It's Not Just About Wrinkles [1 ed.] 1584794070, 2005032118

Citation preview

A

Park Avenue Dermatologist's

Program

for Beautiful Skin

—

in

Just

M.D.,

with

Four Minutes a Day

EAL

B.

SCHULTZ,

W

-9-

(\

It's

Not

Just

About Wrinkles O A

Park Avenue Dermatologist's Program for

Beautiful

NEAL

Skin— in Just Four Minutes a Day

B.

SCHULTZ,

M.D., with Laura Morton

STEWART, TABORI & CHANG

NEW YORK

Levesque

Editor: Jennifer

Nancy Leonard

Designer:

Production Manager: Kim Tyner

Congress Cataloging-in-Publication Data:

Library of

Schultz, Neal B. It's

not just about wrinkles

in just

day

four minutes a

a Park Avenue dermatologist's program

:

/

for beautiful skin

by Neal B. Schultz with Laura Morton.

Includes bibliographical references and index.

ISBN 1-58479-407-0 1.

Skin— Care and

hygiene.

2.

Beauty, Personal.

I.

Morton, Laura, 1964-

II.

Title.

RL87.S36 2006

616.5— dc22 2005032118

Text copyright

Photography

Published

in

in

2006 by

reserved.

any form

M.D.

©

Francois Portmann; pages 10, 20. 21

60

(top), 86,

1

10,

1

12, 153,

on pages 37, 159, 160, and 165: copyright

Stewart, Tabori

Abrams,

imprint of Harry N.

All rights

B. Schultz.

73, 75, 116, 162, 163, 168, 169, 172, 181, 182,

25, 34, 35, 47, 54, 58,

Illustrations

An

by Neal

Pages 8 and 118: copyright

credits:

60 (bottom),

32, 53,

pages

© 2006

or

No

text of this

Printed

© The

book was composed

and bound

n.

in

Canada

abrams,

inc.

subsidiary of La Martiniere Croupe

115 West 18th Street

New

York,

Mitchell

22, 23,

,

2i

Neal B. Schultz, M.D.

McCormack

Design Spot

& Chang

Inc.

portion of this

HNAII harry

©

©

book may be reproduced, stored

in

a

retrieval

system, or transmitted

by any means, mechanical, electronic, photocopying, recording, or otherwise, without

10987654321

a

187: copyright

and 173 copyright

permission from the publisher.

The

and

NY 10011

www.hnabooks.com

in

The Sans and Swiss

written

DEDICATION

o This book

is

my

dedicated to

of

what know about the

all

they have given me.

I

I

patients,

who

art of medicine;

have shared

have taught I

will

in their

priceless,

and

I

am

I

majority

be eternally grateful for

successes and failures, and

our mutual respect has created a bond that makes

rewarding than any other

me the

my

career far

more

can imagine. Their smiles and gratitude are

privileged to experience

them every

day.

CONTENTS

INTRODUCTION

CHAPTER FOUR

6

How CHAPTER ONE

16

Time

Color and Texture Color

Your Skin Got Where Is

Genetics

•

The Sun

Browns

•

Smoking

•

Reds

•

Human

•

More on Blood Vessels

CHAPTER

Concerns

It Is

a Great Healer But a Lousy Beautician

•

•

• African American-related Skin

62

Nature

78

FIVE

Diet and Skin

Texture •

Acne

Vitamins and Minerals That Help Your

•

Enlarged Pores

Complexion

Color, Texture,

CHAPTER

Some

and Contour Combinations

TWO

CHAPTER

38

Is

Nutrition

88

SIX

Beautiful Skin

Skin?

The Epidermis

Let's

•

The Dermis

Products

•

The Subcutaneous Layer

•

and

Recapture and Restore Your

Your Skin What

Fallacies about Skin

•

Take a Closer Look

at

Some Common

Cleansers

Taking the Confusion Out of Skin Care

CHAPTER THREE

48

•

•

Your Skin Type

Toners

Choosing an Active Ingredient That's Right for

The Importance

of Skin

You

Types •

Sunscreens and Moisturizers

Cosmetic, or Facial-skin Types •

Normal Skin

• Oily

CHAPTER SEVEN

/Acne-prone Skin

104

The Program

• Dry Skin

The Simple Four-step Program •

Combination Skin

•

Mature Skin

Morning Routine • Step

One: Cleanse the Skin

• Sensitive Skin

• Step Two: Prepare the Skin with Toner Fitzpatrick Skin

Types • Step Three:

•

Use an Active

Ingredient

What's Your Skin Type? (Quiz) • Step Four:

c

Apply Sunscreen

-o CHAPTER ELEVEN

Evening Routine • Step •

Botox, Collagen, and Other

One: Cleanse the Skin

Step Two: Prepare the Skin with Toner

• Step Three: • Step Four:

Use an

156 Fillers

What Does Botox Do?

Active Ingredient

Collagen and Other

Apply Moisturizer

Fillers

Restylane and Hylaform

CHAPTER EIGHT

114

CHAPTER TWELVE

Skin Type-specific Products for Your

170

Neck, Hands, and Decolletage

Program

CHAPTER THIRTEEN

Choosing Your Products Skin-care Program for Oily

/

Other Procedures

Acne-prone Skin

Skin-care Program for Combination Skin

Filler

Skin-care Program for Dry Skin

Material

• Torn

Earlobes

Skin-care Program for Mature Skin

Sclerotherapy

Skin-care Program for Normal Skin

Laser Therapy

Skin-care Program for Sensitive Skin

• Laser Hair

Skin-care Products for Other Concerns

• Tattoo •

CHAPTER NINE

Removal

Removal

Brown-spot and Age-spot Removal/Freckle

Removal

142

New

Maintain Your

•

Luster

Laser Therapy for Broken Capillaries Including Spider Veins

Choose Your Sun

Carefully

The Smoking Gun It

Can Happen

to

You

If

You Know What

to

176

Do

and Varicose Veins

Hemangiomas

•

Laser Therapy

for

•

Laser Therapy

for Periocular

•

Laser Resurfacing

Veins

Dermabrasion

CHAPTER TEN

.148

Microdermabrasion

Men's Skin Care

SOME

Not Just Venus and Mars

FINAL

THOUGHTS

190

Men's Skin Care

6

ACKNOWLEDGMENTS

194

GLOSSARY

196

SELECTED SOURCES

200

INDEX

203

Introduction FOR MORE THAN TWENTY-FIVE YEARS, gratification in

my career.

In

I've

enjoyed immense

that time working as a board-certified cosmetic

dermatologist on Park Avenue

in

New York,

I've

helped tens of thousands

of patients improve the quality and appearance of their facial skin. The

bottom-line result has always been a meaningful enhancement of patients' self-esteem

we

look better

and

we feel

overall sense of well-being

better.

As a physician,

it is

—

it's

a no-brainer:

just plain fun to be able to share in the joy

with minimal

When

it

effort,

how to finally achieve the

comes to your

face, this

when my

in

in

the mirror.

patients discover,

skin they've always

wanted.

book may be the most important

resource you'll ever encounter. Like the Rosetta stone,

mate guide

when

truly rewarding to witness

the newfound smiles of patients looking at their fresh reflection It's

my

it

will

be your

ulti-

deciphering your skin problems. After reading this book, you

"Wherever the art of medicine also

is

is

loved, there

love of humanity." HIPPOCRATES

o will at last

understand what your face needs, because

I

take the mystery,

confusion, and complexity out of skin care by revealing dermatologists'

trade secrets. This book will swing open the door to your having the flawless,

younger-looking skin you've always wanted, but just didn't

how

to get!

How?

It's

Based on

so simple.

my

clinically

you identify what's it

in

know

proven techniques, the book

really

bothering you, but

will

will also tell

simple-to-understand terms. You won't need

background to understand the techniques: You

not only help

you how to

a scientific or

will learn

how

fix

medical

to identify

what's really bothering you about your facial skin, including color issues

such as red and brown spots and texture issues such as looking or large-pored skin. You will learn

how

dry, flaky, dull-

to look into a mirror and

INTRODUCTION

identify

your problem areas, by

first

learning

what the problems are and why you have them.

Most color and texture issues can be improved through my program. (More severe issues can be You

effectively dealt with

will

also learn

how to

by a qualified dermatologist, as discussed which

correctly identify your skin type,

products to improve the quality and appearance of your

will

chapter

My program

skin.

13.)

crucial to finding the right

is

knowing your correct skin type. Once you know your skin type, you select the right products for your skin, which

in

is

predicated on

effectively learn to

will

help you recapture and restore your bright,

radiant, youthful glow. If

you follow

my

four-step

program

for thirty

days, you

will

see a noticeable difference

in

your complexion, with the improvement of any unwanted color problems and the presence of

a

softer,

smoother

By opening will

this

texture.

book, you have entered a world previously unavailable to you. This world

help you repair and rejuvenate your skin, improve your complexion, and achieve

your desired results. That way, you

can

return to your

everyday world with

an empowering sense of confidence.

And human nature want

to

be

to

better feeling,

us

drives

all

better: better looking,

and

just plain better in

every way.

During almost three decades of practice,

I

have witnessed and treated

every imaginable (and unimaginable) facial-skin

problem out

there. With

twelve thousand patients a year,

Schultz examining a patient for color

and texture

issues.

each

condition on a very personal

level.

So

my

patients,

I

it

all,

know

you simply don't accurately understand your skin

and

that,

I've

if

flaws.

abundantly clear they have no idea what the issues are that constitute in

the

first

they don't

have a

place. like

I'll

hold a mirror

about the way they

in

look,

healthier, better-looking face.

INTRODUCTION

front of their

I've

dealt with

seen Dr.

my

you're

My

like

patients

their skin

most

make

tell

me

it

problems

face and ask them to point out what

and most can

of

it

is

they want to look better and

But they can't describe with any accuracy specifically

what they don't

about

like

one exception: they can,

their skin, with

darn wrinkles, since they are the easiest flaws to articulate looks

—we

know what a

all

those

wrinkle

like!

Let's face

(sorry

it

about the pun):

We

live in

a monomaniacal world focused on

and most skin-care professionals are feeding

wrinkles,

why

small part of the big picture, and that's kles.

of course, point out

To better understand what

The biggest misconception problems

in

I

I've written this

book

But wrinkles are just a

it.

—

it's

facial-skin care

today

is

by color and texture ailments, but only 42

and wrinkles are

you've always wanted

— but

THE AIM OF

IT'S

not just about wrin-

skin.

that lines

and wrinkles are the only

Not

It

true!

million

have

actually the least important

didn't

know how

and

lines

and

the color

is

issues that probably account for your disappointment. Ninety-five million

learn that lines

and

mean, read on.

cause you dissatisfaction with your

that

right into

lines

women

wrinkles.

component

texture

are affected

You

will

quickly

of the beautiful skin

to get.

NOT JUST ABOUT WRINKLES O

The main goal wrong

with your skin,

Skin care

is

can achieve I

want

of this

to

a

all

book

is

to provide

remedy those

skin flaws,

in

or uncomfortable

trenches,

and seen

you have

me fighting

skin type,

you

a

you

will

toner,

will

in

at

to identify what's

maintain your newfound luster

a white coat staring

and

at you,

making you

dermatologist;

have gone behind enemy

I

when

it

comes

your side to help you achieve your goal of

you

will

not only understand

also have learned

how

how to

lines,

of

worked

to facial-skin care.

the simplicity of

my

will

more

in

the

And now

healthier, better-looking skin.

accurately identify your correct

to select the right products (there are five: a

an active ingredient, a sunscreen, and a moisturizer)

you have about skin care

feel

me as your

for

your skin type, so

successfully recapture and restore your bright, radiant, glowing skin.

or intimidation

clarity.

lying in bed, or drinking

about your appearance than you already do. Think

firsthand every possible ailment

After reading this book,

that

and

you need

enable you to tackle your skin while lounging on your sofa,

own personal embedded

cleanser,

of the information

a nonintimidating environment from the privacy of your own home.

your morning coffee, without a stranger

awkward

all

personal and intimidating subject, but with the help of this book you

fiercely

of this

you with

be completely

alleviated

Any

fear

once you understand

program.

INTRODUCTION

.

The

entire world of skin care

is

really

as easy as one, two, three:

1

Identifying your correct skin type

2.

Determining your

3.

Selecting

and using the

products

for

How

simple

is

that? Understanding

to take control of

you can have

such a mystery

one has ever explained what's

wrong

really

important step skin care

is

in

it.

No one has presented

with your skin

when you

winning the battle

(there are six),

remedy your

which

is

the

In fact,

most basic step

ailments. Everything

now? Because no

until

how you can

look into a mirror. That

is

the

most people don't even know

in

book

in this

is

This

is

the

first

skin-care

obtain treatment for your

book

that allows

more important

you

facial color

books

first

that are

and then

and

change

about your facial appearance?

buy

this

Why did you

book?

my book addresses The whole

picture that inspired

me

in

INTRODUCTION

must include the

color.

to write this

It

is

difficult to

the whole

book.

To me, wrinkles are just one of the

moons

of Jupiter

the universe of facial-skin defects; they are a very

small part of what causes you to be discouraged or

unhappy when you look

10

picture

and

lines

the whole picture of

important and compelling, but

describe, subjects of texture

Can you identify color and texture issues?

visibly

texture problems. Unlike skin-care

dedicated to the single defect of

facial rejuvenation.

wrinkles,

realize you're

to learn about, understand,

FOLLOWING QUESTIONS: to

type

you con-

and

more

their skin

until

ASK YOURSELF THE

What do you want

and most

first

predicated on your skin type.

locked up. Whatever you are trying to avoid about your skin won't go away it.

identify

purchasing the correct skin-care products to

Before you can break out of your self-imposed prison, you must

front

been

younger, healthier-looking skin. For most people,

for

a hit-or-miss proposition.

allow

your skin so that

effective skin care

layman's terms

in

will finally

beautiful skin forever.

So why has

Schultz talking to a patient.

Dr.

right

you

these three easy steps

you

imperfections

facial

in

the mirror.

Any woman who

has put on makeup knows, without a doubt, that not just about wrinkles. As

said

I

we

earlier,

GET A TWO-SIDED

it's

MAGNIFYING MIRROR.

a

live in

tunnel-visioned world that has put an emphasis on

and

lines

and you are

wrinkles,

when those

and wrinkles are

lines

imperfections

facial

thinking misses the whole picture. us, fixing lines

quest

overall if

fixed,

and wrinkles

nonmagnifying side and exam-

most

ine your face. List the areas you

In fact, for

for easily attainable beautiful skin.

you have an

hold up the

that line of

a minority factor

is

are sitting in a

well-lit area. First,

your

of

all

be cured. Sadly,

will

Make sure you

led to believe that

in

of

the

think need improving, describ-

Look,

ing

what

that makes you

it is

a dented door and

old, rusted car with

think those areas are not right.

you

the dented door, you

fix

have an

still

old, rusted

Next, switch the mirror to the car! That's exactly the effect of the laser-like

on

wrinkles:

fixing

ignored If

and

color

— problems we

all

texture

focus

magnifying side

problems are

List all visible flaws you'd like

have.

to remedy.

you could change anything about your face, what

would

be?

it

When you

look

see staring back? Your face rest of the world.

important

a hand

first

Whether

your ambassador to the

is

right or

start,

Chances

side of the mirror. Yikes!

else that

tion."

And

plea

for

"little

you don't

"If

that's

help

are,

side. Try to describe anything

you've easily identified your

It

isn't

like

why

fix"?

what you were expecting,

I'll

bet your

what you see I'm here:

— loud and

clear,

into

I

in

answer

five

in

forming

like to

is

will

preserve your skin so that you can look and lie

right?

w word, wrinkles.

feel

terms

in

Now

use the magnifying that is

you are seeing there anything

a resounding "yes!" As the old saying

help you do that.

each and every day.

confidence and well-being. Don't

this time,

the mirror, don't break the mirror,

can and

see

mirror.

times more glaring,

I

want

to

younger, and

about your age

.

.

.

I

change the

hear your

enable you

how

your skin by revealing to you the "insiders' secrets" about

of

you'd

or that

lines,

any

examine your face again, but

times closer and the problems are

needs a

goes,

the feature other people use most

so you can smile when you look

Next, take a few minutes to

five

it's

but remember, wrinkles are a very small part of the whole picture

of improving your skin

your face

wrong,

use the nonmagnified

or improved.

That's an easy

do you

impressions. Take a few minutes and really examine your facial features with

mirror. First,

changed

the mirror, what

in

(at least 5X).

SOS — your

to take control of

to restore, perfect, better, with

Let your skin

reflec-

and then

a renewed sense

do

it

for

you!

INTRODUCTION

11

THE DISCONNECT

o When

it

comes

sumers what

to skin-care products,

manufacturers are doing the best they can to

products do. Unfortunately,

their

and recognize the

different

components

it

of color

can be

and

consumers

difficult for

problems

texture

con-

tell

to identify

that the various skin

products address. There are hundreds of products available, such as cleansers, toners, moisturizers,

acne medications, alleged pore reducers, brown-spot faders

on and on. But when of those

products

typical

consumers look

improve

will

their color, texture,

between your

tessential disconnect

into the mirror, they

can

rarely

—the

list

goes

determine which

and contour problems. That's the quin-

unidentifiable facial-skin-care

problems and the

avail-

able, effective skin-care products out there. Inevitably,

every day

in

my

when one

office,

patient

sees another patient leaving with a

product that she doesn't have, she immediately wants the other patient's product and wants

know why

to

it

was

not included

if

want the newest,

best, latest

is

her skin-care routine.

what she's having

philosophy, even

There

in

isn't

their skin without

something you need. As

and greatest "product"

mean

any

better.

The

reality is that

rational basis for

you? Each

What's good

for

of

girlfriend's skin

Every day,

we

Why

are you buying

may

not be right for yours.

picture, this

book

a product

faster than

how can you expect

in this

INTRODUCTION

so important

It's

own

skin's

for

it

to

for

to personal-

problems and

book

will

word

of

—which expands

my Web

mouth suggesting

it

if

site,

that

it

enable you to

if

you don't

right

offer.

prod-

Nothing

doesn't work,

you are putting the wrong

to perform to your expectations?

is.

type.

your skin-care needs.

consumer marketing

aggravates a problem. But,

you don't know what the problem

the information

More

What do you want

never see the kind of improvement those products

that the product

into the right vehicle,

12

will

ruin the reputation of

if

effect.

through the advertisements and hearsay to help select the

ucts for your skin, you

problem

it?

identifies the solution to

are exposed to massive attempts at

skills to sort

even worse,

its

skin.

most people buy the wrong products

from person to person by word of mouth. And while that's great

or

patients

quest to achieve perfect

in their

your skin-care products according to your

By addressing the whole

can

common, my

us has individual problems and therefore needs a personalized program.

your

ize the selection of

have the

is

buying them. The next time you buy a skin-care

product, ask yourself the following questions: for

want what she's having"

"I

almost no relationship between the cost of a skin-care product and

expensive does not

do

the

It's

You can't

fuel fix

a

Understanding, integrating, and implementing finally target

your individual needs.

ABOUT WRINKLES

REALLY NOT JUST

IT'S

O I

have patients who come

because

lines,

into

my

element of

facial lines are the only

Botox and collagen and other

day asking

office every

can very

fillers

patients have

glad to

fix

some

kind of color or texture condition. still

Some

visible line.

fillers for their facial

problems they can

effectively help lines

have barely a

your wrinkles, but you

Botox or

their facial

nothing to solve color or texture complexion problems. their wrinkles fixed, while others

for

and

identify.

wrinkles, but they

of these patients

Regardless, almost

all

do need of these

usually respond by saying,

I

won't be pleased with your skin because

it

is

do

"I'll

be

not your

wrinkles that are making you unhappy." After

I

tell

problems, skin. I

I

I

(like

you

within sixty

disappear

just did)

their skin texture their

I

know

we

if

not

will

fix

their facial

and show them the reds and browns is

makeup

dull

I

—

lifeless

in their

— and perhaps

flaky.

adhering properly. As harsh as

isn't

seconds they understand what

—with ease. But

and alone

are not the answer

fillers

any large pores and any place

seems,

lines

hold a mirror up

and

demonstrate the places where

point out

that

patients that Botox

am

saying. Yes,

can make those

I

don't take care of the other issues,

my

patients

won't be completely satisfied.

The office,

were

last thing

I

want

spend

five

hundred

to

a thousand dollars

leave thinking they are going to be happy, and then discover

dissatisfied with

bination. Invariably,

up

for patients to

is

with happy,

in

the

when

more

Their friends want to

first

place

—

it

was

radiant, healthier-looking patients

know

their secret

wasn't the lines they

their overall color, texture,

point out the larger issues, patients take

I

it

—and they

tell

the kind of word-of-mouth marketing every physician

who

them

to

hopes

my

in

my

and contour comadvice

—and

I

end

are thrilled with the results.

"go see

Dr.

Schultz." That's

for.

COLOR AND TEXTURE— AS PRECIOUS AS A DIAMOND

—

Ask any woman what type

of

diamond she'd

like

and

she'll

probably answer with the num-

ber of carats and her favorite shape. But what about color and clarity? These two elements are

much more

the four

c's,

important

color

carat size or cut.

and If

when choosing a diamond.

clarity

are far

more meaningful

In fact, in

any jeweler

will

agree that of

determining diamond quality than

you want the best diamond, the one that sparkles and dances

in

every

INTRODUCTION

13

type of

stone

you want superior color and

light,

— not cut or carat their

—which are responsible

it

comes

your

to

facial skin.

face to be likened to a diamond that sparkles

(And

your skin looks:

contour. Every defect, dull spot, blotch, pimple, scar, pore, or

perceived

—

one

into

fits

of

these three categories.

really

who

wouldn't

the light?) There are only three

in

how

essential elements that determine, for better or worse,

and

for that perfect

size.

A comparison can be made when want

clarity

mark

color, texture,

—whether

real or

really that simple.

It's

Color problems include red and brown spots, blotches, linear red marks, and discol-

Some examples

orations.

and aging, and broken

are freckles, caused by broken pigment (color) cells from the sun

capillaries,

which are broken blood vessels (from female hormones,

foods, alcoholic beverages, acne blemishes, and, of course, previous sun exposure). Texture

problems include dullness,

The reason your

stoning.

large pored of

is

that there

skin texture disappoints

an accumulation and

is

roughness, and cobble-

flakes, scales, large pores,

your skin and inside your pores. This

is

you and appears

up

piling

of

the result of sun

dead

matte,

dull,

cells

tired,

and/or

both on the surface

damage, aging

(ugh!),

and even

genetics.

contour problems are the easiest to recognize. They most

Finally,

lines

and

wrinkles, but also include

sagging

are certainly important issues, they pale contributing to the overall

you'll

ing

be

products to

vation

will

fix

skin.

in

your skin's color and texture

the simple

components and the

explain

them

And because

your troubled

I've just

to

of

in

your

relationship of these three

in

each

of the three

of this, you'll actually

be able

elements

chapter

in

of

1),

your chang-

to find the correct skin-care

skin.

described amounts to a skin-care epiphany, which represents

writing this book:

in

skin.

simple and easy-to-understand terms

able, at last, to identify imperfections

and aging

What

I

comparison

consist of

and under-eye bags. While these

appearance

Once you understand elements (and

in

skin, jowls,

commonly

someone

finally

needed

to

empower

my

moti-

you, the consumer, with

basic skin-care information for satisfactorily improving your complexion's overall appear-

ance. After finishing this book, you

problems are and how you can do

it

know, without any doubt, what your facial-skin

to select the right

products

for

your skin. And you

without expensive prescription medications or visits to

dermatologist's

14

will

—

INTRODUCTION

office!

my — or

will

realize

any other

HARMONY

SKIN IN

O

:

Together, color, texture, If

skin color, texture,

and contour are

and contour are

to skin

what musical instruments are

balance, the appearance of your skin pleases your

in

when

eyes, just as an orchestra's music pleases your ears

tuned and

balance. The balance

in

elements are out

ness, frustration, and even shame. If

you follow

my

ment

will

in

people

sole purpose don't

talking

need a

to

about

women

I

will

unhappi-

but

I

/

I've

do

of

makeup

treatments,

succeeded. As a

of

your

of

new

see before-and-after photographs

my

my

products or

me. Everyday people

—

stylish

wear

better.

is

it

is

science.

My

well within your grasp.

professional techniques

—

just like you.

less (or

That

Once you

even no) makeup

may seem

totally

and meticulous Park and

— and

out of your

Fifth

Avenue

since learning the secrets and experiencing

and products. And you want result,

there are an

those people?

I

in

to

—

of patients

and showing the world

reaching

thought so

my

know something?

enormous number

looking better, feeling better,

what a difference education and the correct products make

become one

days

a century of experience and tens of thousands of

that for

(women and men) who walk around

Are you ready to

fifteen to thirty

not even rocket science, but

endorse

have patients

home

first

will

texture under control, you'll

hardly wear any

how know

It's

routine

with great success.

go on more smoothly and look

possibility,

—who

these

unhappy people.

understand that the skin you want

have a quarter

and

skin-care techniques, That's

to

satisfied patients to

any you do use

for

of your

If

see a rapid and noticeable improve-

will

book you

this

a miracle.

high-profile celebrity to

get your skin's color

realm of

isn't

enable you

to establish credibility.

happy and

throughout

In fact,

who have been on my program

is

cause

the root

and performing a personalized simple skin-care

your complexion's color and texture within the

What we're

I

makes

skin

only take you four minutes a day), you

skin-care routine. of real

happiness, and self-confidence.

cacophony can be

Unhappy

the instruments are properly

very simple program, which consists of understanding the three elements

of your skin (color, texture, contour)

(which

pride,

instills

of balance, the visual

to the orchestra.

let's

their skin-care goals.

get started.

INTRODUCTION

15

"The most beautiful thing

can experience

is

we

the mysterious.

ALBERT EINSTEIN

Color and Texture O I

LOVE

WHEN

PATIENTS

COME INTO MY

OFFICE and say,"Doc,you

think you could look at this thing?" and then point to a bump, an age spot,

mild acne, or eczema.

All

of these ailments are simple color and texture

issues that are easily treatable in

order to find out specifically

fortable

A

enough with

recent study

—

if

you know what you're treating

what they

are, patients

their dermatologist to talk

showed that most

have to

feel

need

—to my patients

com-

about their symptoms.

patients have only eighteen seconds

to deliver their story before the doctor interrupts. But listening listening carefully

— and

is

how

I

figured out there

was

— and a real

for the information in this book!

The most important thing a lot of doctors don't

I

learned

understand

patients, their patients will tell

—

is

in

medical school

that

if

—which

I

regret

doctors only listen to their

them what's wrong.

Patients help with

17

the diagnosis. Although most patients don't understand the nature of their problems, their

words ering

of frustration

me

to help

me

offered

and unhappiness regarding

them. Thankfully, that has helped

much

Self-perception

is

the psychological

My approach

dition.

rid of

me

build a very strong practice

and has

what

texture.

I

I

call "the

whole

picture."

can pop a pimple, but

mechanic

MORE THAN

3

MILLION

patient

to

make

I

can

fix

that won't cure

you were having a problem with the brakes on your

If

get

look.

the foundation for understanding

is

it

I

appearance.

to our overall

to skin care involves

address color or

result of their transformation.

people smiling and feeling better about the way they

the reason you bought this book;

bond we have

seen people with defects they

I've

blossom and flower as a

satisfaction from seeing

that won't

empow-

years of professional gratification. For years

thought they'd never be

so

in

have been invaluable

their skin

car,

wrinkles, but

a chronic con-

you wouldn't ask the

the horn louder, right? That's

who comes

in

and asks

for

Botox

for lines

like

a

when

r

what she

workdays are lost each year

really

needs

is

a superficial peel or lasering

problems. She senses that some-

for texture or color

because of skin diseases, with

thing about the

acne as the leading skin disease

by our market-driven society to the wrong segment

(occurring in

but

it's

I

On

smooth, lustrous, and gorgeous.

conspicuous mole

looks into a mirror. As

who

My

will

as she

—a part

that

IT'S

of

partly psychological,

fifty-two-year-old

she's had

She could left

eye

concerned,

she embraces.

is

that your is

happiness

the body's largest

and performs many important

18

is

a

been exposed

that,

lifted.

above her

right

patient,

On

woman, whose

to the sun; her face

is

skin

absolutely

numerous cosmetic procedures.

easily

pass

for thirty-five.

But she has

— something she doesn't see when she

it's

fine.

Perhaps

to

some,

the beautiful skin she has worked so hard to achieve, but to

skin

square

directed

my

that

mole takes

patient

it's

the other end of the spectrum, there are

just

a

women

absolutely not tolerate a freckle or a broken capillary on their face, chest, or hands.

point

The

far

rarely

top of

She's had her eyes done and her face

part of her

is

also influenced by the fact that her lines are the

have a

has

away from

is

but she

only skin defects that she can identify.

skin disorders).

large,

is off,

the whole picture. Her response

20 percent of all

patients seeking treatment for

a

whole picture

is

the ultimate goal

and most

NOT JUST ABOUT WRINKLES

the pursuit of healthier-looking skin.

visible organ.

bodily functions.

feet of skin (about the size of

in

It

reflects

a person's general health

An average-sized person has twenty-one

some New York

City apartments),

which serves as the

body's

frontline

ature, acts

defense against

A

sweat glands,

vast network of blood vessels

nails,

and

composition and function

to

fix;

with the results.

maybe you've Maybe you

older.

of

all

in

the skin provides oxygen and

is

appendages, including

skin

who want

people

it's

vulnerable to

injury,

2.)

disease, ailments,

my

in

make an appointment. Whatever

a

it

was

to get older

—we

skin, especially

want

just don't

that self-inflicted extrication of a

significant

amount

the

treasure trove of practical knowledge.

we grow

as

Whether from

to get old.)

whenever the

appear on every face. But your color and texture issues started

teenage years. Maybe that created

know more about

You already know there's a problem that you

help.

the red of a pimple, or from the pink spots that turn into dark spots injured, color issues

and

oil

—don't blame the messenger). But you bought

are too embarrassed to

OK

to

— see chapter

marks and lesions can appear on the

(And by the way,

facility)

body temper-

already been to a dermatologist and you've been unhappy

case, I'm glad you're here to share

Numerous types

of

complex, exposed organ

surprisingly, this

seem

to

—you're my kind

book because you know you need

can't

skin also regulates

those of you

hair follicles. (For

discolorations, and, of course, aging (sorry this

The

infection.

and motor nerves, and also

nutrients to sensory

Not

and

as a sensory and excretory organ, and synthesizes vitamin D when exposed

to ultraviolet light.

skin's

injury

of

damage

to the

(done with

zit

upper

then, not to think of these issues; with the exception of

in

is

your

grace or

levels of the skin, dark-

ening the area and even creating a hole where the pimple was. Careless

teenage years can become a persistent color and contour problem

little

skin

zit

popping from

But

later on.

it

was

easy,

pockmarks caused by chicken pox

or scars from traumatic lacerations, contour issues are not

a problem

for

most teens.

COLOR O Skin discoloration can be divided into two different groups: browns notice

some

and

it's

The blood those veins hidden all

reds.

You might

blue hues, especially under and above the eyes and sometimes on the

cheeks, but those veins appear blue Tyndall effect,

and

for the

caused by the way carry

is

only a

little

arteries, but the Tyndall effect

color issues are defined by either

light is

the sky

scattered as

it

is

blue.

It's

makes

it

look blue. So, for

called the

passes through objects.

darker than the bright red blood

bit

brown

same reason

all

intents

in

the deeper

and purposes,

or red.

COLOR AND TEXTURE

19

above and below: Sunspots, age

same thing and can

easily be

spots,

and

liver spots are all

the

removed.

Browns Whether sunspots, creet.

Brown spots appear

chest, back, arms,

tan through

cause

ment

brown patches

freckles, or

and

medium and

exposed areas including the

in

legs.

The brown family runs a

darker tan to

of this type of discoloration cells (the cells that

make

is

lighter,

like

a

in

back

spectrum

of the

hands,

hues from

of

light

principal

accumulated sun exposure, which causes the

pig-

our normal color) to produce more color as a result of

tan, but chronic

the pigment cells

full

face,

either diffuse or dis-

medium, and darker brown. The

being stimulated by the energy of the sun. This

darkening

browns are

of skin,

is

sometimes manifested as a

and prolonged exposure

specific areas

on the face

(or

to the

diffuse

sun eventually causes

any other sun-exposed area such as

the chest, back, or hands) to break.

They then overpro-

duce tan and brown pigment. This creates the discrete oval

and round spots called

liver

spots,

age spots,

or

sunspots, which can be anywhere from one-eighth to three-quarters of an inch

same degree cause less orations,

of chronic or

discrete,

in

diameter.

IT'S

NOT JUST ABOUT WRINKLES

addition, the

repeated sun exposure can

blotchy,

uneven brown discol-

which don't have as sharp a border and can be

as large as two or three inches.

20

In

Chloasma (melasma) on upper

Chloasma and melasma in

women. The cause

as a result of

during pregnancy since female tosensitivity

upper

lip.

subside

— leading

Sometimes

after birth

completely.

It

is

—

is

It

female hormones

is

common

—

to

referred to as "the

mask

experience these discolorations

at that

time and can create a pho-

of pregnancy," this

or after going off the birth control I

often

glycolic acids to aid

pill

in

skin.

— but usually never goes away skin-bleaching agents

the lightening of brown discoloration.

are the crusty, warty-looking

commonly appear on

or the

brown pigmentation can

recommend

773

Seborrheic keratoses

naturally occurring or occurring

on the forehead or cheeks, around the eyes

prolonged by breast-feeding.

that

women

for

hormones are abundant

to darkening

and other products such as

brown growths

are brown, blotchy discolorations of the face, usually seen

of both afflictions

birth control pills.

lip.

......

Seborrheic keratosis.

They are

rough, scaly, raised, greasy-looking growths that vary greatly in

size

and appearance. They might be smaller than a

eraser or larger than a quarter.

tan to brown

and

The

pencil

color can vary from yellow-

black. Seborrheic keratoses are

some-

times mistaken for warts, and because they increase

number as we get warts"

older,

— but have nothing

are caused by a large

in

they are sometimes called "senile to

do with your

number

of

normal

state of mind. cells (with

They

a normal

COLOR AND TEXTURE

21

—

amount cells

of

pigment

in

them) accumulating on the surface of the

The

skin.

extra

number

of

alone causes a brown or tan darkening. Seborrheic keratoses occur more frequently

from middle age onward, increase

common are also

skin growths

fairly

common

in

in

size

age

adults over the

of forty.

on the face, arms, and

formation, so look at your parents' skin

Certain lotions

and number over the

if

They occur

legs. Heredity

you want

and medications, when applied

on the trunk but

contributes to their

your future.

and then exposed

can also cause a brown discoloration. These products usually contain

of

oil

or lime juice, which

make the

and are the most

primarily

commonly

to look into

to the skin

years,

all

to the sun,

bergamot

or

lemon

have ingredients

that

meaning

that

skin photosensitive,

the skin overreacts to the energy of the sun

and

turns

brown

being exposed.

after

perfumes contain photosensitizers as

well.

Freckles contain normal pigment

cells

that are

making more

the process of

in

pigment than usual. The pigment in

have a whole network

tentacles, that extend

and they

cells,

around the nose. I

develop

later in

life

up

transfer

These

of dendrites, or

into the overlying

pigment

via those

dendrites into the cells above. The freckles

Hereditary freckles, which darken from the sun, on and

different

cells are

the bottom layer of the epidermis.

cells

as a kid based on genetics, and are

Some

am

referring to here are the

from sunspots, age spots, and

liver

from the degenerative effects of the sun. Freckle pigment

ones you get spots, which

cells are easily

activated by the sun, leaving you with the visible manifestation of a clustering of normal

pigment

that

is

referred to as a freckle. Freckles

can be treated by a dermatologist with a

series of superficial chemical peels or laser therapy but

Colored or pigmented moles ish

is

caused by the presence

same pigment

of cells

return after reexposure to the sun.

known medically as pigmented new. These brown-

black colored lesions can appear at any age and grow

color

various sizes and shapes. The

in

(melanocytes) that

make and

contain melanin, the

responsible for skin color.

A mole

consists of a discrete aggregation of an

increased number of these normal pigment

cells. All

mole

the two top layers of your skin.

22

are

can

IT'S

Some moles

NOT JUST ABOUT WRINKLES

are

flat

cells are in the

and look

like

a

epidermis or dermis

freckle; they are referred

NORMAL MOLES

DYSPLASTIC NEVI

VS.

(ABNORMAL MOLES) NORMAL MOLES SHAPE

Symmetrical, round,

DYSPLASTIC NEVI

Often asymmetrical:

one

or oval

half looks obviously

unlike the other

Regular, sharp,

well-defined

Irregular, concave, or

hazy;

seem to gradually

and unevenly fade into the surrounding skin

Usually one or

two

shades of tan, brown,

Varied (multiple hues) and irregular,

with haphazard

areas of tan, brown, dark

or skin color

brown or black (sometimes with a pinkish hue)

DIAMETER

Usually less than

W;

A

to

/2

or

more

can be covered by a pencil eraser

sun-exposed skin on

Most commonly on the back, chest, abdomen, and

the face, trunk, arms,

extremities, but

Concentrated on

and

legs

may also

occur on normally

unexposed areas such as buttocks, groin,

UNIFORMITY

Resemble one another

and breasts

Greatly varied; look different

from one another

COLOR AND TEXTURE

23

to

as junctional nevi and are confined to the lower layer of the epidermis.

some

raised,

become

older they can

come

Patients

some develop

enlarged, and

into

my

office

mole has a buildup

is

some

color;

and

Squeezing one

solid.

Moles can darken normally with exposure

its

change

way

color can also

if

they are the type most

become

pimples is

likely to turn into

skin cancer. Raised

inside,

mal nevus. And since

The moles most

these

of

trying to

is like

mole

sign that a there

If

painful,

is

is

it

part

is in

likely to

in

risk

into skin

comes from

visibly

rare

to

be uneven in

in color,

small

of

24

IT'S

hair follicles,

a combination

is

on

shape, or

dome-shaped and

so they often develop

of

a

junctional

also

more than

injured

it

of

brown centers and life

so,

in

as a

my

of the potential for

unnecessary

can protect

itself in

is

all

0.6 centimeters

irregular in lighter

in

shape.

edges. They

sun expo-

result of intense

of every twenty-five

abnormal mole has a 15

melanoma and

NOT JUST ABOUT WRINKLES

at birth {con-

becoming cancerous.

at risk for

average mole, and more

with dark

just better not to live with the

is

intrader-

become a melanoma.

cases can occur as a hereditary syndrome. One out

the skin

and an

congenital moles that measure larger than eight

Post-inflammatory hyperpigmentation (PIH)

When

brick;

enlarge overnight.

numbers during

— even though benign. Because it's

size,

cancer are those that are present

larger than the

time probability of becoming a

melanoma,

a mole's

in

it

Americans has dysplastic moles. This type

to injury.

becoming abnormal and

made up of a junctional nevus can

develop

usually develop sporadically

removed

is

a change

moles contain many

—cancers don't

mole may be

These moles tend

sure, but

squeeze a

into fluid.

skin cancer. Intradermal nevi are

a raised mole made up

The biggest

dysplastic

of skin (your

immediately contact your dermatologist.

diameter (about the size of a pencil eraser) are also

A

and

and during puberty and pregnancy,

to the sun,

diameter. But moles that develop after birth that are

in

all.

causing a sudden (overnight) and frightening enlargement of the mole. This

A compound nevus

genital nevi).

never change at

harmless freckles, can be the most misleading moles since

like

nothing to be alarmed by

inches

first

becomes

bleeds, itches, or

it

Junctional nevi, which look

never

be the

becoming cancer (melanoma).

to

color, or

in

so as you get

a volcano pushing your outer layer

like

it's

whereas a pimple has a semifluid content, a mole never degenerates

but

are

colored (pigmented) or just skin-colored (not pigmented). The

of cells,

it

in

time,

the time worried about their raised moles {intradermal

all

,

epidermis) up, although

Moles can change with

elevated and lighter or darker

compound nevi) which can be raised

hairs.

Some moles

to

20 percent

opinion, should always

abnormal moles

to

life-

be

become

risk.

a darkening

of the skin in

response

only two ways: darkening or thickening.

BEFORE:

Here

we see an

example of post-inflammatory hyperpigmentation from

acne that has been picked (resulting in larger

brown

spots than in un-picked pimples), especially

cheek

on her

left

(right side of photo).

AFTER: Now we observe the complete disappearance of post-inflammatory

hyperpigmentation, decreased oiliness, and smaller pores.

An example tan

occurs

that

which

darkening

of

an

is

a sun-

is

a sunburn,

after

injury to the skin.

The

skin doesn't tan to look beautiful,

tans to protect

UV

harmful

ing the skin.

PIH

of

Brown patches on the face.

and normal

ening. PIH usually fades over time,

Pityriases alba are round, patches are the

most

common

result of mild

children,

in

light

patches

A

sunlight,

with

from enter-

radiation,

common cause

very

a burn on the arm from

is

cooking

or

objects.

When

it

— by preventing

damaging

additional its

itself

it

invariably

from

touching

a burn

causes

like this

this

hot

heals,

brown dark-

skin color returns.

of the skin.

eczema, and the loss

Covered with

of color

fine scales, the light

only temporary.

is

The patches,

can occur anywhere on the body, but are most noticeable on the

face and upper arms. See a dermatologist for treatment.

Reds If

you look closely

at

your face, chances are you

will

find

one

or

more red

spots. Perhaps

you've got broken capillaries next to the corner of your nose, or small red dots that

just

won't go away. Have you ever wondered what those reds are from? Red marks are blood in

made

the skin

visible

by enlargement

blood vessels, which are very

superficial, or

near the surface of the skin. Their causes are various and include damaging

sun

female hormones, pregnancy, physical

radiation,

of these

weaken

them. Then

larger

the blood travels

Most

of the

—

in size.

Our

IT'S

and alcohol consumption.

increases and they carry more blood

skin, like the rest of

arteries, veins,

redness

we see

in

and

All

have enough blood

in

we

them

NOT JUST ABOUT WRINKLES

—and therefore

our body, has conduits through which

capillaries.

the skin

veins (venules) or capillaries, which capillaries

injury,

the vessel walls so the normal pressure of the blood actually stretches

their caliber, or diameter,

become even

26

of the tiniest skin

is

call

that

an enlargement or engorgement

—

in

both cases

— broken

of the

capillaries.

you can actually see them through the

little

Broken

skin.

The

normal, unaffected capillaries and venules are too small

be seen with the naked eye. but these blood vessels,

to

as a

reach a sufficient

result of their increase in diameter,

naked eye as

size that they are apparent to the

red curves, red

red

little

lines,

bumps, and red blotches. Most people

have them on the nose and the cheeks, and although they are usually

much

less

common on

the forehead, they can Cherry hemangiomas

occur anywhere on the face and also on the chest, neck,

and

legs.

There are basically four types

of red lesions,

as follows:

Telangiectasias: dilated blood vessels within the skin that

appear on the face and are

particularly

common

on the

side of the nose. They appear as tiny straight or curved red lines.

There are many possible causes including heredity,

overexposure to the sun. alcohol consumption,

liver

dam-

age, pregnancy normal female hormones, birth control pills,

and rosacea.

Injuries

and even mosquito

can

bites

cause telangiectasias.

Spider

Cherry hemangiomas:

sharply bordered spots that occur it

or

flat

strictly

across the

bridge of the nose.

round, tiny (almost always less

than an eighth of an inch) bright red

hemangioma

dome-shaped

as a function

of getting older in

people

who

a tendency toward them. They increase with age, but they are harmless and only

metic importance. You can

literally

have hundreds

Spider hemangiomas: small red from the center

like

they blanch (lose their red color), and bly

refills

result of

tion of tiny

little

These are most

injury).

nonraised red lines emanating

release your finger, the center

common

on the cheeks

bump

visi-

of children

injury.

tend to occur on the face

the course of normal healing after an

cos-

apply pressure on them with your finger

a minor scratch or other

Red blotches or patches:

because

when you

with blood, then the "legs" do.

and often occur as a

When you

of

of them.

raised spots with

the legs of a spider.

inher-

(or

anywhere on the body

They are made up

of

in

a very large aggrega-

enlarged blood vessels that are each too small to see with the naked eye but,

of their large

number and

their

being adjacent to each other, together appear

as a red blotch or spot.

COLOR AND TEXTURE

27

In

addition to these four basic red lesions, sevskin

eral

conditions

by

categorized

are

annoying and sometimes disfiguring red

their

color.

men

Rosacea, a chronic disease that affects

and women

in

and

their thirties, forties,

fifties,

is

characterized by redness (blotches or telangiectasias) of the central area of the face

blood vessels. The dilation

dilation of small

be

is

to note the

absence

of

the face.

develops a

The reds of

all

in

to

that

birth,

color

normal to be born with

or

some

lot

of very small

addition to the redness.

make

other part of the body,

is

it

the differentiation

of rosacea. Also, the red-

glands and collagen fibers on the nose

to

A

person affected with rhinophyma

that looks like W. C. Fields's.

of the reds in the skin. Fifty percent

enlarged capillaries on the back of in

some-

of

you see on the skin are a variation

which are ruby red

common and

oil

may

and adjoining cheeks)

bumpy, very large-pored nose

have, from

cases

to the central part (nose

a condition known as rhinophyma.

big, lumpy,

humans

their hair,

However, an easy way in

is

to

acne because acne-like in

Rosacea can sometimes cause the

enlarge, resulting

with

blemishes are present

blackheads and whiteheads

ness and blemishes are usually confined

The condition

fleeting or long lasting.

times confused Mild to moderate rosacea.

due

and are called port-wine

this condition.

If

their neck, right

stains.

It's

the port-wine stain

often referred to as a birthmark, but

is

it

under

remarkably

on the face is still

just

a

enlarged capillaries. Chronic sun exposure causes a precancerous growth/

Precancerous actinic keratosis.

condition called an actinic keratosis or solar keratosis,

which

is

a precursor

to the

middle-grade skin cancer called

squamous-cell carcinoma. Actinic keratosis most often

appears by

in

light-skinned individuals,

pink, scaly,

involved

is

and

is

characterized

rough areas. At the keratosis stage, the area

usually less than a half inch

in

size (or roughly

smaller than a dime). This spot develops a persistent rough texture,

that

28

IT'S

NOT JUST ABOUT WRINKLES

is

and

is

underscored by a pinkish or reddish hue

based on the degenerative

effects of the sun.

