Are there any wrinkle creams that work?

Television commercials would have us believe that younger skin is only a jar or bottle away. But do any of these wrinkle creams actually work?

There are only two products that I’m aware of that actually make wrinkles softer.The first is Tretinoin, also known as Retin A. Tretinoin is available by prescription or through a doctor’s office. Many Plastic Surgeons and Dermatologists actually carry it in stock, so you may not even need an appointment. Tretinoin increases collagen turnover, and over time will soften wrinkles and even out skin pigmentation. It is very irritating to skin, however, so you have to start using it very gradually. I recommend starting with the lowest strength, 0.05%. Apply a pea-size amount to clean skin at night starting Monday, Wednesday and Friday only. You may notice some dryness and redness at first. As your skin adjusts, you can increase the days you use Tretinoin until you are using it every day.

The other product that can improve the appearance of wrinkles is called TNS Serum,tns serum and it’s made by Skin Medica. This product has growth factors, retinoids, and peptides, and it’s very effective without being irritating. TNS Serum is applied morning and night. Both products take several weeks to see a difference, but they are more effective than anything available in the drug store or at the makeup counter.

 

What is your favorite skin care product?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Is hydroquinone safe?

Skin bleaching creams have been around for decades, both over the counter and by prescription. Melanin is the pigment which gives skin its color, and skin bleaching creams work by decreasing the producting of melanin. The most common ingredient in skin bleaching or lightening creams is hydroquinone.

Hydroquinone falls under the category of medications considered Generally Recognized as Safe and Effective (GRASE) by the FDA. This category contains medications that have been in use since before the formation of the FDA (e.g. aspirin). These medications did not undergo the same rigorous clinical trials demonstrating safety and effectiveness that are required for new medications to be approved. In 2006, the FDA proposed that more research be done to determine the safety of hydroquinone because of two possible safety concerns:

  1. There is some evidence that hydroquinone could be a carcinogen. Studies done on rats and mice fed the animals large amounts of hydroquinone orally, and demonstrated increased rates of cancer. We don’t know how these studies apply to humans because hydroquinone is used in much smaller doses and is applied topically, not ingested.
  2. Ochronosis has been reported after topical use of hydroquinone. This is a condition where the skin becomes darker over time. It is fairly rare, and seems to be more common in darker skin tones. It also seems to occur after prolonged use of hydroquinone, i.e. several years. But there are no data available on how long hydroquinone can safely be used without increasing the risk of ochronosis.

The large majority of skin lightening creams available on the market contain hydroquinone. Because of above-mentioned concerns for safety, alternative products have been developed that do not contain hydroquinone. The most popular of these products is Lytera®, a skin brightening cream released by Skin Medica in 2013. Lytera® contains a proprietary blend of ingredients that work to even skin tone and lighten pigmentation, and in one clinical study it was shown to be as effective as hydroquinone in lightening skin pigmentation.

www.skinmedica.com

www.skinmedica.com

Skin Medical likes to advertise Lytera® as the only FDA-approved skin lightener shown to be as effective as hydroquinone. This statement is factually correct, but slightly misleading. Lytera® is FDA-approved as an over-the-counter (OTC) medication. OTC medications do not undergo the same stringent FDA-approval process as prescription medications. Instead, OTC medications are approved automatically as long as all of the ingredients they contain are already FDA-approved. The ingredients contained in Lytera® are listed on the website, and all of the key ingredients listed have previously been used in other OTC medications. So yes, Lytera® is FDA-approved. And yes, at least one clinical study has shown it to be as effective as hydroquinone. But that doesn’t mean it’s necessarily any safer than hydroquinone, which I will remind you is also FDA-approved.

So what’s the bottom line here? Skin lightening creams have been used for decades, and are generally recognized as safe. There is some data to suggest hydroquinone could have negative side effects, but no clinical trials in humans have ever been done. Non-hydroquinone products such as Lytera® are also available, but no proof exists that they are either more or less safe than hydroquinone.  In the face of little data, you’ll just have to rely on your own judgement.

 

What do you think about hydroquinone- are you worried about negative side effects, or are you on the fence until we have more data?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is the difference between an IPL treatment and a photo facial?

IPL, BBL and fotofacial (or photo facial) are terms that you might hear without really understanding what they are. Today’s post will clarify some of that confusion. Let’s start by explaining the difference between laser treatment and IPL. They are often confused for one another, but they are actually quite different.

IPL stands for intense pulsed light. It may also be known under the name BBL, which stands for broad band light. IPL is a little bit different from a laser. Whereas a laser only produces a single wavelength of light, IPL uses a very bright light in all visible wavelengths (see image below).

