Kimberly Cray
If you are looking to step up your cosmetic business or incorporate aesthetics to your office for the first time, in-office questionnaires are an easy and effective means to field patient interest. 

The exact content of questionnaires is completely up to you. They may be simple or more elaborate for a purely cosmetic office. Since we are a medical and cosmetic based practice, I find our questionnaires are fair in that they are not overpowering to those visiting for a medical reason, but specific enough for our strictly cosmetic patients.  

Our questionnaires, for example, ask, "Are there any additional services you would like to learn more about? Please check all that apply." We then have boxes with items to check off such as skin care products, fine lines, facial veins, excess fat, cellulite, thin lips, chemical peels and hand rejuvenation, just to name a few.  

This is a non-intrusive way to inquire as a patient can simply leave the area blank if that is not a reason for visiting the clinic.

Now, some patients check off everything and those patients you definitely know, even before entering the exam room, have more interest in products and treatments. Meanwhile, such cosmetic questionnaires help us to focus less energy towards cosmetics on the patients who did not check any boxes as their interest.  

Keep in mind though, often the people you might least assume would be interested in a cosmetic treatment or product are the ones who very much are. Aesthetics can often surprise you in this sense. Some people may want to do every treatment in the world, yet leave empty handed, while the patient who didn’t express interest on paper leaves with a new skin care regimen and multiple treatments booked.

Our job is not to sell. It is to educate patients on what is available to them and what experience has shown us to work effectively. Results and confidence sell.   

We also have a section on our questionnaire that asked patients to rank how concerned they are with their image and how true to their age they feel as though they look. If a patients states they are “not concerned” with how they look, you may want to focus your attention elsewhere.

 

Again, know that what someone writes on paper may change when they connect with you in the room, so never let a questionnaire dictate your every move. Get a feel for their concerns and give an honest assessment if it is something that they have inquired about or you feel they will truly benefit from.

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Skincare on a Budget
July 2, 2013 12:35 PM by Kimberly Cray
Quality skincare does not have to come at a steep price. If you splurge in some important areas (that benefit you the most) you may need to skimp a little in other departments and that is okay. Let's call this skincare on a budget, if you will. 

SKIMP:

  1. Face Wash: Don't get me wrong. I love high end, fancy foaming, pretty smelling facial cleanser more than anyone, but that's not the first place I recommend putting your skincare dollars. I mean seriously, you WASH it OFF. If money isn't a concern there are ample products to use that will make you feel like you are in a spa every single day. They will also leave your skin pristine. However, if you are on a budget, take it easy in this department and you will have more to put towards a problem area or something your skin really needs kicked up! Also note that a face wash is not intended to remove eye makeup. For eye makeup I love OTC cloths that are gentle on the skin.    
  2. Moisturizer: This is hard because I love some great (ahem, pricey) moisturizers, but there are many very good OTC options that are much more affordable. For the face, go with a lotion during the day (with sunblock or layer your favorite sunblock on top) and if skin is very dry, opt for a thicker cream formulation in the evening. Shampoo or Conditioner: While I have come across some really nice ($$) shampoos and conditioners, there are so many good inexpensive options out there that it really doesn't make sense to splurge. An idea: pick your favorite shampoo and go with a less expensive conditioner (or vice versa). Use a more expensive conditioner as a weekly treatment so it lasts you longer. Remember, you really only need to condition the midsection and ends -- using too much will bring out excess oil in the roots and weigh your hair down.  

SPLURGE:

  1. Sunblock: If you don't want your eyes to burn, your skin to break out or the dreaded white "vampire" look, splurge here and you will be happy you did. Opt for mineral based with titanium or zinc oxide.
  2. Make-up: Splurge here because it is fun and worth it. Using higher end products will allow your skin to breath and be more radiant. You don't have to go extravagant, but find products that work well for your skin and are less likely to irritate you. Start with your foundation or powder (loose mineral is my preference), blushes and shadows, and then you can always play with OTCs for mascara, liners or trendy nail polishes.
  3. Growth Factors: This splurge is an anti-aging MUST: Gentle yet effective at stimulating collagen and rejuvenating the skin. The key here is to use them sparingly to make them last and to use them on the areas you need them the most. For example, if you have prominent lines around the eyes, stick to an eye product with growth factors or an intense, more concentrated serum in that area.
  4. Facials: Especially if you need them, they are not a treat but a valuable treatment. Deep pore cleansing with extractions or a more fun oxygen infused session will rev up your skin so you can continue keeping it that way at home. Focus more on an aesthetician that is medically trained over the day spa type varieties for the best results. 
  5. Travel Size Versions of Your Favorites: Don't use the hotel soap on your face. Just don't. Splurge on great travel size lotions and washes and you won't suffer on your next trip. Just because you aren't home doesn't mean you can't take care of your skin properly. If you are traveling to drier climates, stock up on hydrating agents such as moisturizers or day creams. And of course, don't forget your travel size SPF!

One of my biggest pet peeves is all the promises a lot of the OTCs make and how glorified "average" products are on commercials. What I've learned in my time in skincare is that often, spending more on a quality product will cost you less in the long run (certainly in the peace of mind department) than if you try numerous over the counters.  

Online reviews can be helpful. Skincare blogs, your dermatologist and even skin savvy friends are great people to go to for product advice. So if your aesthetician recommends ten products, try starting with the one or two you might benefit from the most. Work them into your current routine and you have an improved skin regimen without breaking the bank!
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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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