Sun Protection

Broad spectrum sunscreens are the most important ingredients in any skincare regimen. Sun exposure often causes and exacerbates the most common skin conditions. It is also the number one reason for premature skin aging. There are two main types of sunscreen ingredients, Physical and Chemical.

Physical sunscreens work by physically blocking UV rays, and they include:

• Titanium Dioxide
• Zinc Oxide

Chemical sunscreens work by absorbing UV rays. Common chemical sunscreens (aka ‘organic sunscreens’) are:

• Octinoxate
• Octisalate
• Octocrylene
• Avobenzone

Use a sunscreen that either has a high concentration of a physical sunscreen (such as 4.7% Titanium Dioxide), or contains a combination of two or more sunscreen ingredients.

Hyperpigmentation

Hyperpigmentation (dark spots) results from increased melanin in the skin. Sun damage, hormonal responses and inflammation are the three main causes of hyperpigmentation. When choosing skincare products that help lift and prevent hyperpigmentation, look for some of the following key ingredients:

• Licorice (Glycyrrhiza glabra) – helps lighten brown spots, while inhibiting the internal process that creates the unwanted pigment on the skin’s surface, called melanogenesis.

• Kojic Acid - is sourced from mushrooms. It inhibits the melanogenesis process and also acts as an antibacterial agent.

• Rumex Occidentalis Extract – works to inhibit and reduce the formation of unwanted pigmentation, allowing for control over skin tone and skin brightness.

• Hydroquinone – available in various strengths, but the prescription strength is the most effective. However, this ingredient is not for everyone. Some patients complain of irritation or suffer allergic reactions when using products that include high concentrations of hydroquinone. It is important to follow your dermatologist’s instructions and apply the product as it is intended.

Fine Lines & Wrinkles

There are 3 causes of skin aging. The first cause, Chronologic Aging, is the intrinsic, physiological process occurring naturally through genetics and the passage of time. The second cause is Environmental Damage, which can be controlled by limiting sun exposure, adopting a healthy lifestyle of eating right and exercising, not smoking and avoiding harsh weather conditions. The third cause is Natural Hormonal Progression. Studies now show that starting in our late 20’s/early 30’s, both men and women begin to experience an imbalance of hormones. And because estrogen is responsible for maintaining and regulating the production of Collagen, Hyaluronic Acid and Elastic Tissue in our skin, this imbalance affects our skin in numerous ways. Specifically, an acceleration of fine lines and wrinkles, loss of elasticity, loss of firmness, and skin redness. Here are some key ingredients to address these symptoms:

• Matrixyl Synth’6 - a new patented, clinically proven peptide that works to boost all 6 levels of collagen synthesis. Works to visibly diminish wrinkles and strengthen and firm the skin’s structure.

• Ameliox - A potent combination of amino acids and peptides to fade away expression lines. Considered in the industry as a cosmetic cream alternative to Botox because it works to smooth and relax the skin, thereby reducing the appearance of fine lines and wrinkles.

• MDI Complex – a collagenase inhibitor that helps slow skin aging, and maintain younger looking skin by blocking the enzymes that breaks down collagen. Helps to improve the skin’s strength and firmness while reducing the appearance of visible capillaries, redness and dark circles.

• Hyaluronic Acid (Sodium Hyaluronate) - a naturally-derived component and one of
the Natural Moisturizing Factors (NMF) of the skin. Its ability to bind 1000 times its weight in moisture allows the skin to retain moisture. Look for high concentrations of this ingredient in your skincare products as it provides exceptional skin plumping, moisturization, and skin lubricity.

• Vitamin A (Retinol) - helps to increase cell turnover and to stimulate the production of collagen and elastin.

• Vitamin C (L-absorbic acid) - a powerful antioxidant that stimulates collagen production and helps even skin tone and discoloration.

• Vitamin E (tocopherols or tocoreinols) - an excellent antioxidant and emollient that provides protection against oxidative damage caused by various environmental factors. It is particularly effective when used in combination with Vitamin C.