Photo credit: http://blasononline.blogspot.com/

Photo credit: http://blasononline.blogspot.com/

Different filters are then applied to filter out the wavelength of light used for a particular treatment, e.g. 515 nm  to treat pigmentation, or 560 nm to treat spider veins. This flexibility allows us to use IPL to treat a wide range of clinical conditions. A photo facial (or fotofacial) is simply a particular type of IPL treatment. A conventional IPL treatment has a single target for improvement, e.g. pigmentation.  A fotofacial, in contrast, treats a wide range of conditions including age spots, redness, spider veins, and wrinkles. This is done by making several passes over the skin using the different filters required. It’s a little more time-intensive than a conventional IPL treatment, and thus costs a little bit more. But because it improves the skin in so many different ways, the fotofacial is one of my favorite treatments.

Fotofacials are initially done as a series. I usually recommend 3-5 treatments 6 weeks apart. The end result is more even pigmentation and skin tone. When fotofacials are done annually, they help maintain this even skin tone, and actually help prevent wrinkles and fine lines as well. A 10 year study was done at Stanford showing that this treatment regimen actually resulted in younger looking skin at the end of the 10 year study than at the beginning!

Do you have a question about IPL/BBL or fotofacial?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Can I use Retin A if I am pregnant?

Tretinoin, a.k.a Retin A, is a great medication for skin; it increases collagen turnover, which improves the appearance of fine lines and rough skin. It also helps with acne. Tretinoin is a prescription medication, and is available under several different brand names, e.g. Renova, Retin A, Avita. Tretinoin can be very irritating to the skin, so you may initially see some redness and flaking. I’ve talked about the correct way to use tretinoin in previous posts. Today I’m going to discuss tretinoin and pregnancy.
Topical tretinoin is a pregnancy class C medication. This means that using the medication is only recommended if the benefit of use outweighs the risk. For a cosmetic treatment like tretinoin, the safest course of action, therefore, is to stop using the medication if you are pregnant or trying to become pregnant.

www.obagi.com

www.obagi.com

But what if you recently discovered you are pregnant- do you need to worry about your baby’s exposure? Tretinoin has not actually been studied in pregnancy in humans for obvious reasons. The studies that have been done were all in rats. High doses of tretinoin were given orally to pregnant rats to see if it could cause birth defects, and the conclusion was that it can. But these studies don’t necessarily apply to the way tretinoin is used in people. The most important difference is that tretinoin is used topically, not ingested. And only very little tretinoin is absorbed into the bloodstream when the medication is applied to the skin. So even if you have used tretinoin while pregnant, most likely your baby was exposed to very little, if any, tretinoin. Stop using tretinoin as soon as you discover you are pregnant, and I would also recommend discussing any medications you are using with your Ob.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is the Difference Between Varicose Veins and Spider Veins?

Abnormal leg veins are a common complaint among men and women. They may appear as spider veins, varicose veins, or both. The two types of abnormal veins are treated differently, and by different types of doctors. So how do you know which one you have?

Varicose veins are enlarged veins which most commonly appear in the legs. They may appear bluish, red, or flesh colored, and are ropy or twisted looking in appearance.

Photo Credit: Wikipedia.com

Photo Credit: Wikipedia.com — Varicose Veins

Photo Credit: Wikipedia.com

Photo Credit: Wikipedia.com

Veins have valves that prevent blood from flowing the wrong way. The movement of the leg muscles helps move the blood back toward the heart, and the valves prevent the blood from backflowing. When these valves become incompetent and no longer function correctly, the blood pools in the legs, causing varicose veins. There are several factors that contribute to the development of varicose veins:

  • Increasing age
  • Family history of varicose veins
  • Obesity
  • Sitting or standing for long periods of time without moving around

Varicose veins may cause throbbing, cramping, or aching pain in the legs. The legs often become swollen as well. Varicose veins are a medical problem, and insurance will cover treatment for varicose veins that are symptomatic. Varicose veins are treated by a vein specialist (phlebologist) or a vascular surgeon.

In comparison to varicose veins, spider veins are much smaller (see image below) and are present just under the surface of the skin. They may appear in any area of the body, but most commonly appear on the legs and on the face.  Spider veins are also caused by a backup of blood. They commonly appear in association with varicose veins, but may also appear in people without varicose veins. Spider veins are commonly associated with

  • Hormone changes. Spider veins often appear during pregnancy.
  • Damage to the skin. Spider veins may appear near the site of a trauma such as a cut to the skin, or a surgical site.
Photo Credit: shutterstock.com

Photo Credit: shutterstock.com — Spider Veins

The good news is that effective treatment options are available for both spider veins and varicose veins. The Women’s Health webpage put out by the Department of Health and Human Services has a great information page if you’d like to find out more.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.