How to get ready for your "BIG EVENT"

My patients range from Oscar Winning Actresses to Soccer Moms.

I have found one true thing in my career...

Whether you are walking the Red Carpet or Walking down The Aisle..

Whether it's your High School Prom or 40th High School Reunion...

Or maybe...you have an event you must attend...only to find out your ex will be there....

*insert needle scratching record*

I make no distinctions.

These personal moments matter to us immeasurably.

We all deserve to feel beautiful, confident and at our absolute BEST on these special occasions.

So, the big question is...How do I  get you ready for your big event?

 

I will lay out a general timeline for you, right here, folks.

First,
And, let me be clear about this.
In no uncertain terms, DO NOT try out a bunch of new products and treatments right before your event.
These desperate, last minute attempts are a sure-fire recipe for disaster.
If you ever entertain this idea, even if it is just a vague and fleeting fancy, I offer the following advice.
If there is a chase, let's cut to it. Just start kicking yourself now and save yourself the time money and frustration.

Ideally, you will see me or your Skin Care Professional about 6 months prior to your event so we can put a plan together.

It would go something like this...

6 Months Before schedule an in-depth consultation with a reputable Skin Care Specialist or Physician.

At this point, we may discuss skin tightening procedures to address issues like laxity and collagen loss. This is perfect timing as Thermage and Ulthera take 3-6 months to see results.

We will assess your sun damage and/or vascular concerns (i.e. visible broken vessels or Rosacea).
6 months in advance allows us enough time to work on correcting these issues with office treatments like lasers or IPL.

We will also be able to guide you as to whether you should consider Botox to soften lines and dermal fillers like Juvederm and Voluma to correct and replace volume loss.

If you have never had injections, do your first round about 6 months prior to the Big Day.
That way, you have a chance to make sure you like the results.

Finally, we will talk about your skin care regime.
A licensed Skin Care Professional will be able to tell you what products you should be using to achieve your best results.

I have some all time favorite product staples to improve the overall integrity of the skin and make it look radiant, youthful and glow-y.

My Personal Top 4 Products of all time *insert drumroll*


TNS Essential Serum by SkinMedica.

THIS is the "Cadillac" of  Anti-Aging products.

TNS Essential Serum combines pharmaceutical grade antioxidants and growth factors. Of all the lives and products I have carried over the years, this is my best selling product OF ALL TIME! Proof is right there in the puddin'.

 
ELTA MD SPF 46

I have never felt a sunblock containing 9% Zinc to be so lightweight and elegant.
It does not roll or ball up under make up. And as an added bonus, it also contains niacinimide which is phenomenal for those of us dealing with pigmentation, rosacea or acne.


Vitamin A

Topical Vitamin A is a Skin Superhero!
For acne prone or problematic skin, it unclogs pores and reduces oil production.
For more mature skin, Vitamin A increases collagen, softens fine lines and helps lighten pigmentation.
There are many different forms of Vitamin A (from prescribed formulations like Retin-A, Renova to drug store varieties).
My favorite is SkinMedica's reformulated RETINOL COMPLEX.

It is pharmaceutical grade (available in strengths from .025%  and higher) but compounded to be gentler and more easily tolerated by sensitive skin types. Awesome stuff!!



Lytera by SkinMedica

I am obsessed with this product! NOT only does it help with the appearance of UV damage and Melasma...It just makes your skin look SO BRIGHT!

About 2 weeks after I started this product, I started getting multiple comments every day from patients and friends asking WHAT THE HECK I WAS USING! Because my skin looked so luminous!
Love this stuff. Did I mention I'm kind of obsessed with it? ;)


As we know, topical products can take 8-12 weeks until you begin seeing changes. So, I definitely recommend starting at least 4-6 months in advance.
Furthermore, starting ANY new product regime can lead to temporary, transitional dryness or minor breakouts (which is why I advise against flipping your skin care script right before any major event)
Beginning now gives your skin a chance to acclimate to the new regime.

8 WEEKS BEFORE
I recommend a good exfoliating treatment.
There are a few options but my favorite is a mid level
chemical peel like SkinMedica's Vitalize Peel.

This is a combination of acids that will exfoliate and brighten the skin. This peel only has about 3 days of some minor social downtime.

What does minor social downtime mean??

It means you will have some visible flaking and peeling for about 3 days.
NOT anything like snake-skin peeling or anything too drastic. Small children will not run and hide behind their mothers skirts in the grocery store upon seeing you. But I want you to expect some exfoliation. That's the purpose of a peel.
So, just consider your social calendar for about 3 days afterwards when planning this peel.

This is also the perfect time for you and your practitioner to take a second look at your injections and decide if you need any tweaks to your Botox or fillers.

4 WEEKS BEFORE
Personally, I like to do a DermaPlane and Illuminize Peel combo.
Dermaplaning is a method of exfoliation that uses a blade to remove the upper layer of dead skin cells as well as all the peach fuzz on our faces. It leaves it so smooth and make up looks so flawless after a Dermaplaning.  (Perfect for pictures!)
I immediately follow it with an Illuminize Peel by SkinMedica.

