COSMECEUTICALS 101

Cosmeceuticals can be categorized based on their function.

Cleansers

Cleansers do just what it sounds like they do - cleanse or clean. They clean off the dirt and make-up and oils and bacteria and anything else that shouldn't be there off of your face. Cleansers come as facial washes or facial exfoliants. Exfoliants contain micro beads or perhaps a mild glycolic or salicylic acid for exfoliation with the wash. These cleansers are for younger acne prone skin and may be harsh if they are used every day or if a person is on a RetinA. Facial washes are gentler and can come in a form that foams or moisturize.

Toners

In general, toners remove any traces of dirt, make-up, oils, bacteria etc. remaining on your face after you've used a cleanser.  Beyond that, toners can serve a variety of other purposes.  Some toners restore the protective acid mantle of your skin that can be removed by harsher cleansers. Some toners balance the pH of your skin.  Toners are useful to do a final residue cleansing and to balance the skins ph and act as an astringent to close the pores

Actives

Actives are any product that increases cell turnover. In this group are the RetinAs or vitamin A derivatives and the products that contain growth factors. Vitamin C as well as other ingrediaents can be considered to increase cell turnover

Vitamin A was first used to treat acne (1985) as it increases exfoliation of skin cells and increases cell turnover. It was found to have the additional benefits of improving the skin's elasticity tone and texture as well as smoothing the skin's surface and improving fine lines and wrinkles. Tretinoin in fact is the only chemical to date to receive FDA approval for anti-aging and anti-sun damage properties.

The first and most well known of the vitamin A derivative creams was tretinoin. Tretinoin also known as All-trans-retinoic acid (ATRA) is a natural occurring derivative of vitamin A (retinol). Retinoids such as tretinoin are important regulators of cell reproduction, proliferation and differentiation and are now used to treat acne as well as photo damaged skin. Tretinoin is found in Retin A, Tazorac, Renova and Avita. It is also in many new versions combined with microsphere technology for greater penetration (Retin A micro). It has also been combined with other agents either antibiotics (Ziana) or adapelene (Differin) which makes the skin less photosensitive. Also be aware there is a new more emollient Retin A that has less irritation and goes up to .05%

It is also used effectively in programs in conjunction with hydroquinone for lightening the skin (Obagi Nu Derm). Most of these are available by prescription. While there is no debate whether tretinoin improves the characteristics of aging skin over time, its use is often associated with unwelcome side effects such as irritation, peeling, redness and sun sensitivity.

There are different metabolites of vitamin A now available such as retinol, retinyl palmitate in over the counter preparations. Retinol is considered to be 20 times less potent than retinoic acid and thus need to be present in higher quantities than tretinoin in order to be effective. Once this is achieved, similar results can be obtained without the irritating side effects.

The interesting thing is that ALL of these must be converted to retinaldehyde and then all-trans retinoic acid within the skin to be effective. Which brings us to one of my recommendations in this category: Avene (Paris) has introduced Retrinal HAF.

This product contains Retinaldehyde, which is the immediate precursor to Retinoic Acid (the active ingredient in Retin A, Tazorac, and Tretinoin). Retinoic Acid is known to reduce the appearance of visible deep lines and wrinkles as well as actually preventing collagen loss. It is also known to benefit the CD44 production, which is the receptor for Hyaluronic Acid.

Hyaluronic Acid binds with water thereby plumping, or hydrating the area it is in. It is the primary ingredient in dermal fillers such as Restylane, Juvederm and Perlane, and it hydrates skin beautifully when used as a topical agent. Fragmented Hyaluronic Acid (HAF) when sized to its optimum length has an enhanced firming effect. When used together, Retinaldehyde and HAF have a synergistic action and further demonstrate reduction in the appearance of fine lines and wrinkles.

