Monday, November 14, 2016

Low Cellular Thyroid Levels as a Cause of Hypothyroidism


Most people are probably familiar with the classic symptoms of low thyroid hormone such as fatigue, cold intolerance, cold extremities, and weight gain or difficulty losing weight. There are, however, a myriad of other symptoms, mainly because thyroid hormone affects the metabolism of every single organ system in the body. So, symptoms of low thyroid can include depression, brain fog, panic attacks, muscle and joint aches, muscle cramping, irregular periods, PMS, dry and brittle hair, diffuse hair loss, low body temperature, constipation, irritability, weakness, sluggishness, lack of libido, slow heart rate and high cholesterol. Often people experience many of these symptoms but are told their thyroid labs are normal. This usually means a TSH (thyroid stimulating hormone) level has been checked and maybe a free T4 and/or free T3 level have been checked.

To continue this discussion, it is necessary for the reader to understand some terms and definitions, as well as some basic physiology. Under normal conditions (at least in theory) the pituitary gland sends TSH to the thyroid gland as a message to make thyroid hormone. The thyroid mainly makes thyroxin which is abbreviated T4 for the number of iodine atoms attached to the molecule. T4 then circulates in the bloodstream and is available for uptake into the cells of all the different organ systems via receptors on the cells. Once inside the cells T4 is converted to triiodothyronine, abbreviated T3, again for the number of iodine atoms attached to the molecule (plus it’s just easier to say and spell).  This is important because T3 is much more powerful than T4 and is a major player in terms of how much energy the cell has, how well it metabolizes and how well it does its job. (The thyroid gland also makes some T3.) The pituitary gland receives feedback about how much thyroid hormone is in the bloodstream so it can adjust the amount of TSH it is sending out and therefore regulate the amount of circulating thyroid hormone.  This is why doctors look at the TSH level—it should be high if there is too little thyroid hormone and it should be low if there is too much thyroid hormone.

The problem with this is, under many conditions, including obesity, weight gain, diabetes, insulin/leptin resistance, depression, illness, autoimmune disorders, chronic fatigue syndrome, fibromyalgia, chronic pain, opioid use, physical or emotional stress, dieting, excessive exercise, menopause, heart disease, injury, chronic infection, cancer or iron deficiency, the TSH level has been shown to be a very poor marker for hypothyroidism and does not reflect the often severe levels of hypothyroidism present inside the cells.  Likewise, measuring levels of T4 and T3 in the bloodstream does not give us any information about what is taking place inside the cells.  It has been demonstrated that even small decreases in serum T3 levels reflect a severe intracellular deficit.  When serum T3 levels decrease by 30% they may still be within the normal range, but T3 levels in peripheral tissues may be decreased by 70-80% resulting in severe tissue hypothyroidism with normal lab values. This is bad news because I challenge you to find a single adult human who does not have at least one of those conditions, even if it is only dieting or weight gain. Even the range of normal lab values has been challenged as this normal range is based on the general population, and it is estimated that much of the general population has undiagnosed hypothyroidism.

The reasons behind this discrepancy between what is happening inside cells and what the pituitary is doing are complex and varied.  Here are some of them: under the conditions listed above there is less uptake of T4 and T3 into the cells (less thyroid hormone gets taken into the cells), there is less conversion of T4 to T3 and, most importantly, there is increased conversion of T4 to reverse T3, abbreviated rT3. Reverse T3 occupies the same receptors that T3 would, but is metabolically inactive.  This means the rT3 uses T4 as a substrate, blocks the entry of T4 and T3 into the cell and blocks the action of T3 inside the cell. 

All the conversions of T4 to T3 or rT3 are under the control of a group of enzymes called deiodinases (D1, D2 and D3 for short).  In addition to the reactions to stress listed above, the pituitary behaves completely differently in its reaction to stress. The pituitary continues to take up T4 and T3, continues to convert T4 to T3 and does not convert any T4 to rT3.  Therefore, the pituitary never “sees” the lack of T3 and continues to release TSH as if everything were normal.