Acne

Acne is a disorder of the skin, marked by papules, comdones, or cysts. Effective acne products help control sebum production, and decrease the proliferation of acne-causing bacteria. However, it is important to note there is a significant difference between teenage acne and adult acne. While the same key acne fighting ingredients apply to both situations, there of different concentrations that are more effective for teenage acne versus adult acne. If you are experiencing adult acne, consult a dermatologist to get a prescription for adult acne medications and creams.

• Benzoyl Peroxide - an effective treatment for higher grades of acne because of its ability to deliver oxygen into the base of the follicles to kill the bacteria that cause and perpetuate acne.

• Salicylic acid - an anti-acne ingredient that is able to penetrate through oil-filled follicles. This beta-hydroxy acid also acts as an anti-imflammatory agent. It is effective at reducing both non-inflammatory and inflammatory acne lesions. At lower concentrations, salicylic acid works to exfoliate dead skin cells.

• Azelaic acid - an excellent dual-action ingredient. It is an effective anti-bacterial and anti-microbial agent as well as a strong melanogenesis inhibitor.

1. Turning up the heat? Turn on the humidifier! Air inside your home becomes very dry in winter, especially if your windows are closed and the heat is on. A humidifier will replace moisture in the air. Keep indoor air moisture levels at 40 to 50 percent.

2. Switch your moisturizer from lotions to thicker creams or ointments and use them often. Moisturizers protect your skin from the elements. Think of moisturizers as a daily barrier between your skin and the air. Even if you have oily skin, you still may need a moisturizer in the winter.

3. Use mild soaps, and avoid deodorant, fragranced, antibacterial or abrasive soaps, as these are more drying for your skin. Instead look for a milky textured cleanser like kaplanMD Cleansing Lotion, which features a gentle amino acid based surfactant obtained from apples along with soothing, anti-inflammatory actives like Soy, Panthenol and Chamomile.

4. Remember to use sun protection. Even though it is cold and overcast, your skin is still vulnerable to damage from the sun’s UV rays. Apply a moisturizing broad-spectrum sunscreen with an SPF of at least 15 on any part of your skin that is exposed to the elements. This will not only protect your skin from chafing and drying, but also protect against the winter sun, which can still cause sun damage and burns. Remember, even on overcast days, 80% of UV rays still filter thru. Use a moisturizer plus SPF daily, such as the kaplanMD Day Cream SPF 15, which is an ultra hydrating, lightweight moisturizer, anti-wrinkle cream and sun protectant- All in One. Also look for sunscreens with physical, rather than chemical sunscreens, such as titanium dioxide and zinc oxide. Physical sunscreens are more effective, and less irritating to skin.

5. Remember to use a lip balm that also has at least SPF 15. This will protect against chapped lips, as well as sun damage, which the thin skin on the lips is extra vulnerable to. The lips are often the first place to exhibit signs of aging, so they must not be neglected! For excellent protection that features the added skincare benefits of 10 active ingredients plus a touch of color and shine, try kaplanMD Lip 20 Treatment or kaplanMD Lip 20 Treatment Gloss, both with a sun protection factor of 20.

6. Review your skin care regimen. If you are using products with tretinoin, such as Retin-A or Renova, or are using alpha-hydroxy acids or glycolic acids, you may want to use these less frequently, as they may cause your skin to exfoliate and become more sensitive and dry. Avoid microdermabrasion and abrasive skin treatments, as these exfoliate the top layer of the skin, and leave the new layer of skin unprotected to the harsh elements. If you do use an exfoliant, remember to always apply a moisturizer immediately after rinsing your face to help seal in moisture and prevent skin from chafing.

A new study reported that people who fail to brush their teeth at least twice a day are at increased risk of developing heart disease. Inflammation in the body, including in the mouth and gums, plays an important role in developing clogged arteries, which can lead to heart attacks. Researchers suggest that this may be why they found that those with poor oral hygiene had a 70 percent higher risk of heart disease than those who brushed at least twice a day.