What can you really expect from this product? It will diminish the visible depth of fine lines and deeper wrinkles - It will reduce roughness and blotchiness - It will even out skin tone - It will increase hydration of the skin increasing skin firmness and hydration. For those with a more oily or acne prone complexion consider alternating with Diacneal which is Retinaldehyde mixed with a glycolic acid.

There are two products that we carry that contain growth factors: TNS Recovery Complex and Biomere anti aging crème by Neocutis

TNS Recovery Complex with NouriCel-MD (Skinmedica ) was the first product in the world to contain naturally found human growth factors, proteins, amino acids, antioxidants, matrix proteins, and soluble collagens that our bodies use to stimulate the skin to repair itself when damaged by the sun. TNS Recovery Complex helps restore the skin tone texture and appearance of fine wrinkles and age spots by increasing cell.

TNS Recovery Complex contains a professional concentration of patented NouriCel-MD. NouriCel-MD contains an array of natural human growth factors, proteins, amino acids, antioxidants, and soluble collagens, including: Transforming Growth Factor Beta (TGF-B) is responsible for collagen secretion, increased collagen fills in the depression or wrinkle and restoring the support structure of the skin. Vascular Endothelial Growth Factor (VEGF) and Hepatocyte Growth Factor (HGF) are responsible for new blood vessel formation. New blood vessels deliver nutrients to the tissue that improve growth conditions for fibroblasts, keratinocytes and collagen secretion. Keratinocyte Growth Factor (KGF) is responsible for epithelial cell growth resulting in the renewal of the epidermal layer of the skin. Interleukins (IL3 and IL6) are responsible for reduced inflammation, which leads to more rapid healing.

Neocutis Lumiere contains PSP a new skin nutrient. Inspired by fetal skin's unique properties, Neocutis’ proprietary technology uses cultured fetal skin cells to obtain an optimal, naturally balanced mixture of skin nutrients including cytokines, growth factors and antioxidants. PSP® is obtained in a biotechnology derived process following stringent manufacturing procedures. A cell bank was established starting with a single skin biopsy of fetal skin tissue.  This mixture is called PSP®, which stands for ‘Processed Skin Cell Proteins’.

Preventatives

Preventatives are products that act as an antioxidant thereby protecting skin from any free radical damage.  So what is an antioxidant?  Antioxidants are substances which can prevent or slow the oxidative damage to our bodies and our skin .When our cells use oxygen they naturally produce free radicals which can cause damage.  Antioxidants work by scavenging free radicals. Some antioxidants are natural and found in foods and some are synthetic.  Vitamin C and A are found in bright fruits and carrots, vitamin E is found in nuts and seeds and coffeberry is from the berry of the cocoa plant. Selenium is found in fish and shell fish.  Flavonoids or polyphenols are antioxidants that are found in red wine. purple grapes pomegranates and cranberries. Lycopenes are found in tomatoes watermelon and pink grapefruit.  Luteinis are found in dark green vegetables such as kale and broccoli and ligans are found in oatmeal and rye. The body also makes its own antioxidants in superoxide dismutase catalase and glutathione peroxidase. Coffee berry found in Revale is a remarkable fruit with one of the highest antioxidant score on the ORAC scale (Dept of Agricultures antioxidant scale). There are also synthetic antioxidants such as Idepenone which is the antioxidant found in Prevage (Allergan)

Protectives

Protectives are sun block products. Sunscreens: the first line of defense against aging. Sunscreens and sun blocks are probably the most effective product that you can use on your skin that will effectively retard premature aging as well as protect you from skin cancer.

The number one cause of aging has been shown to be the damaging UV radiation that comes from the sun. UV radiation causes photo aging and results in loss of elasticity of the skin due to free radical damage. UV radiation comes in different wavelengths. None of these are visible to the human eye. While visible light is 400 to 760 NM, UVA is below at 260 and 320 to 400 NM. UVB is from 290 to 320 NM.  Until recently many of the sunscreens by selectively targeting only the UVB rays. This still allows other rays such as UVA to reach the skin. UVA rays are also harmful and responsible for skin aging and skin cancer. Therefore it is important to have a sunscreen that blocks both UVA and UVB rays.