This condition has been called Wilson’s thyroid syndrome or Wilson’s temperature syndrome after one of the first physicians to recognize and describe it, Dr. Denis Wilson.  We could also call it a T4/T3 transport problem and/or a T4 to T3 conversion problem or intracellular hypothyroidism or low cellular thyroid levels. This syndrome is more common in women for several reasons.  Women have more prolonged, sustained elevations of stress hormones under conditions of stress, which drives the changes listed above.  Also, women have lower levels of D1 (the T4 to T3 enzyme) to begin with.

What this means to physicians is they must listen to the patient.  When the patient has some or all the symptoms of hypothyroidism, other signs and labs should be checked.  It is important to check TSH, free T4, free T3 and reverse T3; but also, the antibodies associated with Hashimoto’s thyroiditis to rule out an autoimmune cause of hypothyroidism.  The free T3 to reverse T3 ratio will be very low when intracellular hypothyroidism is present.  Sex hormone binding globulin (abbreviated SHBG) is often low.  Another cardinal sign is low body temperature—any temperature below 98.6° F is a sign of abnormally low metabolism.  A person with normal metabolism will have a normal temperature, period.  The basal metabolic rate can also be checked, which will be low in the presence of intracellular hypothyroidism.  Tendon reflexes should be checked as in certain locations there will often be a delayed relaxation phase in the presence of intracellular hypothyroidism.


It should be obvious that if this syndrome is present, replacement of deficient thyroid hormone with a T4 preparation will not be sufficient. (Remember there is a problem with converting T4 to the more powerful, more active, more useful T3.)  A T3 or combination T4/T3 preparation will be needed to successfully replace thyroid hormone.  There is a well-studied, well-documented protocol using sustained release T3 that can correct this syndrome, called, of course, Wilson’s T3 Protocol after its developer, Dr. Denis Wilson. Why and how this works is the subject of another essay.

Saturday, January 23, 2016

Thoughts on Essential Oils

Lately I've been using essential oils more than ever.  My latest enthusiasm was sparked by a few scientific and medical studies.
Now I've always loved the aromas associated with pure oils, and I search for the most pure and most powerful when I am buying.  And I'm familiar with many of the traditional uses of essential oils; after all they have been used in human societies for thousands of years. So, yes, I use lavender for calming and lemon for cleaning and eucalyptus for breathing difficulties and frankincense for everything! But essential oils have also been used for at least hundreds of years to combat bacteria, fungi and viruses; and what caught my attention was several studies published by the National Institute of Health (NIH) on using essential oils as an antimicrobial strategy.  
You may or may not be familiar with the current frightening situation with hospital acquired infections--they are very difficult to treat because many of them are resistant to nearly every antibiotic in use.  Methicillin-resistant Staphylococcus aureus (abbreviated MRSA) is one of the biggest problems in hospital infections, and is thought to be due to heavy use or overuse of antibiotics. Also related to the prominent use of antibiotics are hospital associated fungal infections, equally challenging to treat.  Over 500 studies have shown essential oils are effective against bacteria, viruses and fungi.  Several NIH studies tested a variety of essential oils on bacterial and fungal growth, including MRSA.  All of the oils had excellent antibacterial and antifungal action, but some were better than the rest.  Some of the top performers were lemon, lemongrass, cinnamon, melaleuca (tea tree), peppermint and clove.
Interestingly, other studies showed that essential oils effectively kill bacteria without promoting the acquisition of resistance as is such a huge problem with antibiotics. In addition, essential oils are easy to obtain, are inexpensive, have low toxicity (for humans, children, pets), and degrade quickly in water and soil making them environmentally friendly. With regards to toxicity, you might be interested to know that in one recent year there were no reported deaths associated with essential oils (and as far as I know there have never been any deaths associated with the proper use of essential oils), whereas prescription medications were associated with nearly 47,000 deaths.
One other interesting study was performed at the Vanderbilt Hospital Emergency Room. Essential oils were diffused as a strategy to manage staff stress.  The Vanderbilt ER found that not only did staff report less stress and a greater sense of well-being, the diffused oils were very popular with patients who found the aroma pleasant and surprising (it didn't "smell like a hospital") as well as relaxing and comforting.
Youthologie Aesthetic & Anti-Aging Medicine is committed to bringing you the very best in pure and powerful essential oils.  Stop by for a sample today!  Also, check our website frequently for events as we provide classes and information on essential oils and other products and procedures of interest to those who are engaged in optimizing their health and vitality!