It

is

—

extremely important to have a dermatologist look at

any area you suspect

be an

to

actinic keratosis.

More on Blood Vessels do

red defects have to

All

not

red defects are

all

with blood vessels, but

flat, like

the ones described

above. However, the reds that occur on our skin

book

the red defects discussed in this

almost

all

facial

—are

they are either painless, discrete

flat:

broken capillaries

rosacea, a

(or telangiectasias),

Broken capillaries on the nose. These are also

combination of the two. or spider hemangiomas.

which can have

Reds are

Topical cortisone can also

can

it

makeup, but

do

learn to

it's

best to

later in this

important

is

sitive to

with topical ointments. Sulfur

be

helpful, but

break

later

Female hormones, which

cheeks and areas adjacent

slightly raised centers.

difficult to treat

adoxically)

common on

you have

use

Reds are not

capillaries.

try to

to

eliminate red tones

is

that

helpful for

some

redness.

on a temporary basis

or (par-

hide with green-tinted

difficult to

— something you

whenever possible

will

book. particularly estrogen,

when

talking

have a stimulatory

about color ailments because

on blood vessels,

effect

women tend to be more

sen-

these issues than men. Hormone-stimulated growth of the blood vessels results

an increase

in

their diameter,

Female hormones can cause possibilities: First,

a

level

develop elevated hormone or

—

less

this dilation of the

woman may

even a normal hormone

trol pills,

which causes them

commonly

in

is

in

the late stages of

almost the entire

lifetime of

factor

in

women, from

Genetics can also play a role

in

as explained

earlier.

result of three different

to

hormones

the capillaries. Second, a

—and

woman may

natural during pregnancy, as a result of birth con-

receiving the relatively elevated levels of synthetic

ment therapy; these are also a

visible,

blood vessels as a

can cause changes

—

become

be susceptible (hypersensitive)

just

levels; this

to

in

liver

disease. Third, a

hormones used

for

woman may be

hormone

replace-

blood vessel changes. These conditions span their

teens to

their sixties

causing redness of the

skin.

and seventies!

People

of Celtic ancestry

have more sensitive skin with less natural protection from the sun: therefore, the damaging effects of the

sun are stronger and stand out more

in

those patients.

COLOR AND TEXTURE

29

Lastly, diet

can cause redness

in

the skin; certain foods have direct dilating effects on the

blood vessels. These foods cause the blood vessels to temporarily increase while the food

foods

— many

minutes

common

the blood. The most

in

is

perpetrators are alcohol and spicy

us have experienced a temporary reddening or blushing

of

after eating

these foods. The effect lasts

tions, drugs,

and vitamins

vitamins) are

known

to

(the

cause

most

common

dilation of facial

of

diameter

in

fifteen to thirty

for several hours. Also, certain

which

any form

is

of niacin,

one

medicaof the

blood vessels and therefore to increase

B

their

conspicuousness.

African American-related Skin Concerns Skin color

is

mostly determined by cells called melanocytes. Within the melanocytes are

structures called

the

melanosomes, which produce the pigment melanin.

same number

of

larger than the

Americans are

dark

skin, African

kling

from sun exposure.

melanosomes

in

better protected against skin

white skin.

Americans. For example, dry skin

is

a problem

for

people

very distressing to people with black skin. Dry skin easily noticed

Pomades can decrease ples often referred to as

because

scalp

color. Try not to

overuse

common among

of

its

pomade

acne;

African

common among

skin colors, but

all

this

occurs not only

in

an

in

can happen

picking,

to

anyone, regardless of skin

African

Americans are the following conditions:

in

cases

of acne.

to prevent post-inflammatory

of the skin

Proper treatment of acne

hyperpigmentation

is

will

to avoid

may

resolve with time.

harsh scrubbing,

is

a

common

condition where pigment cells are destroyed and irregular white

spots or patches appear on the skin. The major skin pigment, melanin,

IT'S

darkens

and abrasive treatments.

Vitiligo

30

skin.

the scalp but also on the face

prevent development of noticeable dark spots, and old dark spots

The best way

may become

products that affect the forehead area.)

such as a cut or scrape, or

injury

it

African

the scalp, causing the pim-

Post-inflammatory hyperpigmentation occurs when an area after

of their

Americans appears grayish and

can block pores

hairline area. (This

hair

in

of

Because

obvious difference from the surrounding

hair dryness, but

—the

just next to the

Also

have

cancer and premature wrin-

However, certain color and texture skin problems are more

is

skin colors

melanocytes, but black skin's melanocytes have more melanosomes.

These melanosomes are also

ashy and

All

NOT JUST ABOUT WRINKLES

is

not being

produced

in

which causes

certain areas,

These are most obvious on dark

skin.

and around

are the face, hands, feet, genitalia,

Caucasians,

in

of the body.

all

form on the

to

in

whom

The most common

body openings.

which affects

vitiligo,

not always easy to cure.

treatments and medication

1

percent of the

common method

The most

prescribed by a dermatologist, but

at least

if

of treatment

that doesn't work,

PUVA

therapy

is

sites

No one

population.

total is

it

addition, vitiligo

In

areas that have been injured by cuts, scrapes, or burns.

in

knows what causes

light

skin but also occur

can occur on any portion

less conspicuous. Vitiligo

tends to develop

shaped white patches

irregularly

It

is

medicated creams

— a combination

of

— may restore the discoloration. There are also new laser

treatments available.

Keloids, or keloid scars, develop when a raised scar from a cut or wound extends

and spreads beyond the location.

size of the original

wound. These scars vary

They are commonly found on the earlobes (from ear

or forearms,

and usually occur

occur, especially

in

after

an

injury or infection.

the midchest area, but

on the chest and back. Depending on the

size,

piercing), neck, chest,

and even enlarge, especially

after

hands,

caused by acne

injury

can be treated with cortisone

injections, pressure, silicone gels, surgery, or laser treatment. Unfortunately, keloids

return

and

They can also spontaneously

most often follow an

location, keloids

shape,

in

tend to

treatment with surgery.

TEXTURE

O While feel

easy

is

it

to look into

a mirror and see color issues on your

them. But without ever looking

When you

touch your face, does

orange? Can you see flakes pores?

there

If

you have

is

a lack

textural skin

Textural skin

your

feel

of skin

skin,

smooth

problems. Don't

problems consist In

you can detect or

feel

when you

bad

of the skin

— most

being

I

find textural

three elements of color, texture,

problems

possible to

feel like the skin of

it

feel the

an

undulation of the

run your fingers across your face,

of

and to

isn't

it

you have texture issues.

us do.

dull, lifeless, or

addition, scales or flakes

gestalt of textural problems.

if

rough? Does

on your fingers? Can you

of "slip factor," or ease,

lacking a luster or glow.

When

it

at

skin,

matte

large pores

all

in

appearance,

contribute to the

be the most consequential

of the

and contour.

thinking about skin texture, imagine a piece of smooth, finished

wood

next to a

COLOR AND TEXTURE

31

wood

piece of raw, unfinished wood. Unfinished

uneven, rough,

is

whereas finished wood reflective. Painting

look worse;

it

and

dull looking,

nonreflective,

smooth, and

shiny,

is

wood

unfinished

accentuates the

only

makes

it

irregularities that

same

characterize unfinished wood. The

holds

true for your skin.

makeup on

Applying

unsatisfactory

skin with

texture (your uneven, rough, dull exterior) usually

accentuates and magnifies

and

Large pores.

defects.

By correcting your

can achieve smooth, To extend our construction metaphor a gled

roof.

As a

some

roof gets older,

of

Those turned-up edges catch unwanted to

your

each

You have an

cells:

other.

infinite

its

further,

your

epidermal

of

cells,

texture defects,

bright, lively looking skin.

facial skin is also

those

and

in

an uneven fashion, causing

causes large

flakes,

which are

undetectable ones. The skin

cells that

cells are only

lie flat

being

and

begins to peel). tion,

of

it

is

No doubt about

much more

those dead

cells

difficult to

and

find

it,

matte-looking skin.

off in strips (like

dull,

apply

lot like

it

a shin-

your new, smooth

to.

But the

skin,

register with

in

shed.

cells,

An accelerated

happens

which accu-

cellular turnover

down

into smaller,

does when you have a bad sunburn

matte skin looks

makeup

thing

partially

being shed before they have broken

cells

comes

dull,

a

The same

twigs.

Anything that decelerates the rate of cellular turnover causes you to retain

mulate

you

shingles break or start to turn up at the edges.

debris, leaves,

number

As you accumulate dead

little

of the imperfections

all

tired

and

less attractive. Not to

reality is that

that

men-

by the time you get

rid

you won't even need makeup!

Acne Acne

is

a disease characterized by a mixture of noninflamed lesions called blackheads

(open comedones) and whiteheads (closed comedones), and a variety of inflamed lesions including papules, pustules, cysts,

Acne develops multiple large

32

IT'S

oil

in

and nodules

specialized glands called

glands, a very small

NOT JUST ABOUT WRINKLES

hair,

—what you and

sebaceous

and a

I

follicles.

follicular canal,

call

pimples or

Sebaceous

zits!

follicles

have

the opening of which

is

—

what you recognize as a pore. These

on the chest and back. Noninflamed acne begins with an abnormally rapid

lesser extent,

generation of the cells lining the but

follicle,

ible

in

are located primarily on the face and, to a

follicles

follicular wall.

acne the newly generated

These

swept out

cells are normally

cells stick together

and form a

which

plug,

of the

is invis-

from the skin surface. This plug, called a microcomedo, can then enlarge to form a

whitehead or a blackhead. blood

that attract white

In

inflammatory acne, bacteria

cells (pus) to the follicle. This

in

the

follicle

release by-products

causes a break

in

more inflammation and pimples, which sometimes develop

leading to

the

follicle wall,

into larger lesions

called nodules, or cysts.

The

material (sebum) secreted by the skin's

oily

sebaceous glands

generation of acne. Without sebum, acne can't occur.

makes acne

not true!

better

stimulate production of

Acne

is

life

and thicken the outer

miserable, though, because

the one outlined its

the drying effect

is

in

the

people believe sunbathing

temporary, and

layer of skin,

essential

UV

rays actually

which then blocks pores.

a complex disease, and the degree of control varies. Acne doesn't have to

make your

of

oil

In fact,

Some

is

in this

book

will

it

treatable; a skin-care routine

is

such as

help minimize the severity of your acne, regardless

condition.

Enlarged Pores Another significant texture issue

occurs when the opening

of

is

the presence of large pores.

a sebaceous

follicular

canal

is

An enlarged pore

widely dilated. Enlarged

pores are most obvious on the nose, lower forehead, chin, and inner aspects of the cheeks, where

engorged

oil

oil

glands are most concentrated. Large pores are caused by swollen,

glands resulting from the canal being clogged, lending a

stoned look to the skin surface. The trapped

in

the

oil,

are actually just

causing

dirt

little

trapped

clogged pores and can't get really

oil

collects

in

the pores, and

dirt

thick,

from the

cobbleair

gets

black dots that people mistake for blackheads; the dots

in in

the

oil

in

the pores. Regular

to emulsify

and

pull

the

oil

soap and

just slides

dirt out.

over the

Large pores

represent an exaggerated enlargement or dilation of the outflow duct from the

gland. This

is

an issue that drives many

of

my

oil

patients crazy. Enlarged pores are the

antithesis of soft, gentle skin.

COLOR AND TEXTURE

33

an example of both color

Here's

(reds)

and texture (enlarged

pores)

problems.

AND CONTOUR COMBINATIONS

COLOR, TEXTURE, Now, you might be wondering ture

and

contour,

if

there are any conditions that exist related to color

and the answer

is

yes.

Dark

circles

under the eyes can be a combination

darkened brown pigment with enlarged surface red blood vessels called surface

adds

with the

brown and

to the dark-circle effect

reticular veins

pound dark

and are

circles

protrusion of the

fat

—

region

prone

Finally,

in turn,

cast shadows, contributing to an even darker appearance.

in this

—a

— also

fine lines in the

book

IT'S

contribute to dark circles. The under-eye

textural issue

—which only contributes

eye area, and when

light

to the darkness.

shines on those

open Venetian

will

help you treat dark circles that are caused by fine

NOT JUST ABOUT WRINKLES

blinds hanging

in

front of a

lines,

window. The

like

dry or flaky skin, and brown discoloration.

34

and contour issues com-

get a puffy appearance under the eye from either swelling or

to flaky skin

shadows much

program outlined

deep blue veins underneath,

under the eyes. These deep blue veins are called periocular

fine lines or wrinkles

you can also get

the lines cast

together with the

capillaries.

pads. This gives the area under your eyes an almost bulged appear-

Contour issues further

that,

easily treated with laser therapy. Texture

when you

ance. Those bulges,

is

tex-

and contour problems. They combine color issues by compounding a

ot color, texture,

The red blends

and

O

lines,

BEFORE: ate

brown

Note the moderdiscoloration

below the eyes (lower eyelids

and area immediately adjacent below eyelids).

AFTER:

There's an

percent reduction

brown

80-90

in

the

discoloration of the

lower eyelids and adjacent area below.

Now that you know what to

look

take your hand mirror and reexamine your face using

tor,

Use

only the nonmagnifying side of the mirror.

the face diagram provided or a plain white

piece of paper (draw a circle to represent your face) and write that

you

think

jump out side

at

need improvement. The easiest place

you now

that you've read

and examine your

different

face, ear to ear.

is

identify red

with color flaws. Color should

about color issues. Turn your head from side to the color even, or

Is

do you see

shades? Do they have sharp borders,

marks? Reds can be more

to the nose, to find the

broken capillaries

specific areas of If

you see brown

or fuzzy borders?

so look carefully

subtle,

Sometimes

looking for broken capillaries.

Can you

into the mirror, especially

helps to stretch the skin, especially next

it

that run

from your cheek onto the wings of the

nose. You can stretch the skin right below your eyelids as well since

damage

the areas on your face

tones? Are there individual areas of drastically different colors?

spots, are they different

when

all

to start

down

as a result of the angle. Don't forget to look

at

it

is

more prone

to

sun

your neck and bust area.

Next, look for textural issues by sitting with the light directed at the side of your face

tangential to your skin horrifying) facial skin.

way to

Does your

how

the

light is

36

IT'S

your

mirror. This is the easiest

lifeless?

coming

your skin. Look

the area between your eyebrows. in

and

skin look dull

vitality reflecting off

trapped

into

look at your skin for texture issues. Search for an

scales? Regardless of lack of

—while looking

If

for

in,

If

you look

you ought

absence

closer, to

not the

most

of luster in

your

can you see flakes and

be able

to easily notice

any

enlarged pores on your nose, cheeks, and

you can spot black dots, you've got

your pores, and therefore have facial-skin textural issues. See?

NOT JUST ABOUT WRINKLES

(if

dirt

We

and debris all

do!

Identify Your Color, Texture,

and Contour Flaws

USE THE MAGNIFYING SIDE OF YOUR MIRROR.

Again, using either a plain

sheet of white paper or the face diagram provided, mark

of the areas you

all

that need attention and improvement. Using the diagram,

you identified color and texture identify by

name such

issues. Write

down

all

mark

all

now

see

of the areas where

of the defects you were able to

as dull areas, broken capillaries, moles, and freckles.

COLOR AND TEXTURE

37

The expert at anything was once a beginner/' HELEN HAYES

Your Skin O LET'S FACE ably

little

made

WHEN

IT,

about what

And what

of?

when

ourselves

is

IT

COMES TO OUR

going on under the surface.

exactly does

and hair-bearing

to

it

What

do? These are questions

is

we

our skin

rarely ask

looking into a mirror.

There are two main kinds of

is

SKIN, we know remark-

skin.

human

Glabrous skin

skin:

is

nonhairy skin (glabrous skin)

found on the palms and soles and

characterized by a thick epidermis. Hair-bearing skin differs from site site:

from the scalp to the arm,

for

example.

It

also contains a

wide

range of other structures depending on the part of the skin examined: Nails are

formed from the epidermis on the fingers and

(sebaceous glands) are found attached to hair

found

in

dermis.

follicles.

toes. Oil glands

Sweat glands are

the dermis with ducts passing to the surface through the epi-

In

certain areas such as the axilla (underarm)

and groin there are

39

THE AVERAGE ADULT HAS SQUARE FEET OF SKIN

(2

specialized sweat glands called apocrine glands, which

21

SO

develop

M), r*

which weighs 7 pounds

(3.2

sense organs and nerves, blood vessels and muscles-

kg)

making the

and has approximately 300 million skin

cells.

On average

75

In fact,

first

its

and

senses

way

(1

most complex organs

of the

and

moments

skin are deeply of

to develop.

to bring

years

forty

3.2 feet

one

the brain

the earliest

sebaceous

glands, 100 sweat glands,

skin

its

later,

hand

Even to

however,

ally

in

a

it's

exactly

we

give very

little

if

thought to

we see something how

it

the

is

one

of the

womb, a baby

different story

When

it

feels

thirty,

and

—we

liter-

mouth. Twenty,

its

lose touch with our skin.

skin,

connected from

and touch

life,

m) of tiny blood vessels.

discoloration,

in

the body.

each square half inch of skin contains 10 hairs,

after puberty. In addition there are specialized

comes

to facial

troubling like a pimple or a

got there. Let's take a closer look at what

makes up our complexions.

WHAT

IS

SKIN? -O

Although you to talk

may have

learned

about the three main

three play an important part

few minutes

to learn

in

high school biology about the seven layers of skin,

layers: the epidermis, the dermis, in

how

and the subcutaneous

the outer surface of the skin appears.

about and appreciate the dynamic nature of

It's

prefer

layer. All

worth taking a

we're

this thing

I

in:

our skin!

Considering the precious cargo that skin protects, and the endless barrage of factors protects against, the fact that our skin weighs a At the surface, skin

is

mere seven pounds

is

it

pretty remarkable.

a tough outer layer that keeps the body waterproof and sealed

off

from invaders. Not only does our skin defend against the sun, cold, burns, viruses, and other germs, but

it

also

combats

all

of the

added

stress

we

force

upon

— not

to

bleaches, hair products, makeup, and abrasive skin-care products

The moment

FACT:

40

IT'S

its

surface

is

harmed, thereby

potentially

Humans shed millions of dead skin flakes

NOT JUST ABOUT WRINKLES

compromising

every day.

it

with razors,

mention

its

pollution!

barrier function,

the skin automatically reacts to block infectious ing out.

Blood

starts clotting

toward the center from

all

and a hyperproduction

a look

our

at

first

and

integrity

getting

in

and

from leak-

fluids

of skin cells kicks into gear.

sides of the wound, migrating

multiply until the skin's normal thickness Let's take

germs from

is

new

skin cells eventually

Flowing

meet and

restored.

defense against damaging factors: the top layer of

skin, the

epidermis.

THE

HUMAN

SKIN:

NORMAL ANATOMY

The three layers of the skin and relevant structures.

STRATUM CORNEUM HAIR

EPIDERMIS

SWEAT DUCT

GRANULAR LAYER PRICKLE LAYER

BASAL LAYER

~EZl

MELANOCYTE CAPILLARY

SEBACEOUS OILGLAND DERMIS VEIN

HAIR FOLLICLE

SWEAT GLAND

NERVE FIBER

SUBCUTANEOUS TISSUE

ARTERY

FIBROUS SEPTA

YOUR SKIN

41

The Epidermis Have you ever thought about how equipped our bodies with

where

it

where we need

durability

it

most and

counts. Think about the skin around our eyes: with

ments and

blinks a week, the skin here

therefore the skin

is

every step

needs

— so the skin there

is

first

away while holding

in fluids,

layer of skin in

thickest

and soles

(1.2

like

made up

is

of

many

lips

the granular

and

eyes. Facial skin

it

is

layer,

is

in

some

in

places

—

others. Although this

flaky skin or dandruff. Essentially, the

The epidermis

is

horny layer

is, in

corneum) are shed, usually

rest of our skin's

main

epidermis

—the

many

makes up our

hair

and

from bottom

layer,

the prickle

layer.

The horny

a basket weave;

like

the soles of our feet

weave acts as our primary

fact,

dead

it

is

of the stratum

associated with

skin cells from the epideroff

by our everyday

activi-

cells

from the surface.

and basal

make

layers

—which

keratin. Keratin

is

are themselves

the

same

protein

which gives you an idea of how tough and protective

produce

it,

invisibly,

defense from our environment comes from the lower

granular, prickle,

nails,

the layers of skin underneath

IT'S

line of

layers of multiple cells that

can be. The keratinocyte

42

The

constantly renewing and growing from the bottom upward and the

skin cells (stratum

of

like

negative terms since

in

mis that provide a parting protection before they are sloughed

total cell

it;

armor against damage, we mostly think

corneum

levels of the

base)

and looks (microscopically)

thicker

than

that

on.

the very outer layer of the

is

about

0.6 millimeters thick.

composed

and so

pol-

different layers of cells,

and the horny

stratum corneum,

0.12 millimeters

and body skin

The

and

infection

is

skin,

dead

keeps

four layers within

to top they are the basal (or

layer, or

ties.

It

a laminate over a piece of plywood.

layer,

thick

as possible,

on the palms

mm to 4.7 mm)

approximately

pliable

electrolytes, chemicals, clotting factors,

YOUR SKIN?

and thinnest on the around the

move-

million tiny

brutal beating they take with

stuff out.

The epidermis has is

the places

—the epidermis —which serves as a

and outside

epidermis

Skin

and

flexible

is,

ten to forty times thicker than the skin on our eyelids.

protective barrier keeping our inside stuff

IS

be as

and protection against the

This can be mainly attributed to the

HOW THICK

to

flexibility in

more than a

she

that

only as thick as a single piece of paper. But the soles of our feet, on

the other hand, require durability

lutants

Mother Nature, genius

versatile skin is?

keratin

and these

little

in

order to protect the epidermis

keratin factories

itself

make up 95 percent

it

and

of the

count of the epidermis. They are also the origin of most skin cancers, so while they

NOT JUST ABOUT WRINKLES

work hard

to protect our bodies, they

have the potential

to

be dangerous when something

goes wrong. Keratinocyte cells are created

in

divides. Then, for the next fourteen days, the cell travels

up through the

toward the surface, flattening out as

ular layers of the skin

whenever a basal

the basal layer of the epidermis

goes.

it

prickle

Finally,

DNA

its

and becomes

material

weave

part of the

of the

ready to be exfoliated (shed). This twenty-eight-day cycle stantly

to a

renewing

itself

so that the potential

damage

and gran-

the basal

much

reaches the surface and then spends another fourteen days flattening out so loses

cell

that

dead outermost horny

means

cell

it

layer,

that the epidermis

is

con-

perpetually threatening our skin

is

kept

minimum.

Making up the other 5 percent

and Langerhans

of the

Melanocytes are

cells.

epidermis are two types of cells that

melanosomes, also known as melanin. Melanin

is

a

cells:

produce pigment critical

melanocytes. Stimulated by sunlight, the melanocytes

in

melanocytes

granules called

molecule manufactured

pump

melanin

in

the

into overlying skin

cells

by a system of tubes (dendrites) that extend from the melanocyte to the overlying

cells.

As they migrate up toward the

to shield the fragile skin

There

is

only

number holds

surface, these overlying cells containing melanin help

below from the sun.

one melanocyte

per every ten keratinocytes

cell

true regardless of skin color.

melanocytes, that determines race or color

It

is

in

the epidermis,

and

this

the melanin, the granules within the

—according

to their size

and number. The more

melanin, the darker the color of the skin and the greater the protection.

Melanocytes are responsible to the sun's

UV

for the

tanning effect

rays. In order to protect

its

we

notice

when our

skin

is

exposed

nucleus from these damaging rays, the

melanocyte reacts by producing larger melanosomes. These melanosomes, under a microscope, look

like

associate with a tan the mutating it

can lead

your skin

is

to the

epidermis to

effects of the sun.

development

darkened,

it's

of

monitor the

The darker color we

because

the system to

immune

When

the

itself

it

line:

If

has been damaged.

irritants that

reactions

from

DNA of a melanocyte is damaged,

a deadly skin cancer called melanoma. Bottom

cells are part of our diverse

alert

of the keratinocyte.

actually the manifestation of our skin's attempt to protect

and damaging

Langerhans

cells

is

a shield over the nucleus

immune system, and cause rashes,

and are an important

like

they reside within the

poison

ivy.

The Langerhans

part of our protection against

external invasion.

YOUR SKIN

43

The Dermis Langerhans

found

cells are not only

the epidermis, they are also interspersed within the

in

below the epidermis. The dermis houses miles

cells of the dermis, the skin layer just

blood vessels, bringing nutrients and oxygen to wherever the epidermis

If

world

like

is

—then the dermis

conditioning

is

where your

is,

room

in

comes

electricity

three millimeters

depth on areas

in

comprises a large percentage

is

it

It's

where your

inner air

it

oil

can reach

to the epidermis, the

dermis

provides the main ingredient

holding skin together.

ALMOST 2 MILLION YEARS AGO,

barrier to the outside

thicker than the epidermis:

because

of the skin

the skin.

in

and where your blood vessels,

Compared

the back.

like

your basement.

from,

glands, sweat glands, and nerves are. The dermis

—the

house

the brick wall around your the mechanical

needed

is

it

of

is

It

for

also the site for most of the

specialized functional parts of the skin that

make

it

such

a dynamic organ.

humans developed a

early

roving

way of life and needed a

different skin to

took

7

The main

go with

million years, but

you might not know

humans

where

in

our bodies.

durability

Its

and when

any

much

fibroblasts

wounds;

it

of scar tissue

an important factor extends through the

is

make

44

IT'S

makes up

all

it

is

is

every-

three-quarters of the

also found

lining that

in

our ten-

covers our bones.

what makes collagen so important durability gives out from constant

want our collagen restored

for

collagen.

new

produced by

skin production

Because collagen

in fact,

in

scarring: scar tissue

full

is

in

order to

is

is

only created

because

produced

when

itself.

But

if

occur,

NOT JUST ABOUT WRINKLES

is

its

strength

the dermis,

it

is

If

the injury

does

able to completely

into the dermis,

sent to the scene, and scarring inevitably occurs.

dispersed to

the depth of an injury

because the epidermis

a wound does extend

is

of

in

thickness of the epidermis and into the dermis.

does not

dermis called

cells in the

long chains. Then the collagen

in

is,

and regenerate

made and

collagen

a building block

not affect the dermis, scarring repair

is

reverse the effects of wrinkling and sagging skin.

Collagen

heal skin

is

this

damage, we

mammal.

The

It

dons, ligaments, and the

an ingenious

system that allows them to

fibroblasts.

that this versatile protein

dry weight of our skin, and

offur, and their sweat glands

other

dermis

creams, but

television advertisements for antiwrinkle

it. It

dissipate heat faster than

of the

collagen. You've probably heard about collagen on

eventually lost their thick coat

multiplied, creating

component

structural

new

collagen

is

Collagen's main partner Elastin's

purpose

is

helping to maintain the skin

in

to provide

— no big surprise here —

you sleep on your side with your tace scrunched people walking around with

their

of elastin. Elastin gives the skin

elasticity,

and helps maintain

but as

many

of

us know

elasticity to the skin.

into the pillow?

And how

it's

and sagging

The dermis tains

many

especially

is

is

been stretched

or pulled.

The

fine

into place,

of the skin

break

down

the coiled filaments of elastin so that,

in

skin.

not just

different

Pheromones

filled

with proteins. Besides collagen

glands that secrete

and

the armpits

are scentless

action creates a scent that

until is

critical,

in

the dermis are sweat glands.

in

These glands provide a

body temperature, the

is

human engine from

a nerve

heat and to emotional stress to affect

Sebaceous glands also responsible for secreting

rise

overheating.

dangerously high, and

find their

fiber called

a cholinergic

when and how much we sweat

home

in

the dermal layer of skin.

oils to lubricate hair

and the

skin

itself.

flaky without moisturizer after

shaving? That's because

sebaceous gland. Take away the are covered with

hair,

about

hair,

hair

is

and

it

die.

responds

to cool ourselves

is

to

down.

Sebaceous glands are

Have you ever noticed

become

irritated

what disperses the

and the sebaceous gland

five million follicles

we would

how much sweat

fiber,

the skin on your forearms rarely gets dry, but the skin on your legs can

than

millions of coiled

where evaporation can begin

ridges of a fingertip harbor sweat glands. The trigger for

released by a single sweat gland

Humans

inter-

seconds. Both of these mechanisms permit the skin to disperse heat

Without sweat, our body temperatures would tiny

pheromones.

down. While blood vessels contract

salts to the skin surface,

necessary, keeping the fragile

Even the

fluids called

unique to every individual.

within the dermis to help regulate

body

dermis con-

they interact with bacteria at the skin's surface; this

sweat glands discharge sweat and to cool the

elastin, the

The dermal apocrine glands, located

life-sustaining service for the body: they cool us

and expand

when

vital fluids.

and

produce and secrete

nipples,

Along with the apocrine glands

fluff

hope, and that

an overused rubber band, they break and can no longer function normally. This leads

to loose

the

do

do you see

often

bounce back and snap

elastin help the skin to

often

and accompanying

invaluable distensibility after

I

How

elastin.

too well, elastin's elasticity wears out over time. Prolonged sun

all

exposure and harsh treatment like

its

shape even

skin's

make up

a protein called

face permanently scrunched? Never,

because

filaments of protein that

is

is

oil

that

and from

less effective.

on average, but thankfully

it's

more

fur.

YOUR SKIN

45

The dermis goes

well

beyond functioning as an

blood vessels, lymph channels, and nerves circulatory, metobolic,

and nervous systems

inner thermostat.

— integrating the skin

It

also very rich

is

in

immune,

into the vast

of our bodies.

The Subcutaneous Layer The bottom,

or third, layer of skin

cutis simply

means

but

The subcutis,

then,

actually considered a part of skin

is

it

"skin."

called the subcutis, or

is

is

subcutaneous

layer.

The word

technically the layer underneath the skin,

because

it

not part of the muscular system

is

below. The subcutaneous layer acts as an energy

WHERE ARE THE

OIL

reserve and an important insulating

GLANDS?

cushioning and protection.

It

is

and provides

layer,

mostly

made up

cells called lipocytes that are held together

There ore

400

to

goo

oil

glands

because

face, but only 100 per square

cutaneous layer has no

unlike the epidermis

centimeter on the rest of the

lipocytes here get

body! The only areas of skin

another name:

oil

normal deeper

and

base like

limit to

most

of their

in

With a better

knowledge

— so when

FACT: The

46

IT'S

press time under

of collagen that

cause

cellulite

as they

the ties used

in

in

doubt, get

it

that

checked

human body creates

NOT JUST ABOUT WRINKLES

a

from the

pull

It's

finishing a quilt: the fibrous

appearance

in this

lot

bands

case, our thighs!)

going on under the surface of our

no one knows more about

skin,

every 28 days.

we can

visible effects.

skin than

out.

new layer of skin

a

of cellulite.

assess when things go wrong, and deal appropriately with the

tologist

can be. The

of the subcutis to the surface of the skin.

of what's normally

cannot be stressed enough, however,

it

The bands

deposits.

fat

the middle creating the unsightly puckered little

thick

of the skin over

of collagen act like thread that pulls the puffy insides of the quilt (or

down

how

puckered appearance

divide the fat cells

the soles of the feet.

and the dermis, the sub-

cellulite.

Cellulite is the

glands

are the palms of the hands

by collagen

bands. This layer gives us our own particular shapes,

per square centimeter on the

that do not have any

of fat

It

a derma-

BEFORE: Shows good example of reds and enlarged pores.

The enlarged pores are

most noticeable on her cheeks

and

just next to her nose

are

more exaggerated there

than between her eyebrows,

where they

what

also are

some-

enlarged. In particular,

she has on her right cheek (left

side of photo) three very

enlarged pores and on her left

cheek

(right side of

photo) several moderately

enlarged pores. Note patchy redness, which

is

diffuse

on

her nose and her cheeks.

AFTER: Shows marked reduction in redness and

improved texture. Her skin just looks smoother, with a significant reduction in pore size

next to the nose (on

both sides) and a somewhat less in

dramatic improvement

pore size between the

eyebrows. Also, her skin is

less oily

water are

and the in

oil

and

better balance.

"How old would you be ifyou didn't know how old you was?" LEROY "SATCHEL" PAIGE

Your Skin Type O THE IMPORTANCE OF SKIN TYPES PATIENTS OFTEN is

too

be

oily

oily

and too

and dry

COME INTO MY

dry.

at the

And then they

same

say,

it

"But that's impossible.

right. Patients

and water are opposites of each other

who

their skin It

can't

time," or they complain of their skin being

too sensitive. Rarely do they have oil

OFFICE complaining

sometimes think that

—which they are not. Patients

complain of sensitive skin usually just can't find the correct prod-

ucts for their skin because they don't

Most people who think they have

know

sensitive skin really don't. But using

the wrong products for your skin type or worse, aggravate

it

or understand their skin type.

— erroneously

will either fail to fix

your problem,

leading you to believe you have

sensitive skin.

49

order to lay out an effective skin-care regimen,

In

two

specific skin type. There are

and the

type,

be

treating

it.

tell

paramount

to

determine your

first

distinct categories of skin type: the cosmetic, or facial-skin

Everyone has a cosmetic type and a Fitzpatrick type

Fitzpatrick skin type.

and the two types

is

it

you remarkably

different things

about your skin and how you should

For the purposes of choosing correct and effective skin-care products,

cosmetic, or facial-skin type, that

it's

the

is critical.

COSMETIC, OR FACIAL-SKIN TYPES

O Cosmetic, or facial-skin types are determined by the in

and on your

skin.

There are

relative

balance between

types of skin that

six different

category: normal, oily/acne-prone, dry, combination, mature, information about each type its

but

will follow,

first

fall

and

and water

oil

under the cosmetic-type

More

sensitive.

detailed

here's a brief description of each type

and

relation to the oil-and-water-balance table.

Normal skin occurs when the net

and

balance. Oily/acne-prone skin occurs

in

more

Combination skin

is

is

both dry and

water balance, but

is

is

and water

when

the

oily in different

older skin with underproductive

and/or retention, so the skin

oil

oil

glands,

by

many common

skin

is

normal

glands overproduce, creating are not producing

places at the

accompanied by

extra dry. Sensitive skin

easily irritated

oil

and on your

in

when water glands

than normal. Dry skin happens

oil

water. skin

result of the

can be normal

same

time.

enough Mature

less water content in

terms

of

oil

and

skin-care products.

There are many ways to determine your facial-skin type. Quizzes and questionnaires

abound on and

year;

the Internet about the state of your skin during different times of the day, month,

about the way stress affects your

products and to certain factors. But

many

activities;

skin;

about the reaction your skin has

and about any number

of the quizzes available

on the

of other specific

Internet are inaccurate,

to certain

environmental

even blending

questions about Fitzpatrick skin types with questions about cosmetic/facial-skin types.

There

is

no

logic

behind these mixed questions since these skin types are not the same.

The easiest way

to

test in the privacy of

tissue or

determine

your

—

at least

roughly

own home. The

brown paper bag. Perform the

IT'S

NOT JUST ABOUT WRINKLES

skin type

is

to

only equipment you need

test at least

before putting any products on your skin.

50

—your

Use the

an hour

tissue or

after

conduct a very simple is

some

water and a

washing your face

bag and press your

— but

entire face

L-AND-WATER-BALANCE CHART WATER CONTENT

NORMAL

INCREASED OIL

DECREASED OIL

NORMAL

Oily/Acne prone

Doesn't exist

Normal

DECREASED

Combination

Mature

Dry

INCREASED

Doesn't exist

Doesn't exist

Doesn't exist

OIL

OF SKIN

with

it.

Make

sure to blot your forehead, chin, cheeks, and nose.

appear on

skin particles

If

the tissue or bag, or you can see flakes or scales on your cheeks, you have dry skin.

have acne or some areas (mainly the forehead and nose) leave an tissue or bag, but other areas

have acne or

no

is

areas leave an

has scales,

entire face

there

all

oily

skin type

flaky skin.

Oil is

a material

Water

is

It

will

made by

also help you

your

topical preparations

skin. oily skin

oil

to thirst for water,

in

skin.

If

you

you are older and your

you have mature

skin.

your facial skin closely, can you it

be able

tell

ends

to pinpoint If

And

if

products?

everything

we do

enough

of

up,

such as

effectively.

and

sensitivity.

barely detectable.

it

is

it,

you don't notice any-

many

by most people but that

or stinging sensation or as

of the skin-type

which

The

spectrum;

of the six categories

if

redness

you read

your skin

falls

you hold up your hand mirror and examine

your skin type simply by sight? Use your fingers and

greasy feeling? Dry and flaky?

to different

proper quantity,

its

water,

oil,

that are easily tolerated

and go from there when choosing products.

Is

skin type are

can occur as a burning

will

pop

skin feels normal. Sensitivity refers to irritation from

are at the two opposite

about both types, you

skin.

If

choose skin-care products more

glands;

— products

on the

your

oily skin.

glands; as long as you have

sensitive skin. Irritation

feel

you have

residue on the

you have combination

not,

when determining your

irritate

into

appears

and your

thing out of the ordinary,

carefully

residue,

do

allow you to troubleshoot any problems that

will

made by your sweat

Dry skin and

oily

flakes, or

three real issues to consider

common

the cheeks)

you

residue or skin flakes, and you are not prone to acne, you have normal skin.

Knowing your a breakout or

(like

oily

If

How

has your skin

historically

responded

understanding your skin type, and

these questions factor

in

to

together from this point forward

is

predicated on determining your skin

All

of

YOUR SKIN TYPE

51

Once you know

type.

you

that,

be able

will

texture issues that brought us together

to find the right

the

in

place.

first

And

products to that

fix

and

the color

a promise.

is

Normal Skin Your skin

considered normal

is

pores and

smooth

is

your face

if

not

is

oily, dry,

Most people have normal

to the touch.

most people never have troubling breakouts

means

moisture. Having normal skin simply

or times

Normal skin has small

or sensitive.

when

that the water

which

skin,

could use a

their skin

and

oil in

not to say that

is

and on your

little

extra

skin are

in

balance, so your skin does not react negatively to products or external factors, and does not

break out excessively. of

If

your skin does not

coming from your pores,

oil

feel flaky or look dry,

an unusual sheen

or

through your makeup, then you probably have normal

at

11:00

skin. In

normal skin reacts best to gentle, non-soap cleansing, and a

if

you don't have puddles

and

a.m.,

breaking

isn't

oil

if

terms of a skin-care program, moisturizer.

light, oil-free

Oily/Acne-prone Skin Now that

you know what doesn't constitute an

you do break through with

two hours

oiliness

exuding from your pores, especially chin),

you have excess

specks

dency

in

to

them have

then you have Oily or

skin

because

ages

at

Oily skin

52

oil

it

oil

seem

oil filling

enlarged, they have these

you have frequent breakouts

to

be considered a curse

and

black

little

acne and a

of

or

ten-

— but

relax,

I

assure you

it

is

not.

glands and normal water content give your skin an excessive sheen and leading to acne. Pores are generally large

means

that

it

can be argued

as you grow

you produce

will

older,

caused by many

and open, and

that having oily skin

is

as your skin eventually loses

skin

It's like

factors. Heredity,

pills,

cosmetics, and the weather

IT'S

NOT JUST ABOUT WRINKLES

all

weigh

in.

It

its

good

natural water is

that oily

trading pimples for wrinkles.

hormone is

coarse

is

actually a

help retain moisture. The great advantage, then,

a slower rate than other skin types.

is

see

the T-zone (the area across your forehead, nose,

out, or

blackheads. However,

to

retention, the

literally

oily skin.

oily feel, often

thing,

washing, or you

If

blackheads (closed comedones) or whiteheads (open comedones),

acne-prone skin tends

and subject

imbalance, here are the things that do.

after

your pores always

If

you can't get

lots of

Overproductive

an

that

oil.

in

oil

levels,

true that the

pregnancy,

hormonal

birth control

shifts of

adoles-

Normal

skin.

cence sometimes stimulate sebaceous glands prone skin

into

producing more

oil,

but

oily or

acne-

not simply a teenage problem: the shiny skin that used to be associated

is

uniquely with adolescence today follows

women and men

even beyond. During pregnancy and menopause,

for

into their twenties, thirties,

and

example, hormonal imbalances

increase the activity of sebaceous glands and the resulting acne can almost drive peri-

menopausal women

When choosing these products bly harsh

to drink.

products

may

claim to specifically target excess

and can sometimes

protect skin from potential

when

detergent-based soaps are not encouraged. While

for oily skin,

trigger

oil

the overdrying effect

glands to produce even more

damage. This

reaction

glands work overtime to compensate

oil

oil,

is

oil

incredi-

as an attempt to

called reactive seborrhea,

for the loss of natural oils.

is

and occurs

Also to be avoided

are products that leave the skin feeling taut. This drying causes the upper layers of skin to shrink, restricting

When

it

and tend

flow through the pores, which leads to blockages

deciding on a moisturizer

water based, course,

oil

oil free,

says

or

(or

any skin-care product), look

noncomedogenic. Otherwise, don't even

for oily skin.

to contain less

oil,

Remember

to

use a

lotion

for

and breakouts. one

that

think of using

it.

is

labeled

unless, of

and not a cream. Lotions are

so they won't clog pores and lead

to

an acne outbreak.

lighter

Oil-free

sunscreens are readily available, so you can protect yourself from sun damage without adding extra shine or aggravating or causing acne.

YOUR SKIN TYPE

53

BEFORE:

Very oily skin,

active pimples on the

chin and forehead, and

multiple spots of increased

pigmentation on the fore-

head from previous acne lesions. In addition, there are

on the cheek

large pores

areas next to the nose as well

as the area

between the

eyebrows and above the nose. Underground pimples are evident on her left chin. Also,

on her forehead, above

her right eyebrow, depressions are apparent

where pimples

have been scratched.

AFTER: Marked ment

in

brown

Reduction

in

improve-

spots.

pore

size,

establishment of balance of oil

and water

in

her skin so

she appears neither dry nor oily,

elimination of acne

lesions (pimples

and pick

marks) on her forehead, and reduction of acne lesions on

the lower face. The overall texture appears smoother

and the skin has a brightness without an

oily sheen.

Dry Skin on your cheeks,

Dull-looking, flaky, scaly skin, especially skin. This

T-zone)

is

because your

glands (which are fewer

oil

make a normal amount

of

in

is

do not produce enough

Dry skin feels tight after cleansing, and

is

Chapping and cracking are signs

you have extremely dry

develop dry skin

flaking

skin

and

in

your T-zone,

and keep your it's

dull,

However,

it's

oil

rare to

glands

natural moisture from easily evaporating.

—unless you are over

If

in

you

forty-nine, in

which case

it

skin.

Flakiness that you see as a result of dry skin causes

a

skin.

probably related to an oil-gland problem (causing inflamed

flakiness) rather than to dry skin

might be a sign of mature

water.

characterized by small pores or a pinched look.

the T-zone area, since you have a higher concentration of

in

that area that coat the skin

see

that

sign of dry

telltale

number on your cheeks than on your

but your water glands

oil,

generally a

NOT EVERY FLAKE OF SKIN

matte appearance. Individual dry flakes of skin

causing them to contract and

stick up,

the underlying normal skin. This

different

away from

which

that form

mini-mounds

is

from piles

caused by more compact

of flakes,

is

is

pull

Flaking or scaling skin

cells

a final

is

common pathway, the result

over your face, creating

all

an indication of dry skin.

of many conditions including

other textural issues. With dry skin, the flakes are just

seborrhea, dandruff, eczema,

one

flake thick

and uniform. Both

and

flaking

dry-skin

and sunburns. have the net

flakiness

effect of

causing a

dull or

matte

appearance, but only flakes caused from dry skin are relevant

in

Flakes, is

determining your skin type.

in

general, are associated with dry skin; however,

actually a final

from inflammation winter months,

common pathway of the skin.

when

from

many

Many people

their skin is

exposed

different

to overdrying of skin.

skin to evaporate,

Exposure

to the

is

important to note that flakiness

medical conditions

—

particularly

with normal skin develop dry skin during the

to the elements.

and extremely low temperatures and low humidity causes moisture on the

it

Dryness

—components

is

exacerbated by wind

of cold

air.

Cold, dry

air

and wind accelerates the process, contributing

sun also has a drying

effect,

as does using certain

cosmetics, harsh soaps, hot water, or bathing excessively. Dry skin can also be a sign of other health conditions, so

dermatologist

if

for dermatitis,

your skin

eczema,

seems abnormally

dry,

psoriasis, or seborrhea.

also cause dry skin, as can certain drugs

like

be sure

to

check with your

An underactive

antihistamines, diuretics,

thyroid

can

and antispasmodics.

YOUR SKIN TYPE

55

Combination Skin Combination skin Overproductive

cause

both

is

glands

oil

this skin type.

your face back

oily in

Caring

and dry simultaneously.

a two-for-one special

and underproductive water glands

the T-zone for

It's

combination skin

is

simply about getting

be easy

a

It's

bit of

a slippery slope since

to further overdry

T-zone you

in

your cheeks.

If

in

in

oil

you don't necessarily need it

you

area,

will

people

moisture to the T-zone;

help

in

of

oil

it

can

from the

then need to

keep

in

mind

that

using moisturizer only

in fact,

difficult

who

than addressing combination skin

also have sensitive skin.

In

you who think you have

is

addressing combina-

these rare cases, three different skin

types simultaneously converge. But because this book can't be

encourage those

oil,

the best route for people with combination skin.

more

thing

tion skin in

is

to return

without remov-

the process of removing the excess

restore that moisture again with an oil-free or water-based moisturizer. But

The only

the zones of

all

your zeal to remove the excess

remove necessary water from the cheek

fact

where you need

the cheeks

in

balance.

in

To restore your skin's natural balance, you need to remove the excess ing the water.

