Surface Clinical

2012-02-05T17:37:00.000-08:00

"Nothing makes a woman more beautiful than the belief that she is beautiful" Sophia Loren said this.

I think it's true.What makes you feel beautiful?
Think about it. Feeling beautiful needs to be inside your head just as much if not more than on your outer self. What makes you feel like you look good? Mani pedi, new dress, Yoga? When you feel pretty, your mood is upbeat and your confidence goes up up up.

There are some tricks to making yourself more beautiful, even if no one but you notices more than a subtle difference.

I'm getting some of this from a cute little book, Things a Woman Should Know About Beauty. I thought of writing on this because it's that time of year when people are trying to improve themselves. Diet, and exercise are usually at the top of the list. Those are really important, but I have a few more suggestions to add the beauty list.

Have a make-up lesson. You can learn how you could accentuate your best features. I would suggest you use an independent person for this rather than someone at the make-up counter. A make up artist that comes to your house isn't trying to sell you a bunch of make-up and they will probably be more honest with you.

Clean out and organize your closet. Separate the clothes that you always feel good in and get the ones that are a struggle, never quite right, out. Rewear things that look good on you. No one remembers or cares except you. There are people you can hire that will help you organize your wardrobe.

Ok, most of you know this, but in my business what we do helps people improve and feel better about their appearance. To start with, I give a skin care consult and make sure the person is on worthwhile products. I also suggest clinical treatments. My favorite is Botox. Easy and quick improvement.
It is awesome to watch how Dr. Barton's surgical patients change how they feel about themselves. For us to see someone go through whatever it might be and then to feel better about themselves, feel beautiful, it is the best!!!

Men, don't feel left out. All of this, except maybe the make-up lesson :), can apply to you. Dr. Barton and I have quite a few male patients. Feeling attractive and handsome is important no matter who you are.

I'm going to get serious about exercise and clean out my closet. I am fired up!

Hope this helps,
Liz

Be Careful With Home Treatments

2012-01-25T18:53:00.000-08:00

Monday, on my way to work, I got a text from a good friend needing help. She had tried a "home made" face peel she had seen on Dr. Oz and her face was blistered!
I like Dr. Oz just fine, but ..... not everything you see on TV or read in your fashion magazine is as good as it sounds. Or maybe I should say "is good for you". She told me it was a few spices mixed in ???something, maybe olive oil and then applied on the face. She did not hear or maybe know to be gentle and not use any of her corrective products she usually applies. She reacted to the spices themselves or to the combination of the peel and her normal skin care regimen.
My friend will be OK. She is just getting a really big peel when she thought it would be no big deal. Luckily she knew to call for help and we can laugh about it. Her skin is very unlikely to have any long term issues such as hyperpigmentation or scaring, but WOW, why risk it?

People need to understand that just because something is out of the kitchen cabinet or the garden (botanical) or just seems simple,doesn't mean it couldn't cause a bad reaction.

When I was a derm nurse, I remember this beautiful patient that came in with bad burns on her face because she applied a glycholic acid peel she had gotten ahold of some how and she left it on all night. Glycolic acid does not neutralize on its own, so it just basically "cooked" her face all night! Her face was burned to where it would more than likely scar.

Please be careful with self induced treatments without full instruction.
Doing it yourself to save a penny or save time is not worth the risk.
Hope this helps,
Liz

OUR NEW OFFICE

2012-01-03T16:11:00.000-08:00

Mary at her new, not quite completed desk.

Everything is all new, clean and fresh just like how you want to start off a new year.

It is such a good and energizing feeling!

It is kind of like that satisfying feeling I get when I clean out closets or organize my desk. That must sound weird that cleaning makes me happy, but it is really just that satisfaction I get when it is done.

I want to work on skin care and our health in general like this, too.

First, clean out the bathroom drawers and get rid of any old, out of date products that you never use. Pull out the worthwhile tubes and bottles and keep it simple. Use your Retin A or corrective products at night and your protective products in the morning. Along with this, I want to get back in the habit of exercising (once a month won't cut it) and healthier eating habits. Plus I need to try to drink more water. Results will be evident in 6 weeks ! Here I go or we go!!
HAPPY NEW YEAR!!!!!
Liz

Surface Clinical is moving

2011-12-01T18:49:00.000-08:00

It has been too long since I blogged and I am so sorry!

The reason why is very exciting !!!!!

Dr. Barton and I have been busy getting ready for our office to move to a new location!
We are moving the week between Christmas and New Years to 4311 Oak Lawn in the Hampton Court Building ,suite 380. I really think everyone will be happy with our cool new office.

I took these pictures tonight of our new suite using my iphone. They are terrible quality and you can't tell much from them, but I am so anxious to share the news with you, that I am not worrying about it.
I will continue to keep you updated and will have more details soon. I hope you all are loving the pretty Christmas lights and the colder weather! Try not to get stressed from the holidays because your skin will show it. Soooooo..................................
My best advise for that is.......put on some bright red lipstick, turn on some Bing Crosby Christmas music, pour a glass of wine, and enjoy the season!

Liz

Over Doing It

2011-09-28T08:32:00.000-07:00

Can you really be doing too much to your skin?

In the September issue of ELLE, there is an interesting article called URGE OVERKILL. In this article, the writer is describing a visit to her dermatologist. She apparently had been using multiple products that seemed to help in the past, but shockingly now, she describes her once nice complexion as "revolting".

Can this happen for no apparent reason? You use the same products for months, or years and all of a sudden your skin can react?

Absolutely yes this can happen! Overnight your skin can go from smooth and clear to a red, bumpy, embarrassing mess! WHY?

It may be due to hormones and aging, stress, or products.