Wednesday, November 19, 2014

New Microneedling Procedure Promises Younger Looking Skin


After careful evaluation of different manufacturers, I (Dr. Lisa Hogan at Youthologie Aesthetic & Anti-Aging Medicine) have chosen to offer Microneedling (the procedure) using Dermapen (the manufacturer). This new procedure holds the promise of dramatically younger looking skin. Here are the whys and wherefores:

Microneedling uses very small needles attached to the end of a piston that moves rapidly up and down as the device is moved gently over the surface of the skin. This creates a fractionated (it involves only a portion of the skin surface) microinjury at the dermis level. The depth of treatment can be varied according to the desired effect and the sensitivity and thickness of the skin being treated. The frequency of the piston strokes can also be varied. Dermapen was chosen as it is, by far, the safest, most reliable device with the most flexibility in treatment parameters.

The advantages of this treatment are:

 1) For a short time there are open channels in the skin that deeply absorb a chosen topical material such as a hydrating agent.
2) As the microneedle channels close back together there is tightening of the skin.
3) The microneedle channels stimulate the skin to produce collagen. This has a number of anti-aging effects including smoothing and tightening, improvement of scars and reduction of fine lines and wrinkles.
4) Acne scarring is dramatically improved.

The treatment is quite comfortable as Youthologie has developed a signature method for anesthetizing the skin.

For information, contact Dr. Lisa Hogan at Youthologie Aesthetic & Anti-Aging Medicine, 919-847-1495 or lisa@youthologie.md, Visit www.youthologie.md

Tuesday, October 1, 2013


Start Aesthetic and Anti-Aging Medicine Early

Our skin reflects cumulative damage from the sun and the environment and belies our general health. Underlying undesirable changes in the skin are some preventable changes in skin metabolism. The skin renews itself every four to eight weeks as new cells are generated in the deep layers. These new skin cells mature and migrate to the surface, where they are soon ready to slough off. The sloughing off is a signal to the deep layers of the skin to begin the process again, and new skin cells are created and sent the surface. As we age, this turnover of our skin cells slows, and can cause a dull, coarse appearance. Another common change seen in aging skin is a decrease in collagen and elastin production. Since collagen and elastin are important for the structure and elasticity of the skin, the loss of these two proteins causes wrinkling and sagging. Anything we can do to increase skin cell turnover and collagen and elastin production will help the skin appear more youthful and will improve the health of the skin. There is good evidence that rapid skin cell turnover via exfoliation reduces the risk for skin cancer.

The trend in aesthetic medicine and cosmetic procedures is to start non-invasive procedures early in order to keep the skin healthy and prevent some of the undesirable changes that occur as we age. One of the most popular treatments at Youthologie is Laser Genesis, which is a comfortable laser treatment that stimulates collagen production. The result is smoother, tighter, younger looking skin with less sun damage. The same treatment improves scars and prevents acne breakouts, and there is no downtime or recovery time. Patients are able to resume normal activities immediately.

Another important tool in anti-aging medicine is bio-identical hormone replacement. This is the use of hormones that are the same as those made by the human body to replace the normal decline in hormone levels that occurs as we age. It is said that we age because our hormone levels decline.  Generally, the hormones being replaced are the sex hormones estrogen, progesterone and testosterone. However, another hormone that commonly becomes deficient with increasing age is thyroid hormone. Every tissue and organ in the body has receptors for hormones, so they have a global influence on virtually every bodily process.

The goal of anti-aging medicine is to live a full, healthy, and happy life for as long as possible and to prevent the common diseases and disorders that typically increase with age. The big killers and disablers are heart disease and stroke, cancer, Alzheimer’s disease, diabetes, and, for women, osteoporosis (cause of hip fractures) and macular degeneration (cause of blindness). All of these conditions are at least somewhat preventable. It is possible to assess our risk for disease and prevent it through changes in lifestyle and nutrition and the use of bio-identical hormone supplementation.