This is a super light peel with virtually zero visible flaking that leaves the skin looking bright, radiant and healthy.
I like to do this at 4 weeks before our the Big Day to make sure you don't have any breakouts or weird reaction (extremely rare) and to make sure that you absolutely LOVE IT (like, I know you will).

1 OR 2 DAYS BEFORE
If all went well with the Dermaplaning/Illuminize Peel then we will do it again right before the BIG DAY!
With this treatment, the skin looks it's most amazing in the next 1-3 days afterwards.
Also, avoid salty foods so you don't look puffy.
HYDRATE!
Plump up those skin cells by drinking plenty of H2O and using a topical hydrating complex to combat the effects of stress and alcohol (Because I see champagne in your future, darlin'!)
AND get your beauty rest!

THE DAY OF...
Relax!
Enjoy this day, my friend.
You've worked hard and done all the heavy lifting.
This is your day! Don't stress it away!
You are beautiful and deserve all of it!

Allow me to propose a toast for you!
Everyone raise your glasses, please.
*ehhh-hmmm*cough*cough*

Here's to champagne for my REAL friends...
And real pain for my SHAM friends!

 

Senior Clinical Aestheticians
Certified Laser Technicians
Skin-gurus.com

How old you are is YOUR business. How old you look is OURS!
Skin-gurus.com

SUNBURN 911 !!!

This Blog was inspired by one of my girlfriends.

She texted me yesterday miserable, in pain and needing help.

ASAP.

It seems July 4th Lake Season, has yet again, snatched another one of my fairer skinned cohorts in its fiery, painful grasp.

Like, if this were a film in the horror movie genre, it would probably be called:

INDEPENDANCE DAY: The Revenge of UV Overexposure 

*insert Michael Myers theme*

 

She texted me saying " I got a sunburn and it's the worst one I've ever had! This hurts! I used sunscreen on my face but the rest of me is on fire!! PLEASE HELP!"

I gave her some tips last night, and she followed all my instructions
(I LOVE IT when people do that!)

She told me today that she felt SO much better instantly afterwards.
SOOOOO...I thought I'd share with the class.

It happens to the best of us.
Even I,  yes me,  got a little crispy last summer despite my efforts to the contrary.

So, here is a little guide to get you through the summer.

Obviously, as the old adage goes, an ounce of prevention is worth a pound of cure.

Use a good, medical grade sunblock.
You only need to use around an SPF 30-45.
Go read my Blog on the Truth About SPF. (It's not as boring as it sounds)

http://theskingurus.blogspot.com/2014/02/the-truth-about-spf-its-not-as-boring_6.html?m=0

My fave is ELTA MD.

 

Apply sunblock EVERY morning and if you will be outside for any extended period of time then reapply every 1-2 hours.

 

The other thing I want to tell you about. HELIOCARE.

 

 

This OTC supplement derived from central and South American ferns is getting rave reviews in the skin care and dermatological circles. It is not FDA approved so I will only tell you what I know. Seems this is a highly potent antioxidant that helps aid in stopping/preventing sun damage.

 

I read the clinical reviews by highly regarded sources and felt confident enough to give this a try on myself and my kids on our Mexico vacation last year. I can’t find any known side effects in 20 years of research. Some studies indicate that the photoprotective properties when taken orally can reduce the risk of sunburn by as much as 200%. 

 

Okay, so it happened.

You have the worst sunburn in the history of sunburns in the history of mankind existence.
What can help soothe it?

First, take two of these and text me in the morning.

Aspirin, Ibuprofen and Acetaminophen can help treat your fever and/or discomfort.
Aspirin also inhibits the prostaglandin release that causes redness and inflammation.

However, you *MAY* feel like taking two of these-

 

BUT DON'T!

Alcohol is Bad News Bears for you right now. You are dehydrated from the burn and these Mambo Taxis (while delicious and extremely potent) as well as other adult beverages will only make you more dehydrated and horribly miserable tomorrow. You need to drink plenty of H2O.

Try these tips....even though they sound weird.

Get a tub of yogurt. Make sure it is PLAIN yogurt not the fruit-on -the-bottom kind (or else your dog/household companions will NOT leave you alone for the rest of the night!)
Rub this on the affected areas. Yogurt has a soothing quality and draws the heat out.
It might leave a slightly chalky appearance but will feel great!

Mix 2 tbs of Apple Cider Vinegar with 2 cups of cold water. Apply this as needed to the sunburn with either a spray bottle or soaked washcloths. Sweet relief!!

Try adding 1/2 cup of Baking Soda to a cool bath and soak in it for a bit.

And, of course, Aloe Vera Gel. As much as you can slather on.


BLISTERS! Well, now you've done it!
Don't rupture these blisters! They are natures band-aids!

However, if a blister pops-apply bacitracin or polysporin if you suspect an infection starting.
This can be characterized by a yellowish discharge or excessive redness around the blister.
Keep it clean, apply one of the topical antibiotics listed above and cover loosely with a bandage or gauze for a day or so to prevent chafing or irritation with clothing.