This week, the Environment Working Group (EWG) released their annual report, and found that only 39 of 500 sunscreen products examined were considered safe and effective to use. The report cites several problems with sunscreens, namely:

1. High SPF sunscreen products are often meaningless and dangerous.
2. The chemical sunscreen, Oxybenzone, can penetrate the skin and may disrupt the body’s hormone systems.
3. Vitamin A (retinol) and retinyl palmitate in sunscreen products may accelerate skin cancer

Higher SPFs Do Not Necessarily Mean Better Protection

This is a statement I have been explaining to patients for the past 25 years. However, it seems every summer, I see higher and higher SPF products on drugstore shelves, and I constantly have to educate patients that higher SPF numbers, such as SPF 45, 80 and 100, are often meaningless and dangerous because it gives people a false sense of security, or a license to stay out longer in the sun.

The new EWG report states, “People don’t get the high SPF they pay for. We apply about a quarter of the recommended amount. So in everyday practice, a product labeled SPF 100 really performs like SPF 3.2, an SPF 30 rating equates to a 2.3 and an SPF 15 translates to 2.”

In 2007, the FDA published proposed regulations that would prohibit manufacturers from labeling sunscreens with high SPFs because it would be “inherently misleading,” given that “there is no assurance that the specific values themselves are in fact truthful.”

In the end, stick with the basics: At least 30 minutes before going outdoors, apply sunscreen. The correct amount to use is approximately 1 oz (a shot glass full) of sunscreen for your face, neck, chest and arms. Apply more sunscreen for if other parts of your body are exposed, such as your back, legs and stomach. Also wear a wide brim hat and sunglasses that cover your entire orbital region. Remember to reapply sunscreen every 2 to 3 hours.

Oxybenzone Can Disrupt Body’s Hormone Systems

There are two groups of sunscreens: Chemical and Physical. Ingredients such as Oxybenzone and Avobenzone are chemical sunscreens, while Titanium Dioxide and Zinc Oxide are physical sunscreens.

Researchers have found that Oxybenzone (from the Benzophenone group of chemical sunscreens) can penetrate the skin and may disrupt the body’s hormone systems.  Physical sunscreens have proven to be more effective in blocking UVA and UVB rays, namely because they are actually physical particles that sit on the surface of your skin and deflect light away.  However, there is new cosmetic trend which tries to incorporate nanotechnology in skincare formulas.  A growing number of researchers believe that in particular, “nanosized” titanium dioxide may have serious health implications.

Vitamin A In Sunscreen Formulations Can Accelerate Skin Cancer Tumors

There are numerous sunscreen products that include Vitamin A, otherwise known as Retinol or Retinyl Palmitate, in their products for anti-aging benefits. However, EWG researchers found the initial findings of an FDA study of vitamin A’s photocarcinogenic properties, meaning the possibility that it results in cancerous tumors when used on skin exposed to sunlight.

“In that yearlong study, tumors and lesions developed up to 21 percent faster in lab animals coated in a vitamin A-laced cream than animals treated with a vitamin-free cream,” the report said.

The conclusion came from EWG’s analysis of initial findings released last fall by the FDA and the National Toxicology Program, the federal government’s principle evaluator of substances that raise public health concerns.

There is currently controversy on why the FDA did not caution consumers against the use of Vitamin A in sunscreens when it appears there was enough evidence 10 years ago.

It seems a hot new skincare ingredient is touted in the news almost daily. This is overwhelming for both the public and medical and esthetic professionals. We are literally surrounded by a sea of literature, and we need to educate ourselves so we can best separate the substance from the hype. As more and more of my patients bring in bags of different products to ask my advice on which ones they should use, I wanted to write a series of articles here to help people understand cosmetic ingredients.