There is widespread misplaced fear and misunderstanding regarding hormone replacement therapy. Bio-identical hormone replacement therapy (BHRT) differs significantly from hormone replacement therapy (HRT), as the latter uses synthetic hormones. Many women stopped using HRT on the advice of their doctors when the Women’s Health Initiative study was discontinued prior to its scheduled completion due to the finding of an increased risk for heart attack, stroke and breast cancer associated with synthetic hormone therapy. This risk is not seen with BHRT. 

One difference between bio-identical hormone replacement and synthetic hormone use is that bio-identical hormones are familiar to the body. The body has the enzymes necessary to metabolize hormones that are identical to those created by the body. As a result, the hormones are present for a only few hours, just as when the body manufactures its own hormones. Because synthetic hormones are unfamiliar to the body and the body does not have enzymes to metabolize them, they can remain in the body for months. This means there is a prolonged period of time during which all tissues of the body are influenced by these hormones. Another example of how BHRT differs from HRT is in the use of progesterone. This natural hormone has a protective effect on breast tissue and helps to prevent breast cancer, whereas progestin, the synthetic substitute often used, does not have a protective effect on breast tissue. 

 For more information about aesthetic and anti-aging medicine, contact Youthologie at 919-847-1495 or email lisa@youthologie.md, or visit our website www.youthologie.md.


Tuesday, November 13, 2012

Lips!

Lips.  They occupy a position in the central column of the face.  They are used for expression in so many ways—not just for talking, but for smiling, pursing, frowning, and tightening.  They are sensual and are an instrument for enjoyment—food, drink… kisses. 

When we are engaged in conversation with another human they are mainly observing our eyes and lips; they are mainly looking at that central column of our face.  For this reason, subtle changes to the areas of the eyes and lips have major impact on our appearance in general. 

As we age, we make less collagen in the skin everywhere, which decreases the structural support of the skin, allowing skin to sag and wrinkle.  In the area of the lips and philtrum, collagen loss means volume loss.  The entire area around the mouth loses volume and becomes more recessed.  Anti-aging maneuvers are often all about collagen building, or structural enhancement, or volume enhancement.  This can be achieved by stimulating and increasing our own collagen production or by adding structure and volume by using an injectable filler, or even by surgically implanting a shaped object (although this has largely fallen out of favor for the lips, thank goodness.) 

Youthful lips are full, sensual lips that are smooth and “juicy” (plump) looking.  Thin, tight lips are a reliable sign of anger. Most people do not want to appear angry or upset when they are not—this is not considered beautiful.  What can we do about it?  There are some lip products that stimulate collagen production; exfoliating peels and laser treatments can be used to increase collagen production; but one of the easiest, quickest  and most effective ways to enhance the lips/philtrum area is with the use of injectable fillers.  This results in a soft and natural appearance to the lips that is long-lasting, semi-permanent or permanent, depending on the filler chosen.  Small changes to this area can greatly enhance the youthfulness of the entire face. 

The fillers can better delineate the outline of the lips, create greater smoothness to the lips, and increase the volume of the lips.  Another effect noticed by patients after lip enhancement is that they have more freedom in the type of lip make-up they can use.  Before lip enhancement many have stopped wearing strong, bold colors of lipstick, as well as minimal lip gloss looks because of lipstick “bleeder lines” and because their lips appear small and anemic.  Once the clock has been turned back and lips are fuller, better defined and poutier, patients can wear any type of lipstick effortlessly. 

Many different fillers are commonly used for lip/philtrum enhancement, but only Restylane is FDA approved for use in the lips as of late 2011.  Our favorite material for lip enhancement at Youthologie is Silikon 1000.  This is a medical, sterile, non-reactive, non-allergenic permanent injectable filler that is clear in color and becomes incorporated into the tissues where it is injected.  It has a very soft and natural appearance, and can be used in small increments; so that there is a gradual building of the lip/philtrum structure over time until the desired effect is achieved.   I have been using this material for lip enhancement since 1999, and I have never seen a complication with it, nor have I ever had an unhappy patient.  The only complaint is usually, “I want more!”  It is very common for patients to undergo 2 or 3 sessions as they proceed with caution and gradually create the lips they have always wanted.  Your perfect lips are yours forever! 