— lucky you!

this rare skin

all

things to

people,

all

I

combination to seek professional

caring for your skin.

Mature Skin Mature skin

is

of the natural

As a

the only skin type that

truly

correlated with age.

aging process, which causes underactivity of both

result, skin is diffusely

quality.

is

dry rough, lacking sheen, and matte.

Mature skin acts very much

like

dry skin,

It

It

occurs as the

oil

and water glands.

has an almost leathery

and should be treated as such,

attention paid to mild but effective exfoliation to increase cell turnover

the skin's appearance.

(In

my

office

we

result

and

with extra to refresh

expedite this process with stronger glycolic

acid treatments.) Normally, retain

water

oil

helps protect, lubricate, soften, and add sheen to your skin

for

normal moisture. But

glands (and corresponding loss Thankfully, though,

56

IT'S

oil)

mature

skin, the naturally occurring loss of

and the underactive water glands

amounts

of

or oil-containing products.

NOT JUST ABOUT WRINKLES

oil

and water

oil

result in dull skin.

you can have satisfactory control over the dryness

replacing the decreased

based

of

in

— and helps skin

of

your skin by

with appropriate moisturizers

and

oil-

Mature skin

medium

lines

is

typically skin that

and

is

wrinkles, broken blood vessels

three layers of the skin, discoloration, cent, almost

becoming a window

and deep

and

capillaries,

wrinkling.

deeper layers

into the

many

It

signs of aging: fine and

roughness, thinning of

can sometimes look

of the skin,

because

all

translu-

of the thinning

your skin layers. That's why you can see broken capillaries and veins more easily

of

all

in

older skin. Mature skin

barrier

which

very fragile

is

— or protective — layer

is

the structural layer,

The best way or external, it

beginning to show

of skin,

because the upper epidermal

which

and the lower

of visible skin aging.

is

layer,

are thinning.

fat layer

The sun

the

is

has diminished; and both the middle dermal

to prevent the signs of aging skin

causes

layer,

is

to

minimize exposure to the

extrinsic,

the main source of extrinsic aging

— and

never, ever, too late for the protective benefits of sunscreen.

is

Mature skin benefits greatly from the application of products with "actives" such as

make mature

alpha- or beta hydroxy acids, which can healthier.

many

These products

be discussed

at length later on, but

it

is

important to note that

moisturizers contain these ingredients, which, as long as they have excellent mois-

turizing additives, are

the increasing

care

will

decades younger and

skin look

line

recommended

number

of

for

people with mature

people with mature

skin. In fact, to

accommodate

skin, three of the six moisturizers in

my

skin-

are formulated exclusively for mature skin.

Sensitive Skin Sensitive skin, regardless of

its oil

or water content,

is

easily irritated by

skin-care products and cosmetics and by the environment.

It

is

many common

typically itchy

and

vari-

ably inflamed (pink, red, scaly, or crusty). Certain foods, and just about anything that

comes use

into

contact with the skin, can cause flare-ups; therefore, the fewer products you

—with the fewest ingredients —the

of a negative reaction.

That way you are minimizing the chances

Any product you do use should be fragrance

hypoallergenic. Fragrance

is

the leading

products, but there are many, topical irritants to

better.

cause

many products

of contact allergy

free,

free,

and

from topically applied

available that are fragrance free. Other

be avoided are preservatives, alpha hydroxy acids,

tretinoin, salicylic

acid, vitamin E, lanolin, fabric softeners, fragranced clothing detergents, oils.

dye

Avoid using toners and astringents unless they are alcohol

and essential

free. Sensitive skin

is,

unsurprisingly, hypersensitive to the ultraviolet rays of the sun, so an effective sunblock

YOUR SKIN TYPE

57

(SPF 30)

is

encouraged

a cream or

and alcohol-

gels

vehicle;

lotion

in

based products are too

irritating.

determining and describing the

In

skin

you are

only

one piece

other

facial-skin type

in,

or dry your skin

— leading

oily

easily

thereby

dam-

premature wrin-

age spots, and

kling,

This

to

is

how

how

but by

is,

your skin burns and

aged

The

of the puzzle.

not determined by

is

is

skin cancer.

second categorization

is

the

Fitzpatrick skin type.

Diffuse blotchy redness

is

very

common

in easily irritated

sensitive skin.

FITZPATRICK SKIN TYPES The

six

types of skin defined as Fitzpatrick skin types were

Fitzpatrick, M.D., professor

wrinkling of the skin. is all

first

characterized by

emeritus of dermatology at Harvard University. The

Thomas

same vulner-

predisposes you to sunburn also predisposes you to skin cancer and premature

ability that

type

O

The

fairer

your

skin, the greater

about assessing skin-cancer

risk factors

your

risk.

Determining your Fitzpatrick

as well as predicting vulnerability to and

thereby prevention of premature and unnecessary photoaging, which manifests as

forms

of

capillaries,

7ype

/

58

skin never tansII,

III,

and

green eyes. Type

IT'S

including premature wrinkling,

sun/age spots, broken

cobblestoning, dullness, enlarged pores, and decreased

(as are types or

damage

degenerative sun

II

—

it

IV),

skin

always burns

and people is

—and

it

NOT JUST ABOUT WRINKLES

elasticity.

freckles easily. Type

I

skin

is

Caucasian

with this type of skin have red or blond hair

very similar to type

I,

in

that

it

is fair

many

and white and

and blue freckles

FITZPATRICK SKIN TYPES SKIN TYPE

NATURAL SKIN COLOR

RESPONSE TO SUN EXPOSURE

Caucasian

Always burns, never tans

Caucasian

Usually burns,

tans minimally

Burns minimally, tans

Caucasian

gradually, uniformly

Caucasian

Light

brown

(Asian and Hispanic)

Dark brown (African American)

but

easily,

of

it

is

slightly less sensitive to the

sun and

eye colors, including hazel and brown. While tan

effort,

lightly.

Type

III

is

borne by people with a broader range

this skin

type burns

light

V

skin

difficult to

hair.

III

brown, and people with

have brown or black

skin

hair

is

this skin

brown and always

VI skin is

eyes. Type VI skin carries the lowest risks for skin cancer,

The

usually Caucasian, nat-

type tend to have brown or black

naturally light

and eyes. 7ype

is

brown or

UV

Fitzpatrick skin types

due

hair.

tans. People with

black,

and tans are

see. People with type VI skin (African Americans) also have black hair

from the sun's damaging

some

have white skin and blond or brown

7ype V skin (often Hispanic or Asian) type

can, with

and

7ype IV skin almost always tans darkly and rarely burns. This skin darker or

it

skin usually tans lightly instead of forming discrete freckles,

only burns occasionally. People with type

urally

easily,

and brown

to the inherent protection

rays afforded by dark, deeply pigmented skin.

can be broadly regarded as generally grouping skin types

according to ethnic origins. Types

I

and

II

tend to belong to people from Celtic (Scotch-Irish).

YOUR SKIN TYPE

59

top: TYPE

"pretty"

V SKIN:

I

consider this a

example of type V

specific lesions or defects

No

skin.

demonstrable

here.

bottom: TYPE of type VI skin type

A good example

VI SKIN:

skin. In addition,

her facial

normal.

is

Scandinavian, or Northern European

backgrounds; types from

III

backgrounds

Mediterranean

Italians,

people

or IV to

Spaniards, and Greeks. East

Asians and Hispanics are generally type

V,

and sub-Saharan Africans

and African Americans, type ethnicities'

mean

evolution

and

skin type

own

responding

specific

own

history

sun exposure

to

—

is

needs and

crucial to evaluating your In

back-

— using the above type cat-

egories as well as your

risks.

But

variation

that regardless of your

ground, determining your

in

VI.

short, Fitzpatrick skin types

represent a scale of the skin's photosensitivity,

which

will

which sunscreens best to protect yourself from

all

types of sun

damage

—from wrinkles

to

to

help

in

use,

deciding

and how

precancers to actual

skin cancer.

Once you determine your two a

line of

your skin

60

IT'S

skin types

skin-care products that in

the best

way

will

possible.

NOT JUST ABOUT WRINKLES

—

facial

and

Fitzpatrick

—

it

will

be easy

to

choose

cleanse, rejuvenate, moisturize, protect, and benefit

What's Your Skin Type?

CIRCLE ALL THAT APPLY.

1.

In

the past three months,

undersurface 2.

The

skin

on

I

have had pimples, blackheads, whiteheads, or

bumps on my face, and/or

my cheeks,

but not around

oily skin.

my

nose or between

my

eyebrows,

is

dry, flaky,

or tight. 3.

age"

I'm "of a certain

and chin)

is

— the skin of my entire

dry, flaky, scaling, or thirsting for

face, including

myT-zone (forehead, nose,

moisture and very

difficult to

keep

moisturized. 4.

Many

different

common

skin-care products easily irritate

my facial

skin causing

redness, a burning sensation, stinging, pain, and/or swelling. 5.

My facial bumps

If

skin

is

neither prone to pimples, blackheads, whiteheads, or undersurface

nor dry or easily irritated by different skin-care products.

the following numbers are

1:

acne prone

2:

dry

3:

mature

circled,

then your skin type

1

& 4: acne prone / oily and sensitive 2 & 3: mature 2 & 4: dry and sensitive 3 & 4: mature and sensitive 1, 2, & 4: combination and sensitive 2, 3, & 4: mature and sensitive

normal

&

2:

combination

Your skin should

fall

into

as indicated:

1

/ oily

4: sensitive 5:

is

one of the above categories, which represent the only

logical

combinations for determining skin type.

YOUR SKIN TYPE

61

"An ounce of prevention is

worth a pound of cure"

PROVERB

How Your

Skin

Got Where

Is

It

O THE SECOND YOU STEP ON A SCALE

and the number

is

bigger

than you expected, you know that something has to change. But you usually don't really need a scale to

are too tight. You easily

that something

is

tell

you

become winded.

South Beach Diet or Atkins

coats.

last

All

wrong. Should you go on

drate diet? Should you go on The Zone?

you bought

that.

year

a try?

—the

Perhaps

is

a high-protein,

wrong and

it

low-carbohy-

Maybe you want it's

How does anyone know for sure what

weight. Something

obvious: Your clothes

the telltale signs are there

to give the

time to use that home

one that serves as

They don't. What they do know, without

It's

a place to

program

a doubt,

is

will

gym

hang winter

work

for

them?

that they are over-

needs to be fixed.

63

how

That's

something

is

most people

think

I

wrong, but are completely

looking at their facial reflection. They

when

feel

a loss as

at

to the

proper course of action

know

for attain-

ing a brighter, healthier reflection. If

never exposed our skin to the sun's damaging effects of photoaging, our aging

we

faces would only be caused by two things: loss of elastic tissue, which

and

layer of the skin,

good

failure, pretty

the sun all

still

loss of

fat.

texture. But

We

is in

the dermis

would have no color issues, and barring any genetic

even someone whose skin has never been abused by

ages and therefore loses

elasticity in the skin.

is

It

an inevitable

reality for

of us.

Loss

When

of elasticity

in

elastic fiber

the skin

happens from sun exposure and

the skin sags

is lost,

Interestingly, the loss of elastic fibers

affects contour. While

it

gone,

it's

has very

effect

tretinoin (Retin A), there

is

on texture

of gravity.

or color;

it

mostly

the skin by either injecting

in

no way

it

or

to restore elastic tissue.

gone.

it's

Three things cause the loss of elastic tissue. ultraviolet radiation

little

immutable forces

to the

possible to restore collagen

is

by using glycolic acids or

Once

response

in

plain chronologic aging.

from the sun

—which

is

First,

the best

the natural aging process. Second,

way

prematurely lose your elastic

to

tis-

sue and thereby prematurely wrinkle your face. Smoking certainly aggravates the situation

and

is

way

the second-best

when

of underwear,

doesn't have the

the skin has

same

why would I

for four to six hours;

uation

been repeatedly stretched, the have a

limited

Much

on an old

pair

elastic just gives out

and

skin. Third, elastic failure.

tension. Elastic fibers

number

like

of stretches before

caution you against creams claiming to reduce or eliminate wrinkles

what these creams are

and thereby a stretching wrinkles

your

breaks and they stop working.

their elasticity

That's

to spoil

come

back.

If

of the elastic

really

doing

fibers— and once that swelling goes down, your

you reapply the cream,

all

you are

worse by creating undue repeated stretching

further shortening their useful

life

causing a temporary swelling

is

by using up

really

of already

their limited

doing

is

damaged

number

making a bad elastic fibers

sit-

and

of lifetime stretches.

If

you want permanent bags and sagging, keep using those so-called magic creams. Like in

dieting,

where everyone

cream, ointment,

comes

64

IT'S

to lines

is

lotion, or

and

looking for that instant-cure

potion

wrinkles.

NOT JUST ABOUT WRINKLES

when

it

comes

to skin

magic

pill,

care— and

there

is

no magic

especially

when

it

TIME

A GREAT HEALER BUT A LOUSY BEAUTICIAN

IS

O Aging

of the skin

damage from

an inevitable and

is

passing time, aggravated by

irreversible result of

dead (and

the sun. Unless you're already

therefore probably not reading this

book) you are aging. After age twenty-five, collagen fibers

down, subcutaneous

away

happens as a

result of time

happening

once. Genetics

Think of your is in

Loss

and

of collagen, to

it

is

and

way

extent,

makes

ground.

from the ground back up

to the

branches, and

their feet

up

in

the

air,

we

will

Until

is

on the ground

Extrinsic

skin

is

—

exposed

caved

all

aging of the skin

and

information

way

of

you can

fall in.

aging of the skin

keeping everything from run, but

in

you can't hide.

the center of the tent.

But loss of

make

fat will

that big

the apples from Newton's tree rise magically until

people

start

walking on their hands with

of gravity-driven falling skin.

Loss

of

causes furrows and troughs. By then, the

in.

caused by the sun, smoking, and

is

to every day, causing

to or not: time, genetics,

extrinsic

of saying

fat

many

of

lems. There are three inexorable factors that

them

extrinsic. Intrinsic

nature's

always have the issue

collagen causes lines and wrinkles. Loss of big top

is

and

the big top

to the

the

fall all

of our elastic fibers break-

which gives the height

taller pole,

way down

top

and holds

wrinkles.

of aging: intrinsic

nature's

and

drier

a circus tent with poles holding up the periphery. The big top

has a much

some

pull of gravity

and genetics. Time

facial skin like

the center,

downward

lead to sagging skin

There are essentially two kinds

at

the dermis begin to break

begins to gradually disappear, and skin becomes

fat

less water. Cumulative years of the ing or withering

in

your face's

will

all

other external forces your

color, texture,

impact your

facial skin

and contour probwhether you want

and the sun. Together, they deviously account

for the intrinsic

aging of your skin that causes you to have a bad mirror day. But don't worry: the

in this

book

will

help you have and keep the skin you've always wanted

—

forever!

Genetics DNA

is

the basic element that controls

related

the processes that

go on

in

the body's function-

compromised

comes

to

your

can be attributed

to

your genetics. Just as there are families with a genetic pre-

ing systems.

age

When

all

it

skin, everything that

is

not externally

disposition to cancer or diabetes, there are families with a conspicuous genetic it

comes

or

bond when

to skin.

HOW YOUR

SKIN GOT

WHERE

IT IS

65

genetics determines the color of the skin:

First,

it

determines whether you have

light-

colored skin or dark-colored skin. Genetics determines your amount of melanocytes, which are the pigment cells

in

melanocytes make. At one end

of the

spectrum are super-fair-skinned

and

the highest risk for sun-induced skin cancers, African Americans.

The darker the

the sun

less skin

people have a genetic predisposition

ultraviolet irradiation.

can be

familial

of basal-cell

It's

just in their

DNA. And

carcinomas are present, or the

oil

like

develop

nevi)

cancer that

melanoma,

will is

innate protection that

production, and

acne are based on

oil

it's

Mom

effects of the sun,

have.

almost independent of

certain other skin conditions

BK mole syndrome,

into

are at

sunspots, broken capil-

cancer that person

rare

you've got acne, chances are you have

cated on

more

(lines, wrinkles,

to skin

who

opposite end of the spectrum are

— such as basal-cell nevus syndrome, a genetic defect

precancerous moles (dysplastic If

Celtics,

and the precancerous and subsequent cancer-causing

and therefore the fewer wrinkles and

Some

at the

color of a person's skin, the

person has against both the degenerative effects laries) of

and how much melanin the

the bottom layer of the epidermis,

and

in

which

in

which hundreds

lots

lots

of

melanoma. and Dad

to

possible to inherit overactive

thank

for

Acne

it.

is

predi-

glands. The causes of

oil

production and the retention of dead cells within the lining of the

pore or duct, both of which can have genetic susceptibilities, and therefore can be

passed along from generation live in

sebaceous

the

follicle

to generation. Nongenetically-related skin bacteria that

can also contribute

to acne.

These

skin "bugs"

can

really

aggravate your complexion. There are also genetic

discussed

in

sensitivity to

melasma

chapter

1.

ties to

An

individual's sensitivity to the

The bottom tible to certain

to

66

—

IT'S

in

his or her

melanocytes'

lighter the skin color, the

more

sun exposure are also

sensitive

it

is

to

sun-induced

discolorations. line

on genetics'

effect

conditions, but alone

Genetics merely makes you in;

sun and

or chloasma. But less specific discolorations induced by

and brown

feed

specific discolorations of the skin

estrogen are based on heredity; the combination of these factors causes

impacted by genetics, since the tan

melasma and chloasma,

on is

skin

is

that genetics rules

not a guarantee you

eligible. External factors

will

in

making you suscep-

develop those conditions.

and choices you make along the way

genetics simply sets up the framework for what you're more or less susceptible

terms of your skin or any other organ.

NOT JUST ABOUT WRINKLES

The Sun •

•

•

"Nature gives you the face you have Life

when you

are twenty.

shapes the face you have at thirty"

COCO CHANEL Coco Chanel

launched the sunbathing craze

herself

spend a

their faces.

have

patients tions

of time in the sun, but

Those

of

my

tell

can

hands

and allowing

of time, but

it

The sun has two

if

The

will

to

cancerous as a

is

help to prevent future

I

see

beautiful skin.

if

on the

The dangerous cells

of repair.

not recognized

to the control to

make

rays.

is

sun

will

inevitable, but

Two simple

solu-

—

limit

collagen level (which

makes

midday strongest

its

its

every day on

will

will

never turn back the

skin:

degenerative and dangerous.

—they cause degeneration or harmless but unattrac-

cause cancer when

it

at

it

damage.

become

result of the ultraviolet radiation

melanin, causing

—

I

your bodies.

Sun protection alone

skin to rejuvenate.

the sun causes degenerative

damage

sun

effects are not dangerous, but they are

become cancerous

ing

who baked

skin's receptivity to restoring

and not having adequate means

When

of the

different deleterious effects

you want

and can go on

a fashion statement.

to the wrath of the

themselves from the damaging, harmful

Degenerative sun effects break things

especially

most people do

those of you

sunscreen and staying out

tive distortions.

that

into

She returned from a

patients to stay out of the sun. Exposure to the sun

damage, increasing

skin suppler),

know

you who have avoided exposing your skin

learn to protect

—wearing

future

to

I

significantly better-looking skin than

don't

I

lot

the 1920s.

and single-handedly turned the tan

cruise with a deep, dark tan

don't

in

sun are precancerous

effects of the sick. This

breaking

DNA

malfunction

and

in

pre-

your skin

ultimately

go on

treated.

changes

When

becomes

here and there

Those precancerous changes

to the

mechanism by which

too much.

damaging and very annoying,

pigment

cells,

the melanin

a melanin

cell

what

cell (a

makes

too

is

really

happen-

melanocyte) makes

much

melanin, that

FACT: Every hour, one American dies from melanoma.

HOW YOUR

SKIN COT

WHERE

IT IS

67

excess melanin feeds up through causing a sun

freckle,

age

its

dendrites to the overlying levels of the epidermis,

freckle, liver spot, or solar lentigo.

These are the most noticeable

sun-induced pigment changes. (Light-skinned people tend

to freckle

These changes are generally not dangerous, though they are

more

obviously.)

unattractive. Ultraviolet

exposure can also cause small, irregular-shaped white spots, especially on the also on the backs of the

cause a malfunction next

it

in

the exfoliation of cells. First the sun causes an excess of pigment,

causes the accumulation

radiation also

legs, but

hands and arms, as melanocytes are destroyed. The sun can also

depth or the concentration and

UV

sun

of cells that

have pigment

intensity of the color of

causes the walls

of

them; the effect reinforces the

in

brown spots, making them

blood vessels to

and

become

darker.

thinner, leading to bruis-

ing—with only minor trauma— in sun-exposed areas. For example, most

of the bruising that

occurs on sun-damaged skin occurs on the back of the hands and forearms— not on the inside of the

upper arm or even the inside

vessel walls,

weakens them so they

of the forearm.

stretch

The sun causes

textural

upper layers

ing of the

These

changes

of the

entire dermis. Thick skin

the neck

—

elastosis

and

is

blood vessels occur

is

found

in

the skin, especially on the face.

coarse wrinkles

—especially on the back

stretched. This condition

of the skin.

lines, wrinkles,

is

easy bruising, and skin tearing.

of moles, especially junctional nevi,

(the type that

causes

blistering sunburns). nevi.

common

can form from

damaging UV

of the

IT'S

is

abnormal

rays of the sun

and are

and cumulative

(rather than

for actinic keratoses.

People

w million Americans, and in sunny

significantly higher.

NOT JUST ABOUT WRINKLES

to

hands. They are small, rough, crusty,

main determinants

FACT: Actinic keratoses affect more than climates their prevalence

but intense

Other precancerous lesions, called actinic

on the face, ears, and back

intense) sun exposure are the

brief

They often progress

scaly red patches or sores on the top layer of the skin. Genetics

68

of

seen as thickened, coarse wrinkling and yellow discoloration

skin

keratoses, are another possible effect of the

and

straight

called solar

precancerous moles called dysplastic

brief

— red squiggly or

is

An increased number

especially

in

tiny

more blood, making

because UV exposure can cause a thicken-

to the skin

do not disappear when the

Thinning of the skin causes fine

sun exposure

— but

with

by thinning the blood

epidermis and/or thinning of the lower layers of the epidermis

and the

that

tiny

also,

and become engorged

previously invisible blood vessels appear as conspicuous lines called telangiectasias.

The sun

with

fair skin,

and light-colored eyes are

light hair,

thought to be most sensitive and

work or spend a

chance

lot

of developing these spots.

can progress

to

melanoma

left

men have the highest mortality

Seborrheic keratoses,

which are warty-looking lesions skin, are

another

that

appear

common

to

rates from

be stuck

do

is

women aged 25 to 29.

in

(although they can also be age related) but they

melanoma, and it

the chief cause of cancer death

sun

effect of the

—5,050 men and

2,860 women. Older Caucasian

untreated, they

an invasive type of skin cancer called

squamous-cell carcinoma.

on the

If

7,910

deaths were attributed to

and those who

outdoors have a greater

of time

A TOTAL OF

Those people

at risk.

with a history of extensive sun exposure

IN 2004,

not

become cancerous. The most dramatic,

harmful,

and

life-threatening effect of the

sun

is

skin cancer.

The three

main skin cancers are melanoma, basal-cell carcinoma, and squamous-cell carcinoma.

Melanoma

is

the most deadly skin cancer

sively than the other skin cancers,

other parts of the

very

difficult.

It

body

and

—which can

it

at risk

living

it

metastasizes more readily and aggres-

the metastases

is

result in death.

usually arises from a pigment cell

normal single melancyte

Those most

because

peacefully

in

•

People with red or

•

People

•

People with a family history of the disease. (For those

fair hair,

blue eyes,

tan with difficulty

melanoma, the chance People

who have had

fair skin,

and burn

of getting

blistering

in

women

men

they've had extensive exposure to the sun, children

ease.

It

is

is

who have

do get melanoma,

it

I

and

II).

already had

only increased by

in

the thirty-to-sixty-year

any age. However, children are

if

at

freckles.

percent.)

1 1

sunburns.

can

or

and

a second tumor

it

When

layer.

the sun (Fitzpatrick skin types

More women than men get melanomas, mainly strike

is

from melanoma include the following:

People with a large number of moles.

•

melanoma

a preexisting mole or from a previously

the basal epidermal

in

spreading to

Treatment of metastatic

•

who

—the cancer's

is

it

age group, but

rarely affected

takes years for the

because even

melanoma

to develop.

testimony to the importance of genetics

in this

dis-

damaging exposure

to the

sun

believed that 80 to 90 percent of our lifetime

occurs by age twenty, and the amount of exposure during early years

HOW YOUR

is

actually

SKIN GOT

one

WHERE

of the

IT IS

69

most important determining

melanomas can

affect

risk factors for

most

on the legs and arms, and

parts of the body,

men

for

to get

Melanomas can grow two ways:

melanomas

melanoma

so they spread sooner and

sun-damaged

horizontally,

and

skin

that

kill

Melanoma

is

one

of the

at the

giving

most unforgiving cancers. Once effective

way

skin cancer,

it

half of all cancers in the United

the basal layer of the skin

is

i

million

almost always

it's

is

and years

with aging

common

most

and outer

locally rather

limited

kills.

It

the

in

develops

is

It

it.

in

layer of the

associated

sun exposure.

of chronic

skin cancer,

cases expected to be diagnosed dle

fatal.

to prevent

—the same bottom

Squamous-cell carcinoma

new

is

much more

can do and almost never

it

very

very strong.

epidermis where the melanocytes are.

rising dramatically,

with more than

who have had sudden,

grows and invades

damage

cancer

is

earlier,

melanomas occur on

to fight this killer

cancers, accounting for nearly

The incidence of skin

— or downward (nodular

spreads,

it

than metastasizing, so

States.

spreading

the other hand, basal-cell carcinoma, the

common of all

on the back.

invade blood vessels and lymph vessels

The only

common

spread

to

them

to get

superficially

to

rise

highest risk are those

On

women

for

trunk, particularly

places where the sun

in

SKIN CANCER

skin cancers. Although

all

There's strong evidence that

faster.

people

for

common

most

them on the

cells to

high intensity short bursts of sunlight

the most

is

— less dangerous because they take longer

melanoma), causing the cancerous

is

it

— and

is

the

second most

which develops from the mid-

layers of the epidermis.

is

It

one

of the

this year.

forms

of skin

and years therefore be

metastasize

fatal, if

it

although not as

occurs

in

The

it

is

It

the

or

Of course,

lips.

it

can metastasize and is

much more

apt to

beneath bathing

suit

should be treated as

detected.

carcinoma or squamous-cell carcinoma

risk of getting basal-cell

the past sixty years,

UV

It

areas— the underarms

sun-protected

person's lifetime exposure to

ful

sun exposure.

commonly as melanoma.

areas— or on mucous membranes such as soon as

of

cancer closely associated with aging

damage

UV

radiation

to the planet's

is

and by the person's pigment ozone

layer

determined by a

Over

protection.

has increased the amount

of

harm-

radiation that reaches skin.

The UV the skin

radiation that reaches the earth

and UVB rays burn the

skin.

is

made up

of

UVA and UVB

Both can cause skin cancer.

UV

rays.

UVA

radiation

is

rays

not

age

felt

as

(continued on page 74)

70

IT'S

NOT JUST ABOUT WRINKLES

—

How You HOW TO

Can Help Prevent Skin Cancer

EXAMINE YOUR BODY

(monthly) for skin cancer, precancers,

and abnormal moles:

1.

Pick a well-lit

room

— preferably with natural sunlight. Examine yourself

in

the same

place each month. 2.

Examine your body front and back sides with your

arms

in

the mirror; then examine your right and

raised.

3.

Bend your elbows and look

4.

Look at the backs of your legs and at your toes,

5.

and the soles of the

carefully at your forearms, upper underarms,

on

the spaces between the

mirror. Part

a cool setting to help part

the

your hair

hair.)

check your back, buttocks, and genitals with your hand mirror.

6.

Finally,

7.

During the exam, look for these changes

•

sudden or gradual increase

•

change

•

increased elevation (above the skin)

•

softening or hardening of the growth

in

• itchiness,

shape

in all

skin growths:

in size

especially concave borders,

which are never normal

tenderness, or pain

bleeding, crusting, or oozing

• redness, swelling, or

new blemishes on

the skin around a lesion.

you notice anything suspicious or detect any of these warning

dermatologist immediately for

Make

and palms.

feet.

for a closer look. (Use a hair dryer

If

feet, especially

Examine the back of both your neck and scalp with your hand

•

left

a professional

signs, contact

your

evaluation as well as a full-body skin exam.

sure to point out areas of concern and discuss

them with your

HOW YOUR

doctor.

SKIN COT

WHERE

IT IS

71

ACTINIC KERATOSES

AND

SKIN CANCER

Face, scalp, neck,

Rough, scaly 1/ •

VV'tol"

sandpaper patches,

lower

lips,

ears,

crusts or sores,

forearms, and back

typically pink to red

of hands

Small, shiny

bumps

or nodules that are

Head, neck, hands,

red, pink, or skin-

BASAL-CELL

colored; persistent

Take

many years

CARCINOMAS

crust and/or bleed;

and occasionally the trunk of the body

nonhealing sores that to reach V2"

reddish flat patches or

bumps with

a

central depression

Face, ears, scalp,

Red, scaly patches,

SQUAMOUS-CELL

CARCINOMAS

nodules or bumps; irregular shape;

Can reach up to 3A" to

1"

neck,

lips,

back

of hands, back,

or larger

and legs bleed and/or crust

Asymmetrical, mottled

Can occur anywhere

patches with notched or blurred borders,

Can be as small

typically in tan,

as Vi6", rarely

brown, or black with

greater than

multiple colors or

an inch

hues and irregular colors

72

IT'S

NOT JUST ABOUT WRINKLF

and shapes

on the body, most frequently on the

upper back or as well as

legs,

on the

head and neck

OTENTIAL FOR METASTASIS

PROGRESSION

PREVALENCE

Very

Most progress

Are, by definition, affect

into squamous-cell

precancers and

carcinoma over a

therefore do not

common,

more than 10

million Americans,

especially Fitzpatrick

period of years

metastasize

types

Very

rare,

over,

then repeat

II

Account for 80

adjoining areas and

and may bleed, crust

and

but

can grow into

may

I

invade any

percent of

all

skin

cancers (more than

adjacent or underlying

800,000 new cases

structures including

each year)

eyes, nose, etc.

cycle

Basal-cell

Basal-cell

carcinoma, typical

carcinoma, advanced

Melanoma,

Melanoma,

early stage

advanced

Can metastasize and

may be fatal treated. in

if

When

left

un-

arising

sun-exposed areas,

rarely metastasize;

when

arising in non-

sun-exposed areas or

on the

lips

much more

they are

Account for 16 percent of

all

skin

cancers (about

200,000 new cases each year) with 2,200 deaths a year

aggressive

and dangerous Account for

May

begin

4 percent of

in or

Will metastasize

near a mole or

all

if

skin cancers (about

not removed at a

other dark spot on

54,200

new

cases

very early stage;

the skin

each year) with

or, less

rarely cured after

I

commonly, appear

more than 7,600

metastasis occurs

without warning

deaths a year

HOW YOUR

SKIN COT

WHERE

IT IS

73

ABOUT 75-80 PERCENT

heat on the skin, so even on a cool and cloudy day,

can be

of new skin

cancer cases are

clear

just

as strong and

and sunny

just

as damaging as on a

So you can

day.

it

still

get burned on

basal-cell carcinoma, 75 percent

cloudy days and incur significant sun damage. Are you

are squamous-cell carcinoma,

ready to put on

and 5-70 percent are melanoma.

detected

If

Both basal-cell carcinoma and

rate.

squamous-cell carcinoma have

in

people

every month

—

the wise

you get most

exposure the

in

like

of

cancer has a 99 percent cure early,

who

regularly

to

be

vigilant

their risk of

half that of

those

your sun exposure

rest of the year. Also, skin

in

who

showed

their skin for

that

suspicious

death from melanoma to nearly

did not

a monthly breast

do exams. Check

yourself

exam on themselves. You may

the summer, but that doesn't

mean you

cancer doesn't necessarily show up

get no

away

right

— so

important to conduct body examinations monthly throughout the year. You'll want to be

a brightly

and other a sore

lit

room

with a full-length mirror

skin growths that display

that doesn't heal;

any

and your

trusty

hand

you can detect

is

mirror, too.

of the potential signs of cancer:

Look

a new

for

bump

moles

or spot;

an asymmetrical blemish; a notched, blurred border; a mixture

colors; or a diameter of at least six millimeters (about the size of

to

you need

recent study

examined

moles cut

women who do

A

your dermatologist.

and treated early.

rate if detected

yet?

conducting self-examinations and making regular

visits to

it's

early, skin

To spot skin cancer

a better than 95 percent cure

think

some sunscreen

not a subtle

of

a pencil eraser). Any change

one but an important one and should immediately be shown

a dermatologist; by the time you can see a change,

it's

already significant.

Smoking Everyone realizes that sun exposure

knows

that

smoking

triples the risk of

When

it

comes

a

risk factor for skin

cancer, but almost no

also an important and independent risk factor.

Smoking more than

to It

your

skin,

smoking exposes you

has two effects on your

to the

skin: internal

worst environmental poisons

and

external. Internally

cuts

down

the circulation within the facial skin by 30 to 40 percent. Cutting

cuts

down

the flow of nutrients necessary for repair of injury

Most people know

IT'S

one

developing squamous-cell carcinoma.

you can encounter.

74

is

is

that

smoking

is

NOT JUST ABOUT WRINKLES

terrible

when

it

comes

and

for

down

smoking

circulation

normal metabolism.

to heart

disease because

it

causes constriction most

vessels, but

coronary

of

aren't

aware

that

smoking also causes constriction of skin

blood vessels. That's what

gives heavy smokers a sallow or pale

appearance. The presence

of the toxic

chemicals causes constriction skin blood vessels

out of the blood

ness

of the

and squeezing

—the

resulting pale-

the opposite effect of the skin

is

redness caused by the opening up of the skin's blood vessels from drink-

Smoker's

lines.

ing alcohol. is

It

and

really difficult to override the efficiency of the

skin, but

smoking

is

so damaging

ing, their facial-skin color will

Smoking's external

effect

be

it

does

slightly off.

on skin

is

normal metabolic processes

just that.

When and

if

they stop, the color

By

virtue of

overuse

of

in

elastic tissue

are often referred to as smoker's lines just

by looking

the lips that

in,

Smoking's most perceptible reports suggest that

nonsmokers don't use as

been found

to create

toxins from

frequently.

—on both the upper

and

effect

these vertical

vertical lines that

and the lower

lip

lines,

which are

dangerous

on the skin

is

the causing of wrinkles

— not a great trade-off

for

free radicals. This results

FACT: The facial wrinkles of smokers aged

nonsmokers 20 years

I

can

tell

a

to other signs of intrinsic or extrinsic aging.

smoking switches on a gene involved

and wrinkles

lip.

significantly out

in

40

to

—

them.

lots of

destroying collagen,

the structural protein that maintains the skin's normal thickness and contour. collagen, you get lines

back.

promoting skin cancer.

and collagen break down, causing

at the distribution of

of proportion to other facial lines

Some

come

those muscles and repetitive subjection of that skin to certain

mechanical stresses, the

smoker

will

caused by the chemical carcinogens and

smokers use muscles

body

the

As long as smokers continue smok-

exhaled smoke. These carcinogens affect the skin from the outside Additionally,

in

When you

lose

smoking. Smoking has also

in

oxygen deprivation

to the

so are similar to those of

older.

HOW YOUR

SKIN GOT

WHERE

IT IS

75

body's cells and reduces blood flow to the

and sagging. Just ten minutes oxygen supply

for

of cigarette

smoking decreases the body's— and skin's-

almost an hour. Nicotine narrows blood vessels and prevents blood from

circulating to the capillaries (tiny blood vessels)

effects are reversible

decades

of

if

smokers

ing involves the hair. Did

you know

that

time to heal, and there

Human

smokers are three

is

from an array

of surgical

more

traditionally

is

a crutch for people

As long as our planet continues remain, there

will

we

we want

to exist,

always be people

only want what

fuller lips.

lustrous texture.

It's

If

we

in

to six times

after

injections three

filler

side effect of smok-

more

likely to

develop

even associated with causing It

has long been known

procedures.

It

ill

to inter-

takes a smoker a longer

•

who

can't cope with drugs."

TOM LIN and our Western

hot pursuit of

human

nature and

want what she's having!"

Men who smoke

culture, values,

becoming

we have peaches-and-cream

ourselves into imaginary beings

who

color,

So

if

we want a

more

likely to

priorities live in

a

beautiful

smoother, more in

the

When

fun to fantasize about looking better

we have

We

we have

great line from the film

a world where

and

better looking.

an incredibly strong driving force

like that

live in

are twice

NOT JUST ABOUT WRINKLES

it's

It's

It's

do not smoke.

IT'S

is

common

don't have, not what we've got.

cosmetic dermatologic services.

FACT:

and creases created

scarring.

•

LILY

world where

The wrinkle

Nature

"Reality

76

Smoking

of the hair?

•

"I

Another

on the circulatory system and on wound healing.

fere with patients' recovery

Sally:

the lines

to reverse without laser surgery or

effects don't stop there.

premature thinning and graying

for

the upper layer of the skin.

a year.

And smoking's negative

eyes,

in

enough— but

quit early

smoking are impossible

to four times

effects

which then causes premature wrinkling

skin,

—

the features

demand

Harry Met

to transform

we

think are

become bald than men who

a

missing, the absence of which prevents

our minds) certain successes

(in

in life,

whether

social or professional.

There's an old saying that goes,

"If

taken better care of myself." Touche!

show about two Miami-based a guest on the season

them

finale;

I

saw a

I

woman

she played

from Larchmont,

much

deliberation, they

graphics, what she would have looked

like

cosmetic dermatological procedures.

It

unrecognizable to

appears with

all

herself.

The basic human

into

a

crystal ball

if

If

York,

had she not had any

if

she had

computer-generated

of her plastic surgery or

revelation.

Joan was

virtually

she was not nearly as appealing as she

to say,

we had known

make

you could have gotten a preview different?

better care of your skin?

and asked

had done. She wanted

Rivers, via

was a shocking

she opted

How many of

then what

to not cosmetically turn

sun damage, bad choices, and us would have taken better care

we know now?

old (slapping

If

you could have looked

baby

oil all

over your body,

sure you soaked up every ray of sun possible) and

sixty-five, seventy-five,

have done something

—

Joan Rivers was

treat.

who she would have been

showed Joan

when you were eighteen years

age

show Nip/Tuck

to these doctors

the work she'd

all

would have

taken aback by her request, but considered the

for better skin.

using a metallic sun reflector to at

hit

I

to stop years ago.

demand

our youth

seen yourself

undo

drive to look better, along with time,

genetics, dictates the in

Needless

She went

of the extra "help" she's had. Ultimately,

back the clock she chose

of our skin

recent episode of the

herself.

New

become famous. The surgeons were

opportunity. After

to live this long,

surgeons and the patients they

to perform the ultimate plastic surgery:

to look like the

never

plastic

had known was going

I

and

eighty-five,

what would you have changed?

of the degenerative effects of

all

your abuse, would you

Would you have worn sunscreen? Would you have taken

Would you have moisturized and sloughed

off

those dead cells

more often?

My of

do

point

imagine being able to perform

is this:

bad choices and right

now

out magic. ing factors,

chapter

is

plastic surgery. Well,

you need

and take

the

first

kind of

to

do

is

start

let

making

better care of your skin.

day

of the best skin

me tell

magic

to erase your years

and appear younger than you

to allow yourself to look better, feel better,

—without

All

some

you: you can have beautiful skin with-

better choices, limit your external contribut-

Would you do

that?

If

you said yes. the next

you've ever imagined.

HOW YOUR

SKIN GOT

WHERE

IT IS

77

I

listen

with love to

my body's

LOUISE

L.

HAY

messages.

and Skin

Diet

o SKIN

IS

A GREAT MIRROR OF YOUR HEALTH.

health, or conversely, illness. Think of

happening on the stress

may first

Since skin

is

it

inside. Nutritional deficiencies, diseases,

be reflected

in

your

skin's

it.

and even

appearance.

the largest organ of your body,

about

can reflect good

as an outside marker of what's

it

makes perfect sense that

something interfering with your body could manifest right? Think

It

itself in

your

skin,

Each square inch of your skin contains blood vessels,

sweat glands,and nerve endings, which measure your body temperature, pain, touch,

The

and pressure.

skin has

many vital

protective functions:

it

protects the underlying

tissues from invasion by bacteria, other microorganisms, the sun's harmful rays,

and toxic substances

in

the environment.

In

addition to keeping

undesirable things out, skin keeps moisture and needed chemicals

in.

79

Like

organs

all

in

the body, the skin, as well as

appendages— like

its

receives nutrition via the bloodstream from nutrients absorbed Believe

it

illustrates perfectly

Most topical

why

and

There are

skin.

some

exceptions, but for the most part, the best

choices about what you put

when

comes

it

blood circulating

in

the body! This

and most vitamins simply cannot be absorbed topical medications,

into

to the

A

of vitamin

creams, alpha hydroxy acids, and a derivative

difference

the gastrointestinal tract.

essential to nourish your skin from the inside.

elastin, essential oils,

your

into the cells of

and nails-

and supplements we hear so much about these days, such as the

nutrients

proteins collagen

is

it

to one-third of the

up

or not, the skin receives

in

hair

method

such as cortisone-type

called retinoic acid that are

of nourishing your skin

your mouth. The foods you eat can

appearance

of

your

is

making

careful

make a meaningful

skin.

VITAMINS AND MINERALS THAT HELP

YOUR COMPLEXION -O As

I've

said before,

the body.

When

this vitamin or

spend on you

if

it

I

hear about

more

what your body needs.

really special

change the

to I

am

going

rate of to

is

on or

pounds

thirty

it's off.

of

a vitamin and

pushing harder on a

It's like

That's exactly

how

it

is

won't do a thing

it

switch to

light

when

it

iron,

that

amount

most

of

make a room

comes

to vitamins,

an enzyme do nothing

of

you are pretty

of vitamins

vitamin A, B, C,

and

them

takes to run the metabolic machine of the

D,

and minerals

in

your daily

and essential amino acids

yourself,

human

well nourished

body.

you have

And

if

to eat

for

and

that

diet.

You

—

all

certain

looking

80

IT'S

is

to

understand what foods you should include

you are getting

and

all

of the essential vitamins

feeling great.

NOT JUST ABOUT WRINKLES

and minerals

in

the

them) elements

some reason you

not eating the right foods, you are hopefully supplementing your mild deficiencies.

important thing

for

chemical reaction.

essential (meaning you can't manufacture it

of

cringe at the millions and millions of dollars people

I

make an assumption

enough

suggest you take more

that

enzymes, and your body. Extra amounts

you're basically getting the right are getting

override the normal metabolic processes of

schemes and empty promises

You can take

brighter. Either the switch

which are

difficult to

of that mineral,

false hopes.

isn't

extremely

is

it

are

The

your daily diet to be

to help

keep your skin

—

body converts beta-carotene

For example, your

dose

of beta-carotene every

into

day helps generate new

vitamin A, so eating a healthy

skin cells

and can even help protect

against skin cancer. Foods such as apricots, peaches, nectarines, sweet potatoes, tomatoes, spinach, and carrots are are rare

impaired absorption of

in

production, clogged hair

follicles,

Vitamin

this vitamin.

and excess

it

probably does not

mean you have

A deficiencies

lead to reduced

keratin buildup, giving the skin

rough, and scaly appearance. Please note, however, that or scaly,

deficiencies

industrialized countries, certain digestive diseases or excessive gastrointestinal

in

surgery can result

sebum

A

great sources of beta-carotene. Although vitamin

all

a vitamin

A

if

your

a

dry.

facial skin is dry, rough,

deficiency;

it's

simply worth noting

the possibility.

Vitamin

C

essential

is

in

building

new

collagen; citrus

fruits, berries,

papaya, spinach, and sweet potatoes are good sources of vitamin C.

can bring on

and

is

sorts of problems, but the

all

characterized by poor

below the surface

indicating bleeding

also cause excess keratin hairs

on the arms and

Selenium, which vitamin

E against

quality of the skin.

oil-rich nuts,

It

is

essential

common

deficiency

which affects the skin

healing, small purplish spots called petechiae

of the skin

hair follicles,

—

ulcers,

and gum weakness. Scurvy can

producing roughened

an antioxidant found

is

in fish, garlic,

bumps

containing coiled

and even

chicken, and grains, works with

skin cancer.

Selenium helps maintain the

functions internally to help close wounds.

hard to get from food without eating too

is

much

fat,

the best sources

much as one-

seeds, and avocados. Recent studies demonstrate that as

E use causes a rash called contact dermatitis.

the diet to maintain healthy-looking skin, but

in

scurvy,

is

A vitamin C

legs.

fourth of topical vitamin

E

in

pollutants, sunburn,

Since vitamin E are

wound

most

melon, tomatoes,

I

I

firmly believe vitamin

do not support any purported

topical benefits.

Calcium

is

important for preventing sagging skin and wrinkles. The best sources of cal-

broccoli, spinach, tofu. salmon,

cium are touted as

good sources

can't break

down

Calcium

to properly

Niacin (one

of calcium, are not the best choice.

dairy products

system. You're better

and absorb

their

members

which

is

well

Our digestive system simply

calcium so that

it

is

of

any use

taking a calcium-enriched vitamin or even a daily

absorb your

of the

tion called pellagra,

off

and soy products. Dairy products, although

dose

to our

of Turns

daily calcium.

of the vitamin

B complex) deficiencies can cause a condi-

characterized by rough, scaly brown skin

in

areas of the body

DIET

AND SKIN

81

exposed

to the

sun— especially

number

drugs— including

can

metabolism. Niacin can be absorbed through lean

interfere with niacin

meats, poultry and

tish,

peanuts, rice bran, and dairy products.