There is a new proposed regulation before the FDA that identifies the rating system for UVA sunscreens products on a scale of one to four stars. One star would represent the low UVA protection, two stars would represent medium protection, three stars higher and finally four stars the very highest UVA protection in over the counter protection. If a sunscreen does not at least carry a one star protection from UVA the FDA proposes the product must carry “no UVA protection” on the front label near the SPF value.

Presently we only have SPF (Sun Protection Factor) which is based on UVB rays. So what is the difference between sunscreens and sun blocks? They are often used interchangeably but they are different.

A sunscreen is a product that actually inactivated the UV light and makes it less damaging to the tissue. Sun blocks on the other hand act as a physical blocker or shield and do not let the UV rays reach the target tissue at all. There is another division in sunscreens. There are organic (chemical) and inorganic (physical) sunscreens.

Organic does not mean it is a sunscreen that is naturally produced; rather it simply means it is composed of carbon and hydrogen. Organic sunscreens are absorbed into the skin to some extent. Most organic sunscreens block only UVB rays. The exception is Avobenzone (Parsol) which blocks UVA. They work by absorbing the radiation (light energy) and then release it in the form of heat energy (infrared). Organics get rid of UV by creating free radicals. Ant oxidants added to the sunscreen preparation or used separately can help stop free radical damage.

Inorganic sunscreens (physical blocks) contain inert microscopic solid and particulate minerals. The most common are titanium dioxide and zinc oxide. Zinc oxide is considered very safe and blocks more UVB than any other single ingredient. Titanium Dioxide blocks some UVA and most UVB. Both ingredients lie on top of the skin and are not absorbed. They work by reflecting and refracting the UVA and UVB rays. They do not create the opportunity for free radical scavengers because they are not absorbed into the body. So there is your update on sunscreens.

UVB Sunscreens are from 260 to 320NM. They may include PABA, Ocinoxate, Homosalate, Cinoxate, Aminobenzoic Acid, Trolamine Salicylate, Ensulizole and Octisalate.

UVA Sunscreens are from 260NM to 400 NM. They contain any of the following ingredients: Oxybenzone (UVA and UVB) Avobenzone or Parasol, Benzophenone, Meradimate, Sulisobensone, Dioxybenzone, or Methyl Anthtanitate and the newest Mexoryl. (Anthelios)

Physical Blockers are from 290 up to 1800NM. These contain Titanium Dioxide, Iron Oxide and Zinc Oxide. (TIZO3).

Sunscreens of today may contain other factors that compliment the SPF factor. Studies have provided us with strong evidence that certain vitamins can protect the body cells and tissues from damage caused by environmental stress (UV radiation and chemical pollutants). Others can provide the proper environment for the correction of damage inflicted on skin hair and nails as result of aging and photo aging. Of particular interest in cosmetics are vitamins A, E, C, pro-vitamin B5 (panthenol) and their derivatives.

Waterproof or not, a sunscreen needs to be applied every two hours or its effect will diminish. Remember a teaspoon of product to cover the face is suggested to achieve full effect.
So finally my favorites are by Fallene.  TIZO3 is a completely water repellent sun block that also has a tint and acts as a pore filler.  This is great for any water sports or sports that will make you sweat.  The 58 block I use every day, yes even in the winter and it is a great daily sun block.

Moisturizers and Hydrators - What's the difference?

Most of us find that as we age we require some type of moisturizer or a hydrator. Even those of you with oily skin will still benefit with a light moisturizer to maintain your skin at its optimum condition. Moisturizers work as a protective sealant to protect your skin against the harsh elements of the environment while keeping ones skin natural moisture in. Exposure to the outside elements, excessive use of degreasing products as well as decrease sebum production with age all make the skin seem dryer with age. Menopause also adds to the dryness of the skin.

So what is the difference between a moisturizer and a hydrator? The presence of oil in the formulation defines a moisturizer as separate from a hydrator.