Saturday, July 21, 2012

Vibradermabrasion

We happen to be working with Plum District this month (July 2012)—the online deal purveyor “for moms, by moms who know”; so watch our FaceBook page and be on the lookout for our emails ‘cause we’ll let you know when our special is running.  We are offering an introductory Vibradermabrasion treatment at 50% the normal pricing, so I thought I would write a little about what Vibradermabrasion is and what it does for your skin.

Vibradermabrasion is considered to be a type of microdermabrasion, but it is so radically different from other types of microdermabrasion as to be almost a totally different treatment.  All microdermabrasion treatments are exfoliating, and the older, more dated versions exist in two forms.  Either they are performed by a sort of dremel like tool that is used on all comers (after a dunk in some disinfectant, at best) or by a sort of sand blasting of aluminum crystals against the skin.  The obvious problem with the dremel type tool is that it is very porous and users are likely sharing some DNA with the previously treated users.  The problems with the sandblasting tool are many; the crystals often get in the eyes and up the nose of users and have been shown to become embedded in the skin, which makes it impossible to follow the treatment with any sort of laser or IPL treatment, difficult to follow with a facial, infusion or mask and allows aluminum, a known neurotoxin, to effect the brain of users.  Another problem with both of these tools is that because the surface area of the treatment device is small, the treatment often takes a fairly long time, it can be uncomfortable, and it often leaves the skin with “streaks” of treated areas, which results in a clawed look. 

Vibradermabrasion uses neither of these two imperfect technologies.  Instead, each user has their own dedicated paddle that is made of surgical steel, which is inert and will not leave deposits in the skin.  No other person uses that same paddle; everyone has their own.  Vibradermabrasion achieves exfoliation by the polishing motion of this paddle against the skin, and the surface area of the paddle is large enough that the treatment is relatively quick and efficient, never looks streaky and leaves the skin looking smooth and polished, both to the naked eye and microscopically.  The strength of the treatment is adjustable, so that the experience is customized for each individual user; and the treatment is pleasant and relaxing.  Other treatments such as laser, IPL, facials, etc. can be performed immediately following Vibradermabrasion; and, in fact, are enhanced by preceding the treatment with Vibradermabrasion.

What, exactly, makes exfoliation such a desirable treatment?  First of all, it removes the dull, coarse layer of dead skin at the surface of the skin; so immediately the skin looks brighter and more luminous.  This action also stimulates new skin cells to be created and increases skin cell turnover.  New skin cells are desirable because they are younger and healthier, which will be reflected in their appearance; and they are better at most functions such as producing collagen (more on this in a minute) and protecting you from sunburn and skin cancer.  Studies have shown that regular exfoliation reduces the risk of developing skin cancer.  Exfoliation also has a sort of deep cleaning type effect on the pores of the skin, and so is often helpful for controlling acne breakouts.  Its exfoliation effects also make Vibradermabrasion a great treatment for keratosis pilaris (red bumps on the upper arms or thighs).

All of this is great, but the genius and unique part, the really cool part of vibradermabrasion is, in addition to the exfoliative effects of the treatment, vibrational energy in the 80-180 Hz range is applied to the skin throughout the treatment. This results in an immediate documented increase in blood flow to the skin, which allows greater oxygen and nutrient delivery to the skin and a delayed documented increase in the collagen content of the skin.  Why would you want more collagen in the skin?  Many of the unwanted changes of aging and photodamage (damage from sun exposure) such as fine lines, wrinkles, sagging, and draping result from a decrease in collagen, so an increase in collagen in the skin is always part of the anti aging strategy. 

Vibradermabrasion can be performed on any area of the body.  It is commonly used in the areas of the face, neck and chest—a series of treatments is transformative and can be followed by regular maintenance treatments. 

Below I have included a list of FAQs.

