Winter and retinoids – how to survive

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Dry skin and winter go hand in hand – so getting along with our best anti-ageing ally can be harder than usual. Lizard skin doesn’t look so hot. The retinoid family includes over-the-counter products like retinol and retinaldehyde (find these in Medik8, La Roche Posay Retriderm and Avene Ystheal lines); and it also includes prescription products like Differin, Retin-A and Isotrex. These are a godsend for acne-prone and sun-damaged skin, but they can be a challenge to use for the uninitiated and winter makes it even harder to build them into your routine – certainly, retinoid queries are the commonest reason for patients emailing me at the moment. Red eyelids, rashy necks and dry cracked lips are all signs that you may need to modify your routine. Here are some insider tricks to get you through ‘til spring.

1)   Switch up your routine. Make sure you’ve banished all foaming cleansers and that you’re using a richer moisturiser formulation at night. You may also want to ditch your exfoliator – or at the very least, cut back.

2)   Apply retinoids to completely dry skin. Try cleansing, then moisturising generously straight away, to lock in water to your skin. Occlusive moisturisers work best like this. Wait 15 minutes, so skin is completely dry. Then apply a pea-sized amount of your chosen retinoid.

3)   Reduce the retinoid strength. Little and often is better than blitzing your skin once every 5 days, because of common side effects like redness and burning. So dilute it with moisturizer to buffer its effect. This will reduce penetration, making it easier to tolerate.

4)   Start slow. Never attempt to use any retinoid daily from the outset. This is a rookie error. Begin with applying every 3rd day and escalate to alternate day application after 2 weeks. Then try daily use or 2 days on/1 day off after another fortnight. Remember the changes you are trying to effect in your skin occur over the course of months, not weeks. Slow and steady wins the race.

5)   Try short-contact therapy. This approach has worked for many of my thin-skinned sensitive patients who struggle with retinoids. Think of it like a mask – so apply to clean skin for 5 minutes initially and then rinse it off off; build up to leaving on for up to 30 minutes over time.

6)   Protect vulnerable areas. Redness around the eyes and cracked lips are common occurrences if you’re applying your retinoid with too little precision. I suggest using moisturiser as a barrier around the eyes and lip balm on the lips before retinoid application, if these issues are occurring.

7)   Don’t skip on sunscreen. Remember, that sunscreen is the yin to the retinoid’s yang. Even in winter. By all means choose a more moisturing formulation, but don’t skip it. UVA rays age and are the only UV rays of significance in cold climes in winter (unless skiing/at altitude) so use proper sunscreen with at least 5% zinc oxide for a complete anti-ageing effect.

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Is Medical Needling The Most Useful Skin–Perfecting Treatment Around?

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The answer – quite probably. And I don’t say this lightly. After Botox, this is the commonest in-office procedure I perform. It involves using a device called a dermaroller on topically anaesthetised skin, and creates multiple tiny punctures through the top layer of the skin, down into the upper part of the dermis, the deeper layer. This creates a multitude of micro-injuries, activating the skin’s healing cascade and prompting the massive release of growth factors from cells called platelets – the things that form a plug to stop bleeding when we cut ourselves.

This procedure is incredibly useful for a number of reasons:

1) Everyone benefits from skin-thickening. Think of folding a piece of card and then think of folding paper –which creases more easily? Exactly.

Thick skin is more resistant to wrinkling than thin skin, which is why our eyes and necks give us away when it comes to ageing. Medical dermaroller therapy, when performed in-office (and that’s specifically what I’m talking about here – not at-home treatments using a device with much shorter needles), causes the new deposition of collagen in the dermis, and thickening of the skin’s outer layer by as much as 40%. Anyone and everyone concerned about ageing will benefit.

2) But that’s not all – medical needling also stimulates new elastin formation. What that means is needling helps restore the skin’s elastic recoil, reducing laxity and sagging – something that’s actually incredibly hard to achieve, even when utilising more invasive procedures.

3) It can be safely used on pigmented skin AND it doesn’t make you light-sensitive, so treatments can continue through the summer. This is because the skin’s top layer isn’t removed and the procedure does not activate melanogenesis, the formation of pigment in the skin. Again, this is in stark contrast to chemical peels and ablative laser therapies, which are higher risk in both darker skin types and when performed during periods of intense UV.

4) As if those benefits weren’t enough, it’s a great treatment for acne scarring. In my practice, that means that it’s the perfect therapy for the tidy-up phase, once we’ve corrected the active acne process; so often, we’re not only trying to minimize the aftermath of acne, but also target the first signs of ageing too. Medical needling targets two birds with one stone.