Likewise, a riboflavin deficiency

can adversely impact

around the nose and mouth and on the ears and hair follicles, giving the skin

a

A deficiency of

a roughened

Many nonsugary,

riboflavin deficiency.

today, except

and antidepres-

take a

that

uncommon

certain antibiotics, anticonvulsants,

some cancer

—

It's

and people who

alcoholics,

sants

chest.

patients going through chemotherapy,

among

ot

and upper

the neck

fortified

So

for

of

all

lips

greasy red skin

scaly,

material builds

up

in

the

can also become red and cracked from

breakfast cereals contain riboflavin.

Uncooked egg whites contain a substance

biotin produces scaling skin.

that prevents absorption of biotin.

Sebaceous

eyelids.

The

look.

causing

skin,

thoroughly cooked. You can supplement biotin

you egg-white in

lovers,

your diet by eating

make liver,

sure eggs are

unpolished

rice,

brewer's yeast, whole grains, sardines, and legumes.

Those

you on

of

body needs

low-fat diets

to avoid scaly skin

with linoleic acid, which

Another concern

I

have

not

be getting

and even

my

doctor's heart, not to mention

ment

may

is

head).

found

hair loss

If

in

loss of hair color.

The

It

(something very near and dear to

vegetable

in

essential fatty acids your

make

sure to supple-

can correct

this deficiency.

low-fat diet,

oils;

it

is

characterized by

protein deficiency

in

children

in

underdeveloped countries,

dry, wrinkly, flaky skin; thinning hair;

produces scaly

skin,

and the

least

once a day

diet consisting of

deficient anemia.

An

symptoms

IT'S

from an iron deficiency

Cracks

may develop

will

notice the early sign of

set

in.

corners of the mouth, and hair growth

can be detected through a simple blood

iron deficiency

anemia

at the

Make

sure you check with your doctor

a severe zinc deficiency results

especially

82

suffer

brittle

if

test,

iron-

may be

long before

you notice any

of the

signs.

Finally,

more

of

and

protein (a serving of fish, chicken, or meat) at

a flattened spoon shape. This often precedes the pale skin associated with

nails with

above

at risk

to avoid this condition.

Men and women who

affected.

some

and a

loss of skin protein

through excessive scaling aggravates the deficiency. Children are especially

must eat a balanced

this

world of fad dieting are low-protein diets, which can cause

in this

this country.

of the

you are on a

a condition known as kwashiorkor, seen mostly but not rare

all

in

subtle,

skin creases

such as dry

and on the

skin,

in

widespread

fingertips. In less

a scaly scalp, and

NOT JUST ABOUT WRINKLES

blisters

and peeling

skin lesions

extreme cases, the signs can be

slight hair loss.

Because vitamin

harmful effects on the skin,

sense

that taking vitamin

it

seem

might

make

to

supplements would help

achieving or maintaining healthy skin. While

I

skin for those eating

skin. lips

can most

Excess vitamin

and

a balanced

To stay well hydrated

in

consuming

don't

think vitamins necessarily influence a positive effect

certain vitamins

HANGOVER HELPER

deficiencies are proven to have

before consumption

certainly adversely affect

A, for example, results

dry, scaly, itching skin.

in

alcohol, try drinking

at least eight ounces of water

on

an overload of

diet,

eight ounces of water per drink

cracked

throughout the celebration. This will also help

the palm

and

of the skin,

morning-after hangover. itching, facial flush-

and warmth. Too much vitamin E can cause an

D may

avoid the dreaded

espe-

soles, almost simulating jaundice.

Excess niacin may cause chronic ing,

and then

Excess beta-carotene

can produce a generalized yellowing cially

when

allergic rash,

and overdoses

of vitamin

result in intense itching.

Another thing ing your

to avoid in

alcohol

alcohol use has

intake.

your

besides overdoing your vitamin intake,

diet,

Aside from the obvious pain

damaging

effects

Have you ever noticed how

puffy

on

virtually

of the day-after

is

overdo-

hangover, chronic

every organ system, especially facial skin.

and sallow your

skin looks after a night of

heavy

drink-

ing? Alcohol dehydrates your skin (and the rest of your body) and causes small blood

vessels to dilate and widen, allowing more blood to flow close to the skin's surface. This causes puffiness under the eyelids and an overall bloated appearance. This also

produces a flushed

skin color

and a

feeling of warmth, but actually

temperature as your body heat escapes from the excess blood

in

decreases body

these engorged blood

vessels.

Another effect

of drinking alcohol

is

"blood sludging,"

in

which the red blood

cells

clump

together, causing the small blood vessels to plug up, starve the tissues of oxygen,

cause

cell

and

death. With this increased pressure and the direct dilating effect of alcohol on

the skin vessels, capillaries break, creating the red, blotchy skin seen on heavy drinkers' faces. This also prompts a lowered resistance to infection, since alcohol depresses the

immune system.

A weekend who

of celebration involving too

are acne prone or

dictable

and preventable

who for

suffer

much

alcohol

may cause a

breakout

in

from rosacea. However, such an occurrence

those people

if

they avoid overdoing

people is

pre-

it.

DIET

AND SKIN

83

Alcohol prematurely ages the skin because

and

dehydrates

it,

robbing precious moisture

such as psoriasis. Research indicates

often significantly worsening skin conditions

women who

average two drinks a day, four days a week, are more than twice as

women who

develop melanoma as ful

it

don't drink. For

good

health

and the sake

complexion, alcohol consumption should be as limited as possible. Experts

that

women

limit

themselves

to

one

drink a day,

and men

of

that

likely to

a beauti-

recommend

—who also get skin cancer —

to

two drinks a day.

The

right diet

may slow down

etables, legumes, fish, olive

Some

skin looks.

oil,

skin aging, but the reality

and

studies have even

to fewer wrinkles than

those

products. Eating a diet high

who in fat

is

low-fat dairy products

shown eat

that

people

more meat,

may

it

won't stop

people

who

it.

eat, the healthier their

eat a healthier diet are prone

and whole-milk

sugar, butter,

to avoid skin cancer,

ond

line of

As

it

now appears

that eating a low-fat diet

is

may be

to ultraviolet radiation

among

developed cancer

diets.

There's significant evidence today that

mice.

A

a

the best

good sec-

at

mice, those fed a high-fat diet and

higher rates than those on low-fat

shows humans

react

recent study by researchers at Baylor College of Medicine

much in

associated with

The bottom

UV

line

same as

and

is,

to prevent increasing

skin cancers

fat.

to healthy skin

and

nutrition

is

to

be aware

of

your needs. Talk to your

way

to supple-

diet.

who

eat a high-fat diet are five times

more likely to have one or more actinic keratoses—premalignant lesions— than people who eat a low-fat diet.

84

IT'S

that

your chances of skin cancer, use more sun-

doctor about what vitamins and/or minerals you are lacking and the best

FACT: People

the

exposure.

screen and eat less

The ultimate key

the

Houston found

eating a high-fat diet promotes the development of premalignant tumors

ment your

still

defense.

early as 1939, animal studies indicated that

exposed

dairy

also promote the development of basal- and

squamous-cell carcinomas. Although avoiding excessive sun exposure

way

The more veg-

NOT JUST ABOUT WRINKLES

SOME My

patients

on the

or

FALLACIES tell

me

Internet

sorts of crazy stories that they hear from friends or read

all

about

and

nutrition

simple: Chocolate

It's

ABOUT SKIN AND NUTRITION

its

And unless you

cause redness even coffee

Food

allergies

come

allergies tion

allergies,

your

own

have been linked

skin rashes

is

more

the skin

like this."

ing back. is

If

waving

a food

his

hand

one mineral found

in

in

fruits

if

you have suffered from food

the

air.

is

seaweed

It's like

"Doctor,

stop going

"So.

food that adversely affects everybody's effect,

is

so

it

it

is

of

weeks

to

that old

when

hurts

like this."

wav-

it.

skin, allergy or no.

causes acne breakouts

— but only

or months. Iodine

A seventeen-year-old

spinach salads a week,

much

it

is

our

in

shrimp, and crabmeat: certain greens from

or kelp; or spinach.

iodine. She's simply getting too

cells, topically

and says,

The doctor says.

shellfish, lobster,

dieting, eating four

cosmetics, to keep

a proven food allergy

for

contact reactions to food.

into the doctor's office

has a cumulative

Another myth floating around

is

iodine, preventing her

that your skin

teenage

girl

who has

going to be adversely affected

acne from clearing up.

can absorb vitamins and minerals from

from aging. Because the outermost layer

of the skin

is

composed

of

applied nutrient-based cosmetics don't have any long-term impact on

aging. You simply can't feed the

dead outer

vitamins. However, topical vitamin in

for

a certain amount has accumulated over a period

the ocean such as

dead

years

adversely impacting your skin, stop eating or handling

is

that's iodine. Iodine

acne and

— hives caused by food and many — but the connec-

many

The best treatment

Same goes

who comes

systems comes from eating

by

for

like shellfish, nuts,

sensitive to sunlight.

joke about the patient

after

do not

handling foods: certain chemicals used to preserve food can

eliminate the food from your diet.

and

oil

history of outbreak. In addition to resulting from eating certain foods, allergic skin

make

There

activity of

your most important piece of evidence linking a certain food to a skin problem

come from

go

foods do not

when consumed.)

greatly overemphasized. Generally,

reactions can

I

fried food. Oily

to believe 9

such as cayenne pepper, tomatoes, alcohol, and

sufferers, triggering flare-ups

from a variety of foods

between the two

So how do you know what

the paper

are allergic, or suffer from rosacea, spicy foods and nuts

rosacea

and

skin.

—only male hormones can increase the

of the face. (Certain foods,

affect

on

does not cause acne. Neither does

influence the skin's degree of oiliness

glands.

effect

in

C

in

layer of skin to replenish minerals, protein,

and

a stabilized preparation can be effectively absorbed

the upper layers of the skin, as an antioxidant helping to prevent sun

damage. Newer

DIET

AND SKIN

85

AFTER: Shows marked reduction size,

in

and acne

example of that

redness, pore

is

—a very good

luster,

and skin

smoother and

brighter. She's a very pretty

woman who, in picture, could

this

be a model.

1

1

technologies are emerging which help topically applied chemicals penetrate into the skin

where they can be effective— but Collagen gets a

when

injected,

it's

this

of attention for

lot

technology has yet to be perfected.

supposedly being a great rejuvenator

when

fabulous. But

applied to the outer layer of the skin, the collagen

molecules simply cannot penetrate through the epidermis the dermis, where

it

needed. They bind water

which

of the epidermis,

but the effect

is

may plump

moisturizer, but for that

purpose

it

a

fat

derived from the

people with

now you and

know

irritation.

Your skin surface

appear

kles might

to

fill

younger,

can help function as an

effective

it

of

jelly,

cocoa

butter,

and mineral

final

oil

to

oil

may appear

loss of

furrows and wrinkles

everywhere There it

is

everywhere

— and

diet,

do.

fat.

for

be smoother and some

to

none

lose weight

of lines, wrinkles,

and even furrows. While

weight. Get your

body healthy

personal health

is

first

this

may be

lines.

Don't get

of

fat,

adipose tissue

your

collagen and certain

I

still

better

make

advise losing the

you I

feel better,

and

promise, a few

sure you read chapter

your options, or see your dermatologist about

me wrong— I'm

in

you increase the appearance

disappointing,

they do,

of fat stored

weight gain and loss. So

you're back into your skinny jeans, if

partly

lose weight, you lose

same way

the

that layer of

extra lines on your face won't bother you. And, all

When you

an indicator

much

the skin's

they lose that excess weight?

and foremost. When you look

number one. Once

to familiarize yourself with

if

of the protective effect of the extra

and decrease

may change

can

are overweight tend to have fewer

of the face.

out lines and furrows,

wrin-

drug, not a cosmetic.

what happens

is

and

of these preparations

because they have a surplus

That's

on the appearance

fine lines

about an aging face as being

how people who

faces. But

you lose some

When you

comes from a

most people, the face

fills

contain lano-

clogs the pores and can cause inflammation

skin. I've talked

But, notice

in their

effect

face. This pre-diet fat fillers

but that

in their facial skin.

— including

an adverse

when you

activity,

thought about diet and the

dependent on the

oil

sheep. While lanolin helps the skin retain moisture,

stop aging of the skin. The topical application of certain minerals

One

and

feel

out from using these products, but

chemical or physiological

look

layer

these products are actually doing more harm than good. By

adding

that

layer,

would be absurdly expensive.

glands

who use

oily skin

already

oil

second

corneum, the outermost

making

the skin temporarily,

Oil-based products, such as petroleum lin,

to the important

to the stratum

short-lived. Topically applied, collagen

is

and

of the skin,

filling

1

those

not against fixing wrinkles!

DIET

AND SKIN

87

"The choices

we make

are

ultimately our responsibility"

ELEANOR ROOSEVELT

Recapture and Restore Your Beautiful Skin O SKIN CARE FOR

maybe

of water, and

come

new

OUR GRANDPARENTS

a long way.

a little moisturizer.

was

a bar of soap, a splash

Needless to

say, skin care

The beauty industry churns out more than

products every year.

In

2004 Americans spent almost

a

has

thousand

$2.4 billion on

over-the-counter products such as cleansers, antiaging lotions, and sun-

number

screens. That

increases by another $5.3 billion

additives, men's products,

We

healthier

is

a

you add

in

bath

and powders.

society where, for

live in a

if

many

of us, looking younger and feeling

daily pursuit. According to the

American Academy of

Dermatology, the quest for younger-looking, softer-feeling skin translates into the

average American female adult using at least seven skin-

care products a day.

89

I'm the

to

first

you

tell

your face, but using too purpose, ties in

that

you absolutely do need some kind

many products

that are not congruent, or that serve

simply a waste of your time and

is

life. In

some

wrong products

cases, you

for

money

step

first

is

—two

your skin

to

regimen

for

no additional

most important commodi-

of the

may be doing more damage

if

you are using the

your skin type and/or condition.

So how do you decide on skin-care products The

of skin-care

determining your skin type.

If

that are right for

you?

you haven't already done so,

refer to

chap-

ter 3. In review, there are six skin types:

normal, oily/acne-prone, dry, combination, mature,

and

one

Most

sensitive.

The

sensitive skin.

excessive

oil

of

you

will fall into

pivotal distinction

oil.

People

products that are water based,

first five.

Very few people actually have

concerning skin type

production, because that

products that contain

of the

is

whether or not you have

is

what determines whether or not you can use

who have

oily/acne-prone or combination skin must use

free, or

noncomedogenic. By the same token, people

oil

with very dry skin should not use a cleanser that extracts excessive

type can change with time, so

need

important to stay

may be

too strong or harsh

The second step

choosing the

to

in

touch with your

skin, moisturizing, or protecting

stand what you want

it

it?

—what's

of water. Skin

facial skin.

just right in

You may

warm, humid

cold, dry weather.

right

those products to do. Are you trying to

LET'S

in

your products depending on the season

to adjust

weather

it's

amounts

fix

products

for

your skin

is

deciding what you want

your color? Texture? Both? Are you cleansing the

You can't choose the

product

right

if

you don't under-

to do.

TAKE A CLOSER LOOK AT SOME

COMMON PRODUCTS o

.

Cleansers A

cleanser

is

any product

stances from the

chosen will

is

90

to

do the

match your trick.

able to grab

IT'S

skin.

that

(skin oils),

dirt,

and other undesirable sub-

Cleansers range from very moisturizing to very drying and should be skin type.

Emulsification

oils off

removes sebum

is

Any cleanser

that acts through a

the term used

when

process

of emulsification

the product contains a chemical that

your skin by virtue of combining them with water, enabling

NOT JUST ABOUT WRINKLES

it

to bind

and therefore remove what's

no

the product, although

in

real function

Bottom

line:

When

it

comes

be

in

many soaps today

impacted during the

of

oil,

and other

debris.

—the perfume serves

potential irritations.

choosing a cleanser or soap, keep

the winter months, look for a milder

all

doesn't really matter

It

recommend perfumed soaps

contain moisturizing ingredients

beneficial for your skin

use the same brand

to

the

in

don't

I

and can only cause

your skin becoming drier In fact,

trapped

dirt

oil,

year round

soap

like oils

— unless you have

simple.

that

and

oily skin.

soap throughout the year as long as your

drier winter

it

If

you

fragrance

is

find free.

vitamins, which It

can

perfectly fine to

is

skin

is

not adversely

months.

CLEANSERS AND THEIR APPROXIMATE PROPERTIEE s SOAPS AND CLEANSERS

MOISTURIZATION

IDEAL SKIN TYPE

Very moisturizing

Dry, sensitive

Lipid cleanser

Surfactant with

Moderately

Mildly moisturizing

oil

Surfactant with oil-free

dry,

Neutral

Normal

Drying

°*

mature

moisturizing ingredients Plain surfactant

and acne cleansers

The simplest cleansers are or

oils

and

water. Normally

oil

and water

in

soaps create a bond between the

Sebum and stances

will

other oily materials not dissolve

in oil.

dissolve

will

Plain

oil

the combination of rinsing with water and using

A

of

lot

removing

on dry

cosmetic companies market oily

skin.

alkaline

lipid

will

dirt

and debris sub-

of these substances,

effective for

so

effective for cleaning the skin.

cleansers because they are very effective

makeup. These cleansers leave an

They are also gentle and

some

remove many

oil is

mix. but cleansers

order to function as a detergent.

However,

in oil.

warm water

and water don't

oily

in

residue and are especially effective

mature or sensitive

skin.

However, highly

soaps and detergents are extremely drying and should be avoided. Many products

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

91

on the market these days allege sitive skin,

however,

ingredients such as

it

that exfoliation

remember

crucial to

is

fruit pits

or

sea

Water-free

oil

tively retaining

which

these skin types

is

and very

has

it

built up,

gentle.

The most important

to look for the gentlest formula available.

products are the most moisturizing by virtue of

it.

combination

or

with oily skin, acne, or

is terrific

may

Please note, water-free products

and acne-prone

someone

barrier

enhance water

their ability to

whereas water-based products can only add moisture without necessarily

retention,

for oily

for

any natural

With dry or sensitive skin, any exfoliation

irritation.

or beta hydroxy acid)

must be chemical (using an alpha-

when choosing a product

mechanical exfoliation by harsh abrasive

that

salt strips the skin of

and can cause extreme dryness and

thing

the key to radiant skin. With dry or sen-

is

induce acne and should be avoided

won't leave

skin; they

I

for dry or sensitive skin

get worse.

When someone

with sensitive skin uses a

the purest

soaps known

humankind but sometimes moderately

to

become aggravated. On

the other hand, a

soap

soap such as

like Ivory is

When

oily skin feeling clean.

even combination skin uses a soap with

and the cleanser recommend

effec-

oil in

—

it,

Dove—

like

their condition

Ivory

can

— allegedly one — skin can

of

their

irritating

very effective as a cleanser for

oily/acne-prone skin.

Now am I

and (I

water.

use

I

going to share a very

have done so

Ivory)

tightly

for nearly thirty years.

and water works very

well.

44

99 Aoo% pure. Because

of

use on babies. Despite removal properties

its

purity,

purity,

its

make

held secret of mine:

it's

its

have

wash my face

oily skin,

Interestingly,

Ivory

marketed as one

so

for

soap

me,

soap

find plain

soap

I

advertised to be

is

of the safest

with plain

and best soaps

to

extremely effective and strong oil-emulsifying and

much more

it

I

I

useful for teenagers with

acne (and

this

dermatol-

ogist) than for babies' bottoms.

Soaps

are surfactants, which are salts derived from plant

free cleansers are detergent cleansers that are synthetic

cleansers, which are soaps, soap-free cleansers,

be made with added

oil

make what

to

ately dry skin. Alternatively, they

such as humectants,

soaps claim

mature

to

be

skin. Plain surfactant

the skin without replacing

92

IT'S

probably a mildly moisturizing product

relatively neutral

it

and are

somewhat

and are therefore best

NOT JUST ABOUT WRINKLES

oil-free moisturizing

sometimes

perfect for normal skin.

drying

ingredients

for

Some

super-

very dry

because they remove

for oilier skin.

moder-

for

referred to as superfatted

however, there are better choices

cleansers are

Soap-

and contain no soap. Surfactant

can be made with added

for dry skin;

oils or fats.

and soap/detergent combinations, can

esters, or fatty acids; these are

soaps. These products are fatted

is

and animal

oil

and from

irritancy of

soaps, which

ACCORDING TO THE

relatively controversial subject.

Many people

FINN

asked about the

I'm often

can be a

believe that plain

your face.

disagree.

I

your skin type simple.

and

for

is

good

not

is

use

to

for

your

cleansing

think that using the right

I

the most important thing

The purpose

dirt off

simple

soap

soap

of

is

to get

You can go

skin.

soap

—even

for it's

if

unwanted debris

and

really no-frills

when choosing a cleanser as

long as

it

works

your skin type.

The normal the

is

is

on the skin

for

a range between 5.6 and

slightly acidic.

cleansers have a basic left

which measures irritancy of

soap and cleansers by leaving

them on the

of time far exceeding normal washing, the following

The

5.8,

some of the most commonly used soaps

pH

but can be

extended periods

of time. In con-

most

irritating):

Dove

combinations have been modified chemically to have

2.

Aveeno

3.

Alpha

ing.

If

pH so

soap

that they

be less

will

(least irritating to

when

irritating

I

a lower

list

least irritating

most soap-free cleansers and soap/detergent

trast,

skin for lengths

denotes the relative irritancy of

pH

skin

which

latter of

CHAMBER TEST,

intrinsically irritat-

Keri, Dial,

Fels-Naptha,

rinsed thoroughly from the skin after use,

is

Neutrogena, Purpose chances

of

important to noting that

irritation

are

wash

as

off

some soaps

ers.

One

after

washing

significantly

much

rinse off

fact to

more

4. Ivory,

a toner/astringent residue.

5.

— such as benzoyl

or salicylic acid. Alternatively they really

Spring

surfactants with the addition

agents or exfoliating agents

acne medications

Basis, Cuticura

6. Irish

7.

of therapeutic

Jergens, Lowila,

Lubriderm, Oi latum

easily than oth-

remove any cleanser

Acne cleansers can be

It's

residue as possible,

of the functions of using is in

reduced.

common

peroxide,

may be

Camay, lava, Zest

in

sulfur,

drying solutions of alcohol or witch hazel, which

puts them more into the category of toner/astringent. Abrasive scrubs that contain

particulate matter are

sometimes marketed

"for

unplugging the skin pores"

abrasive scrubs extol the benefits of removing dead surface skin

debatable whether

some

of

cells;

in

acne.

Many

however,

it

is

these scrubs actually do more harm than good by creating

inflammation or by paradoxically thickening the skin from overuse and overzealous harsh scrubbing. Aluminum oxide and ground sive than polyethylene beads,

fruit pits

which are

in

turn

or nut shells are

supposedly more abra-

more abrasive than sodium

tetraborate

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

93

decahydrate granules. not for the face.

recommend

I

you have severe acne, overzealous use

If

too harsh for your already

means all

that

is

irritated skin

my

opinion,

dissolve the

dead surface

dead

cells

and the

cells,

is

more and gentle

real benefit of

end

fifteen to

of

massage

and which contribute

think

to the

and debris

oil

appearance

what confuses most people about skin-care products

regimen using generic (nonprescription, store-bought

that con-

of large pores.

will

work

in

name brand

care products, that they

I

or store brand) over-

— and

predicting whether

harmony. There are advantages, therefore, of using one

specially or professionally formulated. For example,

know

that the

O

putting together a skin-care

is

the-counter cleansers, astringents, exfoliators, and moisturizers they

to

on the

TAKING THE CONFUSION OUT OF SKIN CARE I

With

is in their ability

with your fingertips

enable the scrub's particles to dislodge the

the pores,

in

carefully.

this

a shower (when the pores have been

twenty second

will

all

always better than overzealous.

abrasive or particle scrubs

steamed open). A gentle

clogs

is

What

be

will

should be removed with chemical exfoliants that gently

at the

stitute the

condition.

products you are considering

unplug skin pores with gentle use

large-pored areas

an abrasive cleanser

of

and may worsen your

to read the label of the

you have

topical skin-care products, less In

ground-fruit-pit or nut-shell scrubs for the body, but

line of

products

when recommending my own

skin-

products have been patient proven and have demonstrated

work harmoniously, without being too strong or too weak.

There must be a convergence and synergy of products achieve success

in

in their

your skin-care plan. You don't have to use

my

respective categories to

products to achieve your

desired results, but you do need to select products that are synergistic

designed

to

work

well together

and they are appropriate

use proven, tried-and-true products

to avoid

for

— meaning they are

your skin type.

any wild-card results and

It's

helpful to

to stack the

deck

to

ensure the results you want and need.

Toners The cleansing process

94

use a toner

is

really

a two-step process. After using a soap or cleanser, the next

remove any

step

is

IT'S

NOT JUST ABOUT WRINKLES

to

to

additional residual

oil, dirt,

or cleanser from the skin's

surface. Toner, clarifying lotion, freshener,

same

The purpose

thing.

of toner

is

and astringent are

oil,

nor

appear smaller by causing a temporary

Most toners basically consist Alcohol-free toners are

hazel

made

products

els of alcohol,

wilt

make your

they permanently shrink your pores. The most they

will

oil

will

glands produce

do

of water, alcohol, fragrance,

for sensitive, very dry,

astringent,

make pores

is

and

and mature

in

some

cases, coloring.

skin. In addition to high lev-

for oily skin generally contain astringent ingredients

and

resorcinol,

such as witch

which acts as a combination

and which may help

to

remove dead surface

Toners complete the cleansing process by removing any leftover debris, cleanser so that your skin

is

broken

—

does the

that

to

is,

trick;

cells, or

evenly and consistently cleansed. The two-step cleansing and

an optimum fashion, but

in

anti-

cells.

oil,

toning process not only prepares the facial skin to allow the active ingredients

products to perform

for the

swelling, tightening, or slight irritation.

and menthol. Some might also contain

septic, preservative,

names

to dissolve things off your skin, not to put anything on.

Despite claims to the contrary, none of these products less

really different

improve your color and

it

also

some

texture. For

however, for most of us, that

is

enhances

corrective

in

their ability to fix

what

is

people, soap and water alone

simply not enough to thoroughly clean the

surface of facial skin. In

order for a cleanser to accomplish this two-step process by

very strong and would probably cause predictability;

products

—and contributes gently and

inated. is

And

the best

to strip off

all

way

of the

to

for

safely toward

oil,

impurities,

dirt,

and

irritation

removing impurities that need

debris,

be

to

be

from elim-

and dead

cells

on the

skin.

skin type

— and toner

normal skin usually contain mild cleansing ingredients as well

as other ingredients that soothe the skin and aid

may

to

ensure predictable and consistent results from active ingredients

excess

no exception. Toners

would have

Using a gentler cleanser plus a toner creates

Remember, every product you use should be predicated on your is

it

optimizes the efficacy of and reduces the possibility of

a certain

it

irritation.

itself,

in

moisture retention. These products

contain variable levels of alcohol, rose water, castor

oil,

glycerin,

sodium borate,

allantoin.

Toners

for dry,

ingredients.

mature, and sensitive skin include very mild cleansers and skin-soothing

They contain no alcohol and are most

refreshed. People with dry skin or

eczema should

alcohol, salicylic acid, or resorcinol. since

making the condition worse instead

all

effective at

making the

skin feel

avoid toners that contain high levels of

these ingredients can dry out already dry skin,

of better.

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

95

Toners

for oily

and combination

more

fore often contain

somewhat

alcohol. This

dry, particularly

you can

that

can leave

oily

and

identify

compensate

oil

and

there-

combination skin

(especially)

on the cheeks, and so may require the use

moisturizer on any dry areas to

Now

remove more

skin are formulated to help

of

a water-based

for the overdrying.

your skin's defects and your skin type,

you'll

be able

to

read

the labels on skin-care products to ensure that you are buying products that are right for

your skin and that

will

make

not

care products as water-based, increase for oily,

move

consumer demand

in

it

worse. Manufacturers are

oil-free, or

forward

skin.

to label skin-

noncomedogenic, because there has been an

for this information

acne-prone, or combination

now motivated

Now

—which

you know

to

choosing products

to

is critical

read labels carefully as you

your pursuit of recapturing and restoring your skin's health and beauty.

in

Cleansers and toners are the two products being shouted from the rooftops by skin-care

companies, but

changes

important to note that this one-two combination

it's

your skin's color and texture. To do

to

this,

is

not

enough

to

see

you must use an active ingredient.

Choosing an Active Ingredient That's Right for You The outer

layer of the skin consists of

replaced. The sloughing process, colorations

and

dead

when

it

works

textural issues, resulting in

off

and

reduces and helps eliminate

dis-

being sloughed

cells that are constantly

properly,

a complexion that

is

more

radiant, youthful,

healthy looking. Unfortunately, the sloughing process doesn't always work as

your tion

late twenties or early thirties, skin that is

dull looking, often discolored,

down and

naturally slows

dead

cells.

But not to

and

has not had the benefit less vibrant.

As

of

some

it

and

should. By

kind of exfolia-

skin ages, dead-cell sloughing

doesn't work properly, causing the accumulation of undesirable

worry— cosmetic manufacturers have developed numerous products

to aid this natural sloughing process.

Products that help remove the dead

cells,

normalizing

the process, are called exfoliators.

Normal

skin

needs the

quite adequately by if

the skin

is

rough,

of the skin. For

active ingredient Exfoliating

96

IT'S

an is

itself.

least

amount

Removing

makes

of help in

off

dead

cells,

since

it

does

it

the outer layers of cells from the epidermis, especially

light reflect

more evenly and improves the

exfoliator to really work,

what acts as an

sloughing

it

requires at least

one

overall

appearance

active ingredient.

The

exfoliant.

can be mechanically accomplished through such procedures as microderm-

NOT JUST ABOUT WRINKLES

—

abrasion or shaving and scalpel abrasions, or through the use of products that incorporate

granules into a cleanser or cream. Or

it

can be chemically accomplished through active

ingredients such as alpha hydroxy acid (glycolic acid, lactic acid) or beta hydroxy acid (salicylic acid).

Salicylic acid

doses and as

agent

it

can't

dozens

of over-the-counter products,

It's

commonly found

and acne. While

skin,

is

It

and when used

is

it

helpful

in

removing dead

excellent for helping treat

rough and/or dry

skin,

common

virtue of

its

many

it

can help

for dry, flaky

when used

ailments such as razor

as well as mild acne, and

irritating

low concentrations,

cells in

irritancy

small

in

years as a peeling

and creams

astringents, cleansers,

in

accomplish what other chemicals can, by

strengths. ing,

in

low concentrations, can be mildly effective over time without being

for the skin.

aging

skin,

found

higher concentrations. Salicylic acid has been used for

is in

it

at

is

higher

at

bumps from

shav-

reduce mildly uneven

to

pigmentation such as freckles and age spots.

One

of the great skin-related

buzzwords and therapeutic successes

has been AHA, or alpha hydroxy acid. Alpha hydroxy acid ical

structure from salicylic acid, which

discovered alpha hydroxy acids and way, as

if

AHA to

products with to

ucts are

and

remove dead

much more

and

rice.

utility,

they used the term

products. Both are pervasive

cells for fixing

Consumers

in

moisturizers

and

products

well

for color

"fruit

improve

as

beautiful skin.

and

skin,

AHAs can

dead

We now

many

fix

use

AHAs

of the color

also help reduce fine and

AHAs work by dissolving This allows the

to

the "glue" that holds

cells to

slough

salicylic acid

dull texture.

and

AHA

prod-

texture skin problems.

from certain plants,

off,

dead

and women

their skin.

medical research has advanced our understanding of these

sun-damaged

a mysterious

in

fruits,

sour milk,

acids" have been used for hundreds of years as

tartaric acid, to

better formulations of these products.

chem-

didn't realize the close

of naturally occurring acids derived

skin fresheners. Ladies of the French court

used aged wine, which contained

ered,

AHA

natural products, including sugarcane, apples, grapes, citrus

History suggests these

in

over-the-counter products and are

brown and tan color as

effective than salicylic acid

Alpha hydroxy acids are a group fruits,

their

so they immediately started replacing old

salicyclic acid,

new AHA

only slightly different

is

decade

a beta hydroxy acid, or BHA. But when scientists

they had invented something groundbreaking.

similarity of

used

is

of the last

to

and

medium

of ancient

Over the

AHAs and

last ten years,

allowed us to create

combat acne and textural

Rome

problems

dull,

weath-

that prevent

facial wrinkles.

cells together

on the surface

leaving behind a layer of smoother,

of the skin.

and thereby

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

97

and

brighter

AHAs

softer, skin. In addition,

help to dissolve the material that clogs pores.

acne

This allows the pore to drain better, decreasing the tendency for the formation of lesions

and helping

reduce pore size and the appearance

to

with salicylic acid

The problem

in

created a revolution

our

chemicals, the three most

The

AHA

first

used

that while

it

common

for skin

care

product called Lac-Hydrin. Sold

of

which are

was

small

amount

in

ammonium

it

does help

is

makes

AHAs

texture.

lactate;

The moisturizer

is

to chemically dissolve

is

it

keratolytic

some

purposes

made

is

smooth, bright texture All

it

A

so

them

little

in

of

its

lot

of over-the-counter

much

of the dry scales.

The bottom

believe glycolic acid

of restoring her skin; milk

dead

cells.

AHA

is

glycolic acid.

stronger than lactic acid, and

all

is

the

line:

most

effective.

The strength

dead

Worse

much more

layer of the epidermis

the keratolytics. You have to use

cent

content,

and

some products and so

of glycolic acid

its

it

in

is critical

to

the right strength

glycolic products

used

become at

go much above 3

(although physician-strength

NOT JUST ABOUT WRINKLES

to

see

or 4 per-

effective as physician-strength glycolic acid

very popular because they offer

home

offer

effect.

and form

products. Physician-strength implies higher strength. "Lunchtime" glycolic peels physician's office have

are

—with the widest therapeutic

with glycolic acid don't

meaning they won't be as

still,

but contain no glycolic acid

effective active ingredient

Most over-the-counter products

in

be

like glycolic,

results.

IT'S

It's

products claim to contain glycolic acid, but most have

that they just can't possibly

benefits.

margin— of

98

in

to the skin.

labeled with words that look or sound

I

available as a

still

the optimal chemical agent for restoring even color

is

the

acids have different strengths. They can be concentrated, or they can be diluted to be

very weak.

none

in

from the chemical manipulation

dissolves keratin, which the uppermost

it

For that reason,

of.

made

a very simple, small molecule

— meaning

acid.

reasonably good and the

the skin smoother by removing

is

and pyruvic

mostly used as a body moisturizer that further

cells.

sugar and sugarcane. Glycolic acid

of

the

are a family of

was introduced

But for the purposes of skin repair and restoration, the most useful is

in

over-the-counter products, and

in

interesting to note that Cleopatra took milk baths for the

contains lactic acid, which

and

lactic acid, glycolic acid,

weaker strengths

dead

superficial, scaly

of lactic acid

Glycolic acid

enough

not really effective

derived from lactic acid, and

stronger strengths by prescription only,

remove

it's

correct skin color

ability to

mid-1970s by Westwood Pharmaceuticals as

acts to

works,

enlarged pores.

over-the-counter products. AHAs, on the other hand, have really

concentration available in

is

of

much

home

done

in

a

greater benefits than

products,

when used

properly, are

dead back

to

work as or

may use

you had no procedure

if

a pyruvic acid

be a superficial peel,

enough

and

my

at

all.

removes

just

enough

radiant, but allows

you

of the top layer of to

immediately go

The benefits are wonderful and

visible after

two treatments.

pyruvic acid, another

Finally,

In

and

skin cells to leave skin looking rosy

one

just

quite effective). This procedure

still

AHA,

the office to

in

like

is

much

do a

controlled peel of the skin, but

glycolic acids peels are.

layers of the skin to

cause

A

it

doctor

certainly wouldn't

pyruvic acid peel would

remove

crusting.

opinion, the three therapeutic active ingredients mentioned so

and

glycolic acids, as well as cleansers

when used as

A

too strong for use by consumers.

toners, are

directed. However, a pregnant

woman

all

far, salicylic, lactic,

safe for use during pregnancy

should always consult her obstetri-

cian before putting any topical agent on her skin.

On

tretinoin,

which

ucts have

also

is

been shown

known by to

the brand

be teratogenic

in

names

Retin A, Avita,

rodents

— meaning they cause malformations

rodents' developing fetuses. Retin A, a brand of tretinoin,

and

early 1980s,

and was used

have a positive

to

cal

women

the other hand, one product that should never be used by pregnant

chemical

for

effect

and Renova. These prod-

very popular

primarily for the treatment of acne.

on photoaging by reducing

reducing fine lines

Retin A, Avita.

was

at

home.

was

It

fine lines,

also

shown

is

and

was

It

it

in

the late 1970s

later

became

to help

in

discovered

the

first

topi-

reduce brown spots.

and Renova have a very narrow therapeutic margin, and some patients

are very easily irritated by the products. Tretinoin

easier to get sunburned

when using

it.

is

also photosensitizing, so

Finally, tretinoin

it's

much

can cause neovascularization, or

the production of tiny blood vessels, and can break capillaries, causing red color issues

instead of erasing them. Renova, which for

an

older,

non-acne-prone population.

because older people have poses

of fighting

drier,

tretinoin in It

difficult to

an emollient base, was developed

has a heavier and more moisturizing base

less oily (mature) skin.

photoaging, or to help reduce

the time asking for Renova, but

much more

is

in

my

fine lines.

experience

use than glycolic acid

Renova was patented

it

for the

is

Women come

into

not nearly as effective

for the pur-

my and

office

all

certainly

treatment of color, texture, and (some)

contour problems. In

summary, although alpha- and beta hydroxy acids have been described by some doctors

as being old news, effective skin care

I

believe they are

and dermatological

and

will

remain state-of-the-art, essential

fixtures in

practices.

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

99

Sunscreens and Moisturizers The

products you need to complete your skin-care routine are a sunscreen and a

final

moisturizer. Let's look

The application

Whether sun on

I

damage

hear about

like to

their skin;

year.

The concept

of protect-

predicated on taking steps to ensure your skin's safety.

is

or not, there are

it

We

good.

feels

it

a sunscreen.

sunscreen should be done 365 days a

of

from future

ing your skin

of using

importance

at the

first

all

many people who

participate

in

outdoor

enjoy the warmth of the

whether jogging

activities,

in

the morning, walking to work, taking the kids to school, eating at an outdoor cafe, or walking the dog. If

I

simply unrealistic

will

tell

shine for

you how

for

me

to

patients to stay out of the sun completely.

tell

a new dermatologist or they simply wouldn't

did, they'd either find

sun to

It's

many more

millions of years,

to protect yourself

when you

Hopefully the

listen.

and therefore the best advice

can

I

offer is

are outdoors.

Sunscreen helps prevent sun damage, both degenerative and precancerous, including

brown spots, broken

capillaries, wrinkles,

and actual cancers. Sunscreen,

product you use, should be predicated on your

every facial

like

facial skin type.

Most sunscreens are moisturizers with added sunscreen ingredients. There are also oil-free

prone

emulsions, solutions, and gels available especially for those of you with

skin.

It

extremely important to use a sunscreen that

is

Sunscreens display cates the amount of

standard thickness. without burning

in

Let's

it

to

It

in

A

live

fifteen

burn. But

IT'S

of

15

will

indi-

a layer

in

if

of

sun

you weren't

allow one-fifteenth of the

UVB

light

to the skin.

minutes.

SPFs

The SPF

to stay out in the

long you could stay out without burning

on the East Coast, and

FACT: More than

100

how

sunscreen with an SPF

stay out ten times longer, will

you how long the product allows you

acne-

your skin type.

pass through the product when applied

mid-July Without sunscreen,

sunburn within

you

tells

right for

(sun protection factor) on the product label.

light that will

also

pass through

say you

sunny day

UVB

SPF

relation to

wearing sunscreen. striking

their

is

oily or

If

it

if

is

beautiful, eighty-degree, bright,

you have type

I

or

II

you use a sunscreen with an SPF

meaning one hundred

are a

noon on a

little

$1.2 billion

like

EPA

fifty

ratings.

When you

you

will

develop a

of 10, in theory,

minutes (two and a

was spent on moisturizers

NOT JUST ABOUT WRINKLES

skin,

half hours)

look at the

last year.

you can

EPA

before

rating

on a

RECOMMENDED SUNSCREENS FOR VARIOUS SUNSCREEN TYPE

IDEAL SKIN TYPE

"Waterproof"

Dry, normal,

No sunscreen

Note: is

really

SKIN TYPES

Oil

mature

based

Stick, oil,

ointment

or absorption

waterproof

Water

Dry, normal,

resistant

mature

Normal to

Regular

Water

dry,

Cream, lotion

in oil

water

Oil in

Cream,

mature Oil free

Oily,

acne prone,

on the

sticker

Oil free or

water

Cream,

or alcohol based

always a disclaimer stating that you

car, there's

lotion,

spray

combination

new

I

FORM

BASE TYPE

may

spray, or gel

not get the

on the open road, because mileage with respect

lotion,

same mileage posted

gas economy

to

deter-

is

mined under laboratory conditions, as are SPFs.

A good tested,

is

rule of it

is

thumb

tested

in

sunscreen with an SPF

mend

is

that

all

SPFs

shrink by one-third

a lab with no wind, no spray of

15

really shrinks to

using a sunscreen with an

SPF

gives you 88 percent protection from sun with an

SPF

of

is

worth

45

to

For

it,

considering

60 tend

women, an

have access turizers with I

is

to

think the

expected

to

be

how

in

If

to

actual use.

don't

I

wearing sunscreen (which

I

know

only

sunlight.

SPF

of 15

A sunscreen to 60,

you

that the last 4 percent

with an

SPF

of

people with mature

skin.

recommend when you

don't

to

wear makeup with an SPF number. Foundation,

change the requirement

So a

always recom-

with an

many sunscreens

lipstick,

and mois-

common.

SPF-number system has confused some consumers. to

I

you double the SPF from 30

protection (99 percent).

of 8 or higher are

When sunscreen

less perspiration.

A sunscreen

—although they can be more acceptable

is

an SPF

in

and

damage caused by UVB

unpleasant, thick, and gooey

alternative to it)

10

of

15 to 30.

30 gives you 95 percent protection.

only gain another 4 percent

actual use.

of water,

an SPF

of at least

in

for

SPF numbers, so

that

In

the near future, the

FDA

sunscreen manufacturers

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

101

no longer have

will

as

medium,

low, It

used

to

to put

all

be said

that

In

shown sunscreen I

still

addition to sunscreen, you

be harmless

to their

recommend keeping babies

add moisture

need a moisturizer to the skin

and emollient tend

to

layer of skin) contains less than

important part

to

six

keep your

young,

six

months

of age,

beautiful, soft skin.

months and younger out

in

skin

in

of

balance. Moisturizers

—whereas emollients are designed

be used interchangeably.

If

skin,

to soften the

and therefore the terms

the stratum

10 percent water, the skin feels

dry.

corneum

Surface

oil

(outer

plays an

preserving dry skin by acting as a barrier that prevents evaporative water

loss. Therefore, traditional moisturizing

102

to

However, adding moisture to the skin tends to soften the

moisturizer

oil

simply label their product

will

— period.

are designed to skin.

packaging; they

sunscreen shouldn't be used on infants under

things considered,

the sun

their

or high protection.

but recent studies have

But

numbers on

products are oil-concentrating products. The more

a moisturizer contains, the more effective the moisturizer becomes, but the greasier and

IT'S

NOT JUST ABOUT WRINKLES

ON VARIOUS

EFFECTS OF MOISTURIZERS TYPE OF SKIN

MOISTURIZER BASE TYPE

Extremely dry or mature

based

Oil

Extremely moist

Absorption

Very moist

Dry

Water-in-oil emulsion

Moderately mois

Normal to dry

Oil-in-water emulsion

Mildly moist

some

oily

Oil free,

people) the more unpleasant

people with

oily

and combination

Finding the right moisturizer

a moisturizer does,

essentially,

is

is

it

an

glands can't compensate

teels

Slightly moist

—and the more apt

it

is

to

aggravate acne

is

any skin-care regimen. One way

integral part of

to apply

in

it

when

the skin

is still

to

damp, because what

lock water on the surface. Your skin (especially dry skin)

water (moisture) replenished;

its

water based

skin.

improve even the best moisturizer

needs

NET EFFECT

Very dry or mature

Normal to

(to

SKIN TYPES

what moisturizers are supposed

this is

for the lack of moisture: oil

is

to do. Oil

not a substitute for water. Water-

based, not oil-based, moisturizers increase the water content on the outer layers of the skin,

and give

it

a

based moisturizer holding is

more comfortable

softer, is

really

an

feel.

"oil-izer" that

no moisture

to hold

in,

it

oil-

works by

or retaining existing moisture. But

in

An

if

can't function effectively as

a moisturizer.

moisturizer are the products you It

is

Use a cold-water humidifier to

add moisture

Cleanser, toner, an active ingredient, sunscreen,

program.

DRY-SKIN TIP

there

will

use

in

and

ment, especially when you sleep

your daily

and

in

the winter. This will help

essential to find the right products that

to reduce the

work harmoniously For

to your environ-

more help

your skin type and condition.

figuring out

you, see chapter

conditions and

for

8.

There

which products are you'll find

recommended

right for

a complete

list

of

amount of mois-

ture lost from the skin through

evaporation.

products.