DANGER SIGNS OF INFECTION!
If you experience any of the following symptoms then see a doctor immediately.

Increased pain, swelling or warmth around the wound (blister) site.

Red streaks extending away from the wound site.

Atypical colored drainage (yellow or green) from the blister.

Swollen lymph nodes in the neck, underarm etc.

Fever, faintness, dizziness, rapid heart beat, nausea, vision impairments or sensitivity to light.

And, please...for the love of St. Francis, my friends....use your common sense.
If something isn't right or you are in doubt- go see a doctor!

I hope these tips help you manage the discomfort should you find yourself with the world's worst sunburn! EVER!

I'm not a vampire BUT I DID meet R-Pats.
Not usually my cup of Earl Grey. But something about that English accent....

Tally-ho,

Michelle and Nancy

The Skin Gurus
How old you are is YOUR business, how old you look is OURS!

Turning 40. The Good, The Bad and The Ugly

TURNING 40

THE GOOD, THE BAD AND THE UGLY

 We couldn't wait to grow up and now that we are here we want time to slow down!  

 

In our 20's, we were busy figuring out "who am I?".

We were going to school, going out on the town, going on dates, going into our chosen careers and deciding what direction our lives will take.

There was a lot of uncertainty. And, there should be at that age.

It's our time to make mistakes, fall down and learn how to get back up.

Then we fell in love, planned weddings and had babies.

If we hadn't already gotten hitched or had babies, we were probably doing it in our 30's.

For many of us, our 30's were spent with long, thankless hours at the office proving ourselves, raising kids, pediatrician visits, soccer games, work deadlines, ballet recitals, and long, thankless hours (and 5 loads of bed sheets) sitting up all night when the kids had the flu. 

And, I wouldn't trade any of that for all the money in the world.

But, I woke up on my 40th birthday feeling like a switch had flipped and a light came on.

About a month after my big 4-0, my boss came to me and asked "What are you doing differently? You're sales were amazing to begin with..now they are phenomenal! Can you give a presentation at the next meeting to explain your new strategy?"

I thought about this. Finally, I told her "I can't explain my strategy."

The truth is, at 40, I finally became comfortable in my own identity.

I woke up one day and realized I needed to stop trying to impress EVERYONE and start impressing myself.

I sat back and looked at my teenage daughters and realized I have done a pretty kick-butt job as a mom (MOST IMPORTANTLY!).

I looked at my career and realized I had become one of the top 1% of revenue generating skin care specialists in the country.

I looked at my friends and family and realized how many great relationships I have forged (sometimes in the fire) over the years.

I feel more confident than I have ever felt.

I stopped agonizing and apologizing for not being Superwoman (though, I do reserve a pair of "S" emblazoned underoos that i wear when I know I'm going to have a challenging day ahead of me. Don't tell anyone.)

It's one of the most empowering and incredible feelings when one accepts and embraces themselves, their past and future.

And it can't be taught. It only comes with time, wisdom and experience.

I have never been happier in my life than I am in my 40s.

I don't question or base my worth on the perception of others.
I FEEL GOOD.
And not in that passing, nonchalant “How are you? ‘Oh, I’m good” kind of way.

I mean really good. Liberated. Solid. Content.

Now, the BAD and the UGLY.

I don't know about you...but it seems like the minute I hit 40..it's like someone slammed on the brakes and sent me into a 180 tailspin.

I was doing all the same things I had always did...except I looked in the mirror and didn't recognize the person looking back at me.

What the heck? When did I get a muffin top?

How did I not see these upper arm bat-wings coming on? I do 2 hours of weighted Hula Hooping WHILE simultaneously doing 5lb tricep presses 3x/week! And still...THIS?

When did my lips start turning downward and these lines on my forehead seem to become so harsh?

WHEN DID I BECOME MY GRANDMOTHER?

Suddenly, this newfound confidence 40 years in the making takes a little (huge) hit.

The sad truth is, my friends, AGING HAPPENS TO ALL of US! And I DON'T LIKE IT!

I read a study that said, after 40, women have to work out an extra hour every day to maintain the body they had at 35.

I may or may not do that.

Okay, I'm not doing that.

I have kids, spouse, home, work, pets, Blogs and not enough time in the day as it is!

SO, if you were to tell me I have to spend AN EXTRA hour every day maintaining my body and ANOTHER EXTRA hour maintaining my skin....

Then stick a fork in me, buy me a button down housecoat, send me a starter box of Crazy Cat Lady Kittens and set my TV to a random home shopping channel.
Because I. AM. DONE.

STOP RIGHT THERE!!

Step away from the housecoat. Put down the kittens and TV remote.

I'M HERE TO HELP!

THIS IS the best time of your life!

Let’s match what you feel inside to what you see outside.  

Together, we can help correct some of this aging nonsense with just a few simple modifications on your part.

First, let me tell you what's happening *insert PSA xylophone chimes with me seriously looking into the camera.....