What is Vibradermabrasion?
Vibradermabrasion is an advanced form of dermabrasion or microdermabrasion that also offers an infusion system to enhance absorption of topical treatments.  The Vibraderm system uses a set of paddles that are unique to each patient, so there is no shared surface between patients.  The paddles are made of stainless steel and plastic.  There is a gentle scrubbing motion that provides a complete and uniform removal of the stratum corneum (the top “dead” layer of skin) while at the same time delivering vibration, which enhances the circulation and oxygen and nutrient delivery to the skin.  The system is also capable of Vibrafusion, an enhanced delivery of topical compounds into the skin; deeper into the skin, at a faster rate, with increased absorption.  The absorption of topical compounds is increased by an estimated 500% using Vibrafusion.
What can Vibradermabrasion treat?
Vibradermabrasion is used as an in-office exfoliation technique that increases cell turnover, collagen production, and skin circulation/oxygenation that ultimately results in smoother, healthier more polished looking skin.  It is also used for Vibrafusion to drive beneficial topical compounds deep into the skin where they can have a greater effect.
How does Vibradermabrasion work?
Vibradermabrasion works by the use of an abrasive stainless steel paddle that “scrubs” the skin in a gentle back-and-forth motion in combination with vibration.  Each patient has their own steel paddle, which can be used many times.  Each paddle also has a pebbled plastic side that is used in the same fashion for Vibrafusion (infusion of topical compounds.)

Indications for treatment with Vibradermabrasion:
Vibradermabrasion is used cosmetically for the treatment of variations in skin pigment, scarring from acne or other injury, coarse or dull skin, enlarged pores, thinning of the layers of the skin, fine lines and wrinkles, loss of collagen and elastin and other evidence of sun damage.  Vibradermabrasion increases results from laser and IPL treatments, chemical peels, facials, and levulan treatments.  Vibradermabrasion is also a valuable tool in preventing acne breakouts and in eliminating keratosis pilaris.
Indications for Vibrafusion:
Vibrafusion is used to enhance the absorption of compounds such as hydrating compounds, moisturizing compounds, hydroquinone for pigment correction, collagen stimulating compounds, and many others.
Who should not have treatment with Vibradermabrasion or Vibrafusion?
Vibradermabrasion is gentle enough to be performed on almost everyone.  It should not be performed in an area with an open wound or a recently healed wound.  Any restrictions that apply for topical compounds would also apply when used with Vibrafusion.  For example, pregnancy would contraindicate the use of tretinoin topically with or without Vibrafusion.
What is treatment with Vibradermabrasion like?
The treatment is performed in the office, and is quick and comfortable.  There is an enjoyable and gentle massaging or “buzzing” sensation as the treatment is performed.  The strength of the treatment is adjustable, and so is customized for the comfort of each individual.   Vibradermabrasion can be performed on any area of the body, but is commonly performed on the face, neck and chest areas.
Will there be restrictions after treatment with the Vibraderm system?
There are no special restrictions after treatment with the Vibraderm system.  Restrictions that apply for topical compounds would also apply when used with Vibrafusion.  For example, use of tretinoin topically is photosensitizing and precludes sun exposure with or without Vibrafusion.  It is fine to exercise or wear make-up immediately following treatments.
How quickly will I see results?
There is an immediate, more smooth and polished look to the skin.  Within 2 to 6 weeks, the skin will show evidence of increased collagen production.  A good skin care program at home will enhance the results.
Are the results permanent?
Typically, a series of 6-10 treatments are performed every 1-4 weeks for maximum improvement, and results last 3-6 months.  Maintenance treatments are usually performed once every 1-3 months following the completion of the initial series.  It is safe and gentle enough to be performed every week for the rest of your life! 
What are the risks, potential complications and side effects of Vibradermabrasion?