Defining Cosmetic Chemistry

Cosmetic ingredients can be divided into categories of activity: cleanse, repair, protect and nourish. Ingredients are then evaluated by how well they perform these tasks, and what level of performance they achieve.

Cleanse
In the cleansing category, you have your Cleansers and Toners. Cleansing is a critical step in a skin care routine. The function of a cleanser is to remove surface debris and makeup without causing any destruction to the delicate acid mantle of the skin. Harsh surfactants that rest at a pH of alkaline (8 to 9+) used daily will disrupt the acid mantle. It is best to use an acidic cleanser so the skin can rebalance itself to a normal pH, between 4.5 and 5.5. Reputable cleansers are in the acid range and can be easily tested by putting a drop on the forearm and dipping a simple pH pencil or litmus paper into the product.

I recommend non-foaming cleansing lotions, as the ingredients make maximum contact with the skin and gently, yet effectively, remove dirt and build up. Foaming cleansers tend to overstrip the skin of its natural oils, causing excess sebum production or irritation. However, if you must use a foaming cleanser, use one with low-foaming surfactants.

Toners work to refine skin texture, lift off any residual impurities, and in some cases, tighten pores. Avoid ones that contain high concentrations of alcohol as they will unnecessarily dry and irritate the skin. Instead, look for bases of witch hazel or purified water.

Proper cleansing and toning of the skin leaves your face clean, pH-balanced and receptive to the next step of your routine, and depending on the time of day, it could be Protecting, Moisturizing or Repairing.

Protect
Always, always, always wear sunscreen. Even on overcast days, 80% of ultraviolet light still filter thru the clouds. An SPF 15 is adequate for normal everyday wear. However, look for higher SPFs if you will be outdoors for longer periods of time playing sports, spending time at the beach, exercising, etc. Physical sunscreens, such as titanium dioxide and zinc oxide work far better in protecting against UVA and UVB rays than chemical sunscreens. Also, a great ingredient to look for in your daily moisturizer is SmartVector UV. This is a patented ingredient that activates the sunscreen once you are exposed to UV light. Since sunscreens begin to decompose the second they touch your skin, SmartVector UV keeps the product intact until you are physically exposed to sunlight. For many of my patients, they start their skincare routine early morning, but don’t go outside until the afternoon to grab lunch or run errands. For SPF moisturizers that contain SmartVector UV (try kaplanMD Day Cream SPF 15), they activate once you go outside, giving you longer- lasting sun protection.

In addition to an SPF moisturizer, also wear wide brim hats, long sleeve shirts, and sunglasses that cover the entire orbital region. Remember to apply SPF on the tops of your ears, back of your neck, back of your hands and décolleté. I see too much sun damage, and non-melanoma skin cancers, in these areas.

Repair
In the repair category, you find your antioxidants, vitamins and peptides. The best vehicle to deliver reparative ingredients is the Serum. Unlike creams, serums come in a variety of viscous, semi-clear liquids. The best serums have a sodium hyaluronate (hyaluronic acid) base, which can more effectively disburse peptides* and antioxidants into the skin (See kaplanMD Perfecting Serum). Whether incorporating a serum into a day or night time regimen, allow 30 to 60 seconds for absorption before applying another cream or makeup foundation.

Also, since the skin loses the most water during the night, evening is the best time for intense hydration, skin repair and rejuvenation. Night creams usually contain the most variety of anti-aging ingredients because the cream stays on your skin for the maximum amount of uninterrupted time. Good night creams at a minimum should contain reparative agents such as vitamin A (retinol), Vitamin C, and at least 1 peptide to promote cell repair and turnover.

*Part 2 of this series will list critical peptides, antioxidant and moisturizers.

Nourish
Ingredients in the repair category work to replace nutrients, boost cell renewal, or fight free-radical damage. Nourishing ingredients on the other hand work to hydrate and lubricate the skin. Obviously, the more categories each of your skincare products can fit into, the better for your skin. In other words, look for products that have an all-in-one approach where they combine multiple categories into each product. For example, a Day Cream that moisturizes, protects AND has anti-wrinkle ingredients. This allows more active ingredients to effectively penetrate your skin without a lot of filler material blocking their path.