RECAPTURE AND RESTORE YOUR BEAUTIFUL SKIN

103

The Program O WHENEVER

I'M

care products,

Perhaps

like

my

into

WHY DEVELOPED I

always respond "because

you,

products that

come

I

ASKED

will

my

my

my own

patients needed them."

patients don't always understand

work

for their skin

around

my

I

developed

notion that patients

into the mirror, but they don't can't identify the problem, If

how

my own

know

they're

know what

line of

(lines,

is

made up

wrinkles,

products revolving

unhappy when they look

they're

unhappy with.

can you effectively treat

If

you

it?

you've ever used the computer program Photoshop, you

an image

to choose

of color and texture issues, and

they simply can't separate them from their contour jowls, furrows) issues. So

how

and their conditions. Most patients

some degree

office with

line of skin-

know

that

of a composite of several layers superimposed on

each other, each layer with

a different

element that makes the

final

105

picture. But unless

superimposed photo. The ing at a

you have an understanding

layers,

same

you can't possibly decipher

holds true

composite

And unless you

one

falls into

The combinations and permutations

moment, when they

make

finally

facial skin

ACHIEVING PERFECT SKIN

So when my

to

guesswork out

addition to a perfect skin-

care program, getting

make sense

sleep, eating diet,

ask

a healthy, nutritious

to

cells.

and

them.

can show them

I

right for their skin,

those color and

for

products. They ask for something to

brown spots

They get

their condition,

and they understand the issues and

for the right

lighten their

and finding adequate

products, and

of skin care.

use the products that are

texture issues,

enough

ultimately

patients have that inevitable "aha"

products developed especially In

and

elements that compose these three cate-

products

how

my

appearance. But

overall

the connection between their skin

my

final

of three categories: color, texture, or contour.

of the

gories cause dissatisfactory reflections.

of

look into a mirror, you are look-

make up your

the program laid out here, were developed to take the

Every condition on your face

use

are a dermatologist, you probably don't yet

on your

layers' implications

effective

its

making up the

the elements

all

when you

your facial skin:

of several different layers that

your outward appearance.

understand those

for

program and

of that

it.

And so

away

or to take will

their

dead

you.

positively

There are endless products available that can

impact having the skin you've

address your skin-care needs, but the most important

relaxation time

all

issue

always wanted.

and

to

is

for

use the

right

your specific concerns.

this very

products. However, to do, but isn't in

the bottle;

When used

106

IT'S

will

it

does

lot

of effort. In fact,

require you to

be

it

only works on the face.

as prescribed,

it

works

NOT JUST ABOUT WRINKLES

for

if

you follow

diligent

The program

thirty

days.

doesn't even require you to use

and consistent.

your skin worth two minutes twice a day? The bottom it

promise:

I

see a rapid and noticeable

your complexion's color and texture within fifteen to

The program doesn't take a

your skin type

and contour) and then using products

appropriate for your problems and your skin type, you in

for

simple program, consisting of understanding

the three categories of your skin (color, texture,

improvement

products

is

almost everyone.

line

It

my

takes two minutes

is,

no product works

almost foolproof

in its

simplicity.

.

THE SIMPLE FOUR-STEP PROGRAM

o

.

This program leads you skin

down a

clear path so that

you can achieve the

you have always wanted. My simple technique makes better-looking,

achievable

for

everyone

—as

long as they follow the plan. There

Look, skin care

isn't like

a

for

dull,

ordering from a Chinese take-out menu. You can't choose one

Products are designed together to work effectively together. line to

complement

the ultimate goal

But before you get started on your

chapter

In

no excuse

column A and another from column B and expect the products

item from

taken.

is

healthier skin

patchy, blotchy, discolored-looking complexion. Not anymore.

tired, dry,

care

beautitul, healthy

1

you learned

,

in

improving

new regimen,

I

deliberately planned

color, texture,

let's

work

to

in

sync.

my

skin-

and contour.

review the steps you've already

to identify those defects that

make up

the various prob-

lems on your face, including color issues such as red and brown spots and texture issues

such as

matte, tired skin;

dry, flaky skin; dull-looking,

cobblestone skin

and acne-prone, large-pored, and

—and you marked them on the face diagram you

filled

out

in

chapter

1

You've identified the areas that need improvement, and you've (hopefully) accurately ascertained your skin type, ing the right products to

read about the radiant,

ing than

it

My program The

first

that

toner,

to correctly recapture

routine into a

three steps are exactly the

will

skin. In

and

same

active ingredient. Your

and

final

make

it

easy

for

you

chapter 6 you

restore your bright,

to look

(for

day),

far less

and

daunt-

for.

You

will

cleanse your

morning routine

will

then include a sunscreen, your

for both.

in

use a

skin,

your evening routine

will

toner,

be using

product. Using sunscreen and moisturizer on a daily

help prevent your problem from coming back or worsening and

a normal balance of water and

crucial to find-

morning regimen and an evening regimen.

product before applying makeup. The difference

basis

is

an active ingredient, a sunscreen

you know exactly which products

down your

moisturizer as your fourth

To

your correct skin type

Finding the correct products for your skin should be

be now

breaks

and then use an final

to

3. Identifying

improve the quality and appearance of your

— a cleanser, a

(for night).

used

chapter

main products you need

five

glowing skin

a moisturizer

in

oil in

your

to follow,

I

will

help maintain

skin.

have broken down the morning and evening

routines into two separate sections.

THE

PROGRAM

107

MORNING ROUTINE __

O

Step One: Cleanse the Skin In

order for an active ingredient to work,

means removing skin.

and debris

oil

that

we

will

all

need

to start from

an even playing

field.

That

prevent an active ingredient from penetrating the

Everyone, regardless of skin type, has to prepare

ment by using a cleanser and a toner appropriate

their

face to accept any topical treat-

for their skin type.

Cleanser begins the preparation process. Never vigorously scrub your face or use a washcloth; applying excessive pressure to an already inflamed, chafed, or sensitive area will

only

make

it

worse. The cleansing process should be gentle: use your fingertips to mas-

sage a small amount

warm

of cleanser

onto your face

seconds, and rinse with

for ten to fifteen

— not hot or cold —water.

Step Two: Prepare the Skin with Toner Toner completes the cleansing process by removing any leftover debris,

so that you a

soft, thin

Now

start with the

cotton

skin surface every time

makeup pad and

the facial skin

perform

same

is

prepared

gently wipe to

cells, or cleanser,

oil,

you wash your

Apply toner to

face.

remove any excess

debris.

to allow the active ingredients in corrective

products to

an optimum fashion.

in

Step Three: Use an Active Ingredient The next step

is

choosing and using the

right active ingredient for

appropriate form (solution, serum, cream, ingredient

The

is

not

in

the right form,

vehicle, or form,

it

will

terms—you

"oil

free," or

may aggravate

skin-care products oily,

make

it

one

that

of

my

easy

you have dry

NOT JUST ABOUT WRINKLES

skin,

make

the

in

the active

If

products

is

for you.

acne-prone, or combination skin

"noncomedogenic." The product need only use one

If

—

your problem.

don't get extra results or efficacy from a product labeled with two or

don't waste your time looking.

IT'S

worse,

skin type. While every

skin-care producers instead label products for

as "water based,"

108

all

ointment) for your skin type.

ineffective, or

depends on your

labeled according to skin type, not

Many

be

lotion, or

your skin-care issues

sure that water

is

all

one

of

these

three,

of the

so

first

ingredients listed.

you have mature

If

skin,

oil

based ingredients should lead the ingredient water should appear somewhere your skin you'll

thirsts for both.

be very lucky so you

sitive skin,"

ingredient

list.

acid).

And

if

you will

you

really

list,

products labeled

find

WHEN

oil-

since

begin with the product that

skin,

"for

or alcohol-based products first;

there's nothing

your skin (such as

you have normal skin

solutions, serums, or lotions

salicylic

— lucky you! Most

second; creams third;

of

for the other five skin

Sometimes you

need

be

A

lighter product will never

just fine to use.

to

use more than one active

mechanism

of

two or more

can often increase efficacy and

orations, after cleansing

skin from

will

and toning the

face,

first

results. For

making additional brown pigment. Second, use an

of glycolic acid

will

exfoliant,

abnormal

cells,

is

the

— but more

most patients

to dull, matte skin. Furthermore,

it

dead cells,

will

irritation

brown

such as a cells.

discol-

glycolic-

The continued

which contributes to

remove some

is

is

most

effective active ingredient

not always better.

It

in

must be started

treating at the

of the early

brown color and

texture

proper strength, which

8 percent. The strength can slowly be advanced to 10 percent and

mately 15 percent to optimize improvement. Advancing the strength

no

for

which might otherwise go on to become precancers.

Glycolic acid

defects

in

dead

help prevent the accumulation of

brown discolorations and

example,

use a bleaching product, which stops the

acid product, which removes extra pigment that already exists

use

last.

penetrate a heavier product. will

ingredient; the synergistic

active ingredients

types

and

petroleum-based products

us do, and therefore most products not labeled as

being

is

the lightest form. Use water-

in

sen-

probably have to resort to the

will irritate

USING MORE THAN

ONE ACTIVE INGREDIENT,

and

list,

have sensitive

Most important, make sure

the bottle that

in

if

If

on the

later

or

is

for

ulti-

only suitable provided

occurs during use. Most people without sensitive skin can easily ascend to the

optimal efficacy of 15 percent

—over a period

of time.

Step Four: Apply Sunscreen After using the active ingredients,

sunscreen. Use sunscreen

in

which ameliorate the problem, the next step

the morning after the

makeup. Reapply as needed during the day or perspire.

Review chapter 6

to help

if

first

is

applying

three steps, but before applying

you spend a

lot

of time outdoors,

determine the correct sunscreen

for

work

out.

your skin type.

THE

PROGRAM

109

EVENING ROUTINE

O

!

Step One: Cleanse the Skin (as described

in

your morning routine)

Step Two: Prepare the Skin with Toner (as described

in

your morning routine)

Step Three: Use an Active Ingredient (as described

in

your morning routine)

Step Four: Apply Moisturizer In

the evening, the

final

step

is

applying moisturizer. Be sure to use the right moisturizer for

your skin type. Refer to chapter 6

for

a detailed recap on choosing your correct

Using sunscreen and moisturizer on a daily basis

coming back your

or worsening

and

will

will

moisturizer.

help prevent your problems from

help maintain a normal balance of water and

oil in

skin.

TIP: Take a

photo

photo of yourself before you begin the program. Take another

thirty days later. You will be

amazed at

the changes in your facial skin!

THE

PROGRAM

111

BEFORE: Shows acne, brown

and

spots, blotches,

large pores.

The discreet

brown spots on her cheeks are post-inflammatory

hyperpigementation as a result of prior

acne lesions

(pimples and cysts). Active

acne papules can be seen

above her

left

eyebrow

(right side of picture).

The

very dark small spot just

next to her nose

is

a normal

mole (junctional nevus

is

the technical name).

AFTER: decrease

Demonstrates in

brown

spots,

including the area above her lip,

improvement

in

acne

bumps, and decrease size.

in

pore

As expected, the dark

spot (normal mole) next to her nose

is

unchanged

despite improvement of the

other brown issues. (Mole color

is

unaffected by the

program.)

If

you are

want

truly

motivated to get the most out of

appearance

to optimize the

process a daily practice. From ting to

brush your teeth or niques

your

by changing

their

It

in

it's all

and

this plan,

be prepared

to

about maintenance

possible,

right

it's

incredibly face.

it

successful dieting. Most people

like

in

success.

identify

in

color

to not only

makeup goes on

and

daily

And

it

maintenance.

It's

all

about

and even

It's

your skin, you

will

at

not only

when you

choose the appropriate skin-care products

working should

is

of the

program

is

that

it

that other

is

different, but

the program

be able

thirty

they

two weeks.

you through touch. You

will

takes less to cover imperfec-

people

will

or

compliment you as

will

changed your

certainly

days or more, you

to actually

for

skin.

start within the first

— have you recently taken a vacation

Once you've been on

discipline.

only takes four minutes a day!

and smoother and

won't be able to pinpoint exactly what

in

diets

particular

texture that are noticeable to

easier

Another wonderful benefit

ference

get-

your problems, you know your correct skin type, and

program

earliest signs that the

secret!

in

who go on

easy because you now understand what you're looking

you've done something

will

see the differences

want

to

hair?

They

know your

not only feel the

in

your

dif-

color, texture,

contour.

Your success of

— both

off

which requires

results

You can

Subtle changes occur

if

this

take two extra minutes to practice the simple tech-

hair,

your problems but to practice daily maintenance to preserve your beautiful

notice your

make

back on

you have the simple technique

The

truly

maintaining them. Just as you get up every morning and

their lifestyle.

any routine

examine your

tions.

to

possible to recapture and restore your youthful, bright, radiant skin.

is

you

if

—and then some. The only way people keep weight eating habits and routine — They stay on a plan it

to maintain their weight loss,

Discipline

in

shared with you. Think of

I've

lose weight, but put is

comb

you have

of your skin,

this point forward,

your desired results and

book and

this

you getting

is

predicated on your commitment and motivation

this far in the

book,

I

know

—and by now, by

virtue

you're ready to put your best face forward.

THE

PROGRAM

113

sou only get

what you give

yourself— so give yourself the DR.

ROBERT ANTHONY

best.

Skin Typespecific Products for

Your Program o

YOU MIGHTTHINKTHAT

HAS NEVER BEEN EASIER

IT

to choose

the correct products for your skin type, right? Well, I'm not so sure.

an eye-opening experience as

major national drugstore.

I

I

walked down the skin-care

had

aisle of a

was absolutely shocked, even confused, by

the dizzying array of skin-care products on the shelves fessional skin-care authority!

It

is

— and

easy to understand

completely baffled, disempowered, and ability to

I

choose skin-care products, as

why

I

am

people are

— ultimately— paralyzed

a result of

a pro-

in

their

the incredibly large and

intimidating selection. Without the help of the information contained this book,

how

in

without an understanding of their skin type and problems,

can anyone possibly make the right choices?

115

No wonder consumers

Products

the skin-care aisle

in

are confused

I

visited

to identify

skin-care products!

were grouped by brand name, not by skin type or

name, there was no

condition. Within the grouping by brand

way

when choosing

particular consistency,

no easy

which products were cleansers, which were toners, which were active ingre-

dients for pimples or facial rejuvenation, or which

were sunscreens. And within the same

brand, there were competing but similar products with only very subtle differences between

them, which required the wisdom of Solomon and the expertise of a cosmetic dermatologist to decipher.

Neutrogena products were the easiest

marked

for

each

of the six skin

Neutrogena products

to

types discussed

of

my

hobbies

course, drinking wine.

than

my

recent

visit

up and down any

for the

When

I

at least fifteen

and

general they were clearly

book, but there were sixty-two

thirty-five

L'Oreal products, forty-

other brands.

past twenty-five years has been studying, collecting, and of

first

started, walking into

to the skin-care aisle

aisle,

in

Aveeno products, and twenty-eight Clean & Clear products, not

mention house-brand products and

One

this

in

choose from! There were also

nine Olay products, sixteen to

because

to figure out

virtually

was. But

every bottle

a wine store was even more confusing

now can

will

I

visit

any wine purveyor and walk

make some sense

to

me

in

terms of the

type of wine, the vintage year, the grapes, the wine maker or winery, the country of origin, and the region of origin. Yet

most people who have not studied wine

wine aisles can be as or more confusing than walking up and

116

IT'S

NOT JUST ABOUT WRINKLES

find that

down

walking up and

skin-care aisles.

down

—

Best Cellars

and purchase

a national chain of wine stores that has tried to simplify the selection

is

wine

of

consumers whose desire

for regular

understanding of

their technical

consumers can more

— by separating

make

it

easy

of their

big,

into categories that

champagnes

and sweet. Each category

which

variety of ten or fifteen wines, for

wines

are: fizzy (obviously,

smooth,

fresh, soft, luscious, juicy,

has a sign under which are a

all

Those categories

easily identify with.

and sparkling wines),

categories and

it

and enjoy wine exceeds

to drink

non-experienced wine drinkers

to

those respective

into

fit

buy a wine

that suits

their taste.

So my goal and

problems

texture

care aisle once you

is

choosing skin-care products that

to simplify

— based on your skin type. You can

know your

problem

ing for your

have the

book

in this

fight

will suit

your color

way through

your

skin type, understand the category of product

you are seek-

(cleanser, toner, active ingredient, sunscreen, or moisturizer),

make you

confusing and even misleading, as they are sometimes purposefully written to

can do things they can't

For instance,

many products

or that they

are labeled alpha-

have ingredients they

and beta hydroxy but

therapeutic alpha hydroxy acids or beta hydroxy acids. But they This brings I

now

me

and

read labels. Product labels are so important. However, they can also be

ability to

think that they

the skin-

full

circle to the

appreciate more than ever

reason

I

created the Stallex

my

value to

its

patients,

make you

that

work harmoniously

to

fact don't

have

think that they do.

because they don't have

accomplish the

that are very simply labeled according to skin type

in

for Perfect Skin skin-care line.

through the research, bewilderment, and guesswork of obtaining the

assembled products

don't.

right

products.

to I

go

have

laid-out goals, products

and therapeutic

application, or the skin-

care goal you want to accomplish.

Now

that

to discern

you have a more complete understanding

and ascertain what combinations are

from cleansers to active ingredients

—

lems (whether they're focal and

random

texture right

problems

just

(dull, tired, flaky

products as you

will

of skin type,

right for you.

effectively

and

spots, or diffuse In

ability

The appropriate products

efficiently

skin or large-pored skin).

wade through

you have a better

solve your color prob-

and blotchy areas) and your an

effort to

help you pick the

the skin-care aisle at your local drugstore,

I

have put

together a comprehensive guide of products that can work together to give you the results

you seek. successful type.

I

hope in

your

that this

new

will

help you

make more informed choices so

skin-care program.

These are recommendations

—

I

All

know

products are formulated

that these

for

that

you

will

be

your specific skin

products work.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

117

CHOOSING YOUR PRODUCTS O I

have developed two

included

the

in

of

list

of

my own

skin-care lines, Stallex for Perfect Skin

product choices

—and Proof Skin Care.

stream, easy-to-find skin-care products that types.

The bottom

happy

of being

allow you, that

Many

and skin;

you don't need

with your skin; there

is

So

"for

labeling

it

makes sense

dry skin"

"oily,"

This guide

if

to

buy products labeled

you have dry

skin.

IT'S

"for

But products

for dry skin

is

will

"oil free,"

improve

normal skin"

may

will

for the

for oily or

or labeled as to skin

you have normal

most

part.

combination

"noncomedogenic,"

or

if

it.

skin,

not be labeled as being for mature

can be substituted,

in

Conspicuous

skin.

They are

addition to their being

"acne-prone," or "combination" skin.

meant

to help

you

find the right

lems, but the real test of whether a product If

various skin

products to accomplish your goal

and toners are marked

can overwhelmingly be found on products

labeled for

for

a huge variety of products on the market that

of these over-the-counter cleansers

labeled as either "water based,"

118

my

buy

have

a cost-effective and easily accessible fashion, to choose cleansers and toners

those labeled as being

cation.

to

I

have also chosen main-

I

accomplish specific goals

properly prepare your skin for other products that

will

type.

in

line is that

will

—which

a cream or

lotion

is

products right for

leaves your skin feeling

NOT JUST ABOUT WRINKLES

for

your skin and skin-related prob-

your skin

irritated,

it

isn't

is

how

it

feels after appli-

working well

for

your

skin.

—

If

it

leaves your skin feeling not too dry and not too

right for

your

The product

listed in

that

present

is

the ingredient deck, or

lesser amount. This holds true

ingredients that ing

vance when

in

make up

and are used

stabilizers

oil

balance, then

it's

in

on product labels according

the largest percentage or proportion

Each successive ingredient

list.

until

listed

you get

less than

the

first

item

therefore present

is

in

a

to the very, very low concentration ingredients

percent of the

1

is

concen-

to

product. At this point, the order-

total

no longer by concentration, but these ingredients are usually preservatives and other

is

So

in

skin.

For the most part, product ingredients are tration.

pleasant and

oily,

let's

comes

it

or petrolatum:

need

of moisturizing,

in

purposes

oily skin,

chances are

because you want a (lacking

to your

say you have

reasons. They don't usually have any significant rele-

for technical

and the

it's

you want

oil),

using the product.

first

ingredient

not for your skin.

make

to

moisturizer, not

both water and

for

an

in

On

even

In fact,

sure that the

oil-izer.

a product you pick up

first

if

you have dry

ingredient

the other hand,

if

is

mineral

is

skin that

water

— not

you have mature skin

then you do want a product with a high concentration of

So how do know this program will work? have had the opportunity to perform what ably the longest and largest

five or

more

for

clinical

skin-care study

in

the history of dermatology. For

have seen tens of thousands of patients succeed using

accurately chosen products (a cleanser, a toner,

tain active ingredients

worked

is

I

I

I

them, and

—a

I

moisturizer,

know

it'll

work

and a sunscreen)

for you. All

one

that

you have

to

or

more

changed

do

is

this

dif-

actives

prob-

more than

—

program

using

—which con-

their skin forever.

It

use the products.

PROGRAM FOR OILY/ACNE-PRONE

SKIN-CARE

oil

hydrocarbon-based chemicals.

ferent types of oils or

twenty years.

is

SKIN

.

Acne. Pimples. four) suffer

Zits.

Nine out of ten teens (and one out of

five

adults

aged

twenty-five to forty-

from these annoying, sometimes painful red bumps. Not to mention whiteheads

and blackheads. A buildup

of

oil.

bacteria,

and dead

skin cells

can clog pores and cause

acne. Stallex professional products and the following over-the-counter products can help you get long-term

relief

from

this often

embarrassing and now completely controllable condition.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

119

Cleansers for Mild Acne: Put your best face forward by keeping your skin fresh, clean, and clear. These facial cleansers

cleanse normal to

oily skin,

and help you achieve and maintain a

Directions: Use two times daily and as needed Gently

and

do not rub

Aveeno Cleansing Bar for Acne: 2%

•

Clearasil

•

FostexAcne Cleansing Bar: 2%

•

Johnson and Johnson Clean

•

Neutrogena Oil-Free Acne Wash: 2%

•

Stallex Cleanse

dissolve

warm

(not hot or cold)

dry.

•

your

radiant complexion.

cleanse and remove excess oiliness.

with fingertips for fifteen to thirty seconds. Rinse with

massage

water. Pat,

to

clear

sulfur,

Medicated Deep Cleanser: 0.5%

&

2%

salicylic acid

salicylic acid

salicylic acid

Clear:

alpha hydroxy,

salicylic acid

salicylic acid

and Purify, Level 2: our specialized ingredients and wash away dirt and oil from the pores to reveal

skin's clarity

while maintaining

its

natural moisture.

Cleansers for Moderate or Severe Acne: These

antibacterial

work gently but use

will

and anticomedonal

effectively

facial

cleansers

for very oily

and acne-prone

and help you maintain a clear and radiant complexion. Regular

help control acne and prevent breakouts.

Directions: Use two times daily and as needed to cleanse and remove excess Gently

massage

water. Pat,

with fingertips for fifteen to thirty seconds. Rinse with

do not rub

•

Fostex

•

Oxy-w

•

Peter

10% BPO Acne Medication Daily Face Wash:

Bar:

Cleanse and

10% benzoyl peroxide

10% benzoyl peroxide

Purify, Level 3:

dirt to

formulated with 10% benzoyl

IT'S

unclog pores and clear up blemishes.

Stallex Pore

Minimizer Cleansing Grains

NOT JUST ABOUT WRINKLES

oil

oiliness.

(not hot or cold)

dry.

peroxide, our cleanser penetrates deeply, dissolving

•

warm

Thomas Roth Medicated BPO io% Acne Wash

• Stallex

120

skin

and

Toners for Oily/Acne-prone Skin: A

toner completes the cleansing process by removing residual

cleanser. Skin

is left

feeling fresh, clean,

Directions: Wash, then pat

up a

faint

hue

of yellow or gray.

dead

cells,

and

healthy.

Sparingly apply toner to a thin cotton pad and gently

dry.

wipe affected area. As the residual

and

dirt. oils,

and

oils

cells are extracted

Repeat with fresh pad

Medicated Astringent: 0.5%

until

from the

there

is

pad picks

skin, the

no color change on pad.

•

Clearasil

•

Clinique Oil Controller

•

Neutrogena Antiseptic Cleanser: benzethonium chloride,

salicylic acid

witch hazel •

Stallex Tone

and Clarify,

these high-potency

and

Level 2 or Stallex Tone

facial

effectively cleanse

and Clarify,

Level 3:

toners for oily or acne-prone skin gently

and tone

for fresh, clean skin

all

daylong.

Active Products for Oily/Acne-prone Skin: Regular use helps to prevent acne breakouts and reduce the appearance of enlarged pores.

Each

of these

products has been formulated

ment, and prevention of acne brighter,

in

for facial rejuvenation

oily/acne-prone skin. Each also helps result

younger-looking skin, with improved texture and

Directions: Cleanse face and pat

two or three drops

dry.

evenly

in

smoother.

color.

Apply very sparingly with

for entire face. Distribute

until fully

fingertips, using only

absorbed.

•

Aqua Giy colic Astringent:

•

Alpha Hydrox Oil-Free

•

Clytone Day Cream for Oily Skin: 10% glycolic acid

•

NeoStrata Oily Skin Solution,

•

Neutrogena Healthy Skin Face Lotion:

•

Peter

•

Stallex Clear Control Solution

Thomas Roth

and manage-

alcohol and 2.5% glycol ic acid

Facial Gel:

8%

AHA

Glycolic Acid

8:

glycol ic acid

8%

glycolic acid

8%

glycolic acid

w% Clarifying Gel

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

121

Stallex Glycolic Therapy 75 Gel for Face

high-potency gel formula for more

and Body:

a concentrated

aggressive revitalization,

smoothing, and softening.

On-the-spot Treatments for Acne: Antibacterial lotions fight infection, dissolve

oil,

acne breakouts. These products get deep

into the pores, fight

reduce inflammation, and promote healing.

Directions: Cleanse skin morning and

night, then

apply a very small amount to acne

blemishes.

&

10% benzoyl peroxide cream

•

Clean

•

Oxy Deep Pore Acne Medicated Cleansing

Clear Persa-Gel:

Strength: •

2%

Pads,

Maximum

salicylic acid

Neutrogena On-the-Spot Acne Treatment: 2.5% benzoyl peroxide cream

1 Lotion: combines effective acne-fighting ingredients with the added benefits of tea tree oil.

• Stallex

Moisturizers for Oily /Acne-prone Skin: Replenish your skin's moisture without oil-free,

IT'S

These refreshingly

for

light,

in oily

and

skin.

Directions: Apply sparingly

122

or a greasy residue.

water-based, noncomedogenic moisturizers replace depleted moisture

acne-prone

makeup

oil

to face to lock in moisture.

a smoother application and appearance.

•

Collastin Oil-Free Moisturizer for the Face

•

Nivea Oil-Free Gel Moisturizer

•

Nivea Visage

•

Olay Oil-Free Beauty Fluid

No

Oil All

NOT JUST ABOUT WRINKLES

Moisture Hydrogel

Reapply as needed. Use under

Purpose Dual Treatment Moisture Lotion, SPF Stallex Hydrate

and

Soften, Level

75

our lightest moisturizer.

i:

Sunscreens for Oily/Acne-prone Skin: Sunscreen protects you from damaging sun rays

that

cause sunburn,

wrinkles, freckling,

premature aging, and of course, skin cancer. These broad-spectrum sunscreens are

and noncomedogenic. So go ahead and have fun Directions: Apply sparingly

Reapply every two hours and

in

the sun

to face, avoiding eyelids,

after

swimming and

a half hour before sun exposure.

perspiring.

Day Gentle

SPF 30

Bain de Soleil Oil-Free All

•

Coppertone

•

Neutrogena Intensified Day Moisture, SPF

•

Oil

•

Physicians Formula Oil-Free Protective Moisturizing Lotion, SPF 75

•

Stallex Solar Protection Gel, SPF 75 (for Face): our ultra-light

ofOlay Daily

free

—you're protected!

•

Oil Free

oil

Block,

Waterproof Sunblock Lotion, SPF

75

75

UV Protectant, SPF 75 Lotion

sunscreen gel goes

a step further

and protects

oily

and acne-

prone skin from breakouts. Very lightweight and PABAfree. •

Stallex Solar Protection Pads, SPF 30

SKIN-CARE

PROGRAM FOR COMBINATION

SKIN

o

_

So. your T-zone

Combination are

many

is oily,

but the rest of your face, especially your cheeks,

facial skin is very

common and

specifically formulated

is

dry,

even

scaly.

requires special treatment. Fortunately, there

products to bring combination skin back

into balance.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

123

Cleansers for Combination Skin: Put your best face forward by keeping your skin fresh, clean, and clear. These products dissolve and taining

its

wash away

dirt

and

oil

from the pores to reveal your skin's

clarity,

while main-

natural moisture.

Directions: Use two times daily and as needed to cleanse and remove excess Gently

massage

water. Pat,

with fingertips for fifteen to thirty seconds. Rinse with

do not rub

(not hot or cold)

dry.

•

Cetaphil Lotion Cleanser

•

Lancome

•

Neutrogena Deep Clean

•

Olay Moisture Balancing Foaming Face Wash

•

Peter

Clarifiance Oil-Free Gel Cleanser Facial Cleanser

Thomas Roth Combination

• Stallex

warm

oiliness.

Cleanse and

Skin Cleansing Gel

Purify, Level 2

Toners for Combination Skin: By removing residual

dirt, oils,

cleanser,

and

flakes from the skin, toners effectively

the cleansing process without overdrying. Skin

Directions: Wash, then pat

is left

feeling fresh, clean,

and

oils

and

cells are extracted

picks up a faint hue of yellow or gray. Repeat with fresh

pad

from the until

•

Neutrogena Deep Clean Astringent

•

Lancome

•

Olay Refreshing Toner (Low-Alcohol Formula)

•

Stallex Tone

Controle Instant T-Zone Mattifier

and

Clarify Level 2: this mild facial toner for oily,

tones for fresh, clean skin

124

IT'S

NOT JUST ABOUT WRINKLES

or acne-prone skin cleanses all

day long.

skin, the

there

change on pad.

normal, combination,

healthy.

Sparingly apply toner to a thin cotton pad and gently

dry.

wipe affected area. As the residual

T.

complete

and

is

pad

no color

Active Products for Combination Skin: These actives are formulated

and

specifically for facial skin,

and can help

brighten. Regular use diminishes the visible signs of aging

to soften,

smooth,

clarify,

and past sun damage, and

reveals a refreshed complexion. Glycolic-acid products are used for effective facial rejuvenation

and improvement

of texture

and

color,

Directions: Cleanse face and pat

dry.

and

to

reduce potential acne breakouts.

Apply product sparingly.

If

desired, apply a

moisturizer to cheeks as needed.

•

Basis All Night Face

•

NeoStrata Oily Skin Solution for AHA

•

Neutrogena Pore Refining

•

Purpose Alpha Hydroxy Moisture Lotion

•

RoC

8:

8%

Mattifier: beta

glycol ic acid,

A,

E,

C

pH 4.0

hydroxy complex

Retinol ActifPur Anti-Wrinkle Treatment, Day: retinol,

vitamin •

Cream: alpha hydroxy acids and vitamins

A

Stallex Clear Control Solution

Moisturizers for Combination Skin: Replenish your skin's moisture without

oil

or a greasy residue.

These

refreshingly

water-based, noncomedogenic moisturizers replace depleted moisture

Directions: Apply sparingly to face

to lock in moisture.

•

Alpha-Hydroxy Oil-Free Lotion

•

Clinique Skin Calming Moisture

•

Neutrogena Healthy Skin Face Lotion

•

Nivea Oil-Free Gel Moisturizer

•

Olay Original Active Hydrating Beauty Fluid

• Stallex

in

light, oil-free,

combination

skin.

Reapply as needed.

Mask

Hydrate and Soften, Level

v.

won't clog pores;

our lightest moisturizer.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

125

Sunscreens for Combination Skin: No excuses! These

lightweight,

comedogenic. They

effectively protect

So

who

the sun.

for

because you're

those of you afraid you'll

broad-spectrum sunscreens are

out,

and non-

combination skin from the damaging rays

of

because you don't have time

or

don't use sunscreen

break

free

oil

remember: there are no excuses not

to protect

yourself.

Directions: Apply sparingly and evenly

to face, avoiding eyelids,

a half hour before sun

exposure. Reapply every two hours and after swimming or perspiring.

Day

•

Bain de Soleil All

•

Clinique City Block Sheer Oil-Free Daily Face Protector, SPF is

•

Neutrogena No-Stick Sunscreen, SPF 30

•

Olay Complete All Day Moisture Lotion,

Oil-Free

Waterproof Sunblock, SPF

is

UV Defense, SPF is,

Combination/Oily Skin •

Stallex Solar Protection Lotion, SPF 75 (for Face)

SKIN-CARE

PROGRAM FOR DRY

SKIN -O

Overexposure

to sun,

and the very dry

air

overuse

of

some

icy blast of winter

on planes can leave your face

moisture. Normal water balance

are

soap, the

is

so

vital for

water-rich moisturizers— both

my

air,

moistureless indoor heat,

itching, scaling, flaking,

healthy-looking

and

and

thirsting for

better-feeling skin.

Here

products and over-the-counter products— that

can restore your water balance, making your skin look and

feel vibrant again.

Cleansers for Dry Skin: These specialized formulas very gently wash away Cleansed

126

IT'S

skin

is left

feeling soft

and smooth— not

NOT JUST ABOUT WRINKLES

dirt

and

oil

without drying skin out.

dry, tight, or irritated.

Directions: Use two times daily and as needed to cleanse your dry

sage

with fingertips for fifteen to thirty seconds. Rinse with

do not rub

Gently mas-

(not hot or cold) water. Pat,

dry.

•

Aveeno Cleansing Bar for Dry

•

Liquid Neutrogena

•

Neutrogena Extra Gentle Cleanser

•

Nivea Visage Gentle Cleansing Cream

•

Olay Daily

Normal •

warm

skin.

Skin

Facials Lathering Cleansing Cloths,

Hydrating for

to Dry Skin

Olay Moisture-Rich Cream Cleanser Pond's Daily Cleanser Facial Cleansing Stallex Cleanse

and

Purify, Level

Foam

i

Toners for Dry Skin: Freshen up! These toners keep even sensitive or dry skin

They are very from skin

gentle, alcohol-free skin fresheners that

after

and

faint

hue

residual

clear

all

dirt, oils,

day

and

long.

flakes

healthy.

Directions: Wash, then pat

up a

remove

and

washing. Toners complete the cleansing step without overdrying, and leave

skin fresh, clean,

affected area.

revitalized

As the

residual

dry.

dirt,

of yellow or gray.

Sparingly apply to a thin cotton pad and gently wipe

cleanser,

and

cells are extracted

Repeat with fresh pad

•

Lancome Tonique Confort

•

Neutrogena Alcohol-Free Toner

•

Prescriptives

until

there

from the is

skin, the

pad picks

no color change on pad.

Immediate Glow, Skin Conditioning Tonic for

Normal/Drier Skin •

Stallex Tone

and

Clarify, Level

i

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

127

Active Products for Dry Skin: These products remove dead

more

lustrous skin texture

cells

and

from the skin's surface, giving you a smoother, brighter,

color.

Directions: Cleanse face and pat entire face until fully

dry.

Apply cream sparingly, distributing evenly over

absorbed. Apply moisturizer

desired.

Cream: 10% glycol ic compound

•

Aqua

•

Basis All Night Face

Clycolic Face

if

Cream: alpha hydroxy acids and vitamins

A,E,C

12%

•

Clytone Day Cream for Dry Skin

•

Neutrogena Healthy Skin Anti-Wrinkle Cream: AHAs and BHAs

•

Purpose Alpha Hydroxy Moisture Lotion

•

Stallex Herbal Clycolic Therapy

12:

glycolic acid

w Cremefor Face: contains

10%

glycolic acid, natural essential oils,

This

is

one of our starter-strength

and herbal

glycolic products. After

using as directed for one month, you

may move up

second-strength product, Glycolic Therapy Creme

Daytime Moisturizers

wrinkles cation

level.

IT'S

They help

and leave your complexion

75 for Face.

visibly

facial moisturizers

to

nourish dry skin to restore

minimize the appearance of

improved. Use under

makeup

for

fine lines

an even

and smoother appearance.

Directions: Apply sparingly

128

to a

for Dry Skin:

Help keep that healthy glow! These enriched your skin's natural moisture

extracts.

to facial skin to lock in moisture.

•

Clinique Moisture Surge Treatment Formula

•

Olay Complete Plus Ultra Rich Day Cream

•

Stallex

AM

Intensive

Reapply as needed.

Creme Therapy: this medium-weight

NOT JUST ABOUT WRINKLES

and

appli-

botanical facial moisturizer

is

excellent for

more mature,

non-oily skin. Stallex Hydrate

and

Soften, Level 3

Nighttime Moisturizers for Dry Skin: Repair tired skin while you sleep. These night-cream formulas offer

and mature

improve skin's

complexion

The moisturizers work hard, while you

facial skin.

and reduce the appearance

elasticity,

that's visibly

improved and

rest, to

of fine lines

to healthy skin that will

vital

hydration for dry

restore lost moisture,

and

remain

wrinkles. soft

Wake

to

a

and supple the

whole day through.

Directions: Apply

to facial skin to lock

in

Use as

moisture.

often as needed.

•

Nivea Visage Nighttime Renewal Creme

•

Olay Complete Plus Ultra Rich Night Cream

•

Peter

•

Stallex

AM

Intensive

Creme Therapy

•

Stallex

PM

Intensive

Creme Therapy

•

Stallex Supra Rich Eye Creme: reduce the look of stress

Thomas Roth Ceramide

Ultra-Rich Night

Renewal

and

fatigue as you rejuvenate and hydrate your eyelids.

Sunscreens for Dry Skin: Sun protection exposure.

is

important for dry skin because skin can

Remember

aggravate dry

skin.

become even

not to use formulations for oily or acne-prone skin

The following

lotions protect

drier after

because they

you from damaging rays

that

sun will

can cause

sunburn, wrinkles, uneven skin tone, freckling, premature aging, and skin cancer. Rich nourishing moisturizers, they are

body and

recommended

for dry,

in

mature, or sensitive skin on the

face.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

129

Directions: Apply generously and evenly

to dry skin

on the face and body, a

before sun exposure. Reapply every two hours and after

Coppertone All-Day Moisturizing Sunblock Lotion, SPF

•

Eucerin Face Protective Moisture Lotion, SPF 25

•

Neutrogena Moisture, SPF

•

Vaseline Intensive Care Moisturizing Sunblock Lotion, SPF 75 or 25

•

Stallex Solar Protection Lotion,

•

Stallex Solar Protection Cream, SPF 25 (for Face

The time-related

if

25

SPF 20 (for Body)

to your skin

natural depletion of

you youthful-looking skin again,

75 or

75

and Body)

PROGRAM FOR MATURE

The aging process can be traumatic

hour

or perspiring.

•

SKIN-CARE

to be.

swimming

half

oil

you use the

SKIN

and your psyche, but

and water can right

O

products.

easily

it

doesn't have

be restored

Remember,

passing of time that causes the skin to age. Sunlight, cigarette smoke, and

it's

air

to give

not just the

pollutants

all

hasten the appearance of aging, so do your part to preserve the youthfulness of your skin!

Cleansers for Mature Skin: These cleansers skin

for

mature and even the most sensitive skin gently but

effectively

cleanse

and help you maintain a clear and radiant complexion. They very gently wash away

and debris without not dry or

further drying skin out.

Cleansed skin

is left

feeling soft

dirt

and smooth

irritated.

Directions: Use two times daily before applying actives and/or moisturizers as needed. Gently

massage

water. Pat,

130

IT'S

do

with fingertips for fifteen to thirty seconds. Rinse with

not rub dry.

NOT JUST ABOUT WRINKLES

warm

(not hot or cold)

•

Cetaphil Lotion Cleanser

•

Neutrogena Extra Gentle Cleanser

•

Neutrogena Healthy Skin Anti-Wrinkle Anti-Blemish Cleanser

•

Nivea Visage Gentle Cleansing Cream

•

Olay Daily Renewal Cleanser: contains

•

Pond's Daily Cleanser Facial Cleansing

•

Stallex Cleanse

and

Purify, Level

BHA complex Foam

1

Toners for Mature Skin: These alcohol-free toners help

to

They remove residual

cleanser,

dirt, oils,

keep mature skin

and

day

long.

flakes from skin after washing: they

com-

plete the cleansing step without overdrying or irritating

and

and

revitalized

and leave

fresh

all

skin feeling fresh, clean,

healthy.

Directions: Wash face, then pat

As the

gently wipe affected area.

pad picks up a

faint

hue

Sparingly apply toner to a thin cotton pad and

dry.

residual oils

and

Repeat with fresh pad

of yellow or gray.

from the

cells are extracted

there

until

is

skin, the

no color

change on pad.

•

Neutrogena Alcohol-Free Toner

•

Stallex Tone

and

Clarify, Level

i

Active Products for Mature Skin: and other actives are used

Glycolic acid of texture

and

color.

These

help to soften, smooth, of

aging and past sun

brighter,

and

full

revitalizing

clarify,

general facial rejuvenation and improvement

creams, formulated specifically

and brighten

damage and

of youthful

for

skin.

for

mature

facial skin,

Regular use diminishes the visible signs

reveals a refreshed complexion that

is

visibly

improved,

vitality.

Directions: Cleanse face and pat

dry.

Apply cream sparingly.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

131

•

Estee Lauder Diminish Anti-Wrinkle Retinol Treatment

•

Estee Lauder Skin Refinisher with Exfoliators

•

Olay Regenerist Daily Regenerating Serum

•

Peter

•

Pond's Dramatic Results products

•

Prescriptives Skin

•

Stallex

Thomas Roth AHA 12% Hydrating Ceramide Repair Gel

Renewal Cream

C Complex Rescue Serum for

antioxidant vitamins C and extract for

combination of

and green tea smoothing, and

glycolic acid,

E,

more aggressive

Face: a

revitalization,

softening of facial skin and prevention of free radical skin

damage. •

Cremefor Face: contains 10% oils, and herbal extracts. This is

Stallex Herbal Glycolic Therapy io glycolic acid, natural essential

one of our starter-strength glycolic products. After using as directed for one month, you may move up to a secondstrength product, Glycolic Therapy 75 Cremefor Face.

Moisturizers for Mature Skin: While delivering a penetrating boost of hydration to alleviate dryness, these products also help restore missing but

vital oils to

and reduce the appearance youthful, healthy,

and

Directions: Use

132

IT'S

complete the balance

of fine lines

and

wrinkles.

ot

They

your skin while they deliver

vital

radiant skin.

at night

and as needed.

•

Clinique Moisture Surge Treatment Formula

•

Estee Lauder Skin Perfecting

•

Olay Complete Plus Ultra-Rich Night Firming Cream

NOT JUST ABOUT WRINKLES

Creme Firming Nourisher

firm, tone,

nutrients for

more

Thomas Roth Hydrating Gel

•

Peter

•

Prescriptives

•

Stallex

AM

Intensive

Creme Therapy

•

Stallex

PM

Intensive

Creme Therapy

•

Stallex

Microsome Concentrate: this

Super Flight Cream

is

our exclusive

extra-rich botanical formula. •

Stallex Supra Rich Eye

Creme

Sunscreens for Mature Skin: Don't run from the sun! These broad-spectrum sunscreens are specially formulated for dry,

mature, or sensitive skin. They protect skin from the damaging rays that can cause sunburn, wrinkles,

Very

rich in

ommended

uneven

skin tone, freckling, premature aging,

and

of course, skin cancer.

nourishing moisturizers, these sun-protection creams are also especially recfor fair skin.

Directions: Apply

two hours and

after

liberally to

swimming

dry skin

thirty

minutes before sun exposure. Reapply every

or perspiring.

•

Coppertone All-Day Moisturizing Sunblock Lotion, SPF

•

Estee Lauder

Creme, SPF

DayWear

or 2$

Plus Multi Protection Anti-oxidant

75

Day Moisture

SPF

•

Olay Complete

•

Stallex Solar Protection Lotion, SPF

•

Stallex Solar Protection Cream, SPF 25 (for Face

•

Stallex Ultimate Solar Protection Cream, SPF 4s (for Face

75

All

Lotion,

20

75

(for Body)

and Body)

and Body)

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

133

PROGRAM FOR NORMAL

SKIN-CARE

SKIN

-O When of us).

the

oil

and water content

Normal

skin,

however,

skin

on the contrary. follow this

is in

your skin

is in

balance, you have normal skin

(like

most

not perfect skin. People with this type of skin are prone to

and go through times when

the occasional breakout,

because your

is

ot

balance doesn't

mean you can

their skin feels itchy or dry. Just

forget about a skin-care

regimen

order to achieve the most glowing, flawless normal-skin complexion,

In

program

diligently; the results will

pay

off,

guaranteed.

Cleansers for Normal Skin: Put your best face forward by keeping your skin fresh, clean, and looking clear. These facial

cleansers for normal skin skin type

will

so clear and free

maintain the delicate balance of

oil

and water

incidental

oil,

makes

this

of blemishes.

Directions: Use two times daily before applying actives and as needed

remove

that

makeup, and

dirt.

Gently

massage

seconds. Rinse with warm (not hot or cold) water.

Pat,

•

Cetaphil Lotion Cleanser

•

Clinique Rinse-Off Foaming Cleanser

•

Estee Lauder Perfectly Clean Splash

•

Neutrogena Fresh Foaming Cleanser

•

Olay Gentle Foaming Face Wash

•

Prescriptives All Clean Fresh

•

Stallex Cleanse

and

do

to

cleanse and

with fingertips for fifteen to thirty

not rub dry.

Away Foaming

Cleanser

Foaming Cleanser for Normal Skin

Purify Level 2

Toners for Normal Skin: Freshen up! Keep your skin revitalized and clear fresheners remove residual

134

IT'S

dirt,

NOT JUST ABOUT WRINKLES

oils,

all

day long. These very gentle skin

and flakes from the

skin after washing.

They

complete the cleansing step without overdrying. and leave skin

fresh, clean,

and

in

balance.

Directions: Wash, then pat

wipe affected area. As the residual

up a faint hue

of yellow or

Sparingly apply toner to a thin cotton pad and gently

dry.

oils

and

cells are extracted

gray Repeat with fresh pad

•

Neutrogena Alcohol-Free Toner

•

Prescriptives

until

from the

there

is

skin, the

pad picks

no color change on pad.

Immediate Glow, Skin Conditioning Tonic for

Normal/Drier Skin •

Stallex Tone

and

Clarify, Level

i

Active Products for Normal Skin: Glycolic acid.

and skin,

AHA.

or

BHA creams

perfection of texture

can help

to soften,

and

These creams, formulated

color.

smooth,

are used for general facial rejuvenation, improvement,

clarify,

the visible signs of aging and past sun is

visibly

and brighten your

damage, and

improved, brighter, even colored, and

Directions: Cleanse face and pat

dry.