Moisturizers consist either of oil in water formula or water in oil formula. They may come as a crème, as a lotion or as a serum.

The oil in water emulsions are the lighter of the two and usually found in day lotions. The water in oil emulsions are heavier and often found in night treatments and creams.

The function of a moisturizer is to prevent loss of moisture in the skin.

A hydrator’s function is to add moisture back into the skin. These are best with patients with oily or normal skin. Remember it is possible and often likely that patients with oily skin are actually also dehydrated. Alcohol based cleansers, exfoliants, and other degreasing treatments can strip ones skin of the body’s natural water.

I believe every skin type benefits from some type of moisturizer or hydrator, the trick is finding the right one. By far the best hydrator available today is hyaluronic acid.

Sodium Hyaluronate, commonly known as Hyaluronic Acid, is the key water holding substance in human skin and plays a pivotal role in the appearance and texture of the skin. Clinical studies have demonstrated that aging skin has lower levels of Hyaluronic Acid than younger skin. During the aging process, the skin tissue becomes dehydrated resulting in dull, lackluster skin which shows fine lines and wrinkles. Keep in mind dryness alone doesn’t promote wrinkles and fine lines it just makes them more visible.

So we know we need to replace Hylauronic acid as we age to maintain optimal hydration however it isn’t that easy. Your skin is hydrophobic and lypophilic. This means your skin repels water and only allows oils to pass through the skins barrier. Skin care products containing this substance are often used in conjunction with vitamin C products to assist in effective penetration or combine the new nanosome technology now available to aid in penetration.

Hyalogy P-Essence beauty serum and Hyalis from the Neocutis line both contain the highest percentage of Hyaluronic acid (1%). P-Essence Beauty Serum, the essential step in the Hyalogy skin care program, contains hyaluronic acid molecules small enough to actually penetrate the epidermal intercellular spaces. This nanotechnology delivery replenishes moisture much deeper than conventional hyaluronic acid.   Some lines include growth factors (Neocutis, Skinmedica) and still others contain antioxidants (Skinmedica, Neocutis). If you are recovering from a peel or use a heavy glycolic at home you may need a true post procedure moisturizer to aid in skin healing (Neocutis Biocream or Journee) at least for the first week or so. No moisturizer or hydrant should ever be irritating.

Bleachers and skin illuminators

Bleachers and skin illuminators are both used to even out skin tone and regulate skin pigment.

Hyperpigmentation is a very common condition in which patches of skin become darker than the normal surrounding skin. This darkening occurs when there is an excess of melanin (the brown pigment in skin) and it forms deposits in the skin.

Spots may form from sun damage and larger areas such as in melasma and chloasma may be due to hormonal changes. Inflammation and trauma to the skin can also result in hyperpigmentation. These areas may fade slightly when sun exposure is minimized but they never go away completely.

As a matter of fact, hyperpigmentation is not a curable condition, just one we can learn to control. No matter what the treatment, sunscreens at all times are a must. The sunscreen used must also be a broad spectrum covering both UVB and UVA rays. Most prescription creams used to lighten the skin contain hydroquinone. A bleaching cream will lighten and fade dark patches by slowing the production of melanin.

Hydroquinone can only be used up to 2% in over the counter medication. Most medical lines contain 4% (such as Blanche by Neocutis) unless they are specially compounded in which case they can go up to 12%.

To improve penetration many creams combine tretinoin with hydroquinone (such as Epiquin or Triluma. This increases cell turnover so that the old darker cells slough off faster, speeding results. Many excellent hyperpigmentation or lightening creams combine hydroquinone with other natural ingredients that interfere with the melanin production cycle at other places than hydroquinone such as Lumixyl which also contains Licorice and Beri-Beri. Lumixyl if tfor the patient that does not want to go on Hydroquinone.