Nourishing, moisturizing ingredients* range from simple oils like Shea Butter, Coconut Oil and Squalane to more exotic and complex ingredients, such as Acai, Seabuckthorn, Marine Collagen Spheres and Hawaiian Algae. It is hard to suggest the best moisturizer because you need to factor in how dry a person’s skin is and what other categories are being included in the moisturizer. The best suggestion in finding the right moisturizer is to try the product first. This will help ensure there is no irritation, and there is adequate hydration without a heavy, greasy after feel.

*Part 2 of this series will list critical peptides, antioxidant and moisturizers. ]]> http://www.kaplanmd.com/blog/2010/04/19/a-guide-to-cosmetic-ingredients-part-1/feed/ http://www.kaplanmd.com/blog/2010/04/05/defining-your-skincare-regimen/ http://www.kaplanmd.com/blog/2010/04/05/defining-your-skincare-regimen/#comments Mon, 05 Apr 2010 16:33:54 +0000 kaplanmd http://www.kaplanmd.com/blog/?p=318

First, decide your skincare goal ~ whether you are looking to prevent acne, balance skin tone, or start a preventative regimen to fight skin aging, it is important to define what type of results you want.

Second, select skincare products that contain ingredients designed to help treat your specific skincare goal. Remember, ingredients alone do not make a good skin care cream. Formulation and concentration of those ingredients are key in providing results.

As an aside, keep in mind that one “star” ingredient cannot make a quality skin care product. The most effective formulations combine multiple patented ingredients so you get widespread benefits with minimal side effects. Quality skincare formulations should meet 4 criteria for competence:

1. The careful selection of the right ingredients
2. Key ingredients are in the effective concentration
3. Formula is blended into a stable, physiologically compatible formulation (texture and absorption)
4. Contains a delivery system that gets functional actives to the right place at the right time.

And the third step in defining your skincare regimen is establishing a skincare routine. Don’t make it too difficult or inconvenient. Choose products that fit into a routine that mirrors your lifestyle. For example, if you barely have enough time in the morning to wash your face, don’t pick a product line that has 2-3 steps for cleansing.

There are 2 categories of skin cancer – non-malignant and malignant. Non-malignant skin cancers include Basal Cell Carcinoma and Squamous Cell Carcinoma. If detected early, these type of skin cancers are not life threatening, and can be removed as an out-patient procedure. Dr. Kaplan performs Mohs Surgery to remove Basal and Squamous Cell Carcinomas right in his dermatology office.

Melanoma is a malignant type of skin cancer. A 2007 study showed that melanoma accounts for up to 3% of all pediatric malignancies, including about 2% of malignancies in those aged younger than 20 years and 0.3%-0.4% of malignancies in pre-pubescent children. The study also showed that melanoma diagnoses are seven times more common between the ages of 10 and 20 years than between 0 and 10 years (J. Clin. Oncol. 2007;25:1363-8).

Furthermore, the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) database showed an increased incidence of nearly 3% per year during 1985-2003 in those aged 1-19 years in the United States.

Yet there remains a lack of awareness of the prevalence of melanoma in children, and some physicians, including dermatologists, still believe that children don’t get the disease.

Those who believe that children don’t get melanoma are doing their patients an injustice, and such thinking is largely to blame for the fact that diagnosis and treatment are delayed in 40% of childhood melanoma cases. A review of 13 melanoma cases in children younger than 17 years showed that 85% of the cancers were nodular in type and had a mean thickness of 3.2 mm when diagnosed; 5-year survival was a mean of 59% in the children (J. Am. Acad. Dermatol. 2005;53:816-22). The authors concluded that “the lack of awareness and reluctance to diagnose pediatric melanoma can lead to higher incidence of thick melanomas.”