Neutrogena Healthy Skin products

•

Aqua

•

Glytone Day Cream for Dry Skin

•

Kinerase

•

NeoStrata Face Cream

•

Stallex Glycolic Therapy 8

Therapy

vitality.

if

desired.

w% glycolic compound

Cream:

12:

12%

glycolic acid

75:

15%

glycolic acid

Cream Plus,

AHA

Cremefor

Face: This

starter-strength glycolic products. After

move up

facial

reveals a refreshed complexion that

Apply cream sparingly. Apply a moisturizer

•

Glycolic Face

normal

Regular use diminishes

skin.

of youthful

full

specifically for

to Glycolic Therapy 10 75

Cremefor

is

one of our

one month of

Cremefor Face or

use,

Glycolic

Face.

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

135

Moisturizers for Normal Skin: Help keep that healthy glow! These enriched your skin's natural moisture tone,

level.

and reduce the appearance

application

facial moisturizers

nourish skin to maintain

While delivering a balancing boost of hydration, they of fine lines

and

wrinkles.

Use under makeup

for

firm,

an even

and smoother appearance. facial skin to lock in moisture.

Directions: Apply product sparingly to

•

Clinique Moisture On-Call

•

Lancome Aqua Fusion Lotion

•

Neutrogena Healthy Skin Anti -Wrinkle Cream

• Peter

Reapply as needed.

Thomas Roth Ceramide Night Renewal

•

Prescriptives Fast Acting Moisturizer for

•

Stallex Hydrate

and

•

Stallex Hydrate

and Soften,

• Stallex

Normal

Skin

Soften, Level 2

Level 3

Supra Rich Eye Creme

Sunscreens for Normal Skin: Sun-protection lotions defend your skin against wrinkles,

uneven

skin tone, freckling,

in

the sun

recommended

to skin

normal

skin.

swimming

Clinique City Block Sheer Oil-Free Daily Face Protector, SPF is

•

Coppertone All-Day Moisturizing Sunblock Lotion, SPF

•

Estee Lauder

•

So go ahead

or perspiring.

•

Creme, SPF

nourishing

on the face and body, a

before sun exposure. Reapply every two hours and after

IT'S

for

in

—you're protected!

Directions: Apply generously and evenly

136

rays that can cause sunburn,

premature aging, and skin cancer. Rich

moisturizers, these easy-spreading lotions are

and have fun

damaging

DayWear Plus Multi

NOT JUST ABOUT WRINKLES

75,

or 25

Protection Anti-Oxidant

75

Neutrogena Moisture, SPF

75

Sheer Tint

half

hour

•

Olay Complete

Normal

All

Day Moisture

UV Defense, SPF 15,

Lotion,

Skin

•

Stallex Solar Protection Lotion, SPF

•

Stallex Solar Protection Cream, SPF 25 (for Face

PROGRAM FOR

SKIN-CARE

20

(for Body)

and Body)

SENSITIVE SKIN

O Are you leery about skin-care products because they can wreak havoc on your sensitive skin? Sensitive skin

tends to be easily skin products

may have normal by

irritated

or

common

abnormal

oil

and water content and balance, but

skin-care products. Specially formulated sensitive-

can help keep skin reactions

to a

minimum.

Cleansers for Sensitive Skin: These cleansers are

for

even the most sensitive

skin

and help maintain a

and

oil

—without

clear

and

Skin

is left

irritation.

skin.

They gently but

radiant complexion, by very gently feeling soft

and smooth

effectively

washing away

— not dry or

massage

water. Pat,

do

with fingertips for fifteen to thirty seconds. Rinse with

dirt

irritated.

Directions: Use two times daily and as needed to cleanse and remove excess Gently

cleanse

warm

oiliness.

(not hot or cold)

not rub dry.

•

Cetaphil Lotion Cleanser

•

Dove

•

Estee Lauder Verite LightLotion Cleanser

•

Neutrogena Sensitive Skin Solutions

•

Nivea Visage Gentle Cleansing Cream

•

Olay Daily

Sensitive Skin

Beauty Bar

Oil-Free

Foaming Cleanser

Facials Lathering Cleansing Cloths,

Soothing for

Sensitive Skin

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

137

Preschptives Comfort Cleanser

— Gentle Lotion for

Sensitive Skin Stallex Cleanse

and

Purify, Level

i

Toners for Sensitive Skin: These toners help

keep even sensitive

to

They remove residual

dirt, oils,

cleanser,

and

long.

flakes from skin after washing; they

com-

plete the cleansing step without overdrying or irritating

and

and

day

or dry skin revitalized

and leave

fresh

all

skin feeling fresh, clean,

healthy.

Directions:

Wash

face, then pat dry. Sparingly apply toner to a thin cotton

gently wipe affected area.

pad picks up a

faint

hue

As the

residual oils

and

cells are extracted

Repeat with fresh pad

of yellow or gray.

from the

until

there

is

pad and skin, the

no color

change on pad.

•

Neutrogena Alcohol-Free Toner

•

Stallex Tone

and

Clarify, Level

i

Active Products for Sensitive Skin: Truly sensitive skin effectively

is

too sensitive for the exfoliating action of the active ingredients that so

improve color and texture flaws

dry, or oily skin to

increase

cell

turnover only

good conscience, recommend any be

all

things to

sensitive skin.

If

all

people.

line of

skin

nate your complexion, your best bet that

is

other skin types. Products used on normal, irritate

sensitive skin. That

is

why

I

active products for people with this skin type;

My own

you have sensitive

and create a plan

in

is

think

you

really

need a product

in

you can't

products does not include a glycolic active

and

to

cannot,

for

to help rejuve-

schedule an appointment with your dermatologist

tailored to your specific sensitivities.

Moisturizers for Sensitive Skin: Replenish your sensitive skin's moisture without light, oil-free,

138

IT'S

oil

or a greasy residue.

These

refreshingly

water-based, noncomedogenic moisturizers replace depleted moisture without

NOT JUST ABOUT WRINKLES

added fragrances application

or

irritants.

And

they won't clog pores.

Use under makeup

for

an even

and smoother appearance.

Directions: Cleanse face and pat

dry,

then apply sparingly to facial skin to lock

in

moisture.

Reapply as needed.

Cetaphil Moisture Lotion Clinique Skin Calming Moisture

Mask

Estee Lauder Verite Calming Fluid Estee Lauder Verite Moisture Relief Creme

Lubriderm Seriously Sensitive Lotion

Neutrogena Moisture for Sensitive Skin Prescriptives Redness Relief Gel

Stallex Hydrate

and

Soften, Level

Stallex Hydrate

and

Soften, Level 2

v.

our lightest moisturizer

Sunscreens for Sensitive Skin: Sun

protection for sensitive skin

become

is

uncomfortable, burn, and

to look for fragrance-free

and

especially important is

more prone

oil-free

to

because

damage

this

type of skin can easily

from sun exposure.

Remember

versions of popular sunscreen brands.

Directions: Apply sparingly and evenly to the face and body a

half

hour before sun

exposure. Reapply every two hours and after swimming or perspiring.

•

Eucerin Face Protective Moisture Lotion, Fragrance Free, SPF 25

•

Neutrogena Intensified Day Moisture, SPF

•

Olay Complete All Day Moisture Lotion

•

Stallex Solar Protection Cream, SPF 25 (for Face

PABA

75

UV Defense for Sensitive Skin and Body):

free

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

139

SKIN-CARE PRODUCTS FOR OTHER CONCERNS

-O Skin-care Products for Eye Concerns: Don't

your eyes reveal age or fatigue. These soothing eye creams have a unique

let

combination

eyes

of emollients

to hydrate, firm,

skin looks

and

active ingredients that penetrate the skin surrounding the

and tone. The appearance

smoother and more

extra-gentle

resilient.

eye-makeup removers

for

Not

and wrinkles

of lines

for sensitive skin.

those of you

who

diminished and

Also included are

some

hate waking up with raccoon eyes!

•

Bobbi Brown Extra Eye Balm

•

Bobbi Brown Eye Makeup Remover

•

Clinique Naturally Centle Eye

•

Estee Lauder Eyzone Repair Gel

•

MAC Pro Eye Makeup Remover

•

Peter

•

Prescriptives Super Line Preventor+ Intensive Eye

•

Stallex Clycolic Therapy Refining Eye

Makeup Remover

Thomas Roth Power K Eye Cream

• Stallex

is

Rescue, or

Oxygen Eye Rescue

Treatment

Creme

Supra Rich Eye Creme

Skin-care Products for Discoloration: Facial discolorations, from light tan colors to browns,

can

result

from sun damage, certain

medications, acne blemishes, hormones, and even picking at pimples (your mother told

you not

to— and she was

develop "the mask

of

right).

They can occur during pregnancy, when some

pregnancy," a discoloration of the skin on the upper cheeks, forehead,

and around the eyes (see page

21).

If

your freckles suddenly darken, or blotches and spots

spring up on your face, these lightening and fading

140

IT'S

women

NOT JUST ABOUT WRINKLES

creams

will

help.

•

Clinique Active White Lab Solutions products

•

Estee Lauder WhiteLight EX products

•

Lancome Absolue Anti-Age Spot Serum

•

Prescriptives Skin Tone Correcting

•

Peter

•

Stallex Epi-Peel Revitalizing Pads (for Face

•

Stallex

Serum

Thomas Roth Potent Botanical Skin Brightening Gel Complex and Body)

C Complex Rescue Serum for Face

Skin-care Products for Sunless Tanning: After

all

you've learned about the damaging effects of the sun.

rushing out to the beach with baby

oi!

and a

reflector.

hope

that

you

aren't

There are ways to achieve that

sun" glow without exposing your precious skin to those harmful will

I

UV

rays.

"in

still

the

These products

give you an even, realistic tan: just be sure to exfoliate before you apply any of these

sunless tanning products.

•

Au Courant

•

Avon Sun Self-Tanning Lotion

•

Estee Lauder

•

Lancome

•

Neutrogena Sunless Tanning Spray or Lotion

•

Peter

•

Prescriptives

Instant Sunless Tanning

Go Bronze

Mousse

Plus Tinted Self-Tanner

Flash Bronzerfor

Medium

Thomas Roth Natural Looking Sunsheen Bronzing

Colour or Deep Colour

Self Tanner

Gel, or Al lover Self

Tanner

SKIN TYPE-SPECIFIC PRODUCTS FOR YOUR

PROGRAM

141

"The best

way

your future

is

to predict

to create

UNKNOWN

it:

Maintain Your

New

Luster O

CONGRATULATIONS!

You have discovered

how

easy

it

is

to have

healthier-looking, younger-looking, better-feeling skin. Don't you wish

you had known how to get the skin you always wanted sooner? you know how to have beautiful

skin,

maintaining

it

will

be

Now that

a snap.

Continue to examine your skin monthly. As your skin quality improves,

your need for products the plan

laid

out

in this

will

probably change. While you'll want to continue

book, you might find that you need less moisturizer

or a lighter-formula active ingredient. Skin care isn't

automated. Your skin

is

a living,

something that can be

changing organ. You need to monitor

your progress from time to time and tweak your program occasionally. As you go from season to season, enduring extreme temperature and

humidity changes, your different needs.

facial skin

Warmer weather

responds accordingly

usually

meansyou need

— and can have

lighterformulas.

143

Colder weather usually

means

so you might need a heavier moisturizer. Hot

drier skin,

showers and indoor heat can also contribute

and windy conditions might require you you think you need

it

or not.

Needless

mate, remember to use sunscreen

need

for

it

damaging

Reapply

or higher. lips:

look for a

lip

so look

every two hours

it

balm with an SPF

when

to say,

enjoying outdoor activities

more than 80 percent

reflect

maximum

of at least

benefit.

routine

— especially

newfound can't

I

any

cli-

of the sun's

SPF

if

15

of

don't forget to protect your

come

sunscreen needs

or hail,

AND DRY-WEATHER

And

15 to prevent chapped

To borrow from the United States Postal Service creed,

COLD-

in

a broad-spectrum sunscreen with an

for

for

—whether

the type of sunscreen you use changes, the

if

snow can

never does. Remember, ultraviolet radiation,

use extra moisturizer every morning

to

— even

and extremely cold

to dry skin during winter,

lips.

snow,

rain or shine,

to

be a part

you expect

of

sleet,

your daily your

to maintain

luster.

tell

you how many times patients have come

For very dry skin, try dabbing

my

into

petroleum jelly on problem

office

weekend

areas to seal in moisture.

keep

After washing your hands,

after the

year's

sporting severe sunburns. The brave at heart

appointments with me, and the

their

immediately apply hand

change them

cream.

ing their dermatologist a severe sunburn.

Consider purchasing a cold-

life

water humidifier to keep

understand

the humidity in your

home

is

higher during the winter.

they're

door, violet irradiation.

Some,

ability to

protect yourself from. Learning

like

genetics, you can't

results of your skin-care is

I

in

you

for fear of the

we

that.

I

never

teach them the sun. will

tell

how

is

We do my

get sunburns.

be exposed that

to

dangerous, harmful,

have caused you like

in

themselves when

to

front ultra-

have imper-

the sun, you have the

the secret to maintaining longevity

a difference between regular and effective use of sunscreen. Regular use

half

hour

after

means

putting

in

the

(like this

one

NOT JUST ABOUT WRINKLES

means

on sunscreen a

half

you've been outside, and after each and every

time you perspire, swim, play a set of rigorous tennis, and so on. Even

outside reading a book

go

I

program.

hour before you go outside, a

IT'S

reality of

As long as you venture out your

applying sunscreen to your skin every day. Effective use

144

The

show-

of

patients not to

to protect

do much about. Others,

how

faint of heart

embarrassment

aren't perfect.

You already know there are elements

fect skin.

There

that

the sun.

spring

beautiful

first

for instance),

if

you are

just sitting

you should reapply your sunscreen

every two hours, because whether you Perspiration you are not ration

you are making

skin as fast as

aware

is in

you make

of

is

know

you are perspiring

or not,

it

called insensible perspiration, which

means

balance with the evaporation of that perspiration. it

so there's no collection

to notice. But your skin breathes just

of the perspiration

as your body breathes;

a very sophisticated and effective metabolic regulation

you are perspiring every day, every night— all the

It

the time.

the perspi-

comes

on your

you

called respiration, part of

it's

in

which

is

no such thing as

become

vulnerable to the

since there

waterproof sunscreen, every time you break a sweat, you again

your

off

skin for

your body temperature

of

And

time.

all

harmful rays of the sun.

Using a higher SPF

isn't

the answer.

SPFs come

All

screens must be regularly reapplied to be

do

it.

the skin after wear,

The most

Sitting in the

essential step

use sunscreen regularly and While

in

sun-

shade without sunscreen won't do

protecting yourself or loved

it.

Sand,

damaging

ones from the sun

rays is

to

effectively.

have the greatest respect

I

all

your best defense. Sitting under an umbrella

is

sidewalks, snow, and water can reflect between 75 and 80 percent of the of the sun.

and

effective.

Regular and effective use of sunscreen without sunscreen won't

off

sunscreens

for the ability of

to protect the skin

from

both degenerative and precancerous types of sun damage, even the best intentioned and

most

efficient

amount little

of

color,

use

sunscreen

of

damage. Even a

little

will

allow

it.

darkening of the

The

to get

with regular use of sunscreen, skin.

fact that there

is

through and cause a small

you might

find that

you

get a

still

Darkening equals damage. But the darkening

your skin that occurs with sunscreen use

occurs without

some sun

is

much

any change

less in

damaging than

of

the darkening that

color confirms that the sun

is

seep-

ing through the sunscreen.

When

the sun impacts on the skin whether the skin

is

unprotected or protected, what-

ever sun irradiation does penetrate into the skin causes the formation of dangerous

chemicals called free radicals. Free radicals are very toxic chemicals of events, actually

damage

the

Antioxidants such as vitamin taking these vitamins effects.

It's

radicals,

a second

is

DNA that

C and

causes the

be

through a chain

either

broken or

sick.

vitamin E are chemicals that destroy free radicals.

a safety net of sorts

level of

skin cells to

that,

in

the fight against the sun's

So

damaging

defense, because antioxidants can actually destroy the free

which are the ultimate cause

leading to broken or sick skin

of

molecular and subsequent cellular

damage

cells.

MAINTAIN YOUR NEW LUSTER

145

Topical vitamin

many

C

is

one

of the

different topical forms.

I

most

effective

recommend

•

Cellex-C SkinCeuticals Vitamin

•

effectives Vitamin

•

La Rouche Posay Active

•

SkinMedica Vitamin C Complex

•

Physicians

•

Physician's Choice

oxidized, so

It

comes

in

C Complex Rescue Serum

Stallex

When a

antioxidants.

the following easy-to-find products:

•

FACT:

and accessible

C Serum by Obagi

Complex

losing

its

C

C-Plus Antioxidant

Serum

PCA pHazeis Serum-C

topical vitamin

it is

C Serum

C preparation

starts to turn

brown,

it is

being

preventative therapeutic effects.

CHOOSE YOUR SUN CAREFULLY -O

Common So

if

you

later in

sense

tells

like to run,

lip,

is

strongest between the hours of

play golf, bike ride, or participate

the day. Don't

as your lower

us that the sun

choose to be outdoors

at high

in

other outdoor

needs extra-special

attention

wearing protective clothing

when

it

:00 a.m.

activities,

and 3:00

do so

rm.

earlier or

noon. Protect your horizontal surfaces, such

your shoulders, and the bridge of your nose most

also pay attention to their upper chest.

1 1

effectively.

Women

need

to

Any area on your body that faces upward toward the sun

comes

—a baseball

to

sun protection. These areas are best served by

hat to protect the face or a cover-up to protect the

shoulders and chest. White material that gets wet transmits most of the damaging rays of the sun, so

if

you are wearing a wet

and weave

of fabric plays

T-shirt,

a huge

you can get sunburned

role in

right

through the

fabric.

The

color

sun protection. High thread counts keep out more sun

than low weaves; darker colored fabrics keep out more than lighter colored fabrics. But

whatever you're wearing, always remember

146

IT'S

NOT JUST ABOUT WRINKLES

to

wear sunscreen.

THE SMOKING GUN

O

:

Smoking

is

a choice that compromises what you can accomplish

ing or preserving your skin, as discussed earlier

how much

you'll

new

ductive to your

ahead color

in

and

choose

to maintain your

routine

and

lifestyle.

If

new

4.

beautiful skin

you choose

it

comes

Continuing to

to restor-

smoke

will limit

— besides being counterpro-

to quit,

you

will

be so much

further

both what you can achieve and what you can maintain. Not just with respect to texture issues, but also with respect to contour issues

you

to quit,

below your In

be able

chapter

in

when

will

certainly

develop smoker's

lines,

deep

— because

if

vertical lines

you don't

above and

which do nothing to enhance your beauty.

lips,

addition to the impact

smoking has on color and sallowness,

any damage

ability to repair itself after

—especially

after

it

diminishes the skin's

any damage from smoking

itself.

Diminished blood supply resulting from the nicotine and tars causes constriction of the

blood vessels

day

in

the skin. Not

— especially now

IT

is

as fundamental as putting on sunscreen every

you know the dangers.

that

upside to smoking when

smoking

it

comes

to your facial

CAN HAPPEN TO YOU

IF

It's

in

your control. There

is

simply no

appearance.

YOU KNOW WHAT TO DO O

To

fulfill

your ultimate goal of improving and maintaining your skin color, texture, and

contour you have to stick complicated, and once you

and even

try to

to

your plan

start

improve upon them. Using the

and

texture

—

if

it

seeing the results

your condition, products that work skin's color

— make

in

a part of your everyday routine. you'll

five

harmony,

will

want

to

It's

not

keep them, maintain them,

products that are

right for

your skin and

allow you to restore and maintain your

you use them regularly and

correctly.

MAINTAIN YOUR NEW LUSTER

147

my life be like if had as much faith in the parts of me that were fading away had in the parts of me that were growing?"

'What would

as

I

I

DAVID WHYTE

Men's Skin Care O IN

THE

but

men

PAST, SKIN

now

CARE was

largely

the world of skin care

as well.

is

thought of as women's territory—

becoming increasingly appealing to

With more men's skin-care products being produced, and

our culture's desire for younger-looking skin,

begun.

Now more

their appearance,

than

ever,

men have starters,

it

it

era in skin care has

both genders are equally concerned about

isn't

their

money on unnecessary products

an essential part of their daily routine.

a little easier

men

new

and willing to take the necessary steps to maintain

Most men don't waste skin, believing

a

when

it

comes to taking care of

naturally exfoliate their facial skin

It's

it.

for their

true that

their skin. For

whenever they shave,

and many have shaved since they were teenagers, so they already have a

head start when

it

comes to

for smoother, brighter,

exfoliating and sloughing off dead cells

more even-colored

skin.

Men's skin care

is

the

149

fastest-growing demographic

men

More and more,

the ever-expanding world of skin care.

in

are beginning to understand the value of taking better care of their skin.

Most everything dedicated to

really

book

in this

all

the

men

is

reading

The

come

this

truth

comes

to skin care

I've

is,

about cosmetic issues and procedures from

same

thing

women

mostly achieved by

remarkable

have been asking

many

fixing

how many men

how does men's

are

skin differ from

same

of the

in

for

—

healthier,

color

man

practice.

of.

Men

to lasering, hair

fillers

more and more, men are asking me

removal, acne, and everyday skin-care issues. And, for the

is

dominate

ashamed

my own

in

still

you are a

If

nothing to be

is

noticed a significant increase of male patients

me

see

women

and skin-care products.

everyone and

is for

chapter

this

My theory behind

skin.

not gender biased, although

is

book, remember that skin care

to

in

it

however,

who want to improve their facial

out there

achieving the skin you've always wanted

consumer consumption when

men and women;

relevant to both

and

younger-looking skin, which

texture issues

women

touch with the importance of better-looking

have.

skin.

is

It's

But just

women's?

NOT JUST VENUS AND MARS O Often

it

ns that

s

women's

i.

men

are blessed with skin that holds on to

As men age, they embrace

their wrinkles,

its

youth a

feeling

little

longer than

more rugged,

distin-

guished, dashing, and elegant with a few lines around the eyes, cheeks, and forehead.

While the aging process

is

essentially the

top layer of the skin (the epidermis) are found

in

for

why men's

development

and

wrinkles.

men and women

And

men

to look younger.

conversely,

in

women

which makes women's skin look older sooner. As mentioned,

when

skin,

on average, produces more

women's

150

within the skin also vary

skin typically

produces less

And

oily skin

IT'S

NOT JUST ABOUT WRINKLES

ages more

giving

oil,

slowly.

oil,

— some differences

the dermis

A

is

layer).

thicker,

which

thicker dermis delays the

the dermis

men

they shave, because the razor removes a fine layer of

Hormonal balances

— because the

and the subcutaneous

different. Typically, in

sometimes seems

skin

of lines

is

both

both genders functions similarly

the lower layers of the skin (the dermis

To begin with, skin thickness explains

in

same

is

usually thinner,

also exfoliate their skin

dead

skin

— every

day.

between men and women. That's why men's

men

women

larger pores

and

oilier skin.

And

since

tend to have smaller pores and drier skin.

In

adolescence,

natural

oil),

women,

but

staying

drops sharply

men and women

adulthood things change.

in

constant

tairly

production

is

sebum

of

higher

in

(the skin's

men

than

women, sebum production

of sixty. For

menopause.

after

smoking. According

lines,

Sebum

about the age

until

Another significant difference

wrinkles from

produce the same amount

usually

one study done

to

smoking than men

And

since

more apparent.

are

1996,

in

I

skin

women

Smoking shuts

are.

especially around the mouth.

show up sooner and

men's and women's

in

women's

off

their relative reactions to

is

are at greater risk of developing the blood flow

skin

and forms stress

usually thinner, these wrinkles

is

don't recollect ever seeing smoker's lines

in

a male patient.

One

area of importance to

use a blade or an

such as

you

electric shaver.

facial hair

irritations, cost,

prefer.

and

I

shaving.

advise them

I

find that using

whereas a blade razor cuts length,

is

Men

often ask

—and you —

an

electric razor leaves hair

hair closer to the surface

as acne, inflammation, or sensitive will irritate

presence

skin,

and aggravate the

problems

of skin

to

or

see which split,

less stubble, or stubble of

you have skin problems such

may be

a close shave

better to

ends more ragged and

and leaves If

it's

different factors

suggest experimenting with both methods

producing a smoother, closer shave.

blade can and probably

me whether

weigh out the

to

skin type, frequency of shaving, the

and convenience.

You might

more uniform

many men

condition,

less desirable since the

and an

electric

shaver

will

probably be preferable.

Pre-shave preparation

is

essential to assure a clean, close, less

Preparing for your shave includes using a cleanser that type

— a gentle cleanser

effective, oil-removing

to

for

normal,

cleanser

dry,

for oily or

shaving preparation to cut

them

— and

more comfortable. cut them, greater.

A

and the

is

twofold: to wet

appropriate for your skin

combination

skin.

If

using a blade, you'll need

available, including gels, brush-

and brush-lathering creams. The purpose

between the

the hairs are hard, dry,

risk of irritation or,

and

stiff,

it

skin

and

of

any

— making easier razor — making shaving

and thereby soften the beard

to diminish the friction If

faster shave.

mature, or sensitive skin and a stronger, more

choose a shaving preparation from the various types

less shaving creams, aerosol foams,

is

irritating,

takes more

hairs

effort

it

and pressure

even worse, cutting or nicking the skin

is

to

much

proper shaving preparation should soften the hairs quickly and hold them erect

so that they can easily be To help reduce

irritation

cut.

and promote a

closer, better shave, follow the

steps

in

the shaving

MEN'S SKIN CARE

151

Shaving Tips

THERE'S

NO REASON TO HAVE

Here's a shaving system that

I

IRRITATED SKIN

developed for

my own

FROM SHAVING!

sensitive skin,

and since then

has also helped countless grateful patients.

1.

the shower, at the end of the shower, so the steam can soften your

Shave

in

beard

hairs.

(Not

recommended

for electric razor users!)

foam

2.

Use a shaving gel rather than

3.

Shave with the grain of your hair

a

or cream.

first;

then, for a closer shave, shave against

the grain. 4.

Shave only with the grain to avoid ingrown hairs

5.

Don't shave too closely.

6.

Always use

7.

Consult a dermatologist

a sharp blade with

and become

if

two

if

you are prone to them.

or three parallel blades.

ingrown hairs resulting from shaving

irritated, swollen, or painful.

persist

it

Shaving

tips sidebar.

shower

is

in

the

steamy environment

a great way to prevent shaving

BASIC SKIN-CARE RULE

of the

irritation.

NUMBER ONE

Use

the appropriate cleanser tor your skin type at the

beginning of the shower and then rinse

end

of the

shower, with the water

still

shaving gel and shave as described,

and then against of

it

if

it

off.

for both

men and women: if

running, use a

the skin-care product you use

with the grain,

burns, irritates, causes inflam-

first

you want a closer shave.

shaving preparations, gels (which are

At the

my

In

terms

mation, or hurts, don't use

it.

preference)

and brushless shaving creams are probably superior in

reducing

irritated

and

and

friction

by a

gel,

in

so they

may

you have very sensitive

not reduce friction

allowing your razor to effectively

After shaving,

If

skin,

which can be

use a brushless shaving cream. Aerosol foams tend to be less viscous

less lubricating,

factor

potential irritation.

and

irritation

and painlessly do

its

and provide as much

slip

job.

use the same skin

type-appropriate toner/astringent (which that

is

what aftershave

you would use

for

lotions are)

general skin

care to help remove any residual debris left

from the shaving products.

Finally,

use your skin type-appropriate moisturizer,

especially

Shows glabellar and

in

cold, dry weather.

texture, oily skin,

large pores.

MEN'S SKIN CARE

153

MEN'S SKIN CARE The good news

(for

women. Thanks

to

women

better than

expect to age

men)

do. However, that

Many men

oil

men have

does not mean

that

— used daily—a good cleanser

that

cellulite,

and they generally age

you men can ignore your

is

a must, one that

accumulates on the skin during the course

skip toning the skin; however, that

can be an important step

stronger skin tone than

a mistake.

is

of the

will

and

skin

products can help a man's skin look better and age

well. High-quality

and

debris,

speaking,

male hormones, men almost never get

Aside from sunscreen dirt,

that, generally

is

remove

better.

the

all

day and overnight.

Particularly after shaving, toning

cooling the skin and preparing the face for any moisturizer

in

to follow.

A

but effective moisturizer

light

help keep the skin soft and hydrated.

will

antioxidant power, such as vitamins A, C,

(and slow

down

solution or a

and you can

E,

significantly

more sophisticated formulation

alpha hydroxy acids

of

reduce

irritation

may be

from shaving, and decrease ingrown

nicked, resulting

in

So whether you have

breakouts, avoid close shaves.

Use an adjustable

as a blade

razor.

until

If

An

electric razor

shaving

irritates

the acne subsides

shaving. There are a

FACT:

Men

number

regular

your skin and causes severe

enough

to allow for

common

of factors that play

improve and

have thicker skin than

women

role in

NOT JUST ABOUT WRINKLES

pulling

on

or experience occasional it

on the

light-

does not shave as closely results,

I

I

suggest growing

hear from

men

regarding

what causes an ingrown

because of higher

terone. As a result, men's skin tends to sag less

further

a clean shave.

complaints

a

acid

dramatic

may be

razor so that you can set it

damage

and uncomfortable. Acne

acne

another option, since

is

Ingrown hairs are one of the most

IT'S

difficult

little

hairs.

bleeding or oozing. Sore, inflamed skin

the skin, aggravating the acne.

est shaving position.

154

offer

will

a

salicylic

Whiteheads may be ruptured below the skin by the razor pushing and

irritated.

a beard

good

their ability to soften skin,

you have acne, any shaving procedure may be

lesions

fight free radical

the aging process). For razor burn or ingrown hairs, a

Both acids have consistently demonstrated

results.

If

and

Add

levels

and produce fewer

hair.

of testoswrinkles.

If,

for

example, you have coarse, curly

tendency which

the skin

this condition, off

it

aggravates

is

has been

it

along the side of the

—

just like

a

Using a angle,

blade can

dull

cut; the

When

comes

it

rougher or sharper

likely to

become

and

skin In

is

effective

UVA

is

the

the hair reenters

result in clipping

the roughness of the hair's sur-

the

more

likely

the hair

is

to

catch

and become ingrown.

follicle,

hairs being cut

on a sharp

ingrown.

to treating breakouts, preventing wrinkles,

acids, alpha hydroxy acids,

SPF 15 and

is,

is

more pressure being exerted and

ture issues or dry skin, the protocol

least

it

may have a

Shaving not only causes

splinter.

or along the skin next to the

result in

making them more

When

Shaving too close or against the grain can

it.

follicle,

beard hairs

a condition called pseudofolliculitis,

whiskers beneath the skin's surface. Another factor

face where

of

with black skin than with white skin.

causes an inflammatory response

it

ends

the closely cut

curve back and reenter the skin. This

to

much more common

is

hair,

same

for

men

as

and addressing color and it

is

for

women

tex-

(beta hydroxy

disinfectant for blemishes; daily sun protection with at

protection;

and a good moisturizer

to

use when and where

dry).

terms of the sun, skin

skin equally. Both

skin.

is

UV

rays are not picky.

men and women

should embrace

abstain from smoking, and implement a

guys out

there, don't

if

It

is

or participate

in

a

lot

ing your kid's soccer, football, or baseball team. its

sense: use sunscreen,

skin-care system. Most of us, especially you

essential to use sunscreen to protect

you work outside

are allowing

common

use sunscreen on a consistent basis, leaving skin

not to mention wrinkles. especially

good

They damage men's and women's

of

at risk for cancer,

and preserve your

outdoor sports

activities,

Any time you are exposed

skin

even coach-

to the sun,

you

harmful rays to penetrate your skin.

Think of your skin as having a meter that measures cumulatively any time the sun strikes the skin. Five minutes twice a day, merely going to is

almost

like

protection

in

spending

fifty

minutes

at the

and coming from work

five

beach on the weekend. You need

days a week effective

sun

both situations!

MEN'S SKIN CARE

155

CHAPTER

'If

you beat yourself up because you procrastinate, your problem is not that you procrastinate, your problem is that you beat yourself up." VICTORIA NELSON

Botox, Collagen,

and Other

Fillers o

YOU'VE MADE ITTHROUGHTHE CORE OF MY BOOKandbynow you surely understand why it

would have been

a

I

say

is

A very

facial skin.

dedicated to patients

free skin

— especially

not just about wrinkles." However,

mistake of colossal proportion on

include everything you need to

comes to your

"it's

know about contour

large portion of

who want

my

my

part not to

defects

when

it

professional practice

to have smoother-looking, wrinkle-

after their color

and texture issues have been

addressed and successfully eliminated. Remember, achieving the skin you've always wanted means fixing your facial problems

caused by It

a

composite of

color, texture,

and contour

—which

are

defects.

used to be true that cosmetic surgery and dermatological treatments

were

a

luxury for only a few select people

agances." Twenty years ago,

who

could afford such "extrav-

many such treatments

required long recovery

157

periods spent

hiding

in

and were extremely

These days, many

costly.

procedures

of the

perform daily require no downtime and can be done cost-effectively and quickly times over a lunch hour.

a quick superficial fine lines or hair.

It's

common

facial peel,

practice these days for

a few shots

their

and a zap here

of collagen,

do so

will

As

only continue to grow.

better than the prior generation

parents did, and therefore want to look better at

the

lines,

marionette

have a good understanding by exposure

The net

to the sun.

and

loss of fat

how

this point of

result of

Most

wrinkles.

the facial skin

ages

crow's-feet around the eyes (from smiling

Whenever on what

I

call

downside.

I

disadvantages? of the

want

their entire

to wrinkle

Next

is

with time

and sag. Another cause

I

effects

in

And

finally,

How long will

it

our faces look

weigh the upside

of the

improvement

is

will

predicated

procedure against the

compared

the patient derive,

Some

is

with the

and how much

patients see three fine lines

outweighed by the If

I

intrinsic risk.

laser

an

and

The nature

entire face for three

is

the likelihood of failure?

In

the

spirit of

regarding downtime,

the medical

potential side effects or

how will

is

adverse

the cost of

the procedure influence quality of

take for the procedure to

up

its

signs with

become

indiscernible by virtue of

fully

com-

makeup?

these questions are important to ask yourself before deciding on any elective

cosmetic procedure.

IT'S

make

is

the same, but the benefits are significantly different.

is

plete healing or the ability to cover All of

with

what causes

the postoperative period? Will the patient miss work? School? Will he/she be

functional?

158

I

do no harm," what are the

"first

and

of wrinkles

is

— such as scarring, discoloration, dispigmentation, or infection? What

the procedure? life

ratio.

on a subjective basis?

the risk

lines,

lines that

are the relative advantages for the patient

weigh the downside: What

profession's credo

and

squinting)

too severe for such a modest problem.

one hundred

you probably

decision as to whether or not to treat

actual ultimate

exists

and

face lasered. To me, the benefit

procedure

lines or

What

How much

problem actually

of that

my

the success (benefit/risk) the upside:

than

— especially on the forehead.

look at a skin problem,

First

fifty

eighty!

of

our natural use of our facial muscles. Our constant use of those muscles

aged, and sometimes even stern

at

those two elements, plus smoking and genetics, and

what causes us

elasticity is

and forehead

lines,

are

and wrinkles such

This chapter focuses on erasing facial contour issues including lines

as crow's-feet, frown

unwanted

baby boomer gener-

and even

seventy,

in for

facial wrinkles

— meaning they look better sixty,

— some-

come

to

or there for

estimated that about 2.7 million procedures to erase

It's

performed annually, and that number ation ages, they

women and men

I

I

insist that

my

NOT JUST ABOUT WRINKLES

patients do.

Isn't

it

worth

it

for

you

to

do the same?

One In

of

my

patients' chief complaints

most cases, they immediately ask

agree that Botox

is

one

is

for

of the greatest

that their skin doesn't look

Botox

—the alleged

advances

in

appropriate facial areas

color

and

texture

will

wrinkles, the patients

still

who

only be satisfied with the results

problems (lucky

for

cause

used

to.

it's

I

important to

request Botox for wrinkles if

they have no significant

them). Otherwise, even though the Botox fixes their

won't be happy with what they see

texture flaws are really the

it

cure-all for wrinkles. While

cosmetic dermatology,

understand what Botox can and cannot accomplish. Patients in

as good as

in

the mirror since color and

of their dissatisfaction.

COMMON CONTOUR PROBLEMS

Which of these contour

issues are affecting

you?

FOREHEAD

FROWN

LINES

LINES

CROW'S-FEET LOWER-LID

HORIZONTAL

BUNNY

LINES

LINES

ACNE OR OTHER SCARS

CHEEK SMILE LINES

EXAGGERATED SMOKER'S LINES

MARIONETTE LINES

DOWNTURNED CORNERS OF MOUTH

FURROWS BELOW CORNERS OF THE MOUTH

CHIN RIPPLING OR DIMPLING

THINNED OR SMALLER

LIPS

BOTOX, COLLAGEN, AND OTHER FILLERS

159

WHAT DOES BOTOX DO? O To better understand what Botox can and can't do, think of the difference between lines at rest (static lines)

(dynamic they

lines).

and

facial lines that are visible

when a muscle

is

facial

being used

Lines at rest are visible whether you're using a muscle or not, and while

may become more pronounced

there.

Examples are furrows

wings

of the

nose

or

facial

or marionette lines, which

to the corners of the

BOTOX

deeper during

expressions, they are always

come down

from

just

above the

mouth and then continue sloping diagonally toward

Areas where Botox can help correct contour problems.

FOREHEAD LINES

FROWN

CROW'S-FEET LOWER-LID

BUNNY

HORIZONTAL

LINES

LINES

EXAGGERATED SMOKER'S LINES

CHIN RIPPLING OR DIMPLING

160

IT'S

NOT JUST ABOUT WRINKLES

LINES

the center or sides of the chin. Lines on the cheeks often parallel the marionette lines, but

extend

a curving fashion back toward the ear

in

Dynamic there to the

lines are visible only

some

extent, they are

movement

when muscles

deepened

muscles causes

of

in

or

concentric or parallel lines or arcs.

worsened by muscle

moving the sheet on your bed causes the overlying blanket

ment. Rule number one with Botox the

cheek muscles

make you

that

will

see they are not

you can't use

is

to all

about how pulling and

move. These dynamic candidates

on muscles

it

smile. While your marionette

improve, you wouldn't be able to smile. To me,

this

that

for

Botox

lines treat-

you need, such as

and cheek

would

lines

On

not a great trade-off.

is

why

use. To understand

lines in the overlying skin, think

are the ones Botox can help, but as you

may always be

are used; although they

the other

hand, the frown lines between your eyebrows are caused by muscles that serve no useful function,

so

you want

if

to get rid of

become prominent

Lines that

improved by

Botox

injecting

become deeper and more Botox,

and some

lines

may

or

into the

those

lines, that's

a great place

for

Botox use.

more prominent when making an expression can be muscles

controlling those lines, preventing

prominent. But again, not every facial

may be

require further treatments. There

them from

a candidate

line is

on your face

lines

for

that

are permanently etched from years of muscle contracting. You've essentially broken the elastic tissue

the use of a Filler

and collagen, creating a permanent crease you simply

filler

oxymoron) Articol or

—

like

Radiance

(collagen

Artifil

temporary,

following the Botox treatment.

can be permanent

material

like

can't get out without

collagen

in

(a

—

like silicone

made up

product

—or semipermanent (which

of

bone

—whether bovine or human — and comb

of

consider an

material called hydroxyappatite) or

which polyethylene beads are suspended).

bacteria (Restylane) or from the

I

Fillers

haluronic acid

a rooster (Hylaform). These are

can also be

—whether from

all

injected under

the skin to reoccupy the volume that has been lost and the void that has been created

by the loss

of collagen

eligible (unimportant)

Despite

this

and

muscles

a protein

in

are used for lines at

rest;

made by

fillers

Botox

and Botox. Botox

is

a brand

the bacterium botulinum Clostridium.

is

used

for lines

from

name It

is

a great deal of confusion of

botulinum

made by

under other brand names such as Myobloc and Dysport. Myobloc product and works faster than Botox, but difficult to predict.

is

motion.

very simple and straightforward difference, there

surrounding the uses of is

fat. Fillers

it

doesn't

Botox (and other forms

of

last

is

other

a

which

toxin,

companies

relatively

as long and the results of

it

newer

are

more

botulinum toxin) erases wrinkles because

it

BOTOX, COLLAGEN, AND OTHER FILLERS

161

Before Botox.

temporarily prevents the release ot acetylcholine, the physiologic neurotransmitter that

causes muscles

— including

facial

ones

and ophthalmologists who used the the eyes to appear crossed.

spasms cease,

of the

rid

vertical or

was

first

introduced by neurologists

eye muscles that cause

that not only did their patients'

your skin texture, prevent useful to those people

new

who

hairline.

can also erase the

It

perspire profusely. big

It's

not

skin

for this condition

is

so close

to the

uncommon

awards show so they

can also stop excessive sweating

although using Botox

horizontal forehead

on your neck, smooth

lines

of the

for celebrities to

aren't

palms.

is

It

can cause temporary weakening

muscles

of the palms.

is

Botox

one is

of the

most dramatic

effects of

cerebral palsy,

162

IT'S

in

terms

of

of the

and

is

even used

is

for

esophageal sphincter.

NOT JUST ABOUT WRINKLES

used

for spastic

have Botox

extremely effective, of the

hand muscles

Besides being embarrassing, life.

The

ability to

improving a person's daily

also used for various medical conditions to relax muscles

help prevent migraine headaches,

spasms

Botox

is

seen sweating on the red

hyperhidrosis, or excessive sweating, has a significant effect on quality of it

lines),

from forming, and even stop excessive sweating. This

lines

arms before a

injected under their

treat

eye-muscle

diagonal creases between your eyes (frown

and remove the deep, unpleasant

lines),

between your eyebrows and

because hand

It

toxin to treat uncontrollable

The doctors noticed

deep

eradicate crow's-feet (smile

carpet. Botox

to contract.

but their facial wrinkles also softened.

Botox can get

lines

—

paralyses

people who suffer from acid

in

and spasms.

cases

reflux

It

of stroke

by helping

life.

can

and relax

After Botox.

With Botox, specific muscles are selectively relaxed. Botox dles into the desired muscle groups horizontal lines line in

erly there

and the platysmata, which form

should be very

little (if

your head erect and not to

have been injected

to

lie

benefit. But

Botox

is

slight

will

Typically,

burning sensation, but

any) bruising to the injected areas.

or

bend down

for

—where

it

two hours in its

after

It's

if

off

the

bad news about Botox

to It

may wear

and needs

and the

effects

to

is

is

done prop-

important to keep

your forehead muscles

designated

site

and does not

can cause a temporary eyelid droop. The onset

have occurred.

temporary and

when Botox

seven days,

may

at

which point 90 percent

weeks

take up to two

off within

for

the same:

three to four months, although

The bad news

be repeated. The good news

is

if

of

100 percent

lucky patients maintain their improvement for up to eight or nine months.

news and

off

can be a

muscle paralysis takes anywhere from four

the paralysis (and benefit)

neck

lines in the

ensure that the Botox remains

migrate to the eyelid muscles

wears

muscles, which cause the

on the forehead; the procerous and corregator muscles, which form the

injected to paralyze the muscle, there

some

trontalis

the glabella, or frown lines between the eyes; the orbicularis oculi, which form

crow's-feet;

of

such as the

injected with small nee-

is

is

you don't

if

you

like

like

The good

the effect,

the Botox,

it

it

wears

go away.

Extraordinary things can be accomplished with Botox. Aside from stopping undesirable lines,

Botox can prevent sagging eyebrows and dimpling and rippling

raise the corners of the

mouth and decrease

vertical (smoker's) lines

in

the chin area.

It

above the upper

can lip.

BOTOX, COLLAGEN, AND OTHER FILLERS

163

COLLAGEN AND OTHER

FILLERS

O Collagen makes up bodies. That

makes

much it

of the

a perfect

dermis and material,

filler

of wrinkles, including marionette lines

atrophic (pushed the

scars

in) facial

most popular choice

late

and

lines

human disease

The company

in

million

cows

cows have as a cows

result,

viral

but

I

disease) to the herd.

can

tell

our

improve

to

of collagen

is

col-

bovine

No case

of

American cow collagen has ever been documented. of

I

can't

tell

cows

has been

that

new animal

continuously inbred since the 1970s so as to avoid introducing any

(and hence no source of

as

raised for this purpose.

manufactures these products has a unique group

that

well

people have safely received

commonly used form

1970s. The most

or from

in

widely used to smooth certain types

around the mouth, as

More than one

collagen, obtained from the skin of American

animal or

is

it

most abundant proteins

the

acne and chicken pox scars. Collagen has become

like

for this use.

lagen injections since the

and

among

is

or protein

you how many hooves these

you they produce pure, noninfected collagen. These

are checked on a regular basis for the presence of disease; the manufacturer has

had a perfect track record

of quality control for over twenty-five years.

The screening process involved

in

developing and producing

the possibility of such an occurrence

cow disease was

a concern

in

in this

this

filler

significantly limits

ago when mad

country; however, a few years

Europe, bovine collagen produced and imported from

Europe was banned and eliminated from use by American physicians. Bovine collagen II

is

available

in

three forms:

superficially get rid of etched-in lines

be used

areas where the skin

in

of collagen

and

is

injected into

are often used together

in

is

and

thicker.

deeper

Zyderm

scars.

it

comes from

Zyderm

Zyderm

Zyplast

is

the

II

layers to effectively treat first

II,

and

Zyplast.

thicker than

is

most viscous

hollows, furrows,

lines,

To be treated with bovine collagen, you must tion since

I,

and

Zyderm and I

Zyderm and can I

or concentrated form

Zyderm and Zyplast

folds.

more complex contours. be tested

for sensitivity or allergic reac-

a nonhuman, animal source. About 3 percent of those tested

will

which can cause temporary uncomfortable red

be sensitive

or allergic to bovine collagen,

bumps and

unsuitable results. Forearm skin

is

tested twice during a period of six

weeks

before treatment can be performed. The chance of developing an allergy after double testing

is

An

rare but

can occur

IT'S

one out

alternative to bovine collagen

obtained from a

164

in

human source and

of every is

a form

thousand

patients.

human

collagen

of

made

from tissue

replicated synthetically for use. Patients

NOT JUST ABOUT WRINKLES

who

originally

are allergic

to

bovine collagen or

dates

for this

who want

deeper furrows,

I

human it

is

tissue

comes from

use

lines,

makes American bovine which there

six-week testing period are appropriate candi-

type of collagen.