Every decade our hormones change and this is probably THE BIGGEST factor in our skincare frustrations.

I'm focusing today on the 40-50 year old skin.

There are, of course, intrinsic (genetics) and external factors (UV exposure, lifestyle) that contribute to accelerated aging issues.

I'm going to give you some basic information because no two people are the same but we all share commonality in the aging process.

40-50 year old women fall into the category of  'peri-menopausal’.

Peri-Menopause refers to the timeframe (up to 10 years before actual menopause) when estrogen production slows down.

Estrogen production effects very key functions in the skin.

Estrogen helps regulate the rate of how quickly the cells in your body turn over.


What is skin cellular turnover?

This refers to how quickly our skin produces new cells.

Think of it this way.
When your skin cell is produced at the base layer, it looks like a nice, round healthy grape.

  As these nice, grape-like skin cells migrate up towards the surface of the skin, they begin to, deplete, shrivel up and lose volume.

By the time they reach the visible surface, the beautiful grape like cells have turned into a cornflake.

When we were 20 years old , the process of grape-to-cornflake took about 20 days.
At 40,  it takes AT LEAST twice as long or more.

What does this mean to you and why should you care?

It means you are stacking up a bunch of dead cornflakes on the surface of your skin. This will make your skin look dull, your lines look deeper, your brown spots look darker and, generally, a less plump and youthful appearance.
The other 2 major categories that are major complaints in the 40-50 age bracket is due to plain, old genetics, my friends. Some of it can be prevented if not reversed.

Collagen Loss

This collagen loss that starts to manifest during our 40s has many contributing factors.
Collagen Loss is what causes lines and wrinkles created by underlying loss of collagen and elastin start to appear.

This loss of underlying structure also contributes to thinning of the epidermis, which can cause skin to look crepe-y or papery, and lead to sagginess and neck wattles. 
Skin become uneven, creating shadows, blotches and dark circles under eyes due to thinning skin and volume loss.

Pigmentation

Those once darling freckles (brown spots that have accrued from years of sun exposure) start to darken. AND! They've brought friends!

Growing up in the 70s and 80s, we didn't use sunblock.

In fact, you could find this particularly pasty, red-headed, blue eyed Irish kid dousing herself in tanning oil and Sun-in on any given day of every given summer of my youth.

I never actually tanned but I DID perfect the lobster-y red skin/orange hair look.

Now, decades later, and every failed attempt to emulate Christie Brinkley, we are left with those reminders and tell-tale signs of accelerated photo-aging on our faces, arms, hands and legs.
.

Yeh, I was always THAT KID that had to wear a T-shirt at every pool or beach.

Instantly crispy.

OUCH!

And yet, to this day, I can't figure out how I was/am NOT popular?

*Ponders and stares into space*

So, now that we know the specific skin care issues we face over 40, lets talk about how to begin correcting them.

 

PEPTIDES

Peptides are a type of amino acid, which are found naturally in the skin. They encourage the production of collagen and elastin and actually tell your skin cells how to repair themselves and function properly without inflammation or injury (which is the mechanism utilized by lasers and other modalities).

 
ANTIOXIDANTS

Let's get down to the nuts and bolts of this "Free Radical" term you keep hearing about.

Free Radicals are scavenger particles of oxygen that start destroying organic substances (like proteins) in your body and skin.

Free Radicals can be introduced in many different ways like, environmental (UV, pollution) and lifestyle (smoking or even exercise).

Once the proteins are damaged, the result is oxidation. (Think about rust on a grill that you left out or when apples start to brown after you cut them).

When the skin is introduced to Free Radicals it leads to oxidative destruction which is characterized by loss of collagen, skin wrinkling, and darkening of pigment.

The only way to neutralize Free Radicals is with Antioxidants (think Vit C and E).

I don't care how clean you eat or how healthy you are, only about 15-20% of antioxidants you take orally will make it to your skin. Your body will disperse it elsewhere.

Therefore, you need a strong topical antioxidant that is molecularly small enough to penetrate and deliver the benefits directly to the skin.


GROWTH FACTORS

Growth factors are proteins that responsible for regulating cell growth and division in the skin.

Topical Growth Factors are absorbed by cells in the epidermis and dermis, that then signal the surrounding cells to begin a 'wound healing' response.

This is crucial in anti-aging as it tricks your body to stimulate and regenerate new collagen and elastin.

Now, this might sound a little overwhelming. I get it.

Fortunately, for us, SkinMedica has formulated your 'one-stop-shop" product that includes 7 different pharmaceutical grade strength Peptides and Antioxidants AS WELL as the most potent Growth Factor I have ever encountered.

TNS ESSENTIAL SERUM

I have read the clinical studies, and even more than that, I use it. I stand behind it. It is my #1 best-selling product of all time.

The science is there, folks. And IT WORKS!
I am an unapologetic cherry-picker when it comes to products. I have a 4 tiered spice rack by my bathroom sink full of products I have tried and tested out.
I ALWAYS come back to TNS Essential Serum.