5) The downtime is incredibly short for a treatment with such high yield – I’ve renamed clinics run on Friday ‘Dermaroller Fridays’. Practically this means you can have a treatment at the end of the working week, recover over the weekend, and be ready for work again on Monday. You’ll look sunburnt straight afterwards and for the next 24 hours but over the course of Sunday, normality  gradually resumes. A weekend off is a small social sacrifice to pay for complexion renovation.

And complexion renovation is really what this is all about – stimulating regeneration of the dermis and epidermis in an entirely natural but longlasting way. This is what makes medical needling so popular with my clientele – and ultimately, delivers a very attainable British kind of beauty, which is based on fantastic skin. 

5 Things You Must Know Before Using a Facial Cleansing Brush

Home-use devices are a huge growth area in beauty right now.  And rightly so. They represent a brilliant stepping stone on the path to great skin, providing a little more oomph for women who’ve been disappointed by too many over-the-counter cosmetics but aren’t quite ready yet for the dermatologist’s office.

The cleansing brush is one of thImagee easiest to use and the benefits are immediately obvious – they provide thorough make-up removal without the need for double-cleansing and provide better penetration of serums and moisturiser used afterwards. They also look and feel …. well, fun. A little bit like high-end sex-toys. BUT they can also completely wreck your skin if used wrongly.

So here are some simple tips to help make sure you get the most out of your gismo.

1)   Let it do all the work. Now I’ve listened to many disillusioned women who come into clinic bemoaning the fact that they’ve spent serious cash on one of these devices and then wonder why they’re all red/irritated/broken-out. So I asked one of them to bring it in with her and show me how she used it. Answer: like a Brillo pad. We girls just love a good old scrub. Wrong. It does the heavy lifting so we don’t have to. Literally just hold it in contact with your skin, and let it whirr away as you gently pass it over the various zones of the face.

2)   Now, speaking of red/irritated…. I really don’t think anyone needs to use these devices twice a day. Start off using 3 times a week at night. See how you get on. Thick, oily skin with big pores may well tolerate up to nightly use, but it’s rarely necessary, unless you are wearing industrial-strength make-up every day (in which case we need to talk about make-up!). Sensitive skin needs a brush with a sensitive head, and 3 times a week, like physical exfoliants, is more than enough. Be especially cautious coming into winter.

3)   Which brings me to the cleanser that comes with many of these brushes. It should be gentle and non-foaming. Otherwise the combination of manual cleansing plus surfactants will demolish your skin’s barrier function, leaving you…yes, that’s right. Red/irritated/broken-out. Good ones include Cetaphil Cleanser, La Roche Posay Physiological Cleansing Gel and Avene Extremely Gentle Cleanser. All are non-comedogenic, which is how I like my cleansers.

4)   Avoid if you have active acne or rosacea. These may well be suitable at a later point, when the battlefield is calm and you have the active inflammatory ‘fire’ under control. But do this first with topical actives and keep everything else gentle. Introduce your brush only when stability has kicked in and all your comedones (i.e. spot precursors) have been sorted with a retinoid.

5)   Recognise that the cleansing brush is only one part of a comprehensive skincare regime – alone, it won’t anti-age anyone but what it does do is make useful things you leave on the skin work more effectively and give you the feel-good factor that comes with a senses-pleasing ritual.

5 Ways to Anti-Age Your Eye Area

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Eyes are the focal point of the face (see above if you’re in any doubt)– but what to do when the skin around them serves as a distraction from the main event? Drooping lids, crinkly under-eye skin, dark circles and crows feet that don’t disappear when you stop smiling ….. the most common anti-ageing complaints I hear relate to the eye area.

Now there is good reason why the skin around the eyes is the first to demonstrate that we aren’t getting any younger. It’s thinner than anywhere else, it is constantly being subjected to the creasing forces of the underlying muscle which allows us to close our eyes and the muscle lies right under the skin, meaning its colour creates a dusky hue quite naturally. And then factor in that there are little fat pads under the lower eye-lid which can droop and shrink with time, creating hollows and bulges…..is it any wonder we look tired???

Thankfully prompt action yields results. Here are the things that I think are worth doing to preserve the beauty of the eye area.

1) Protect your elastin.

The sun is the enemy of our eyelids. Of course it makes us squint, promoting wrinkles but more importantly it damages our elastin, the protein that gives skin its snap. Once its gone (and UVA rays which travel deep into the skin are the culprit) its gone – so preserve it by wearing sunglasses. Choose glasses that cover the whole eye area up to the eyebrow and offer maximal UVA and UVB protection (100% block is possible). A layer of broad-spectrum sunscreen is essential. All year-round please.

2) Strengthen collagen.

The thinness of the skin is why its so prone to creasing, so thicken it up. Think how much easier paper creases compared to cardboard and you’ll get the idea. Its why men with thick skin age better than we ladies with thin skin. The key ingredients to build and strengthen collagen are sunscreen (to protect what we have), vitamin A-derivatives and vitamin C (at least 10% l-ascorbic acid is best). Peptides like Matrixyl may also have a role to play and are easy to tolerate. Olay Regenerist 3-point serum is a good, affordable source.