The human collagen (for

to avoid the

a

called

hollows,

Cosmoderm

and

folds)

and

(for thin, superficial lines) or is

for

human

Cosmoplast

produced by the same company

collagen. This human-derived collagen

no potential is

is

is

made by

that

a process

in

infectious contaminants. Collagen derived from

safe and effective and requires no allergy or sensitivity testing since

human

FILLERS

source, so treatment can be performed immediately. Those with

Areas where fillers can help correct contour problems.

FOREHEAD

FROWN (not

LINES

LINES

removed by BOTOX)

CROW'S-FEET

BUNNY

LINES

CHEEK SMILE LINES

ACNE OR OTHER SCARS MARIONETTE LINES SMOKER'S LINES

DOWNTURNED CORNERS OF MOUTH

FURROWS BELOW CORNERS OF THE MOUTH

LIP

AUGMENTATION

BOTOX, COLLAGEN, AND OTHER FILLERS

165

a history

autoimmune disorders such as lupus

of

human

didates for either bovine or

Collagen

is

and

find

be one

to

it

collagen treatments.

injected just beneath the skin,

location

severity of the wrinkles. Not

most

of the

good can-

or rheumatoid arthritis are not

all

and the number

of injections

depends on

the

types of wrinkles are helped by collagen, but

effective, predictable,

and

long-lasting

I

available. Wrinkles

fillers

caused by smiling and frowning, which appear around the eyes, mouth, and nose respond very well to collagen injections, as

below the

lips,

those

to get

full,

As we age, our youthful look

marionette

do forehead

neck

lines,

pouty Angelina Jolie get smaller

lips

lines,

and acne scars. Collagen

and lose

their

shape, so enhancing the

vertical lines, especially for

on the forehead or cheeks can be improved but are

some

lines

make

often seen as

meaning you are

add a rugged, more

to the face

dignified

The collagen used most

The

injection sites look pink

patients

can have collagen

How

to

might appear

—and

at

first

up

is

to five or six

months

months

cases, especially

injected into

and

injections

and

on the

if

Collagen treatments

in

depends on

you've had a the

and duration

so make sure you

166

IT'S

find

a

for

men, a few

feel that

lines

even

exposure

normal routine the those too

older.

lips (to

face-lift or laser

create is

fuller,

of thirty

and

is

patient

fifty,

and

for

last

up

resurfacing,

greatly

to

depends

has had other cosmetic proce-

you may need

larger lips) last the least time,

is

It

gradually

treatment can

long collagen lasts also

dependent on the

cosmetic dermatologist with expertise

NOT JUST ABOUT WRINKLES

day. Small

less collagen.

about two months,

placed, the faster the body absorbs and eliminates

of individual results skilled

How

A collagen

my

after injection.

injected collagen

it.

of

quickly subside.

sun immediately

The

between the ages

will

normal

Most

same

it

fine lines.

after injection but return to

to the

several factors.

and

which makes

contour and superficial

not, unfortunately, replace

for patients

because the deeper the collagen quality

I

and happy. They give

levels of the dermis,

at the site of the injections, but

on how many treatments are done and whether the

The

eliminate.

severity of the bruising.

return to their

for patients in their sixties

dures. For example,

all

altering facial

— depending

to limit vigorous exercise or

long collagen lasts

four to six

some

and even bruised immediately

absorbed by the body, which does for

in

wrinkles

a few days

few hours

recommended

difficult to fully

smiley, friendly, approachable,

often today

within a

is

smokers. Deep furrows

appearance.

deep

effective for treating

bumps

more

gives a

lips

a face look more natural, especially crow's-feet, which by themselves are

warmth and character

more

also widely used

is

everyone seems to admire and desire these days.

lips

and helps eliminate most

above and

lines, crow's-feet, vertical lines

skill

in filler

it.

of the doctor, injections.

O

RESTYLANE AND HYLAFORM

—

:

Two

other

fillers

popular with dermatologists today are Restylane and Hylaform, which are both

hyaluronic acid. Our bodies have

The

natural effect of this acid

much

occupy volume, and enhance

to retain water,

is

the skin, thus keeping the skin looking younger.

As we age,

and dynamic

successful use

people

who

are allergic to collagen. Restylane

from

synthetically

Hylaform

is

roosters.

No

sources

bacterial

a hyaluronic acid allergy testing

made is

hyaluronic acid product; there

chance

of

extremely popular

countries outside the United States

in

an

is

human, animal,

same from

or synthetic,

and because they are

a hyaluronic acid that

combs

like

human

excellent for

a thick gel

made

DO NOT HUNT FOR BARGAINS

of

is

when

an extremely small

sources, whether

all

and

Some

collagen).

comes to fillers. These

procedures that should only be

not a protein.

is

it

are technique-dependent

is

administered by experienced

Treatment can be performed immediately with immediate results (just

is

of their

required to use either

allergic reaction since hyaluronic acid

almost exactly the

America because

in

Botox).

(like

from the

defects as collagen,

completely eliminated by Botox.

lines not

become

Restylane and Hylaform have

elasticity in

substance naturally

this

same

decreases. Restylane and Hylaform are used to correct the specifically static lines

sugar polysaccharide.

of this naturally occurring

and skilled practitioners.

doctors

believe Restylane lasts longer than collagen; however, it

is

and

also it

is

more

painful since there

significantly

is

no

more expensive.

local anesthetic

mixed

(as there

in

is in

should be administered by a

All fillers

collagen)

skilled

cos-

metic dermatologist.

Another popular

filler

used today

is

one's

own

fat.

areas of your body, processed, and then reinjected contour defects than

for superficial lines

The FDA approved Botox

was (and

still

is)

used as an

indications. Off-label

use

is

for

use

in

and

is

is

harvested or removed from other

into you.

It

is

uncommon

more

meaning practice

it

in

is

in

used

lasts

was never FDA approved

much

longer, but

I

for this use.

It

deeper

is

useful

April for

2002, although

in all

it

non-FDA-approved

cosmetic dermatology, nor

general medicine. Silicone, for example, although used for years as a results,

effective for

very safe.

the glabella (frown lines)

off-label product,

not an

It

filling

agent with

areas collagen

is

in

terrific

used, and

have also witnessed some horrendous reactions from using

BOTOX, COLLAGEN, AND OTHER FILLERS

167

top: Before treatment.

bottom: After Botox. opposite page: After filler correction of residual uncorrected lines following Botox.

silicone as

filler,

and draining cone

is

such as huge cysts Since

facial sores.

a permanent

filler,

sili-

the sores

last for years. Unfortunately,

the use

impure products or the overuse

of

silicone,

combined

with

bad

of

publicity

related to silicone breast implants,

has a

really put

filler

a damper on

its

over the years. That

use as

may be

changing, as newer types of silicone

have been introduced and are being

used as

effective

filler.

Many products

available to you

these days offer false promises that they can do

know: they lotion with

in

a

jar

what Botox or

fillers

to

have any

effect.

to create a visible or worthwhile

An

allergic reaction to

anyone, except

IT'S

an

injection.

Here's

creams. You can't

all

just

you need to

smear a

little

collagen on your face and expect results because collagen needs to be placed

ifyou're

trying to

It's like

etrate that wall, just as a collagen or a

168

in

can't. Wrinkles are not that receptive to

under the skin

FACT:

can do

walk though a brick

wall.

You can't pen-

Botox cream can't penetrate the skin

improvement

Botox

is

in

lines

and

uncommon

so

wrinkles.

it

Some

sufficiently

products lend

can be used by almost

pregnant, breastfeeding, or have a neurological disease.

NOT JUST ABOUT WRINKLES

a temporary swelling effect to an area with ished

lines.

fine lines, giving the false

appearance

of dimin-

But after a few hours, those lines return. Even worse, every time you swell an

area you are stretching the skin and using up the limited amount of

elasticity in that area,

thereby risking adding to the severity of your wrinkles as a result of overstretched skin.

Remember, your that

way

Botox setting.

wrinkles didn't form overnight, so they certainly aren't going to disappear

— not without a shot or two is

very safe

its

professional

Botox injections are the fastest-growing cosmetic procedure

people received

FDA

the face.

when administered by a competent

according to the American Society million

in

approval

in

injections,

for

Aesthetic Plastic Surgery.

an increase

of

2002, the percentages keep

In

in

in

the industry,

2001 more than

46 percent over the previous rising.

The

a medical

benefits are

1

.6

year. Since

terrific,

with

little

risk involved.

BOTOX, COLLAGEN, AND OTHER FILLERS

169

CHAPTER

"All

our progress

You have first an

is

an unfolding.

instinct,

then an opinion,

then a knowledge. Trust the instinct to the end."

RALPH WALDO EMERSON

Hands,

and O

WHEN JUDGING AGE AND GENERAL APPEARANCE, we look not only at the face, but also at the neck, hands, and for chest area, or decolletage. To the extent that a

myriad of reasons, not the least of which

is

women, the upper

we want

to look better for

to feel better, there's

to improving appearance than focusing solely on the face.

more

Women

in

particular find that after they have finessed the appearance of their face, their

hands are

still

a

dead giveaway of their true age. They are

embarrassed by the brown splotches that connote the age of their grandmothers. it

When you

can be very disturbing

measures to prevent aged skin

in

start to see yourself

— but

this

it

from that perspective,

doesn't have to be, since you can take

from occurring and to improve already dam-

these areas.

171

Your neck, the back of your hands, your fore-

arms, and your decolletage are

all

a story of time, sun, genetics, and

tell

factors that determine the ultimate

your skin. But they

tell

becomes damaged,

doesn't start

off with

damage

skin does,

facial

same

the

to

way

those areas, once

in

same

doesn't have the

powers the

reparative

those

all

a less forgiving

in

it

than the face does. The skin it

areas that

and

it

potential to with-

stand and repair damage. Multiple sun freckles on the back of a hand It's

Your

a dead giveaway of age.

enable

that

insult

body.

It

that, right?

which means those other

cell of

The

glands are what

is

much

we

elastic tissue

refer to

physical

When you

new

of

cells

of the

— but by now

as pluripotential

stimulated to grow and divide, can

even removed.

that there's

you're

oil

So they are a source

so well

much more

cells of the

the epidermis.

or

much more

and damage than any other area

glands and

when

has two very unique features

withstand

to

oil

cells,

damaged

it

of

has a higher concentration

you knew

skin

facial

when

cells,

become almost any old cells have

been

get a cut or a scrape, one reason your face heals

such a high concentration

of

oil

glands supplying these

cells

— so

even discolorations on your face than on other parts

less apt to get scars or

of your body.

As

those other areas, not only do they lack the elastic tissue and

for

face has, they also have chest,

intrinsically thinner skin.

oil

glands that the

These areas, the neck, hands, upper

and especially the forearms from the elbow down (which seem

to get

much more

sun than the upper arms between the shoulder and elbow), are extremely vulnerable

damage. are often

I

that the

in

some

That's

of

sun

these areas as horizontal surfaces; the hands and the forearms

a horizontal or angulated position. Even the chest tends to be angled out so

sun doesn't

when you bit.

refer to

to

lie

really

glance

off

The chest

it.

certainly gets the direct

down, while the neck has the overhang

why you

don't see as

many brown

of the chin

impact

and face

to

of the

shadow

sun it

a

spots on the neck as you see on the hands

or decolletage.

Skin on the neck tends to be

fairly

upper chest, hands, and forearms

172

IT'S

NOT JUST ABOUT WRINKLES

is

sensitive

more

and

easily irritated,

resistant to irritation

whereas

—which

is

skin

on the

fortunate since

BEFORE: Most striking is

the redness of the neck

and decolletage

(in

addition

to the face) accentuated by

browns

in

the same three

areas. Large pores are

observed places

in

the usual

—the middle cheeks,

the cheeks next to the nose,

and the area between the eyebrows. This

example of a type

I

is

a

good

Fitzpatrick

skin type.

more

the lesions there tend to be

see

me

It

the tace

a

lot of

so

of these areas,

it

is

sun damage.

skin.

and promoting

what

repair of it

is

there

Start to treat these

I

refer to

that the back

of one hand often looks

differ-

most of their sun

exposure on the golf course while wearing a glove on one

it

becomes

visible.

and young by giving

of freckles

on your

browns you get

that

if

tell

the

versus that of the other.

damage were

the benefits of the medi-

hormones do

in

not tend to

these areas tend to be actual sun

to

and age spots, which are sharply

—as opposed

to the diffuse blotches

occur on the face. Freckles

be

larger,

because there

can be an inch or

is

larger, rather is

appear most often on the chest and the back

in

these areas tend

less protection.

common

of the

They

than a quarter or an for the face.

hands

after

discolorations often occur on the chest, as a result of the skin having

vessels and being more susceptible to the breakage of those blood vessels.

The

decades

It's

more blood not unusual

see broken capillaries on the chest.

The sides (which

is

of the neck,

ken capillaries and loss

IT'S

which are more subject

to

sun exposure than the

front of the

neck

shielded by the shadowing of the head) can suffer from a condition called

Poikiloderma of Civatte

174

patients

sun worship.

Red

to

my

face.

eighth of an inch, which

of

always

occur on the neck, hands, or decolletage. Most of the

demarcated spots

on the back of one

it

get on the face from female

easy to pick them

larger freckles

I

The hormonally induced brown discolorations you

out by the number of sun

hand

areas before you see freckles

these areas as

freckles, liver spots,

freckles

of protection

cines or topical preparations that prevent the formation

ent from that of the other.

it's

terms

in

in all

already there. This practice keeps the skin looking fresh

Golfers get

an area

as subclinical damage. Even though you can't yet

—years before

ONE PECULIAR FEATURE is

It's

to

Implement an early proactive regimen preventing damage

to start treating

avid golfers

a close second.

is

extremely important to pay attention to them

early prevention from

see the damage,

most patients come

damage and abnormal, precancerous sun damage occur

and rough and/or scaly

hand, so

the area

abuse from the environment and the sun.

Both degenerative sun

in

is

about, without any question the back of the hands

that takes

and

extensive.

—the appearance of elastic tissue.

NOT JUST ABOUT WRINKLES

of stippled red

and white spots caused by bro-

People with Fitzpatrick skin types

I

and

II

are most

who spend most

susceptible to this condition, especially those

park rangers, construction workers,

cannot be treated

topically,

same

so there

Wash

as

isn't

is

easily treated

four steps, skipping toner

much

oil

on the

The chest and hand

work

facial skin will

office with lasers.

—there

as

aren't

for

many

your

treat

glands

oil

skin

pretty

is

becoming

dirt

and

irritated.

The same

these areas, although you can

a

start with

alternatively,

using the

every-other-day basis. People with very sensitive skin

regimen and

Choose your

is

be

certain their skin

will

eye creams, not

on your

a requisite

facial skin

types

for the routine, but

become

irritated

sensitive,

face, but

does not have

to

or,

on an

use an even lower acclimated

from the glycolic acid.

— here, moisturizer

— again, because

it

to

higher

recommend

I

just to get their skin

moisturizer according to personal preference

essarily predicated

Moisturizer

to

in

may need

slightly

more

is

do on your

concentration on your neck as you

you use

glycolic acid

a lower concentration on your neck since the skin there

strength concentration, such as those found

use your

tough and can take a higher concen-

starting with

to the

these areas

in

impurities, then

concentration (10 percent instead of 8 percent) on the chest and hands.

same

facial skin.

skin.

tration of the active ingredient without

your

a dermatologist's

in

the area with your cleanser, removing entrapped

active ingredient.

for

workers, farmers, and gardeners. This condition

utility

and decolletage exactly the same way you

Treat the neck, hands,

Follow the

but

of their time outdoors, like

of the paucity of

is

not nec-

oil

glands.

be the same moisturizer you

use on your face. Obviously, the need for sunscreen

is

the

same

Prevention, prevention, prevention: the three

choose

to

patients

like

a

lotion

day, even

if

me it's

that they

SPF

15.

begin to

your

skin.

If

feel

the feel of a lower it

is

for

your face.

You may

skin care.

your face, or a sunscreen

that,

when

all

it's

more

over the sun-vulnerable parts of the body every

Anything between 15 and 30 serves the purpose. As SPFs go up,

goes

up,

heavy and gooey, and

So remember, when

for

in

it

the happiest dermatologist on Park Avenue,

use sunscreen

the viscosity of the product often

may

three areas as

—which spreads more evenly than a cream. While my

who use an SPF 30 make me

important to

all

most important words

use the same sunscreen that you use

applied, feels less thick,

for

and once you get past an SPF

this

might

SPF motivates you

comes

to taking

become an

to

use

it

of 30,

sunscreens

daily,

aesthetic consideration for I

say go

for

it!

care of the sensitive non-face regions,

and be most aggressive on the hands and

start early

chest.

NECK, HANDS,

AND DECOLLETAGE

175

CHAPTER

"If

we want peace, we must give up

the idea of conflict once DR.

and for all."

ROBERT ANTHONY

—

—

Other Procedures O

WHEN

IT

COMES TO OUR

FACIAL SKIN, we

looking, healthier skin. Addressing color

all

want younger-

and texture flaws

in

particular

has been the focus of this book. The disappearance of lines and wrinkles is

another element making up the whole picture. But there are numerous

other procedures that are available to you to bring out your total radiance. skill

All

of the procedures described

of an expert physician

—whether

in this

a

chapter are reliant on the

cosmetic dermatologist,

a skilled

practioner, or even a qualified plastic surgeon. Flawless, beautiful skin

can be yours

especially after

explained to you further

— and

in this

implementing the techniques already

book. But for those of you

who want to go one

step

who

have the financial means to support that journey

some

of the more popular procedures

we do

in

my

each and every day. Remember, none of these procedures

is

necessary

I've

outlined

office

177

to having the skin you've

my easy Many

always wanted. You already know

procedures can take your

relatively

noninvasive skin treatments.

of lasers;

new chemicals

for sclerotherapy,

Today,

many

them

out).

today

for

is,

does have

it

contour issues to the next

facial

There have been incredible improvements

to achieve that goal with

my program

four-step program. But as effective as

of these

how

technology over the

in

have an armamentarium

I

for injection; fillers to

fill

limitations.

its

level.

decade

last

relating to

technology consisting

of

out lines; and sclerosants, which are used

the technique of destroying spider veins

and varicose veins

via injection.

scars can be fixed by lasers (as well as by the traditional technique of cutting

The following pages

some

highlight

of the

more common procedures

available

addressing issues beyond color and texture problems.

FILLER

MATERIAL

O Filler

categories:

be used after

used

materials are chemicals that are First, lines that

Botox works, are

of the skin

still

that serve

no useful

present because they have

that exist but are not influenced or

caused by the use

have not responded

The gold standard

of

the

a form

materials,

filler

of injectable collagen.

FDA-approved

fillers for

have more experience with of the

lines it

(I've

and

I

call

is

it

is

the

same

manufactured, and put

or scar with a very fine

been using

in

into

been etched

third, lines at rest,

a syringe,

in

use

IT'S

and

for well

for

it

been around the

surface

which are (It

lines

goes unsaid

texture issues.)

over twenty years,

cows and

and

the dermis, or the

from which collagen at

As a

is

puri-

which point

it

is

second

extracted.

tiny

we

some

effective.

quality control.

It

can be injected

A

result,

with

—which are also safe and

of safety, efficacy, in

longest.

more than twenty years) than

needle by a qualified dermatologist.

NOT JUST ABOUT WRINKLES

into the

muscles.

extracted from the skin of

it's

terms

layer of skin

lines or wrinkles that,

amount

the dermis, from which the collagen has dissipated as a result of ultraviolet

178

three different

in

collagen "the gold standard" because, out of

You've already learned that collagen resides

fied,

literally

which has been

wrinkles,

Collagen has an excellent track record

cow

Second,

of your facial

newer products coming onto the market today

skin; in the

and wrinkles

to the treatment of your color

bovine or cow-derived collagen. This material fied into

function.

by repeated contraction of the muscle. And

that these lines

lines

are not suitable for treatment with Botox, since Botox can only

muscles

to paralyze

improve

to

is

layer of the is

into

then puri-

a wrinkle

injected into

damage

or simply

usage and breakage, thereby creating a restores the lost

volume

comes

Collagen

thick (Zyplast).

called

is

dure.

It

the procedure.

a trough or a furrow, a deeper

for.

And

in

the

in

for

skill

very fine lines

the smallest

improve

is

a

a deeper

for

more viscous

thicker,

used.

is

a technique-dependent proce-

is

not injected at the right level of the skin,

it's

if

outcome

most commonly occurs

deeply). At worst,

can

the collagen

injected too superficially,

is

risks involved in using

the manufacturer

bovine collagen;

period of four

weeks

for

any

in

literally

it's

allergic reaction

done, you have to redo

eliminates

bump

it.

And

the

—

within three to six

Four years ago, the

it

in

—which would

three to six

good news months

that

same company

form of collagen under the names

is

is

that

it

does not

injects

after

Cosmoderm, one

of

to

Those

like

it

patients

chose

to

is

is

many

brief,

wears

it's

injected into

then observed for a

bump.

off.

or

is

that

when

if

the

you

body

—such as creating

done

is

eliminated.

human

and Cosmoplast

(thicker,

of the filling

same

flow characteristics as

bovine collagen.

just like the

advantage

comes from

that, in

of

our

human own

colla-

species,

the past two years

I

have

unimportant allergic reactions to

uncommon

be treated with

is

large, tender, red

a redness and swelling

not

For that reason,

collagen started making a

identical, the

have

it.

The bad news

it

what

a

lower viscosity)

and causes

whom had

about a week or two. Such a reaction

collagen.

result in

should not occur. Having said

had three patients who did appear or

The area

require a skin test. Since the collagen

allergic reactions, in theory,

Cosmoplast

injected too

too large an amount,

disappear as the collagen

(thinner,

Although the techniques of injection are almost

gen

in

is

of the collagen

the same.

makes bovine

higher viscosity). The human-derived collagen has it

bit

months when

bump will

that

is

you don't

if

Cosmoderm

bovine-derived collagen, meaning

little

front of the elbow.

The good news and the bad news about collagen what

and

humans can be allergic to

recommends a skin test during which a

the skin of the forearm, near the crease

like

the collagen

fail-

lumps and bumps.

result in

There are

if

if

of

not injected

the right quantities, or not spaced properly, the results can be, at best, unsatisfactory,

ing to improve the line or wrinkle (which

a

So

wrinkles.

injection, with

and wrinkles

lines

and

lines

and

II).

those next to the eyes, called crow's-feet,

like

amounts

medium (Zyderm

I),

of the physician injecting the material that determines the

the collagen

If

line or wrinkle.

depths and widths to

different

injection of collagen to is strictly

the

reoccupies or

injection of the collagen

like

the thinnest material

The

in

The

three different viscosities: fine (Zyderm

There are

contour problem, material,

in

that resulted

void.

different

in

filler

in

the injected area

allergic reactions to

bovine

material thereafter.

OTHER PROCEDURES

179

Another important

one

of the

sugars

filler

has emerged

that

the dermis

in

— unlike collagen, which

support of the dermis as a brick the mortar is

between the

a material called hyaluronic acid, which

is

collagen

wall:

bricks. Hyaluronic acid

suspended, holding the collagen

composes is

the bricks

a semiliquid matrix

place so that

in

a protein. Think

is

of the structural

and hyaluronic acid

in

can best perform

it

is

which the collagen its

structural role-

providing support for the skin.

Torn Earlobes Women

often find that as they age, they develop poor, beaten-up earlobes, which can

either partially torn or

completely torn by earrings

torn, the earring will not

completely of

sit

properly

the ear or

in

besides being unattractive,

torn,

of

skin

is

appear

to

the earlobe

droop down.

be impossible

literally, in

If

to

wear an

is

partially

the lobe

If

is

earring. Both

the partially torn earlobe, cutting

— normal skin

like

you have on the outside

your body. For skin to adhere to skin, raw, exposed dermis must be opposed to raw,

exposed dermis. Skin

will

then

glue together by

literally

collagen and a semiliquid matrix material form sides of the

When sew up

wound

performing

The type

Just as

this

procedure,

of closure

some people

some people have have very

fat

I

are

it

has

do tall

earlobes,

thin earlobes.

and therefore the

its

own

repair process,

in

which new

the dermis to permanently hold the two

in

together.

the resulting hole. But

earlobe.

of

pierced ears.

will

will

it

these conditions are very easily repaired by

out the hole. The lining of the piercing

for

be

is

I

literally

to

have

be done

in

to cut out the lining of the hole

and then

a fashion that preserves the shape of the

a plastic surgical closure, and

I

get

terrific results.

and muscular and some people are short and

some people have normal

The thinner the earlobe, the

less able that earlobe

is

some people

earlobes, and

less material there

skinny,

is

to

work with

support any weight, particularly the weight

to

an earring. So people with thinner earlobes should not wear heavy earrings. They

should not wear dangling earrings, since dangling earrings invariably droop and get

caught on

sweaters, or

hair,

the lobe tears a the support

needed

difficult to repair,

performing the

180

IT'S

bit

little

shirts,

more

for the

until

the hole

enlarged to the point that

because, again, there's

NOT JUST ABOUT WRINKLES

Each time

pull

cosmetic use

repair.

on the

causing a

of

is

lobe.

it

that

happens,

won't provide

an earring. Also, thinner earlobes are more

just not

as

much

material there to work with

in

The procedure anesthesia that

is

is

done

no

remove growths on the little

two,

bit of

and

painless.

we use

all

burning for a second or

after that,

The defect

the

to

skin. You'll feel

completely

it's

that

we create

either cutting out the hole or

torn

from

different

the local anesthesia that

a

with local

way through

—

in

—

if

in

it's

removing

wedge-shaped open-

the skin of the is

closed with stitches that stay

in for

seven or eight days. Suture

ing

removal

age

is

is

for

another

week

discourage re-piercing

I

or two.

a period

for

completely heal and remodel. line,

months

cf four to six

When do I

re-pierce,

I

to give the lobe the

never re-pierce

in

chance

to

the scar or the repair

since scars are not nearly as strong as healthy tissue.

No two the

torn earlobe can easily be repaired.

A tape band-

never painful.

worn

An incompletely

same

earlobes are the same. time anyway, so

in

When

people look

at you. they can't

the process of re-piercing, just as

piercing, the best piercing site

is

in

see both earlobes

at

the original process of

the spot that looks proper for that earlobe.

SCLEROTHERAPY Z Sclerotherapy to

make them

is

a procedure

in

which chemicals are injected

any functional loss by

their

sides together making

will

we can

it

it

and step on

it,

you

will

glue the

so water can no longer flow through the hose. That's a good way

about sclerotherapy.

cause inflammation

destroy them and not suffer

removal.

you have a garden hose, and you run glue through

to think

unwanted blood vessels

disappear. Spider veins or broken capillaries are enlarged blood vessels that

serve no useful purpose; as long as they're not useful,

If

into

in

against the opposing side

It

the vessel will

a material

involves injecting the undesirable vessel with lining.

Next,

compressing one side

cause the inflamed walls

to heal while

still

that

of the vessel

stuck together.

OTHER PROCEDURES

181

Sclerotherapy for leg spicier veins.

so blood can no longer flow through the vessel. the blood vessel dies

The treatments are

painless, despite the fact that a needle

even

realize

injections are so superficial, they

sion stockings should

be worn

for three

when

best to avoid this procedure

Immediately

in

July

after the treatments, patients

it.

is

used

to inject the

days

after the style,

but they're tight

full

Tight

compres-

procedure, to obtain optimal

and August, when

can resume

medicine

the injections are being performed;

do not stimulate pain nerves.

improvement. The best stockings are panty-hose it's

blood can't flow through a blood vessel,

and disappears as the body reabsorbs

into the vessel. Often, patients don't

because the

If

it's

and

confining, so

very hot and humid.

activities.

LASER THERAPY

O Lasers are devices that emit uniquely focused energy. Daylight, or visible

blue to red, which

an angular piece

is

light,

light

consisting of a single wavelength of

consists of a spectrum, or an array of colors of

most apparent when we see a rainbow,

of glass.

Laser energy, which

is

Each color has a unique wavelength

used

to destroy

mis and the upper layers of dermis, target for the laser energy.

light

When

until

it

IT'S

going through a prism, or

of energy.

encounters blood. The blood

the laser energy hits the blood

NOT JUST ABOUT WRINKLES

from

blood vessels, passes harmlessly through the epider-

destruction of that blood, which destroys the blood vessel without

182

light

in

in

the blood vessel

the blood vessel,

it

is

the

causes

damaging anything around

it.

Laser Hair Removal used

Different lasers are

use lasers

to destroy hair,

THE VISIBLE SPECTRUM When

for different targets. I

am

I

either using lasers that

target the blood vessels that supply the hair follicle or

lasers that destroy the

bulb or hair

organ

critical

organ,

I

in

pigment

the hair

done

is

of the hair

By destroying the

follicle.

whole

effectively destroy the

the technique

body

the

in

which also destroys the adjoining

follicle,

OF LIGHT

hair follicle.

no

properly, there's

critical

When

consists

of about 400 different

wavelengths, from

target

to

800

nanometers. A laser emits light

of a single wavelength, so

it

collateral

energy

will

only be

hurt.

is

absorbed by a substance or The most common areas from which women have

removed are the chin and the upper

common Beyond

area

is

on the breast

Hair

is

between the

hair

removed.

The next most

lip.

Literally

are very

commonly

treated.

Some women want

easily treated.

and the pubic

belly button

hair

any area on the skin can be treated

grows

with laser therapy since hair

all

over the body.

Men

usually seek hair removal for the back, arms,

ears,

and the back

get whose absorption matches its

wavelength.

Every structure has an opti-

mal pattern or wavelength of absorption of light. (Blood vessels,

which are

red, are best

treated with green

light.)

The

absorption of laser energy

The predicate

what causes for

successful laser hair removal

is

be darker than the color

of

— because the laser energy

by the darker target. There blond hair or white hair with a is

intrinsically

difference

in

between

be absorbed

will

no way

is

hair.

skin

of

removing

because the

laser,

darker than the

color

is

of the neck.

that the color of the hair

the skin

tar-

hair

the bikini area; next, under the arms.

that, entire legs

has

the ability to be a very smart missile. Its

damage. Nothing around the

400

and

skin

The greater the hair,

that

is,

darker the hair with respect to the skin, the easier

the it

target,

destruction of a

and the

laser emission

the

damage

specificity

is

what

of a

confines

to the specific

— without resulting

target

collateral

damage

in

to other skin

structures. Lasers are hugely

is

successful because of their to

remove.

It

takes anywhere from three to

six treat-

unique ments, but the removal of hair by laser Patients

who

removal

is

It

is

previously

waxed

tell

me

is

that laser hair

any

hair lasering

target only

what needs

to

be destroyed.

less painful.

crucial that

ability to specifically

permanent.

be done by properly

OTHER PROCEDURES

183

trained professional. Nonprofessionals are a formula for disaster. I've seen terrible scars on

patients

who were

Make

treated improperly.

sure that you are treated by

somebody who

is

both qualified and experienced.

The best way

American Society that the

cient

a professional

credentialing

of

sites

to find

of

Academy

the American

like

visiting the

recommended

professional or the

and proficiency

office

standards of that

to satisfy the high

Web

Dermatology or the

of

Laser Medicine and Surgery. Credentialing by such an authority

recommended

skill

authorities

by personal recommendation or by

is

means

has demonstrated

suffi-

authority.

Tattoo Removal One

of the

reasons

was an upsurge Angels.

It

in

occurred

would a decade

became

involved

in

laser surgery

cosmetic tattooing

in

an

I

to

later

me that what these

tattoo might

like

and

in their

twenties and

anterior hips.

often

in

and

a good idea

another undesirable mar on the

women

entire population disparate

be undesirable and regrettable

seem

in

Most

skin.

forever

these situations, a patient's

is

to

them.

that motivated

I

my

of

on

ago was

that there

from bikers and

and fashionable

me

to

buy

my

later

A

of the

more popular treatments

professional tattoo has

which means there's

it

may become

when

it

comes

the ex-mate's

to love.

than an amateur

of a target to destroy.

destroy a professional tattoo, and

And

name removed

very

before

become

office.

much more pigment

much more

the

hands, shoulders, backs, ankles,

their

not exactly forever

my

in

patients seeking tattoo removal are

new mate wants

in

time

first laser.

things proceed. Whatever the motivation behind the removal, tattoo removal has

one

Hell's

at the

predicted an increase

moment, but years

the

thirties with tattoos

Sometimes

ten years

individuals thought cute

desire to have cosmetic tattoos removed,

A

more than

maybe

It

(or self-inflicted) tattoo,

takes ten to twelve treatments to

four to six to destroy an

amateur

tattoo.

These

treatments are performed every other month, meaning an elaborate professional tattoo can take up to two years to destroy!

Lasers are the lasers,

first

modality allowing for the removal of tattoos without scarring. Prior to

anybody who wanted

to

remove a

tattoo

had

to

have a disfiguring procedure

which the skin was either cut out or dermabraded, leaving a nasty

was worse than

IT'S

scar. Truly, the treatment

the problem.

The removal process with the

184

in

laser

NOT JUST ABOUT WRINKLES

can be

painful.

It

depends on

the person's pain

Sometimes use

threshold.

use

I

for other skin

local anesthesia,

I

into the skin

a fraction of a second. As the removal process pro-

gresses and there's less pigment

left,

the target.

It

becomes

specific colors

a

in

hits

every color because laser

no single

light

laser

can

cannot destroy

its

$50 or $ioo to get

a tattoo,

it

it

less painful. Specific lasers treat

tattoo, but

If it costs

can cost anywhere

from $2,000

there's less of a

so there's less of an explosion as the energy

target,

THIS:

procedures. Laser tattoo removal

concentrates a massive amount of energy for

CONSIDER

as would

to $6,000 to have

removed. This

may be the

most painful part of removing

treat

a tattoo!

own

color (so green light lasers can't destroy green tattoos).

Consequently, the more colors there are Black

is

trickiest colors

We've talked about cosmetic

When was a I

student

in

remained

in

my

removed by a

more

is

it

to eradicate

difficult to

remove.

tattoos, but there's another kind of tattoo: traumatic tattoos.

my palm

I

was on my way

with a lead pencil.

my

to

first

neuroanatomy exam

The pigment

when you in

accidentally

and

bicycle

cause yourself

and motorbike accidents,

something. Unanticipated collisions with the ground cause skin

and create a

skin

in

it

of the lead pencil

can be (and was)

easily

tattoo.

A

tattoo

is

really

dirt

caused by a foreign

injury,

or

as

I

did, or

when you

when you simply

and gravel

trip

garbage. But the scavenger Large particles

cells

like splinters will

sit

there

there

full

of the tattoo

be engulfed by scavenger

of foreign material. But tattoo

the scavenger cells just

sit

pigment

and

fill

is

so

fine

up with the

— as

on

your

to get into

material being put under the

a small enough particle to be engulfed by scavenger cells that attempt to get

by permanent

it.

laser.

and scrape your body

body

difficult

and blues are very

skin as a black spot. That's a traumatic tattoo

Traumatic tattoos occur fall

tattoo, the

are flesh tones.

medical school,

accidentally stuck

I

a

the easiest color to remove, whereas greens

The hardest and

when

in

rid of

pigment and never go away. cells,

is dirt

which attempt to

from

spills

and

the

rid

falls

—

that

tattoo pigment, until they are replaced

cells that create the tattoo.

Brown-spot and Age-spot Removal/Freckle Removal The same spots.

It

laser that

does

it

with

removes tattoos also removes brown age spots, sunspots, and

terrific efficacy,

leaving no marks.

The

simplicity,

liver

ease, and painlessness

OTHER PROCEDURES

185

of the

procedure can sometimes appall patients

the sense of

commonly seek treatment

years ago." Patients most

this ten

in

days (on the back

merely turns the brown spot

and-blue piece of skin literally

It

into

that the

second treatment

—which

is

seven days (on the

six to

brown residue underneath

takes a second or two to eradicate a freckle. Bacitracin

brown discoloration

of the

of the hands, the chest, or the legs), lasering

following the procedure, but there are really no side effects. is

do

didn't

a purple spot. At the end of that time period, a thin black-

leaving no

falls off,

I

back

for the face, the

hands, the chest, the back of the arms, and the legs. For about face) or twelve to fourteen

can't believe

"I

not be completely

will

it.

applied for a few days

is

The worst

removed the

that

can happen

time, requiring a

first

very rare.

Laser Therapy for Broken Capillaries Including Spider Veins and Varicose Veins Laser therapy treat

is

excellent for removing broken capillaries or spider veins.

areas on the face, legs, and chest

Let's start with the face.

look

like

removed

with

one treatment

laser device

is

capillaries are thin

why

has a cooling

tip that

(discussed

treats spider veins

All

that's

on the legs with

earlier), or with lasers is really

you, even as

somebody who owns

than chicken soup,

I

can

still

get

with injections than with lasers.

IT'S

occur

typically

usually effectively

a mild burning sen-

passes through the epidermis results.

The

skin

can be a

changed

in

your appearance

is

the

of your spider veins.

Whether a doctor

186

almost

pink for ten or fifteen minutes, but usually fades. By the time you get to where you

absence

works

They

and are feel

lines that

cools the skin to about four degrees centigrade,

are going, there's no evidence of any treatment.

tell

to

briefly.

upper dermis, where the spider vein resides. No bruising

little bit

curved

— not requiring any anesthesia. You do

protecting the overlying epidermis as the targeted laser energy to the

little

face,

can be used

it.

they're called spider veins.

nose but can occur anywhere on the

of the

sation but only very

The

Those broken

the legs of a spider, which

on the sides

—or anywhere you need

It

rid of

It

faster.

NOT JUST ABOUT WRINKLES

is

injections,

which

is

sclerotherapy

a matter of personal preference. But

sixteen lasers

and

I

can

thinks that lasers are better

the spider veins on your legs better

less painful with injections.

It

and

heals faster.

faster

And

it

Hemangiomas

Laser Therapy for The same

laser that treats spider veins

can

treat cherry spots, or cherry

hemangiomas,

which are those very sharply circumscribed, almost dome-shaped or flat-topped onesixteenth to one-thirty-second of an inch red spots that you have

back. They tend to be hereditary and they increase

them a

little

gray,

bit

in

on your arms, chest,

number with age. The treatment

and then over the next few days they

just

or

turns

fade and go away.

Laser Therapy for Periocular Veins Lasers can also be used to remove larger veins on the face. Periocular veins are two to three millimeters

wide and tend

to

occur around the eyes. Some-

times they occur on the temples or just below the lower eyelids. They are very easily treated and

removed by bit

laser therapy.

The treatment

is

a

little

uncomfortable, consists of a few pulses from the

and

laser,

no side

a few seconds. There are usually

lasts

effects.

The

skin

becomes

pink or a

little

swollen for an hour, but the veins disappear immediately

When

patients look

in

the mirror right after

the procedure they can't believe their eyes!

Periocular veins> which can easUy be treoted

with laser therapy.

Laser Resurfacing One

of the earliest applications of

acne scars. An ensues, with

ablative laser

lines, wrinkles,

of skin without burning

scars) in

is

called ablation;

cosmetic lasers was the removal

literally

removes the upper

(that

and the

entire

The carbon dioxide (CO2)

technology and thereby lasers

to

be able

work by focusing a beam

of

and

which healing

removing the upper layers

without using dangerous heat, which would cause

is,

the improvement or removal of lines,

resurfacing.

layers of the skin, after

and scars removed. The process

them

of lines, wrinkles,

— resulting wrinkles, sunspots, precancers, or scars — called process of ablation, followed by healing

laser

is

was

the

first

of

its

kind to

to actually resurface the skin.

of amplified uniform light at

be adapted

to ablative

As previously explained,

a specific target

in

the skin.

In

OTHER PROCEDURES

187

CO:' laser resurfacing, the target of the laser

and dermis

removes

is

upper layers

or ablates the

entire

epidermis

skin (epidermis).

It

is

red

is

the process

in

sunspots, wrinkles, and

of

damage.

treated.

is

red

You

with the

will

and swollen

upper quarter or

of the dermis,

fifth

leave your doctor's office

depend-

without any outer

literally

(like

a bad sunburn) immediately

all

after the treatment;

followed by the restoration of the removed skin within ten days and the fading of the

— and then pink — color within

It

the skin. Since the epidermis

the functional equivalent of a superficial or mid-second-degree burn

over your face. The skin this

in

along with years

of skin

removed along

is

on the condition being

ing

the water

90 percent water, the water absorbs the laser energy, and

other remnants of accumulated

The

is

became apparent

delivered a precise

six

me when

to

amount

weeks

CO2

started

I

after the

new

skin

lasering ten years

ago

that anything that

to four

months

in.

of heat to the underportion of the skin (the dermis) without dis-

would create some tightening

turbing the epidermis

has grown

of the skin.

That

was

just intuitive

and

based on my empiric observations using CO;' resurfacing over the years. This has now been proven and adapted kles,

and scars without

results.

than happy with their

many

nonablative lasers, which attempt to improve

ablation, or

CO:' laser resurfacing

most dramatic

to

is

removing the overlying epidermis.

the most dramatic laser procedure available

(It's

my favorite

final results

Be forewarned, however.

just

This procedure

is

most things

in life,

is

if

to ear

my

because there first

is

nets the

patients are

more

truly ecstatic.)

a ten-

couple

it

— they are heart — either on the part to

of

of

eleven-day recovery period,

days during recovery, you're

you scraped your knee or suffered a second-degree burn.

the bigger the benefit, the bigger the

risk.

lasers consist of scarring, loss of pigmentation, infections,

stances

because

not for the faint of

reformed. For the

oozing as you would ooze

Like

procedure to perform because

and beam from ear

the physician or the part of the patient,

during which the outer skin

lines, wrin-

The

and

risks in

using ablative

— under

rare circum-

— long, delayed healing, which can take as much as a year and cause scarring.

Fortunately, this

is

rare

and happens

in

only a very small percentage of cases.

DERMABRASION O Dermabrasion

is

a procedure that

and embodied imperfections

188

IT'S

literally

abrades or grinds away

(scars, lines,

NOT JUST ABOUT WRINKLES

all

of

your facial skin

and wrinkles) using an instrument with a

very rapidly rotating wire brush. to strip paint off

wood. The

It's

a smaller version of a tool you would use

like

rotating brush

moved back and

is

across stretched

forth

facial skin.

The operator takes the

skin

down,

by

layer

layer, until

experienced operator can get the layers even

it

levels.

A

bleed and then crust. Dermabrasion very effectively removes the upper layers of

makes your body regenerate those fresh

and without color

layers of skin, so

and (some) contour

texture,

much improved. Experienced

baby, but

it

procedure

—especially when they do a

is

replaced by CO2 resurfacing, which

two weeks before you are able

is

full

safer

when you

flaws.

It's

— but

and

heal, the

good

which

skin

is

newborn from

this

procedure has largely been

this

yields superior results.

wear makeup, and several months

to

new

results

and

skin to

skin,

not the skin of a

physicians get very

face

skilled

The procedure causes the

over.

all

bleeding

hits

It

for

can take up all

to

of the red-

ness to subside.

MICRODERMABRASION O Microdermabrasion involves a completely

different level of

does dermabrasion.

sion or /n/croinvasion) into the skin than

Derma

Peel.

Power

names. They are is

all

Peel, Parisian Peel. pretty

much

the

akin to a glycolic acid peel, which

uppermost of the

layer of the epidermis.

to

crystals (the

same

and the speed

at

to as a

— or by many other

reduce some

stuff that

which the device

is

indicates, only the

cells of the

is

these particles along with the dislodged skin pelled

can be referred

Peel, or Silk Peel

As the term micro

is

a process that

uppermost

epidermis are removed. The

removes

or fades

layers treat-

brown spots, age

fine lines.

As a microdermabrasion machine bombards the minum-oxide

(or r/oninva-

a very superficial peel that only removes part of the

skin texture; unblocks pores:

and sunspots: and helps

It

procedure. Microdermabrasion

accumulated, undesirable, retained

ment helps improve spots,

Diamond

same is

depth of invasion

skin with

thousands

of sterilized alu-

on sandpaper), a vacuum suction removes cells.

The force

passed over the

at

which the particles are pro-

skin determine the depth

and

thereby efficacy of the treatment. There's usually no bleeding, there's no penetration into the dermis,

and there

is

no

pain. Nonetheless.

I

recommend

that only

a properly trained

physician, nurse, or esthetician perform this procedure.

OTHER PROCEDURES

189

Some

Final

Thoughts YOU'VE MADE your

THROUGH THE MOST CHALLENGING

new journey toward

look better. You at

IT

home

beautiful skin. By now, you surely

know about the

you have chosen to make this utes, twice a day. That's

it

know you can

easy, straightforward steps

to achieve your goal of better-looking skin.

change.

lifestyle

—that's

all it

It's

I

am

part of

you can take

so pleased that

so simple.

Two min-

takes. Isn't your happiness

worth

four minutes a day? If

you follow the four easy steps, you

your

facial skin

changed. They

will tell

a haircut or lost better,

first thirty

some weight.

In

tell

days. People will

in

wonder what's

look. They'll ask

if

you got

other words, they'll notice that you look

—

you can

see a vast improvement

you how fabulous you

younger, fresher, more radiant

different,

190

within the

will

them you found

alive.

And when they ask what's

a virtual fountain of youth.