I put my reputation behind this product. Beyond all the clinical data I could tell you...the biggest thing for me is that MY PATIENTS LOVE IT. I can’t tell you how many patients have tried switching to something else, for whatever reason, and always call or email me to make sure I have TNS Essential Serum in stock because they see the difference when they stopped and WANT IT BACK .

RETINOL COMPLEX

Retinol refers to Vitamin A.

This is one of the only vitamins our bodies CSNNOT naturally produce. Yet, it is essential to maintaining the integrity of the skin.

Topical Vitamin A is heavily involved in the growth, elasticity, strength and repair of skin tissue.

Topical Vitamin A increases dermal collagen and stimulates cellular turnover (cornflakes) resulting in a refinement to lines and texture as well as reduction in the appearance of pigmentation.

SPF

If you are going to commit to a healthy skin care regime then I need you using at least an SPF 30-45 daily. No need to go beyond and SPF 45. You won't get any more protection, just more chemicals dumped into your skin. Why do that if you don't need to?

For good measure....

Use LYTERA

I'm obsessing about this product.

It is a Skin Brightening Complex without the increasing controversy that surrounds traditional Hydroquinone.
 

 

 

 

Not only does it inhibit overproduction of pigment, but it makes the skin..just GLOW! 

I've never gotten so many compliments on my skin as I did when I began this product.

I know it's a lot of info. But it's easier than you think.

 

Your Skin Care Regime should look something like this:

AM:

Cleanse

#1- TNS ESSENTIAL SERUM

#2- LYTERA

Moisturize

Eye Cream

Sunblock

 

PM:

Cleanse

#1- TNS ESSENTIAL SERUM

#2-LYTERA

#3-RETINOL COMPLEX

Moisturize

Eye Cream

 

All your bases covered RIGHT HERE with the best products out there on the market.

Less than 3 minutes every morning and night.

Easy, right?

Now that we understand the specific challenges of this age bracket, we can understand how best to address those concerns.

You can file this Blog in the rolodex of your mind. And when the girl at the department store counter is trying to sell you on the necessity of overpriced BS products...tell them you need to check with your Skin Guru first and refer to this Blog or email us anytime with specific questions!

After all,

HOW OLD YOU ARE IS YOUR BUSINESS, HOW OLD YOU LOOK IS OURS!

Ohhh, baby, baby, it’s a Wild World. I’ll always remember you like a child, girl.

 

              Michelle and Nancy

               The SKIN GURUS

                  skin-gurus.com



Managing Pigment in Ethnic Skin Types

We all deal with pigmentation issues at some point in our lives.
No getting around it, my friends. And it's NO FUN for ANY of us!

Today we are focusing on pigmentation in Ethnic skin types.
I have been writing and rewriting this Blog for a few weeks because this is a serious issue that effects millions of people.
I wanted to make sure I got this right for you.

Now, DON'T stop reading right here because you don't have ethnic skin and you think this Blog won't apply to you. It applies to all of us! (Thanks Ancestry websites for telling me just how much Native American heritage I have!)

There is oodles of great info coming up regarding pigmentation in ANY skin type.
Beyond that, here's why you should keep reading....

The face of America is evolving.

Courtesy National Geographic

The U.S. truly is a Melting Pot and these statistics from the US Census Bureau prove it!

"U.S. minorities now represent more than half of America's population under the age of 1, a historic demographic milestone with profound political, economic and social implications."

"Non Hispanic Whites are projected to no longer make up a majority of the population by 2042."
Just to give you some perspective, Non Hispanic Whites made up 85% of the population in 1960.

I'm super proud to see stats like this that prove how inclusive, accepting and progressive this young nation of ours, founded mostly of immigrants, has become in such a short time. Take a second and appreciate how amazing that is.
Okay, back to task at hand.

SO, WHAT ARE THE CLINICAL IMPLICATIONS OF MANAGING PIGMENTATION IN THE CHANGING FACE OF AMERICA?

Patients with ethnic heritage (African American, Spanish, Middle Eastern, Asian, Native American) inherently produce more melanin than Caucasians.
And while ethnic skin types have many benefits...managing pigmentation in ethnic skin presents a very specific and unique challenge.

Many of the tools in my expansive and cutting edge toolbox include Lasers, IPL, and other light based treatments. These treatments are awesome but can be problematic (or flat out contra indicated) for darker skin types. Thusly, limiting our options.

Here's why:
The mechanism of most of these modalities of treatment typically relies on a controlled injury to the skin to create a wound healing response, or they target pigmentation (which is hard to do when a laser cannot tell the difference between a freckle vs the natural pigment in the skin.)

For ethnic skin, many times, when skin or tissue is injured-the response of the body is to create MORE pigmentation. "HYPERPIGMENTATION"!

There is also a condition called Post Inflammatory Pigmentation (PIH). This is a direct response of trauma to the skin (lasers, peels, injuries, acne etc.).


One of the main concerns I hear daily from patients with ethnic skin types, is how to correct or manage pigmentation issues.