It also is important to keep in mind that childhood melanoma occurs most often in white patients, with only 6.5% of cases occurring in nonwhites, which is a higher percentage than seen in adults. Also, unlike adults, there is a higher predominance of cases in females, with 56%-61% of pediatric cases occurring in girls. Further, the incidence of melanoma is increasing at a faster rate in girls aged 10-19 years than among boys in that same age group, which may reflect the popularity of tanning beds among girls.

In regards to where malignant melanoma lesions appear in children, studies show 20% of cases occur on the head and neck, and 80% occur on the trunk or extremities. The study also showed that younger children tend to get skin cancers on their head and neck; of those aged 1-4 years, 39% presented with head and neck cancers, compared with only 12% of those aged 5-19 years.

Bed bugs are small parasites that feed on the blood of humans and other warm-blooded animals. Adult bed bugs are reddish brown, oval shaped and wingless. They are mainly active at night, and can be seen by the naked eye. They are attracted to their hosts by warmth and the presence of carbon dioxide. And like a mosquito, they inject their saliva, which contains anti-coagulants and anesthetics, into your skin with one tube, while withdrawing blood with the other tube. They feed for about 5 minutes before returning to its hiding place.

Due to the anesthetics in the saliva it injects, you usually cannot feel the bite for some minutes or hours later. Bites are usually raised red bumps or flat welts, and are very itchy. Bedbug bites look very similar to mosquito bites, except they last longer. They also appear in bites of three, similar to flea bites, but they do not have the red dot in the center which is characteristic of flea bites.

Almost 50% of people get no visible sign of the bites whatsoever. For the rest of us, the bites can burn and become extremely itchy. If over-the-counter cortisone creams are not effective, see your dermatologist for a prescription strength cream or cortisone shot for more expedient relief.

In the February 15, 2010 issue of Time magazine, researchers at Rutgers University created a homemade bedbug trap using a plastic cat-food dish, an insulated jug and some dry ice pellets. They reported that this homemade contraption captured the bloodsucking critters in an infested apartment just as effectively as, if not more so than, equipment used by professional exterminators:

Get an insulated 1/3 gallon jug, like the kind sold in camping supply stores. Fill with 2.5 lbs of dry ice, which costs about $1 per lb. Tilt the spout over a cat-food dish. As the dry ice pellets slowly evaporate during the night, the open thermos spout seeps out the carbon dioxide – which falsely signals bedbugs that a breathing, blood-filled meal is nearby. The bedbugs will climb the outer surface of the dish, which you should scuff with sandpaper to give them better traction, then get stuck in its moat, made slippery smooth with a dusting of talcum powder. This is an inexpensive way to determine if you have bed bugs, or in many cases, still have bed bugs. Just an FYI…adult bedbugs can survive up to 12-18 months without feeding.

Everyone has some form of flaking on his or her scalp because of the normal process of shedding the outer layer of skin cells. But if the flaking gets obvious on your hair and clothing, it’s called dandruff. This condition is not contagious, but does have periodic flare-ups.

The medical explanation for dandruff is that it is a mild form of a skin condition called seborrheic dermatitis. This condition is caused by overactive oil glands or, in some cases, by a yeast infection. It can also be hereditary. Certain other factors can also make the dermatitis worse, such as illness, poor diet, and emotional stress. Environmental conditions like cold dry air in the wintertime, as well as over-washing your hair can also lead to dandruff flare-ups.

If your dandruff lasts a long time, or if you have unusually large flakes combined with greasy scaling on either side of your nose, behind your ears, between your eyebrows, in skin folds, or on your breast bone, you probably have a more severe form of seborrheic dermatitis. You should contact your dermatologist to get diagnosed and hear about different treatment options. There are prescription strength dandruff shampoos available as well as cortico-steriod lotions to help reduce flaking. Below are some commonly asked questions about dandruff control:

1. Do dandruff shampoos really help?

Over-the-counter dandruff shampoos can often control mild to moderate dandruff. These shampoos contain various effective ingredients, such as sulfur, salicylic acid, selenium, or tar. Remember to rinse your hair thoroughly so that no shampoo buildup occurs, since this can also cause flaking. After rinsing, apply a conditioner to smooth your hair and make it easier to comb or brush. It may also help to comb or brush your hair before shampooing to loosen the flakes so they’ll wash off more easily.