You

o can explain that

it

was there

all

the time, but that

reap the benefits of taking care of your skin

now you know how to

— because together we have

bridged the gap, the disconnect between available skin-care products

and your needs.

my program works

If

doesn't,

way you

I

Look,

if

the very

know you

for you,

will tell

I

hope

everyone.

look that I'm willing to stake

you never practice least,

a

you'll tell a

I

am my

reputation on

book

is

thing you learned from this book, you

my job

in

if

is

will, at

within

the only thing you do

get that funny brown spot you've always

dered about checked out by a dermatologist,

have done

if it

it.

walk away with the knowledge that beautiful skin

after reading this

I

— and

so confident you will love the

your reach and certainly within your control. And

that

few friends

it

would

satisfy

me

to

won-

know

informing you on the importance of skin care.

SOME FINAL THOUGHTS

191

QUESTIONS TO ASK YOUR

Not too long ago,

DERMATOLOGIST

York

when

manager 7.

How long have you been

I

was shopping

I

did something

I

rarely do.

in

noticed that the

I

had two unusual brown spots on

of the store

in

her upper chest.

was immediately

It

New

upstate

clear to

me

that

if

practice?

she did nothing, 2.

Where did you attend

become

pulled this

3.

What

is

that,

4.

What

hospital are you

felt

she needed

two spots would

within six

months.

to

I

felt telling

I

to her

her about her spots,

know so she could do something

I

to

dangerous precancerous moles from

her

worsening. 5.

of those

young woman aside and explained

as awkward as

prevent

affiliated with?

one

melanoma

a dangerous

medical school?

your specialty?

at least

I

encouraged her

Do you have any statistical

needed

also told her she

to

see a dermatologist.

to properly research

I

a der-

information on the procedure matologist I

am

interested

in,

outcome, success

regarding

7.

her town.

When choosing

a qualified dermatologist, you want

vs. failure?

be sure they have the

to 6.

in

result with a patient while

expertise are the three

performing the procedure

for

I

when

most important

criteria to

selecting a dermatologist. Since so

am seeking?

the procedures discussed throughout this

How many times have you

reliant

performed the procedure

tial

I

on a physician's

that the doctor

when

it

comes

to patient care.

your doctor, you probably only

made an have say

it

to

error,

you

many

of

book are it's

essen-

to perform

friends, family,

likely tell

Word

—

in

mouth

mouth works

is

in

Or,

for their rec-

the best tool a

two ways:

about him or her when asked. But

talk

anyone and everyone.

say anything to anyone

of

of

and co-workers

if

If

good

you love

your doctor has

worst-case scenario, you don't even

cosmetic dermatology, the results

of

a physician's work

for you.

Look

for

a dermatologist

who

is

board

certified

Certification indicates that a dermatologist

school, completed at least

one year

a dermatologist, and passed a very

IT'S

and judgement,

you choose has both

ommendations. Word physician has

skill

look

your desired procedure.

considering?

Ask your

J

proce-

dures you want performed. Training, reputation, and

am

192

right credentials for the

Have you ever had a negative

NOT JUST ABOUT WRINKLES

of

Dermatology.

has graduated from an accredited medical

of internship difficult

by the American Board

and another three years

of residency

three-day examination given by the board.

as

You can read about a physician's education, credentials,

and licensure by doing a

school,

Once you've

Web

and expectations

understands what you are looking

communicates

tor

search on the doctor.

selected a dermatologist, don't be afraid to ask questions during your

consultation. Share your vision

tial

medical

training, certifications,

for in results.

Be

with patients.

with that doctor.

You

get a

will

good

Make

sure he or she

feel for

you both share the same

certain

ini-

how

vision.

doc-

this

you

If

feel

uncomfortable, you have the choice to walk out of the office without having a procedure. Skin care

a sensitive topic

is

for

most people.

If

your doctor doesn't understand your needs

or doesn't listen to you, find another doctor.

Most dermatologists provide

procedure brochures

helpful

in

rooms and exami-

waiting

nation rooms. Take the time to read about procedures you are thinking about. You

will

a very good description

entails.

of the

also a great source for

It's

work you are considering and

coming up

comfort, ligent,

and

measure

to

and don't worry

his or her style.

that

that reads, "Asking

dumb

couldn't have said

better!

I

want

life's

it

thank you

to

work.

am

I

truly

The doctor

to is

questions

my

much

is

book.

lucky to practice

my

is

It

one

my

else's.

approach

may

It's

in

not be

made you

not that

my one

I

practice of

my

feel that

am more and my

patients

patients, but

you, too, can

I

I

believe

go

off

more

because

it's

know they can

hope

I

Whenever we are to

call

on

and

thirty

in

be

my

intel-

office

mistakes."

years of

I

my

have friends who at

a professional

frequently than any

have a very personal

I

me

that reading this book,

depend on my advice

direct,

dumb

the culmination of nearly

passion each and every day.

popular.

Be

have a sign

I

easier than correcting

my beeper seems

colleagues marvel that

of in

the doctor, to build trust

there to help you.

are cardiologists, gynecologists, and plastic surgeons. function,

know

you are asking too many questions.

reading

for

you may not have thought

with questions

advance. Use your questions as a framework to get

what the process

of

get

twenty-four/seven. You

in

some

small way. has

—with the added luxury

of being

able to go back and read any section at any time.

One

solution." his

life

my

of I

favorite sayings

raised

my

The

I

will

this

book,

it

is

skin you've always

being part of the problem and

on your journey.

"You are either part of the problem, or you are part of the

son, Stuart, on this advice;

journey After reading

part of the solution.

is

become

my

it

has helped him make sound choices on

sincerest

wanted

is thirty

part of the solution

be with you every step

hope

that you, too,

days away.

—the Schultz

It's

will

become

time to stop

solution.

Good

luck

of the way.

SOME FINAL THOUGHTS

193

ACKNOWLEDGMENTS I

would

like to

who have had a

thank a number of people

a physician and

and creation

the genesis

in

vital

book, which

of this

my career

impact both on is

intimately related to

as

my

career as a cosmetic dermatologist.

My

late father, Sidney,

pack

part of the

who impressed upon me

you are ahead

or

of the pack.

that

And so

I

a race, as

in

you are

in life,

either

learned the importance of not see-

ing other people's heels. Stuart,

my a

pride

my son, my and my

better

person

for

my moral compass, my

great kid

(after

who has

Schultz,

and

What a

love.

sensitive, caring

Gwen

best friend,

skin-care

loved, stood by,

when

it

line,

described by patients and

of her style

and

Alan Altman,

as are

taste, first

friend,

was time

visitors

for

me

me for more than to

The

many aspects

of the

my

coauthor) that

I've

in

named). years, for

thirty

history.

and one

of Stallex.

of the

patients

two clearest, most

and public

in

—they exude what can only be

They have designed everything

is

just

in

related to Stallex Truitt Bell

tional its

have gone

has been

that

into the incredibly beautiful presentation of everything

and Gus Bezas, preeminent skin-care-industry professionals, in

started

Avenue Skin Care

Web

and remains the sites,

for their

validating the importance of this book's

contribution to the understanding of skin care by

who

exhibits,

all

women and men

Chris Helmbrecht, founder of http://www.Cygen.net,

194

of five finalists at the

and Park Avenue Skin Care.

support and encouragement

friend but

drop-

the past six years, from the Stallex packaging of

that

incisive

ever known.

labeling

and design elements

in

a product

is

—which earned them the recognition and pride being one 2003 —to International Packaging Competition of the brochures, stationary

and

me

My dermatology

haute couture, the net result of which

exciting, innovative designs.

my

is

what

then attorney and legal counselor, then life-issues advisor, then

described as creative genius dressed

so well received by

rest

is

specialty, told

design and packaging

Glyn Eppy and Domenic Lopergolo of the Design Spot

dead gorgeous,

choose a

inspiration,

importantly,

as wonderfully soothing and calming,

deal maker, then amateur but effective psychiatrist, thinkers (the other being

my root

Stallex for Perfect Skin,

and supported

her consistently supportive mantra, "Follow your heart." office,

for being,

—and now, young adult—but more

whom my

worse, and who,

reason

which are

Web

message and

everywhere.

who has become such an

master and designer

uncondi-

of the Stallex

important

and Park

pivotal vehicles for disseminating information,

first

o about skin-care issues about Stallex

—

written

a

in

products

for Perfect Skin

products or wants to get on track with

John Kulesza,

for

and

chemistry, pharmacology, to

ful

me

me

sharing with

—

their skin care.

his incredible

which has been so enlightening and help-

of

whom

is

of

my

patients' skin-care problems.

indispensable.

—without her unrelenting help and unconditional support,

profoundly more solicited

tant to

fund of knowledge of the marriage of

and curing many

The Park Avenue Skin Care team, each Coplan

difficult for

and sometimes

me

— not

to

my

me, as would

warm

this

to

I'd like

thank Joyce

book would have been

day-to-day existence. Her sound judgment,

know-how, perseverance, and

unsolicited advice,

mention her very

—and second,

and anyone who uses these

for patients, readers,

clinical therapeutics,

better treating, improving,

in

easy-to-understand style

plain, simple,

smile.

Thanks also

to

style are

so impor-

Angela Favale; Debbie Case,

RN; Deborah VanCoughnett, RPA; Dianne Funes; Gina Alvarado; Marina Konstantinova;

Monica

O'Neill;

and Stephanie Dockstader. They share a devotion and

our patients feel welcome, appreciated, and important (as they are).

such a

with

The

and cohesive

terrific

Leon Hess, who had the unique

late

most important person

me

ing

to

in

communicate

The team

at

STC

ability to

and create a comfort

for taking

agree was important

Our research

with

to convey.

assistants,

Adam

make anyone he spoke

was so

this

and

inspiring

level with

publisher, Leslie Stoker,

a chance on

am very

makes

lucky to work

and capable professionals.

the room; his approach

—especially the

Levesque. Thank you all

family of caring

I

sensitivity, that

my

instructive in help-

patients.

and my wonderful

book and

to feel like the

editor, Jennifer

for believing in the

message we

Your support and enthusiasm are so greatly appreciated. Mitchell

and Emily Copeland,

tagious curiosity, enthusiasm, accuracy, and youthful energy

in

for their tireless efforts,

con-

researching and integrating

countless multimedia sources. Lastly,

and most

ularly well,

Laura, with felt

I

they

know

importantly,

make

it

that writing

my

look easy, but

a book

such finesse, expertise, and

thanks to Ms. Morton

coauthor, Laura Morton.

for her

is

in fact,

a very

having been through

difficult,

ability that

When people do this

experience with

complex procedure, and

she makes

it

look easy.

I

want

things partic-

to

yet

she does

extend a heart-

enthusiasm, commitment, and professionalism.

For further information about Stallex for Perfect Skin skin-care products, please

Web

it

visit

our

site at http://stallexskincare.com.

ACKNOWLEDGMENTS

195

GLOSSARY ACID:

pH

skin-care terms, anything with a

in

to

1

pH

a

a weak

to skin than

has an

skin

A weak

7.

acid

less irritating

is

because normal

alkali

Antioxidants convert free radicals into harm-

waste products. Examples

less

dants are vitamins A, C,

ACTINIC KERATOSIS: a sharply skin-colored

or

and selenium.

E,

scaly

typically

outlined,

lesion

vitamin C,

added

face,

and the upper

ASTRINGENT: a cosmetic

that helps

Astringents are very effective

complexions.

the

same as

They are premalignant and,

may become

a type of skin cancer known

as squamous-cell carcinoma.

AGE SPOTS:

(also called liver spots, sun-

spots, or solar lentigines) usually found

on the

flat

chronic sun exposure

They are

easily

and

is

are found

in fruits

of

are used

in

the skin layers of

removed by a

of

these

as

to

"fruit

compounds

— besides being

in

other

AHAs

skin-care products such as

skin cells.

commonly found

in

include glycolic acid

Examples

of

AHAs

products

that

damaging

is

synthetic

capable

of

or

skin,

Oxidation

counteracting

produces

in

(when

the

in

those muscles.

they are facial muscles

If

it

prevent them from forming wrinkles and

furrows. This paralysis relaxes facial cles for three to six months.

cells in the skin.

type of skin cancer,

Fair-skinned

skin).

it

arises from the

who

individuals

don't

basal-cell

mus-

sun exposure.

does not invade the

It

bloodstream or move

to other parts of the

body, but can grow extensively on the skin surface and may,

in

muscle and bone.

It

is

of

characterized by the skin that

bleed.

potentially

inside surfaces of the body, for

ple,

the skin cells

stomach and

BHA,

salicylic acid,

an organic acid

is

in

that

skin-care products.

peels because of

to soften the skin

in

CELLULITE: deposits of

causing dimpling fatty

its

It

skin cells.

skin-care products to

It

is

ability

and cause shedding

dead

other ingredients that are

in

is

COLLAGEN: the Greek word Collagen

is

support structure

of

enhance the

the

same

fibers

of the dry

seen

in

acne

follicle

for

"glue."

a protein that serves as the for the skin In

and

human

all

other

skin, colla-

comprise more than 70 percent weight of the dermis.

COMEDOGENIC:

term used to describe a

pore-blocking ingredient that can cause

blackheads or whiteheads.

cos-

COMEDONES: pores

and

filled

enlarged

hair

sebum

(oil),

with

bacteria.

If

that

is

becomes

or

cells,

known as blackheads, If

skin surface, they are

or closed

follicles

dead

they are open to the skin

open comedones.

hair

fibrous tissue

area of the body.

surface, they are

lesion

and

also

metic formulation.

caused when the

fat

of the skin overlying a

is

absorption and penetration into the skin of

BLACKHEAD: a

exam-

cells that line the

intestines.

connective tissues.

BETA HYDROXY ACID (BHA):

in facial

and

that

cover the outside

and

gen

the only

any cancer

for

cells that

cases, invade

bumps on

small shiny raised

may

rare

causing extensive destruction

deeply,

name

a

carcinoma with prolonged

body

harmful molecules such as free radicals.

196

a

when

that,

squamous

the top layers of

natural

effects of oxidation

oxygen molecules break down) tissues.

the skin.

are responsible for producing the overlying

used

substance

in

will

commonly used

lactic acid.

ANGIOMA: a benign tumor in the made up of blood or lymph vessels. ANTIOXIDANT: any

of

outer layer (epidermis) of skin. Basal cells

found

the

found

cells

of the top

skin-care

and

soften

ability to

and cause shedding dead

of

basal cells of the epidermis (outer layer of

peels because of their

to

components

of the

BOTULINUM TOXIN TYPE A (BOTOX):

a major cause.

foods such as milk and sugarcane.

facial

surface.

open and exposed

chemical derived from bacteria

develops from

referred

many

hair follicles

CARCINOMA:

various organic acids with a similar strucoften

cells

BOIL: tender red swollen areas that form

around

BASAL-CELL CARCINOMA: the most com-

and

ALPHA HYDROXY ACIDS (AHAS): any are

and

skin

injected into specific muscles, immobilizes

BASAL CELLS: type

ing

that

skin. This is

toner or freshener.

tan well are highly susceptible to develop-

acids" because

the

the plug causes the surface of the plug to

mon

safely

is

one

oxidation of

with aging, but

dermatologist.

ture

the plug

bacteria,

brown areas

face, hands, back,

They are associated

feet.

cleanse

untreated,

left

if

to

removing

in

and soap residue from the

fair

oil,

turn black.

the skin and temporarily tightens the pores.

oils

those with

to skin-

care products as an antioxidant.

trunks of middle-aged or elderly individuals,

especially

with a plug of

remains open

(sore)

appear on the

neck, ears, hands, forearm,

but

air,

associated with long-term sun exposure.

These lesions

filled

Because

acidity level of 5.5-6.5.

ASCORBIC ACID:

red-

of antioxi-

or

they are closed to the

known as whiteheads,

comedones.

-o CYST: a deep lesion that

pus

with

is filled

such as keratin and

or other contents,

oil.

EPIDERMIS: the outer

thick as

which

layer of skin,

covers the entire body and

a single sheet

is

only about as

of paper.

CYSTIC ACNE: a severe form of acne distinguished by large cysts and eventual

EXFOLIANT: an agent

scarring.

tion, or

ed

with a

number

and

the

of

layer

beneath the epidermis. The dermis

and contains collagen and

fibrous

skin,

largely

is

elastin,

and

the proteins responsible for the support elasticity of the skin.

ECZEMA:

lymph vessels,

hair follicles.

(also called atopic dermatitis)

inflammation that

is

usually located

a skin

characterized by itching,

and thickening

scaling,

latter

causes

hydroxy

(alpha

on the

of the skin,

and

is

face, elbows, knees,

on the

skin by interfering with the produc-

tion of

new pigment.

HYPERPIGMENTATION: pigmentation ducing darker-than-usual

exfoliants

(facial

are lotions or

creams

wound and

is

skin.

HYPERTROPHIC SCARRING: caused by

to

remove

Microdermabrasion

new

excessive formation of

rubbed vigorously over the skin cells.

pro-

and polyhydroxy

containing small, rough particles that are

the top layers of

agent that causes

exfolia-

skin cells. There

the

tissue during

healing. Hypertrophic scars are hard

raised; different than keloids, they are

confined to the area of the original

injury.

also a form of physical exfoliation.

HYPOALLERGENIC: a term commonly seen

The dermis also con-

tains blood vessels, nerves,

sweat glands, and

dead

physical

The

scrubs).

DERMIS: the middle

that

acids, beta hydroxy acids,

acids)

of skin conditions.

of

chemical exfoliants

are

DERMATITIS: inflammation of the skin associat-

shedding

HYDROOUINONE: an

depigmentation (lightening) of dark spots

FILLER INJECTIONS: most

gen

(a gel-like

fied

animal tissue, and

or

fat

puri-

harvested from a

abdomen)

plump up

acne scars,

colla-

substance derived from

patient's thigh or

the skin to

commonly

injected into

facial lines, wrinkles,

any other depressed or

on skin-care products

may

or redness

an individual has sen-

Products are classified as

skin.

sitive

if

and arms.

the

Irritation

occur (these are not

still

allergic reactions)

hypoallergenic

if

fewer than

five

thousand have been shown

sunken-in area.

indicate

to

improbability of allergic reactions.

to

people per

have

allergic

reactions to the product.

FOLLICULITIS: an inflammation of the hair

ELASTIN: a connective tissue protein that

forms

resilient fibers in

the skin to

follicles

due

to

an infection or

KELOIDS: formed when the scar from a

irritation.

wound

the skin and allows

snap back when stretched.

FREE RADICALS: unstable molecules

in

our

bodies that attack other molecules, setting

EMOLLIENT: an agent skin soft

make

the

and smooth by increasing hydra-

through enhancing water retention.

Petrolatum that

will

water content, of the outer layer of

tion, or

skin

that

is

an example

is

widely used

in

of

an emollient

products applied

to

the skin.

up reactions cells.

that are

damaging

Free radicals are created

to healthy

when oxygen

molecules break down due to metabolism, radiation, exercise,

beyond the Keloids vary

are found

is

distributed

another

may be

in

liquid.

of

small droplets throughout

dispersed throughout

lotions

liquid that

For instance, water droplets

be dispersed throughout

and

one

environmental toxins, especially

ultraviolet

from the sun.

require the

oil,

water.

or

oil

may

Creams

presence

of

an

size, in

and

wound.

location,

and

darkly pigmented

occurrence are the

sites of

earlobes, neck, forearms,

and hands.

KERATIN: the name

made

a group of proteins

for

by the keratinocytes

and

component

nails. Keratin

tive barrier for

in

the skin.

It

is

of the epidermis,

serves as a protec-

the body.

a group of naturally occurring acids that

collectively are

acids, or

found acid

known as alpha hydroxy

AHAs. Many

in fruits

itself

as a chemical peel ficial

for

sloughing

off

super-

skin cells to reveal a fresher

complexion, and to breakouts.

these acids are

KERATINOCYTES: the most abundant in

cells

the epidermis (95 percent), keratinocytes

make

the proteins

known as

keratin.

comes from sugarcane. Used

and

dead

of

and other foods. Glycolic

emulsifier to allow the combination of water oils.

shape,

most often

the principal

GLYCOLIC ACID: the simplest and smallest of

and spreads

cut extends

size of the original in

Common

skin.

hair,

EMULSION: a preparation

deep

ozone exposure, cancer-

causing substances (carcinogens), or other

irradiation

or

treat or

prevent acne

LASER RESURFACING: uses high-energy to

peel

away sun-damaged

skin,

scars, or birthmarks. Laser resurfacing

used

to

minimize wrinkles and

light

wrinkies,

may be

fine scars.

GLOSSARY

197

LENTIGO: an age spot, sunspot, or

liver

taking birth control

exposed

spot.

pills,

whose

skin

is

to sunlight.

may cause photosensitivity, an individual may get a sunburn in a much shorter period of time

common name

LIVER SPOT:

a

for

brown

flat

spot frequently found on the face and the

backs

of the

hands, caused by exposure to

seen

sunlight. Rarely

pigmented

skin,

it

people with darkly

in

has no

relation to the

Also known as an age spot or by the

liver.

technical

name

MICRODERMABRASION:

ing with minimal risk of dyspigmentation

or scarring that

achieved by projecting

is

aluminum microcrystals onto the

known by the names Power and Derma

Parisian Peel,

than

is

typical for that individual.

superficial peel-

skin (also

Peel, Europeel,

Peel); safe for

all

PIGMENT: any substance whose presence in

the tissues or cells of animals or plants

colors them. Melanin

duced by the skin.

common

PITYRIASIS ROSEA: a

reference

to

cancer. Malignant can also refer to a disease is

MOLES:

small skin marks caused by pig-

ment-producing

may be smooth regularly

pigment-producing skin

ored or noncolored.

a darkening

cells (melanocytes).

melanin results

exposure to the

flat,

or irregularly shaped, col-

ultraviolet rays of the sun.

PORT-WINE STAINS: meus) permanent, marks on the

(also called nevi flampink, red, or purple

flat,

skin.

PUSTULE: a pimplelike swelling

in

a tan, following

of the skin, or

shaped

lesion that

or rough, raised or

MELANIN: a brown pigment produced by

of

NODULE: raised

bump

papule)

called

(also

one

greater than

a

solid

skin cells located

in

the

basal layer at the epidermis that produce

pigment known as melanin, which

the

gives color to the skin.

MELANOMA:

centimeter.

a type of skin cancer arising skin

shaped

growths

or raised

flat

that are dark brown, black, or tan

and asymmetric, The incidence at

an alarming

when detected

with

rate, early.

family history of

irregular

melanoma

for

seen on skin-care products

was

the product

tested and

but

it

is

commonly

that indicates

does not cause

become plugged

in

A acid,

skin,

increasing

can be cured

melanoma, severe sun-

numerous moles

and unusually shaped

or col-

ored moles.

spot."

Melasma

results

in

Greek word

an area

is

a

dyschromia

of light or

body that are exposed

often the face.

common

198

in

women who

GLOSSARY

in

in

acne.

PAPULE: the

Latin

word

for "pimple."

small, solid, raised lesion

on the

It

is

a

to

fine

and coarse

wrinkling,

age spots, helps the

It

may

skin feel

fibers.

most

be most

are pregnant or

RETINOL: a derivative

used

skin.

of vitamin

skin-care products.

in

It

A is

that

is

weaker

than retinoic acid but penetrates the skin

PHOTOAGING:

the

lates in the skin

damage

that

accumu-

and chronic sun exposure. Photoaging accounts

for

well

and

less

is

much

of the "old look"

asso-

ROSACEA: a chronic, inflammatory, acnelike

disease of the

characterized the cumulative effects of

sun exposure. The severity depends on the

and

skin, usually involving

the middle third of the face.

ciated with aging.

PHOTODAMAGE:

irritating.

from years of excessive

intensity

of

sun exposure

skin type of the individual.

It

visible

tasias),

Rosacea

persistent

is

redness

and blushing) and often by

(flushing

small

by

with

blood vessels

episodes

of

(telangiec-

papules and

pustules.

appears as blotchiness, uneven tones, rough ken

texture, wrinkles, fine lines,

and bro-

SALICYLIC ACID: a keratolytic drug (a drug that

capillaries.

removes the outer

used

areas of

to sunlight,

Melasma tends

that

dark brown

hyperpigmented skin occurring the

"black

for

acne and photodamage.

of

improves lighten

known

the treat-

lagen and elastic

duration

the

also

in

whiteheads), as seen

and on the

MELASMA:

ment

commonly used

smoother, and increases production of col-

burn before age fourteen, red hair and

on the

tretinoin,

and form comedones (blackheads and

color

borders.

Risk factors include a

freckling, inability to tan,

as

cells

(melanocytes). The tumors typically appear irregularly

a term

the pores of the skin to

from the pigment-producing

as

NONCOMEDOGENIC:

of the skin

that contains pus.

RETINOIC ACID: vitamin

MELANOCYTES:

skin condi-

scaly, pink, inflamed

skin.

cells in the skin.

NEVUS: a mole; a pigmented

fatal.

An increased amount

by

tion characterized

and

resistant to therapy, very severe,

frequently

the pigment pro-

skin types except sensitive skin.

solar lentigo.

MALIGNANT: a term used that

is

skin cells (melanocytes) that colors

PHOTOSENSITIVITY: an abnormal to sunlight, usually tain drugs.

When

due

layer of skin) that

is

to treat various skin conditions.

sensitivity

to the action of cer-

a label states that a drug

SCALES: dead skin or dry skin.

cells that look like flakes

SCLEROTHERAPY: a process whereby a concentrated solution of

salt

substance (salerusant)

is

water or other

injected into a

induces inflammation and even-

vein. This tually

causes the vessel

to collapse

close.

The vein becomes

invisible,

no longer

UVB

is

for protection against ultraviolet

The term SPF

radiation.

not used to

is

it

is

for spider

all

tumors are cancers, and not

UVA

UVA:

radiation.

ultraviolet radiation with the longest

Long-wave UVA

papule with red blanchable tentacles

skin

ating from

radi-

but

it.

open

of the skin that usually follicles

in

the dermis

into the hair

more deeply and causes

tiny

broken dilated blood

overactivity of the

glands that results

sebum. This

greasy or

in

sebaceous

an excessive amount

appearance

results in the

oily skin (especially

of

vessels on the face and other body parts, usually

caused by the sun's

radiation or

by

SQUAMOUS

SEBORRHEIC DERMATITIS: a chronic

inflam-

matory disease of the skin characterized itching,

and

scaling, occurring

regions where the sebaceous glands are active,

such as the face, body

and especially the shedding

scalp,

folds,

where there

is

and

ation

yellow,

called

is

the radiation emitted by tan-

ning beds.

ker-

ultraviolet radiation with

wavelengths

between 290 and 320 nanometers. Much of the

UVB

radiation

ozone

layer

and never reaches the

SQUAMOUS-CELL CARCINOMA:

trum of

in

UVB

skin that

becomes an open

from the skin

cells

It

known as

may resemble

cinoma but

sore.

most common

atinocytes, the

epidermis.

a Skin

characterized by red, scaly

is

less

is

It

arises

the

basal-cell car-

common

—

—and tends

to enlarge

affecting

more

who

is

absorbed by the earth.

referred to as the "sunburn" spec-

is

ultraviolet radiation since the rays

cause reddening

of the skin

and do not

penetrate to the deeper layers of the skin.

ker-

cells of the

about 15-20 percent of patients with skin

Fair-skinned individuals

greasy-looking,

called

(also

atinocytes) the primary cell types found

cancer

of the scales (dandruff).

SEBORRHEIC KERATOSIS:

is

the epidermis, the outer layer of skin.

cancer that

by redness,

CELLS:

on the face)

hair.

most

UVA

the "tanning" spectrum of ultraviolet radi-

UVB:

in

less burning,

believed to be responsible for pre-

is

female hormones.

and release sebum.

SEBORRHEA:

and

400 nanometers

to

radiation penetrates the

mature aging and wrinkling.

SPIDER VEINS:

of

—320

wavelengths SPIDER ANGIOMA: a bright red blanchable

veins.

SEBACEOUS GLANDS: glands

cancers

all

are tumors.

describe sunscreens that protect against

and

since

carries blood. Sclerotherapy

used as a cosmetic treatment

product

rapidly.

UVC:

ultraviolet radiation with the shortest

wavelengths

—200

290 nanometers.

to

These rays are completely absorbed by the ozone and are not present

natural

in

sunlight.

don't tan

flesh-colored,

well are highly susceptible to developing

VARICOSE VEINS: permanent enlargement

brown, or black

squamous-cell carcinoma with prolonged

and

sun exposure.

in the legs.

wartlike papules.

twisting of veins,

The

most commonly seen

veins appear large and

swollen as a result of a problem with the

SKIN CANCER: see

basal-cell carcinoma,

SUBCUTIS: the deepest

known as

(third) layer of skin;

the subcutaneous layer.

melanoma, and squamous-cell carcinoma.

also

SKIN RESURFACING: removal

SURFACTANTS: compounds

valves

in

position of the outer

layer of the skin using abrasion, chemicals,

or a laser, resulting

in

smoother and less

wrinkled skin

oil,

so they cleanse thetic or natural

flaps

soft, small,

break up

grease, and water into small particles

Some SKIN TAGS:

that

better.

(such as from coconut

oil).

long periods of standing. They also tend to

occur during pregnancy.

VITILIGO: a skin disorder characterized by

the

body caused by the

of

sunscreen products that protect against

ultraviolet

label

B (UVB)

their

radiation are required to

products with an

SPF

which can range from 4 to 60 (some higher).

The higher the number, the

TRETINOIN: a vitamin

A acid,

all-trans retinoic acid,

commonly used

also

known as in

may be

lost in

the white patches

WHITEHEAD: a

treatment of acne and photodamage.

lesion

caused when the

TUMOR: a mass the

hand

or

lump that can be

or seen with the

felt

due

to

that

is

an autoimmune process

the

value,

better the

parts of

loss of the natural

pigment. The pigment-producing cells are

astringent.

completely SPF: sun protection factor. Manufacturers

a hereditary

smooth white patches on various

are very harsh on the skin.

TONER: see

groin.

is

in

They can be syn-

flesh-colored skin

on the neck, armpits, or

the veins. There

some individuals, and a predisamong people in jobs that require

influence

with

naked eye. Not

filled

with a plug of

and remains closed

seen

hair oil,

in

acne

follicle

bacteria,

becomes and

cells

to the skin surface.

GLOSSARY

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INDEX -O

ablative laser,

1

87-88

aluminum

oxide,

chest, red discolorations on, 174

93

abrasive scrubs, 93-94

ammonium

acetylcholine, 162

anemia, iron-deficient, 82

acid

reflux,

162

apocrine glands, 40, 45

acne, 32-33, 86 active ingredients

four-step

145-46

antioxidants, 85,

and cleansers,

chicken pox scars, 164

98

lactate,

121-22

for,

92, 93-94,

program

for,

1 1

arteries, 26,

120

29-30

39

axilla,

and genetics, 66 moisturizers

and

122-23

for,

oily skin, 50, 51

,

B

52-53, 92

on-the-spot treatments

for,

babies, sunscreen

122

for,

102

scars from, 164, 166, 187-88

basal-cell carcinoma, 69, 70, 72

and shaving, 154

basal-cell

skin care products

sunscreens

and

for,

for,

119-23

basal

123

bergamot,

toners, 121

actinic keratosis, 28-29, 68-69, 72-73,

active ingredients,

nevus syndrome, 66

layer, 42,

108-9

84

combination

for

dry skin, 128

for

mature

skin,

for

normal

skin,

for

oily/acne-prone skin, 121-22

125

45 95

22

combination

for

dry skin, 126-27

for

mature

for

neck, hands, and decolletage, 175

for

normal

skin.

130-31

skin,

134

skin,

and pregnancy, 99 for sensitive skin,

butter,

cold-weather

137-38

87 tips,

144

collagen, 44, 87, 161, 164-66. 178-79

BHA

color,

(beta hydroxy acid), 97

see

skin color

combination

82

skin,

50

active ingredients

birthmarks, 28

cleansers

131-32

BK mole syndrome, 66

description,

135

blackheads, 32-33, 52

four-step

blood sludging, 83

moisturizers

blood vessels, 29-30, 68, 181-82

skin care products

blotches or patches, 27

sunscreens

138

for sensitive skin,

adipose tissue, 87

American concerns, 30-31

for,

for,

56

program

for,

for,

for,

testing

toners

aging:

bovine collagen, 164, 178-79

comedones, 32-33. 52

age-spot removal, 185-86

brown-spot removal, 185-86

compound

age spots,

brown tones, 20

congenital nevi, 24

and

diet,

process

and

20, 174

84 of,

skin cancer,

nevi,

70

c

diagram, 159

skin

calcium, 81

and success

97-99

83-84

cancer, see skin cancer capillaries,

26-27, 28, 29, 76, 186

carbon dioxide

allergies: to Botox,

51 96, 124

24

contour defects, 157-59

84

(alpha hydroxy acid),

alcohol,

123-26

contact dermatitis, 81 64, 65,

see also mature

AHA

92,

101, 126

Botox, 159, 160-63, 167-69, 178

for,

123-26

125

for,

blue tones, 19

for,

125

124

aftershave, 153, 154

African

124

for

birth control pills, 21

skin,

120

for acne/oily skin, 92,

beta-carotene, 81

biotin,

for

fiber,

clarifying lotion,

cocoa

43

oil of,

,

cholinergic

cleansers, 90-94, 108

astringents, 93, 95, 153

9-23

chloasma, 21 66

168

cellular turnover, 32,

food, 85 to skin-care products,

laser,

cellulite,

153

cherry

187-88 42

ratio,

158

corregator muscles, 163 cortisone,

29

cosmetics, and nutrients, 85, 87 crow's-feet, 162, 163. 166, 179

46

hemangiomas, 27

203

G decolletage, 171-75

essential fatty acids, 82

dendrites, 43, 68

esters,

dermabrasion, 188-89

estrogen, 29

dermatitis, 81

evening routine,

dermatologist:

exfoliation, 43, 92, 94,

genetics:

and DNA, 65-66

92

role of, 1

and

1

96-99

65

skin tone,

glabella, 163,

29

167

choosing, 192

eye creams, 140

glabrous (nonhairy)

questions to ask, 192, 193

eyes, dark circles under, 34

glossary,

dermis diet,

layer, 40, 41

,

44-46, 87

glycolic acid, 97, 98, 99,

79-87

30, 84

of,

and

groin area, sweating,

contour defects

dynamic in,

80-82

discoloration, skin-care products

dry skin, 30, 50

cleansers

128

for,

in

55 92

exfoliation of,

as extreme condition, 51 four-step

program

humidifier

for,

sunscreens for, for,

dry-weather

for,

for,

101,

90,

126-30

129-30

hairs,

hands, 171-75

hemangiomas,

44

material, 161, 164-66, 167,

Finn

Chamber

95, 127

85

horny

combination

107-13 skin,

123-26

126-30

evening routine, 111

dysplastic nevi, 23, 24, 68

for

mature

skin,

layer,

human

166

lines,

of,

hypersensitivity

forearms, 172

130-33

therapy,

hormones: elevated levels

for dry skin,

160-61

hormone replacement

58-60

85

horizontal surfaces, 172

55

allergies,

for

144

tips,

178-81

93

Test,

Fitzpatrick skin types,

forehead

27, 29, 187

hives, from food allergies,

filler

food

29

to,

29

42

collagen, 164-65, 179

humectants, 92 humidifiers, 103, 144

hyaluronic acid, 167, 180

Hylaform, 167 hyperhidrosis, 162

morning program, 108-10

180-81

earlobes, torn, elastic failure,

elastin,

normal

for

oily/acne-prone skin, 119-23

freckles, 22,

free radicals,

emollients, 102

freshener,

emulsification, 90-91

frontalis

cells,

32

epidermis, 40, 41, 42-43, 87

204

INDEX

skin,

freckle removal,

64

45

epidermal

134-37

for

for sensitive skin,

64

elastic tissue, loss of,

frown

137-39

185-86

I

ingrown

hairs,

154-55

insensible perspiration, 145 inspection, 36, 37

174

intradermal nevi, 24

145

95

iodine,

muscles, 163

lines, 162, 163,

fruit pits,

183-84

ingrown, 154-55

hand cream, 144

four-step program,

51

lines,

hair removal, laser therapy,

soaps, 92

flaking,

128-29

103,

skin care products

testing

126-30

for,

103

for,

moisturizers

160

hair-bearing skin, 39

82

fibroblasts,

39-40

H

172

84

essential,

126-27

for,

description,

in,

fatty acids:

active ingredients

42

layer,

160-61

body, 87, 167

fats, dietary,

109

157-59

of,

powers

static lines, fat,

DNA, 65-66

lines,

reparative

for,

140-41

dynamic

granular

84

skin cancer,

vitamins and minerals

toners

F face:

87

fallacies about, 85,

39

189

glycolic acid peel,

and aging, 84 effects

skin,

196-99

85

iron defiency,

167

ground, 93-94

82

29

J

24

junctional nevi,

program

four-step

moisturizers

skin care products

2: toner,

51

Step

3:

active ingredient,

95, 131

Step

4:

sunscreen, 109-10

testing

98

toners

keratinocyte cells,

42-43

101, 133

for,

and

84

alcohol,

chart,

nails,

72-73 43

of,

nevi (moles),

nodular, 70

99

melanosomes,

44

cells, 43,

melasma,

broken

1

82-88

sebum

brown-spot, age-spot, and freckle removal, 185-86

of,

skin, 50,

53

active ingredients

151

shaving, 151-53

cleansers

154-55

skin thickness

81-82

76

nonhairy (glabrous) skin, 39

normal

for,

22-24

nodular melanoma, 70

43

30,

66

21,

skin care

183-84

hair removal,

nicotine,

men, 148-55 186

capillaries,

niacin, 30,

69-70

risk factors for,

87

163, 166

neovascularization, 99

and moles, 24

lactic acid, 97, 98,

in,

Poikiloderma of Civatte on, 174-75

70

of,

39

lines

and genetics, 66 growth

laser therapy,

of,

for,

134

description, 52

150

four-step

program

for,

menthol, 95

moisturizers

periocular veins, 187

metastasis, 69

skin care products

microcomedo, 33

sunscreens

microdermabrasion, 189

testing

187-88

resurfacing,

spider veins, 186 tattoo removal,

184-85

migraine headaches, 162

varicose veins, 186

spectrum

linoleic acid, lipid

of,

183

82

oil,

minerals,

87

toners nutrition,

80-82

for,

for,

see

for,

for,

spots, 20, 174

for, 1

101,

134-35

95, diet

93-94

for

cold weather, 144

for

combination

skin,

o 125

128-29 132-33

off-label use, oil,

167

51

(sebaceous) glands, 39, 45, 46

for

mature

M

for

men, 154

maintenance, 142-47

for

neck, hands, and decolletage, 175

for

normal

136

oily/acne-prone skin, 50

for

oily/acne-prone skin, 122-23

active ingredients

mature

skin,

166

50

active ingredients

cleansers

for,

description,

34-37

136-37

51

nut shells, ground,

for dry skin, 103,

lines,

34-37

and cleansers, 91

46

marionette

1

103, 136

moisturizers, 100, 102-3, 111

cleansers, 91

lipocytes, liver

mineral

135

for,

hemangiomas, 187

light, visible

108-9

neck, 171-75

development

28

Langerhans

108

N

melanoma: 28-29, 68-69, 72-73, 84

kwashiorkor, 82

lanolin,

cleanser, 108

melanocytes, 22, 30, 43, 66, 67-68

seborrheic, 21-22, 69 solar,

for,

for,

melanin, 22, 30, 43, 66, 67-68

98

keratoses: actinic,

routine:

Step

keloids or keloid scars, 31

keratolytics,

morning

130-33

1:

sunscreens

for,

and sun exposure, 68

Step

K keratin, 42,

130-33

for,

103, 132-33

for,

for,

130-31

56-57

131-32

skin,

skin,

oil-and-water balance chart, 51

for sensitive skin,

138-39

moles, 22-24

and

oil

skin cancer, 72-73, 74

oil

of

bergamot, 22

cleansers

for,

for,

121-22

92, 120

description, 52-53, 54

as extreme condition, 51

INDEX

205

four-step

program

moisturizers

103,

for,

skin care products

sunscreens testing

toners

race, determination of color

122-23

for,

90, 92,

119-23

101, 123

for,

53

anatomy area

1

95

resorcinol,

187-88

thickness

chart,

and

77

rosacea, 28, 29

periocular reticular veins, 34 periocular veins, laser removal, 187 perspiration, insensible,

petroleum

jelly,

187-88

scars, 164, 166,

scar tissue, creation

physician-strength products, 98-99

pigment

cells,

pigmented

20

nevi, 22,

24

pimples, 32-33 pityriases alba,

26

172

(oil)

sebaceous

follicles,

sebum,

glands, 39, 45, 46

50

post-inflammatory hyperpigmentation

description,

pseudofolliculitis,

pyruvic acid, 99

for, 1

moisturizers

206

INDEX

for,

140-41

50-58

for,

52-58

55

dry, 50,

Fitzpatrick,

58-60

mature, 50, 56-57

for,

137-39

138-39 for,

139

95, 138

137-39

oily/acne-prone, 50, 52-53

products

for,

questionnaire sensitive, 50,

testing

for,

114-41 (for facial skin type),

57-58

51

sloughing process, 96-99

sensitivity, 51

shaving, 151-53, 154 silicone, 161,

to,

31-33

normal, 50, 52

skin care products

for,

138

92

program

sunscreens

155

for,

37-38

57-58

exfoliation of,

toners

skin-care products related

descriptions,

cleansers

procerous muscles, 163

43

race,

red tones, 26-29, 174

combination, 50, 56

port-wine stains, 28

42

and

skin types, 39,

pores, large, 32, 33

four-step

and genetics, 66

skin texture,

active ingredients

prickle layer,

32-33

33, 90, 151

sensitive skin,

used during, 99

skin color, 19-31

combination problems, 34

sebaceous

pomade

skin discolorations during, 21

74

scurvy, 81

senile warts, 21

skin care products

,

blue, 19

selenium, 81

24-26, 30

71

brown tones, 20

polyethylene beads, 93

pregnancy:

for,

scrubs, abrasive, 93-94

Poikiloderma of Civatte, 174-75

acne, 30

71

of,

sclerotherapy, 181-82

seborrheic keratoses, 21-22, 69

pluripotential cells,

69-70

43,

skin-care program, see four-step program

44

seborrhea, reactive, 53

platysmata, 163

(PIH),

of,

74

of,

melanoma,

squamous-cell carcinoma, 69-70

99

salicylic acid, 97, 98,

pheromones, 45

21-22

84

early detection

self-examination

pH, normal, 93

photosensitivity,

72-73

diet,

prevention

145

87, 144

42, 150

of,

basal-cell carcinoma, 69, 70, 72

82

Rivers, Joan,

patches or blotches, 27

142-47

skin cancer:

rhinophyma, 28

94

of,

106

perfect,

99

riboflavin,

79

of,

maintenance

resurfacing, laser, Retin-A,

41

of,

40

of,

functions

145

Restylane, 167

particle scrubs,

skin:

74

96, 121

163

43

red tones, 26-29,

respiration,

orbicularis oculi,

in,

reactive seborrhea,

51

for, for,

119-23

for,

167-68

smile

lines,

162, 163, 166

smoking, 64, 74-76, 147, 151, 166

61

9

u soaps, 90-94 in

Finn

for

Chamber

purpose

93

Test.

for

93

of,

skin, 101,

mature

for neck,

126

hands, and decolletage, 175

for

normal

as surfactants, 92

for

oily/acne-prone skin, 123

sodium tetraborate decahydrate granules, 93-94

regular vs. effective use for sensitive skin,

68

solar elastosis.

for

snowy

of,

144-45

139

UVBrays,

70. 74.

100

climates,

1

V varicose veins, laser removal. 186

44

186-87

veins, 26,

SPFsof. 100-102, 144, 175

28

solar keratoses.

70

rays.

136-37

superfatted. 92

skin,

155

70, 74,

UVA

133

skin,

ultraviolet (UV) radiation, 26, 64. 67. 68.

129-30

for dry skin, 101,

93

irritants in,

combination

venules, 26

spastic paralysis, 162

sunspots, 20

vitamin A. 81

SPF

(sun protection factor), 100-102,

superfatted soaps, 92

vitamin C, 81, 85, 146

144, 175

surface capillaries, 34

vitamin E, 81

spider hemangiomas, 27, 29

surfactants. 92.

spider veins, 181-82. 186

sweat glands, 39-40, 44, 45, 51

spot removal, 185-86

sweating, excessive, 162

93

vitamins,

80-82

30-31

vitiligo,

squamous-cell carcinoma, 72-73

and aging, 70

w

and smoking, 74

water:

and sun exposure, static lines,

69,

70

tanning, sunless, 141

160

stratum corneum, 42, 87

subcutaneous

telangiectasias, 27, 29, 68

41

layer, 40,

,

46

degenerative effects

and

to,

of,

precancerous effects

UV

of,

21-22 of,

67

67

radiation from, 26, 64, 67, 68,

70.

74

sunburn:

and

skin type,

and

tretinoin,

sun

72

20, 68, 146, 155

photosensitivity,

staying out

67,

1

freckles,

1

58-60

99

74

and

for dry skin, 95,

127

men, 153, 154

for

normal

for

oily/acne-prone skin, 96, 121

skin, 95,

of,

187-88

134-35

pregnancy, 99 of,

zinc, zits,

82

32-33

94-95

for sensitive skin, 95,

sunscreens:

tretinoin,

102

wrinkle creams, 64 wrinkles, laser removal

for

traumatic tattoos, 185

for babies,

87

skin, 95, 131

sunless tanning, 141

applying, 109-10

124

mature

purposes

loss,

witch hazel, 95

skin, 96,

for

in

skin type. 51

balance chart, 51

whiteheads, 32-33. 52

93

astringents,

combination

and

weight

aftershave, 153, 154

for

oil,

weather, tips for dealing with, 144

55

108

toners, 94-96,

83

and

water-free products, 92

thyroid, underactive,

sun, 67-70

exposure

31-33

texture, skin,

29

sulfur,

drinking,

184-85

tattoo removal,

138

99

Tyndall effect,

1

T-zone, 52, 123

benefits of use, 67, 100

INDEX

207

for

Neal B

CBS EARLY SHOW BEAUTY/FASHION CONTRIBUTOR

VICE PRESIDENT, PUBLIC RELATIONS, MAYBELLINE/GARNIER