The short answer: YOU'RE DOING IT WRONG.  (But that doesn't give you much help, does it?)

The longer answer involves educating you, my readers, and my patients about the types of pigmentation, their causes and giving you the knowledge to become an advocate for yourself and your skin.

If you are ready...then get comfortable, grab yourself a cup of tea or glass of wine and settle in for a few minutes. I will condense this as much as I can but commit to reading for the next 10 minutes. You will thank yourself.

First, let's discuss the causes of pigmentation.

Melasma
This is a genetic predisposition and hormonally induced specific type of pigmentation. It presents differently than your run-of the-mill UV damage. Instead of scattered freckles-you will see patches/blocks of pigments that usually show up bilaterally on the face (temples, cheeks, jawline or upper lip).
See my Blog about Melasma for more detailed info.
We are getting away from calling this a "cosmetic issue" as it has been found to be a dysfunction of the skin.

Though this is a hormonal induced condition, it never presents in isolation. There are compounding factors in play.
Usually, pregnancy, birth control, hormone replacement therapy or UV exposure are the instigators.
FYI- certain Over the Counter supplements like Cohosh and St. Johns Wort have been found to mimic estrogen and make Melasma worse!!

The trick is to FIND YOUR TRIGGER!


Melanocytes (those pigment producing cells) are, in fact, immune cells. They respond when trauma or inflammation is present in the skin.

Certain traumas like cuts, scratches, acne, ingrown hairs, eczema or other dermatological conditions can lead to hyperpigmentation.

Acne Induced PIH

Some clinical causes include: lasers, IPL, microdermabrasion and chemical peels.

Certain medications- ranging from oral antibiotics to medications to treat heart disease and cancer-can create hyperpigmentation in the skin.

UV exposure. Don't make me say it again!!!
Even if you have darker skin, your skin can still over produce melanin when traumatized with UV radiation.

MANAGING YOUR PIGMENTATION
I'm not going to get into whether you are a candidate for laser treatment. This is very specific to your skin type and condition. You must be personally assessed by your Skin Care Professional to determine if this is right for you.

Lets talk about what you can do at home.

HYDROQUINONE (HQ)  4%-6% (prescription strength) has long been considered the Gold Standard for Melasma, pigmentation and PIH.
However, HQ is becoming more and more controversial due to long term effects like potential cytotoxity and contact dermatitis.

The other major issue with HQ is the potential for Exogenous Ochrinosis.

That's a lot of big words! Speak to me in plain English, you say? Here you go.

HQ IS A DRUG and you MUST take drug holidays.
The current thinking is you can only use this topical for 8 weeks (MAX 12 weeks) and then take 16 weeks off.
Otherwise, you may induce Ochrinosis which is a condition that results from an overuse of HQ.
The hyperpigmentation takes on a blue/black appearance and this...ugh...is irreversible.

I don't know about you...but I have too much going on between kids, work, house, pets, doctors/ortho appts etc to remember how to keep the HQ dosage straight. Was it 6 weeks on/8 weeks off? 8 weeks on/10 weeks off?
Who cares. I'll just use it all the time. Every day. For years. After all, MORE is BETTER, right?
It's easy to get lazy...AND I GET LAZY, TOO!  AND I'M THE PROFESSIONAL, Y'ALL!!!!

There's an easier way, folks.

1- Avoid UV radiation. And remember, this occurs insidiously and from an early age. Even incidental exposure can create irrevocable damage. Have you considered the ambient heat factor?
Living in Texas (as the saying goes, Texas has 2 seasons: Summer and August!) can cause major pigment issues. Dangit, enough already!

2-Wear SPF EVERY DAY! At least once in the AM. If you are going to be outdoors for any extended period of time, Reapply every 1-2 hours.

However, all you need is an SPF 30-45. Once the number of the SPF is increased higher than that...well, you really aren't getting more protection.
In fact, to get to those higher SPF #'s manufacturers must introduce more chemicals. More chemicals=more pro-inflammatory ingredients.
I like Elta MD SPF 46. It contains Niacinimide which inhibits melanin transfer.

3- Antioxidants are proven to augment the efficacy of SPF. Use a good one every morning. My fave is SkinMedica's C+E Complex or their TNS Essential Serum.

4-Use a good pigment inhibitor. There are lots of different ones on the market if you are looking for a non HQ option. Alternatives include:
Arbutin
Azelaic Acid
Kojic Acid
Licorice Extract
etc...

My fave right now is Lytera by SkinMedica.

It is a non-hydroquinone brightener that works on all skin types without a prescription.
This product has been scientifically proven to address all 4 stages of hyperpigmentation in the skin..
-Activation
-Production
-Transfer
-Migration

No breaks or drug holidays needed. I'm kind of obsessed with this product. Like, seriously obsessed.
Even though I don't have Melasma, I use this product twice per day. I have never gotten so many compliments on my "radiant, glowing skin" as did after 2 weeks on Lytera.