·         Mild swelling or redness of the skin immediately following the treatment, but generally no downtime
·         Hypersensitivity to the treatment or to a topical compound
·         Allergic reaction to a topical compound
·         Tickling sensation or sneezing with treatment of the nose


Monday, May 2, 2011

Take a Sec (S.E.C.) to Understand the Elements of Good Skincare


Our entire “suit” of skin replaces itself approximately every 6 weeks. It does this by sloughing off old, dead skin cells on the surface of the skin, which stimulates the production of new skin cells in the deep layers of the skin. The new skin cells then undergo some changes as they migrate gradually to the surface of the skin. Once the skin cells reach the surface of the skin they are then in the category of old, dead skin cells, and they are ready to slough off. This process, known as skin cell turnover, slows down as we get older; so that the old, dead skin cells accumulate at the surface of the skin making the skin look dull and coarse. Newer skin cells are not as rapidly or frequently produced and skin loses the healthy glow it once had.

As we age many other undesirable changes begin to occur in our skin unless we take the time to encourage our skin to remain healthy. Because skin is the largest organ in the body, keeping it healthy makes a big difference in how we look and feel. Along with the slowdown in skin cell turnover there is a decrease in the production of collagen and elastin, two of the proteins that give skin its shape and elasticity. Loss of collagen and elastin leads to sagging and wrinkling. The decrease in skin cell turnover also means the skin heals more slowly and does not protect itself as well from damaging sun rays. There is a decrease in production of glycosaminoglycans (GAGS, for short) such as hyaluronan which bind water and give our skin plumpness or juiciness. Hyaluronan also participates in tissue repair and hydrodynamics, as well as migration and proliferation of cells. This extremely important polysaccharide acts as a free radical scavenger and drives collagen formation. Two of the most damaging influences for our skin are UV or ultraviolet light (sun and/or tanning bed exposure) and tobacco use (smoking). Both of these environmental exposures accelerate the changes of aging in the skin. Prolonged UV exposure creates additional signs of aging in the skin such as age spots, diffuse uneven pigmentation, spider veins and eventually dermatoheliosis or photoaging, a term usually describing the leathery, pebbly texture of skin that has been chronically and extremely damaged by the sun.

Unfortunately, the damaging effects of sun exposure do not really appear until 10-20 years into the exposure. This can make it difficult to convince a person in their 20’s that tanning will eventually result in some very ugly and unhealthy skin changes. It is often difficult to convince a person over 40 that it is the sun that has caused all of the changes they would now like to improve. I tell my patients that using really good skincare products, consistently, every day, at home is the most cost effective way to begin their journey to healthy skin. Any other treatments or procedures they choose to do will be far more effective if we prepare their skin with good skincare.

There are basically 3 elements of good skincare that everyone can incorporate into their daily routine. We use the S.E.C. acronym and advise taking a sec to improve the health of the skin twice a day.

S is for sun protection. This is an absolute must if you are serious about maintaining healthy skin. It does mean using a sunblock every day (yes, winter too—have you never gotten a sunburn in the snow?); but this is really only meant to protect you during brief forays into the outdoors, such as walking from your house to your car. When you are spending an extended period of time outdoors (walking, gardening, attending a sports event, etc.) you actually need to cover your skin with protective clothing and provide your own shelter in the form of a large-brimmed hat or parasol (no, a baseball cap is not good enough for obvious reasons—it only shades about 25% of your head and neck and exposes your vulnerable ears). The argument I usually hear in favor of sun exposure is the need for vitamin D. Vitamin D is an extremely important vitamin produced in the skin in UV light that actually behaves as a vital hormone (see previous vitamin D blog), but here’s the thing: you cannot get enough sun exposure to create adequate amounts of vitamin D in your system without damaging your skin. Normally I am all for living like a caveman or caveperson, but not in this case. Cave people had an intact ozone layer to protect them, which we do not; and cave people died by the time they reached the age of 35, which we do not. It is best to simply take your vitamin D3 as a supplement, at least 5,000 u per day as an adult, and avoid the damaging rays of the sun.

If you do nothing else, an increase in sun protection will improve your skin.