Others use acids such as glycolic or azelaic acid as found in Cosmelan Depigmentation Mask and Cosmelan 2. These acids effectively exfoliate the skin, helping to lighten the post inflammatory pigmentation. Cosmelan MD has 8% hydroquinone.

Whatever the treatment one must be patient with the treatment as one skin cycle or 28 days is required to see noticeable results.

The oh-so-delicate eye area

One of the first places many people notices changes in their appearance is in the skin around the eyes. The skinaround the eye area is delicate and thin so it is this area that shows the ravages of time first. As collagen production falls and elastic fibers weaken, the periocular skin no longer retains its form. Environmental pollutants, stress, photo damage, heredity and aging all contribute to this problem. Damage around the eye areas usually manifests itself as wrinkles, crow’s feet, dark circles or puffiness.

This delicate eye area deserves special attention. Fine lines, dark circles, "crepe" appearance are all problems that find their solution with our targeted selection of eye care products. This area has a few attributes that should be considered prior to deciding what eye cream is best for you.

The first is of course that the skin is thin in this area. Therefore moisturizing is extremely important. Products in this area should be applied gently with a patting technique and not rubbed in.

The second thing to keep in mind is because the skin is so thin; the underlying vascular structures readily show thru. This is one component of the dark rings patients often complain about. Another factor to consider is that this is the area that responds with fluid retention and puffiness depending on what is happening in your daily life. Underneath the infraorbital skin lies the SOOF or the Suborbicularis orbital fat.  This fat tends to herniate with age and can lead to the under eye puffiness that concerns most of us.  This is the fat that is usually taken out when a patient has an under eye blepharoplasty.  sleep?? This is where it will show. Too much alcohol? This is where you will be puffy. Therefore a good eye cream should contain something that hydrates, acts as an antioxidant, increases cell turnover, decreases vascularity and decreases puffiness. It should do all of this while at the same time it is non irritating and non inflammatory.

In order for an eye cream to be non irritating and non inflammatory it should NOT contain certain products. Check the label to make sure there is no alcohol or preservatives that may sensitize this delicate eye area. It should not have too strong of an acid to cause inflammation.

What your eye cream should contain:

• Antioxidants (idebenone, green tea, vitamin C, coffeeberry and others). All of these will act prophylactically to protect this delicate area from environmental and UV damage. A moisturizer, such as hyaluronic acid, is an absolute must. We like Hyalogy Eye Treatment pads and Revale eye crème.

• A growth factor to increase cell turnover ( Lumiere , Skinmedica TNS Illuminating Eye Cream ).

• An agent that decreases vascularity as well as puffiness such as caffeine which is found in Lumiere by Neocutis and Skin Medica’s illuminating Eye Cream.

My picks are as follows:

• A hydrating agent: By far the most effective are the Hyalogy Eye pads but these are for once or twice a week or before a big event.  These sheets refresh and rejuvenate while smoothing the fine lines around the eyes. The eye creams all contain some hydrator or moisturizer as well.

• The following is a summary of the products I love. For actual improvement with skin tone and texture as well as all around eye care I love Neocutis Lumiere. This product contains 30% more of the growth factor than is in their face cream. It is also filled with antioxidants and caffeine so it is active, preventative and therapeutic. This product reduces dark circles, smooths fine lines and wrinkles, reduces puffiness and refreshes fragile skin.

• I also like Skin Medica illuminating Eye Cream with Nouri-cell MD.  This peptide technology helps to help reduce the appearance of dark circles and puffiness and brighten the skin around the eyes.

• Revale eye cream contains coffeeberry and caffeine.

Post-Peel Care: How to manage your skin after a peel or laser treatment

There are many amazing peels and new lasers treatments  that have allowed us to undo much of the damage we have done to our skin. Most of these should be done by a highly qualified and knowledgeable medical doctor.

These new procedures often require little down time and the patient can return to work soon after. Still, after the procedure patients want to know what is the best post-procedural product to use to optimize the procedure's outcome. This may involve the immediate period but long after the procedure as well. In addition I am often asked what is the best foundation or cover up to use in the immediate post procedure time period. This section will address all of these questions.