5-Retinol.
Retinoids (Vitamin A) have been clinically proven to down-regulate tyrosinase.
Tyrosinase refers to the enzyme in your body that controls and regulates melanin (pigment) production.
So, if you have overactive pigment production-i.e. Melasma, UV damage, PIH...Then Retinoids helps slow down and "police" that over production!!
I did a write up on the importance of Vitamin A ("The Best Thing You Aren't Using"). Read it.


Okayyyy. So, you feel like you just got spit out of a F5 tornado of information, right?

I know. It's a lot to take in.

But I want you familiar with this terminology and what these products do.
Education is the key to helping you manage your pigmentation.

Don't go blow your hard earned cash on some department store product that upcharges you to pay for their Prime Time commercial featuring a spotted Robin's egg that miraculously clears up within their 30 second time allotment. You won't get the results you are looking for.

There s a very specific and scientific regime to control and combat pigmentation issues, even in the most diverse skin types.

I'll break it down real simple for you.
Your basic skincare will look something like this:

AM:
Cleanse
Topical Antioxidant
Lytera
Elta SPF 46

PM:
Cleanse
Anti-Aging Serum
Lytera
Retinol Complex

This is the bare Nuts-N-Bolts of a skin care regime to aid in managing pigmentation (AND AGING!! It's a two-fer!!!).
Every case is specific. I'm here to educate you and make sure you walk into your doctor or skin care professional's office armed with as much knowledge as I can force down your gullet.

**Last Note***
Keep your eyeballs peeled for my write up on an Over The Counter Supplement called HelioCare (available at Walgreens, CVS etc).
It claims to reduce the absorption and negate the effects of UV by up to 400% when taken daily.

I have done a lot of research on this and I cannot find a single negative.
I have been using it myself for the last year. I had my daughters take it when we went to Mexico.
I was already convinced based on my personal experience.

Then, I went to a Plastic Surgical Skin Care Conference in San Francisco a few weeks ago and this product was brought up repeatedly in my lectures.
Not only for prevention of sun burns, but also in management of pigmentation/melasma in ethnic skin types.
I have begun my own personal study to test this theory and will let you know my findings in a few weeks.

Until then,
Buy the ticket, take the ride.

Michelle and Nancy
THE SKIN GURUS

How old you are is YOUR business, how old you LOOK is ours.
skin-gurus.com

Off topic...But On Point

I am back from hiatus and ready to blog!

So, over the last few weeks I have been gathering data and collecting my thoughts..should I tell y'all about the importance of retinols, or Managing Pigmentation in Ethnic Skin types, or the role Hormones play in skin throughout a lifespan (These Blogs are coming soon!!) ...but..

Something else kept coming to the forefront of my brain.

And it's not really related to skincare in the clinical sense, but more the 'WHY'  I got into this field in the first place.

Humanity lost one of its most treasured gifts last week.

So, I'm putting those Blogs on the back burner for a moment to pay a little tribute to Maya Angelou.

Ssshhhhh. Just keep reading. TRUST ME. It's not going where you think it's going.

I have always been inspired and captivated by this woman. As I started pinning and posting my favorite quotes from her and reading other peoples tributes... it started to dawn on me....just how many times in my life I have repeated her words in my head. Especially during rough times.

There are dozens of others of sayings that I put in a special little folder on my iPhone dedicated to inspirational quotes *nerd alert*
I've repeated them so often that I know them by heart and rarely think much anymore about the author. So, when I started reading all these posts, pins and tweets of Ms. Angelou's amazing insightful and graceful words...I realized how big of an influence she was to me.

I began to question whether I could ever be as influential as Maya Angelou.
I mean C'mon. I work in Plastic Surgical Skin Care. I'm a blonde from Texas! Can I make that kind of impact on the world?

I thought about this and started to remember why I was drawn to this field in the first place.
Then, I answered my own question. Yes, I can. And Yes, I do. One person at a time.

We all have baggage. Myself included. (Lawdyyyyy! Don't get me started! I don't have 'issues', I have SUBSRICPTIONS!)

Isn't funny how someone can say one thoughtless, cruel or careless remark in some crucial, pivotal moment in your life...and that seems to stick with you over the years, fuel insecurity and direct the course of your internal monologue for weeks or decades?
Especially for young women and men who have been teased about their appearance or body-shamed during those formative years, this can shape self and body image for a lifetime.

I was made fun of for my 'bologna-lips', my bad home perm, my chub... not to mention my snort-laugh and my innate clumsiness (which I never grew out of ;)

We all have issues and insecurities. If you tell me you don't, I call BS on that.

I have the absolute best job in the world. I get to make people feel better about themselves every. single. day.
I won't ever win a Pulitzer or Nobel or an Oscar (though some days I think I give Meryl Streep a real run for her money! And, I can legitimately tell you that I have a Best Actress Oscar winner as a patient. But that's the closest I will ever get to a golden statue.*sigh* all those hours wasted practicing my acceptance speeches in my bathroom mirror with a hairbrush-microphone ...C'est la vie.)
God knows, I don't do this job for money or lavish lifestyle.

I do it for you!