2. How can I keep dandruff away?

After your dandruff clears up, you should shampoo only as often as necessary and occasionally use the dandruff shampoo to keep it from coming back. Also keep in mind that hair products create buildup that can irritate your scalp and cause flaking. If you use a lot of hair products, and you notice flaking, try to shampoo daily. If the scales do keep coming back, your doctor may recommend that you use shampoos, lotions, creams, or ointments containing sulfur, salicylic acid, or tar to keep it under control.

3. What is cradle cap, and how is it treated?

Cradle cap, which is another form of seborrheic dermatitis, usually occurs in infants during their first month of life. It appears as dry, scaly patches on the baby’s scalp, and it may become a thick, yellow crust. Its cause is unknown. Scaly areas can also appear at the hairline, eyebrows, nose, or ears, and the dermatitis sometimes affects the diaper area or the entire body.

Treatment options vary, such as using an anti-dandruff shampoo, then oiling the scalp with a light layer of petroleum jelly (Vaseline®) to help loosen the scaly patches. However, you should first consult your dermatologist to correctly diagnose the condition and provide treatment options that are right for your baby.

Estrogen levels in women decline faster than testosterone starting in their late 20s. Now what this means for the skin is Testosterone, which is an androgenic hormone, causes the masculine qualities of testosterone to increase and become more visible. Examples include facial hair growth around the chin, jawline and cheeks, as well as oil production which can clog pores and cause blemishes. At the same time, the decrease in estrogen causes fine lines and wrinkles to develop, as well as loss of elasticity, dry and thinning skin, and a lackluster complexion. And even if you did not experience breakouts at a younger age, about a third of women will get adult acne, usually in their 30s.

As an aside, the difference between adolescent acne and adult acne is rather than presenting as painful, cystic pimples, adult (or, hormonal) acne is usually small red bumps that often run along the jaw line and around the mouth area. A few examples of how to combat hormonal acne would be to go on the birth control pill, or take spironolactone, a water pill with anti-androgenic effects.

But what exactly causes facial wrinkles? Facial wrinkles occur when the skin loses elasticity, support,and volume. This is caused by a reduction in elastic tissue, collagen, and hyaluronic acid in the skin. Basically, your skin becomes too big for the tissue underneath. The first place a woman will usually start seeing fine lines is around the eyes (the peri-orbital region) where the skin is the thinnest. Next will be the areas that crease the most when we smile or laugh, such as the nasolabial folds, which run from the corners of our nose to the outer corner of our mouth.

How do we combat the effects of Natural Hormonal Progression on the skin? I recommend a two-prong approach to anti-aging: Procedures and Products. Procedures include Botox to relax the muscles that cause creases, Laser Skin Resurfacing to smooth away fine lines and regenerate fresh new skin, and Injectible Fillers to plump deep creases, as well as plump hollows under the eyes, temples and cheeks. Depending on the look you want to achieve, a combination of different procedures might be the right solution for you.

The second prong to anti-aging is Products. If someone only uses Procedures, they are doing nothing for the quality and texture of their skin. Look for skincare products that treat all 3 causes of skin aging (time, environment and natural hormonal progression) AND contain ingredients such as Soy and Black Cohosh, which mimic the positive effects of estrogen on the skin. The key to any skincare regimen is using quality products that contain multiple active ingredients so every application is like nourishing your skin with a multivitamin.

Understanding the difference between Procedures and Products, and combining the benefits of both prongs, will give the most complete approach to fighting skin aging. And of course, limit your sun exposure!