3) Treat pigmentation

The cause of this can vary – those with pigmented skin are much more likely to have dark circles due to genetics but the ageing process and sun exposure can exacerbate the situation. Leaky capillaries are though to be one of the principle causes, in which case seek out an eye product with vitamin K like Peter Thomas Roth Power K Eye Rescue, which also contains brighteners like kojic acid. And of course, never be without an excellent under-eye concealer. I’m currently obsessed with Ellis Faas Concealer.

4) Halt crows feet.

There’s nothing wrong with crows feet. In fact when you smile, if you didn’t crinkle a bit, you’d look insincere. But once they start to set in at rest, they will only get deeper. So if they bother you, act promptly and address the issue with a little Botox. If injections scare you, topical Botox is on the horizon, so be patient. And if that’s still too much, try one of the pseudo-Botox peptides that can now be found in many eye-creams: try Snoxin, fairly priced and good levels of actives.

5) Lift the hood(s).

Yes, loss of fat and skin snap leads to droopy eye-lids. It’s a sad fact of life. Topical things don’t work when this happens. So what you are contemplating is either a non-invasive approach (pricey, may work) or surgery (v pricey, scary for most).

Of the non-invasive methods, Ulthera is probably the most promising method for skin tightening and it appeals because you can actually visualize the layer of tissue that’s being targeted as, after all, ultrasound was first and foremost a diagnostic tool for ‘seeing’ inside the body. It can be used to lift and tighten the skin above the brow and around the crows feet, thereby creating a more open youthful eye area – although unfortunately it’s not safe to use on the eyelids themselves. Botox injected strategically may further enhance the brow lift. But this approach won’t solve the problem if there’s too much excess skin…..

Alas, if there is a proper ‘hood’, surgery is your best bet. A blepharoplasty is the 2nd most popular cosmetic surgery procedure in the UK – and can be done with an ablative laser (like CO2) or a scalpel. The key thing is to do your research beforehand, as with any cosmetic surgery procedure. For more info, read on : http://www.baaps.org.uk/procedures/eyelid-surgery

Image:courtesy of National Geographic

Heat Wave Beauty – 5 Ways to Survive This Unprecedented Sticky Spell

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I was rather shocked by the picture of a certain young socialite looking beyond-bronzed in the recent press – aside from the serious implications in terms of skin health, from an aesthetic perspective, it just looked……well, dated. This heavily bronzed look circa Lancaster 1982 is about a million light years away from the modern ideal of dewy, luminous light-reflective skin.

From my experience, I think a lot of people still rely on a tan for concealment –whether its to hide blemishes, the pigmentation they leave behind or to mask scarring.  THIS. IS. NOT. A. GOOD. IDEA.  Sun makes dark patches darker, makes skin break out when you come back to cool climes and will give you wrinkles and sagging to worry about as an extra bonus.

Here are some tips to get the most from this mood-boosting time of year without sacrificing your complexion.

1)   Switch your usual sunscreen cream formulation to a lightweight gel; this simple tip is often much appreciated by my male patients, who simply can’t abide that sticky feel on their skin, which leads to them skipping it. I love Heliocare Advanced SPF 50 Gel and La Roche Posay Anthelios  Gel-Cream SPF50.

2)   Add in an antioxidant layer under your sunscreen – Silymarin is of great interest at the moment – you might have heard of its liver detoxifying properties. But it’s also a powerful photo-protector too. This milk-thistle extract is a polyphenol, which has potent free radical zapping properties and is great for hyperpigmentation.  Find it in Skinceuticals Face Balm – great for dry, sun-damaged skin.

3)   Boost your skin’s defenses from the inside – drink green tea after meals, make your own pasta sauce from fresh tomatoes slow-cooked in olive oil and graze on leafy greens.  All are rich in nutrients, which help block the chemical reactions that lead to sun damage.

4)   Skip powder. Powder and summer don’t gel well. A gooey mess quickly develops, and it becomes impossible to touch up through the course of the day and will cake, highlighting lines. Ick. Keep base sheer and light and only build coverage where you need it with concealer. Keep t-zone shine at bay with blotting papers, leaving cheeks naturally glowy.

5)   If you need bronze, fake it. If you’re breakout prone, don’t leave it on overnight and try to use non-comedogenic self tanner. Try Clarins Liquid Bronze and Neutrogena Build-a-Tan Gradual Sunless Tanning.

5 Skincare Tricks To Survive the Glastonbury Festival

Image Its festival time of year and the cooler members of my client-base have recently been asking for some easy skin care cheats which will ensure that their Instagram pics don’t shame them for years to come. Naturally, the easiest way to look great in adverse circumstances (dermatologically speaking) is to have the best skin possible naturally, rendering products de trop.  Alas, for most mortals this is not feasible. So here is my guide to getting by in the great outdoors.