You, my lovely patients and online followers, let me into your life every single day. You open up to me about your fears and insecurities. You tell me about your loves, your aspirations, your families and your past. You put your faith and trust in me to guide in the right direction (and use lasers on your face! Talk about TRUST!)

What I love most about my profession is watching the transformation happen.
Because it's not just a physical.

Patients come to each appointment with a little more bounce in their step. And as their confidence grows, the narrative of their life starts to change.

For instance, that person, who, the first day I met her at our consult, had tears in her eyes. Her husband just left her. Now she is a 40 year old single mother of 3 and feeling low and beating herself up.
Or the nervous guy who had a hard time telling me why he came to see me. It took me 20 minutes to drag it out of him. Turns out, he wouldn't date or even be seen at the pool/lake or go to the gym due to his Gynecomastia.
It takes real courage to open up to a stranger like me about these personal insecurities. People probably tell me more about themselves than even their best friend in the world knows about them.
I don't take that lightly.

My greatest professional and personal (outside of my kids and loved ones) satisfaction comes on a daily basis when patients hug me and tell me how great they feel.
All of the sudden, their world is changing. They are happier. They have the confidence to take chances they otherwise would not have taken. I get to be your biggest cheerleader, high five and hug you and jump up and down and celebrate in your accomplishments!

Like a proud mama bird, my gratification comes by watching you take flight.
And when you leave my office, I look in the mirror and give myself some Shooter McGavin finger guns. Because, DAMN! I'm good at this!

Nancy and I also volunteer for the Phoenix Society for Burn Survivors annual World Burn Congress as part of the Image Enhancement Team for traumatic burn injury survivors.

If you know anyone who has suffered a traumatic burn injury, I highly recommend this organization.
They are a phenomenal support system.

As part of the Image Enhancement Team, we teach people how to camouflage scars, draw on lips and brows etc to help those who have suffered traumatic burn injuries re-enter society and cope with not only physical limitation but also the emotional trauma associated with disfigurement from traumatic burn injuries. It's not just changing faces, it's changing lives.

 

This is a wonderful profession and we are privileged to have y'alls continued trust and support.
This is our dedication and calling.
We promise to keep bringing you Blogs you find informative, useful and (hopefully) a little funny and sassy.

I leave you with this last quote because....well...Dammit. YES!

And now..back to your regularly scheduled programming.

Michelle and Nancy
The Skin Gurus

How old you are is your business, how old you look is ours!

What your kids need to know!

What your kids need to know about Skin Cancer
Easy talking points to eliminate the eyeball rolls

    As mothers, we try our best to provide our children with the knowledge that they need to keep them safe throughout life. Don’t talk to strangers, look both ways before crossing the street and Stop! Drop! And Roll!

  But, how much does your teen know about Skin Cancer and sun safety?

 We have decided to assemble some common myths and talking points that you can discuss with your child.  

 TEEN MYTH- Skin Cancer only happens to old people.

FACT- Among young American adults aged 25-29, melanoma is the most commonly diagnosed cancer, and the No. 1 cause of cancer death among 15-20 year olds.

 

TEEN MYTH- You don’t have to wear sunblock if you have a naturally tan or olive skin.

FACT- All skin types, regardless of race, should be using sunblock. Naturally darker skin types have a lower incidence of skin cancer, but when melanoma is discovered on darker skin, it is at a more advanced stage than on lighter skin.

 

TEEN MYTH- Tan skin looks healthy and prettier than pale skin.

FACT-
Tanned skin is actually an indicator that the skin is injured or damaged, so there is no safe tan. If you desire the appearance of a tan, there are much safer alternatives. For instance, Tan Towels self tanner is easy to use, not orange-y and not smelly. Fake-Bake away!!

TEEN MYTH- You only have to wear sunblock on sunny summer days.

FACT- UVA rays penetrate through clouds and windows, and are reflected off concrete, asphalt, snow and grass.
These rays are present from sun up to sun down, all year-round.
Sunblock should be worn every day, regardless of season or how sunny it is.

TEEN MYTH- Tanning beds are a safer alternative to sun exposure.

FACT- Tanning beds can expose an individual to four times the amount of UVA (aging rays) and two times the amount of UVB (burning rays) as a similar period of sun exposure. 
People are unable to feel the UVA rays on their skin, but they contribute the most to skin aging and skin cancer.

 

KNOW WHAT TO LOOK FOR:

 

    

    A – Asymmetry: Most early melanomas are asymmetrical

     B – Borders:  The borders are uneven

     C – Color:  Varied shades of brown, tan or black are often the first signs

     D – Diameter:  Early melanomas tend to grow larger than common moles.

     E – Evolving:  Change in any parameter: color, size, shape or feel

Educate those kiddos! NO matter how disinterested they seem, it's our job as parents!
Be the example!
They will thank you in 20 or so years! Then you can say "Sure, no big thing. Day in the life of a mom." and roll your own eyeballs back at them :)

Sincerely,
The Breakfast Club
Michelle and Nancy
The Skin Gurus
skin-gurus.com