E is for exfoliation. This is a term given to the act of removing the outer layer of coarse, dead skin cells and is usually done mechanically or chemically. Mechanical exfoliation is simply performed by abrading the surface of the skin in a gentle manner. Methods of mechanical exfoliation include washing with a loofah or buffing pad, washing with scrubbing granules, or using a microdermabrasion device. Chemical exfoliation is performed by applying an agent that loosens and removes the surface skin cells. Alpha hydroxy acids (AHAs) are commonly used for exfoliation. All of the AHAs are derived from natural substances such as fruit, nuts, or milk. The most effective AHA is glycolic acid, derived from sugar cane. Glycolic acid is the smallest molecule in the AHA category, which allows it to penetrate more deeply into the skin for greater effectiveness. In a glycolic acid solution, the pH or acidity of the solution and the concentration of glycolic acid determine how strongly the solution interacts with the skin.

Whatever method of exfoliation is chosen, the end result is that the gentle removal of the outer layer of coarse, dead skin cells stimulates the creation of new, fresh skin cells in the deeper layers of the skin. There is an increase in skin cell turnover, so that more new skin cells are coming to the surface of the skin. Consistent, daily exfoliation means that new skin cells are constantly being sent to the surface of the skin. Why is this a good thing? Because new skin cells are better at making collagen and glycosaminoglycans, and new skin cells are better at protecting you from damaging UV rays. In fact, regular exfoliation can decrease your risk of skin cancer.

My personal favorite methods of exfoliation include use of Rx Systems glycolic acid wash and cream because this line has a lower pH (more acidic) and includes alpha lipoic acid, a very potent antioxidant (see previous antioxidant blog) that has even more protective effect versus UV rays; use of the Clarisonic device for cleansing because the brush is gentle and nonabrasive yet the sonic energy applied to the skin is super cleansing and stimulating; and the occasional (monthly) treatment with an in office glycolic or combination chemical peel (see previous chemical peel blog) alternating with treatment with vibradermabrasion because this is the absolute best of the microdermabrasion world (each patient has their own treatment paddle made of surgical steel and the polishing effect of the paddle is enhanced by the application of vibrational energy for maximum skin transformation.)

C is for collagen stimulation. As I noted above, many of the more undesirable changes of aging in the skin involve a decrease in the amount of collagen produced by the skin. Therefore, when addressing fine lines and wrinkles, enlarged pores, and sagging or draping of the skin it is all about the collagen. Regular exfoliation will have an effect on collagen production, but we can do better still.

If you are young and relatively line-free you can get by with a low level collagen stimulator for maintenance and prevention such as vitamin C serum. My personal favorite is the Rx Systems vitamin C serum because it is packaged in such a way as to prevent contact with air and light until you actually use it. This is advantageous because the exposure of vitamin C serums to air and light not only begins the breakdown of the vitamin C; it actually creates free radicals that are harmful to the skin (see previous antioxidant blog.) Vitamin C applied to the skin also helps to prevent skin cancer.

The most powerful of the collagen stimulating topicals are the retinoids, or molecules related to vitamin A. I love the retinoids because they do so many things for the skin. They reverse sun damage, they stimulate collagen and so are anti-aging, they are anti-acne (and let’s face it, many of us fight both acne and lines), and they take any other product you use with them deeper into the skin. My personal favorite is Retrinál from Avene because it is a top performer when it comes to collagen stimulation, but does not have many of the undesirable side effects of the other retinoids such as redness and peeling with regular use and sun sensitivity, making it OK to use year round.

There may be a need for a fourth element of good skin care if you have pigment issues. If you have freckles or solar lentigos (superficial depositions of darker pigment indicating your skin is very sun sensitive) or if you have what is known as actinic bronzing (pigment variability with both dark and light spots from chronic sun exposure) you will want to include a lightener twice a day to encourage pigment evening and extra attention to sun protection. I have my personal favorites here as well—for a lightener with hydroquinone I like Blanche from Neocutis and for a lightener without hydroquinone I like Vibrance from Vivité by Allergan.

It may sound like a lot of effort, but taking a S.E.C. to improve your skin twice daily and maybe even adding in an office procedure once a month or so will result in skin that is healthier and skin that looks healthier. Your skin will have fewer lines and will be tighter, the pigment variations will be improved and your skin will have a new luminescence or glow.

Additional recommendations:
Use a good eye cream twice daily.
Consider a good lip treatment twice daily.
Don’t forget the neck and décolleté!