1)   Get thee a big bottle of Micellar Lotion and a wad of cotton pads.Image

These are the smart girl’s wipe. No rinsing required and no nasty pore-clogging residue left in its wake. I adore Bioderma Sensibio Micelle Solution. Thankfully now widely available at Lloyds chemists.

2)   Moisturising sunscreen – now, I’m usually a separatist, when it comes to skin care. I’m a firm believer that there is only so much ‘space’ in a product for active ingredients so trying to cram 8 different functions into one usually means that none of them are done very well…..but you CAN moisturise whilst sun-protecting….. And it would be madly unfortunate to get sunburnt during a freak spell of UV on day 1. I’m fond of La Roche Posay Melt-in Cream for this purpose,as it offers a bit more hydration than the other Anthelios products, along with the stellar UVA/B protections. BUT it’s also tinted – so it’s practically a BB cream ( and far more effective at doing the things it’s designed to than most of those will ever be).  Genius.

3)   Spot cream. Yes, this might seem like a luxury, in priority terms – but ultimately if clear skin is the key to the minimalist festival skin approach, then its imperative to have some sort of zit zapper to hand for when the late nights lead to that throbbing sensation of doom on your chin and you spy Vesuvius erupting in your tiny compact mirror. So nuke it with either benzoyl peroxide or salicylic acid. I like Murad Acne Spot Treatment and Obagi Therapeutic Lotion.Image

4)   A balm to heal all irritated ails, whether nettle stings, cracked lips, sore heels or just general dry bits. La Roche Posay Cicoplast Baume is fab. Image

5)   Eye-liner. Ok, so not strictly a skin care trick (you caught me out) but actually, you can get by on the above 4 things, just about but ‘4 skincare tricks….’ doesn’t make for such a catchy title. Eyeliner is the one make-up item that transforms a look. Think Carine Roitfeld, who apparently can apply her signature black eyeliner without a mirror. Quite a nifty talent for a festival, I’d have thought….although somehow I don’t see her camping. I’ve discovered the amazing Kevyn Aucoin’s ‘The Eyeliner Primatif’. Uber-premium but glides on like a dream with no pesky drag and has a wonderful smudging gismo on the end.

So there you have it. Your skin care 101 to surviving a festival. Go forth and party (relatively) bare-faced and enjoy with my blessing.

Q:When is acne not acne? A: When it’s perioral dermatitis

I’ve had a cluster of patients presenting with a troublesome facial eruption that’s been mislabelled and thought I’d blog about it because it’s very pleasing to sort and responds rapidly to correct treatment – woo-hoo!

So the common scenario is a female (like melasma, only about 10% of sufferers are men) who has spots near the mouth – within the nose-to-mouth creases and around the chin.

This has a very classic appearance – lots of tiny bumps that look the same, often joining up – but they tend to spare the skin directly next to the lip edge. The skin may be dry and flakey. The bumps on the chin are what tend to lead to the misdiagnosis of acne, as it bears similarity to the distribution of adult female-pattern acne. It can also appear around the eyes (and is then termed periorificial dermatitis) and if severe, spread onto the cheeks. Importantly, clogged pores or comedones are not a feature; this is one of the key features that distinguishes it from acne.

No-one really knows what causes this annoying problem – but the ‘wrong’ type of skin care aggravates it and topical steroids, especially the stronger variants are a common trigger.

When someone presents with this, the first thing I do is to suspend the current skincare regime (and frequently impose a make-up cull). A non-comedogenic regime is the order of the day (I know…I sound like a broken record). We have an excellent choice of soothing, non-clogging products to choose from, courtesy of French pharmacy brands like Bioderma and La Roche Posay and sometimes this will be enough to solve the problem. If topical steroids are the cause, occasionally things get worse before they get better, but stopping them is essential so stick at it.

More severe cases will benefit from prescription medication – my preferred approach is topical (azelaic acid 15-20%) and oral tetracyclines. Usually treatment for 6-8 weeks will sort things out. So satisfying.

A good skin care regime to try if you suffer from perioral dermatitis is as follows  :

Cleanse : La Roche Posay Physiological Cleansing Gel (one of my all-time favourites, non-foaming but effective at removing make-up)

Treatment product – if using a prescription product like Finacea (15% azelaic acid) apply it now, to clean skin morning and night.

Moisturise : Bioderma Sebium Hydra ( a lightweight non-clogging moisturiser for oily skin that’s dry or irritated)

Protect : Obagi Nu Derm Sunshield SPF 50 (lightweight matte finish, excellent physical block without the whitish cast)

Image : courtesy of http://www.drumd.com/