First we have to start with the duration of the skin cycle. The skin regenerates new cells every 28 days. This means when you have a procedure done you will not see the true results for ABOUT A MONTH. The truth is the final result takes even longer than that, up to 6 months.

In the immediate post treatment phase let your physician guide you. Many will use something similar to Aquaphor which is a petroleum based product that allow your skin to have a protective barrier during this time. As soon as you have your new skin however consider any of the following products:

• Skin Medica Dermal Repair/Anti aging cream: Containing Vitamin C and E in the highest concentration, this cream offers free radical defense. It also contains Hyaluronic acid and essential fatty acids, all in a luxurious creamy base. This product is for skin once it is re-epithelialized but still within the first 28 days.

• Neocutis Bio-crème:  This post procedure  and anti aging cream helps promote recovery and skin restoration after cosmetic or dermatologic procedures such as chemical peels, resurfacing treatments, microdermabrasion, laser and light therapy. This product also acts as an antiaging product which enhances skin firmness and tone. Journee  can also be used post procedure.  It has antioxidants, hyaluronic acid and the protection of 30+ UVA/UVB. As in the biocreme it has a complete blend of Human Growth Factor Cytokines and Interleukins. We may be adding the bio serum 7 day 100% PSP vials as a post treatment as well.

• Revale Coffeeberry Intensive Therapy: This product is in our post op instruction sheet after the pixel.  The topical super anti oxidant coffeeberry .

So what else can you use post procedure?  As soon as the epidermis is intact again we suggest you stay with the one of two types of makeup base.  

We suggest that after a peel you use Oxygenix. Oxygenix is a cover up makeup that is a color corrective makeup and is formulated for all skin types.  Through the use of biotechnology and nanotechnology they were able to deliver to the skin tissue respiratory factors. It does this by containing live yeast cell derivatives. It is based in a breathable triple-silica base.

Overall this cover up or camouflage product promotes moisture and oxygen back into the damaged or peeled areas. The oxygen and moisture of course assist with recovery of the skin, while it allows you to return to work wearing a base foundation. Oxygenix Camouflage was shown to be the only foundation to increase the delivery of essential oxygen to the wearer's skin, up to three times more than wearing nothing at all.

Clinical studies showed that patients who had chemical peels had a two day advance recovery compared to the patients who did not use it at all. It can be used immediately after a procedure. Oxygenix also contains UVA and UVB sun protection with titanium dioxide and moisturizers, and also contains Vitamin A, E and C. This keeps the skin protected and hydrated. It will stay on the skin even with heavy exercise and swimming. It is also hypoallergenic and can be used with most skin types. Oxygenix is a aloe gel based product that does not irritate. It can be worn even if no procedure is done and a person just wants full correction.

Immediately after the peel and fractional lasers we may be adding the mesoesthetic fibercrystal mask.  We also suggest one week following a treatment a patient returns for a microdermabrassion and a collagen mask treatment.

For the final section I wanted to address how to read and evaluate a products list of ingredients.

Avoid the disappointment of buying a skin care product that ends up producing very little result: read the back of the package label!

The back label lists all active as well as inactive ingredients in a product. The active and main ingredients are usually listed first. These are the ingredients that come in the highest concentration and to be listed as an active main ingredient, a concentration of 1% or greater is needed, but this isn’t always the case.

If an ingredient falls near the end of the ingredient list, it is usually present in a very low concentration and may not be effective. So for example if you’re favorite Vitamin C serum has Vitamin C or Ascorbic Acid listed towards the middle or the end of the ingredients deck, it may not be packing as much of a punch as you'd like. Buyers beware...

The inactive ingredients listed are used for some other purpose than the product's main intent. They may be used to preserve the product, increase shelf life, and enhance its color or its fragrance.

Spend a little time reading the labels, and know what you are really putting on your skin!