In this article the derm thinks she's doing too much to her skin, over using products. He suggests giving her skin a "skincation". The doctor recommended she treat her skin with gentle soothing oils.

I don't really agree with the oils for everyone, but I do think it is a good idea to give your skin a rest from your normal routine and only do basics.... Just use a gentle cleanser, a plain soothing moisturizer and sun screen. An easy time to do this is when you go on a vacation. That way you don't have to pack all the jars and bottles. This gives you and your skin a temporary break. I don't think you should do this long term, just occasionally is enough.

Hope this helps,

Liz

Baby Skin

2011-08-08T14:38:00.000-07:00

There is nothing as soft and smooth as a newborn baby's skin. I thought about it yesterday as I was holding my new grand baby. Wouldn't it be nice if our skin stayed that way forever? We wouldn't have any freckles or wrinkles or large pores. The sun affects our skin more than any other factor, even more than father time, but hormones are another factor that I am not sure many people think about. As you grow into teens and your hormones are raging, some teens get acne and hormones play a big part of that. Then as you age, our skin gets dryer from the loss of hormones.

Dr. Barton and I are looking into transdermal creams that may help with the loss of hormones, therefore, help with skin quality. I am not sure how I really feel about hormone replacement therapy (HRT). My concerns are about safety and whether or not it can be an effective treatment for the skin. Dr. Barton is very thorough in researching anything and everything we use so I am interested in what he thinks. Besides his talent, the quality of care he gives to our patients is why I respect him so much.

I will keep you posted on what we figure out, but in the mean time, keep using your sunscreen.

Hope this helps,

Liz

Moisturizers

2011-07-27T13:47:00.000-07:00

Moisturizers
How important are they?

Moisturizers are basically made up of oil in water. Moisturizers lubricate the skin making it feel soft and smooth. They are generally made up of large molecules so they remain on the surface of the skin and help prevent water from leaving the skin. In a sense they are protecting your skin…keeping things from coming in and going out.

Believe it or not, moisturizers do very little in preventing wrinkles and aging. Your grandmother that gobbed on her night cream and had beautiful skin really had beautiful skin from genetics and sun protection not the night cream. Moisturizers plump up your skin making wrinkles appear smoother. The only way a moisturizer helps with aging is if it has sunscreen or active ingredients like Retin A.

The moisturizers that are medical grade should only be found in doctor’s office. The expensive, fancy “anti-aging“ creams found at cosmetic counters have very little effect because they do not have any medical strength ingredients. Also, products claiming to have “collagen and will build more collagen” make me crazy! Collagen is too big of a molecule to get through the epidermal skin layer to the dermis and the dermis is where collagen lives.

Another eye opener is, not everyone needs to moisturize. If you are not dry, then you don’t need to moisturize. It is as basic as that. Oily skin doesn’t need more oil. Climates and age do affect skin’s moisture so the need to moisturize depends on the person and environment.

The moisturizers that I most recommend found in a drugstore are: Cetaphil, CeraVe, and Moisturel. Some I carry at Surface Clinical are: Elta MD’s Daily Moisture with SPF 40, Skin Medica’s Ultra Sheer, Rejuvenize, and Dermal Repair, and Neocutis and Vivite have several options.

Hope this helps,

Liz

Sun Protection

2011-06-29T09:52:00.000-07:00

Sun protection is the last, but certainly not the least important step of basic skin care. In fact, it may be the MOST important.

If you do nothing else at all, use a broad spectrum sunscreen that protects against UVA and UVB.

UVA is the long wavelength that causes skin cancer and aging. UVB is the short wavelength that causes sunburns. Most sunscreens protect better against UVB. SPF refers to UVB only. Problems start when someone applies a sunscreen with a high SPF which blocks only UVB and then stays out for long periods of time. This allows more time for UVA to penetrate into the skin, damaging skin cells and increasing your risk of skin cancer.

SAVE YOUR SKIN!
Get in the habit of applying sunscreen daily, all year round, even on cold, cloudy days. Choose a sunscreen that smells good and feels good so you don't mind putting it on. Use it for your moisturizer. When choosing a sunscreen, I think even more important than the SPF are the active ingredients. I want to make sure there is zinc oxide listed which is the best block, in my opinion. It is a physical block, as opposed to chemical, and people tolerate it easily. Zinc oxide is now clear and might be listed as Z cote. These cosmetically nice sunscreens are hard to find in a drug store. Plastics and dermatology offices and spas sell them. I sell a pretty big variety because people's needs are different, like acne prone skin and aging dry skin.
Antioxidants also play a role in skin protection. Topical vitamin C and E have been proven to fight off free radicals which damages the skin's collagen, elastin, and DNA. They are not to be used as a sunscreen, but used along with sunscreen for added benefits.

Clothing obviously helps protect the skin against nature's elements. Tightly woven darker cotton hats and shirts are good choices. You can also find clothing that has been treated and actually has sun protection in it.
I always tell people that you will still get some color despite all of these precautions plus just use self tanners and take care of your skin.
Hope this helps,
Liz

Correcting and Stimulating

2011-06-24T12:45:00.000-07:00

Correcting and stimulating is a biggie in the steps of basic skin care.

Most everyone that walks in my office wants to correct something and slow down aging. There are many options available for correcting skin and stimulating skin cells. The only problem is it takes time. If you are compliant with a regime and patient, you can see results.
I like to start with products.
For selecting skin care products, some of the same exfoliants I talked about in my last blog, also correct and stimulate skin cells. Number 1 on my list is Retin A or Tretinoin. Retin A is tough to beat. It's a prescription cream that actually penetrates and reaches the dermal layer of skin. The dermis is basically the second layer of your skin where collagen and elastin fibers intertwine. With aging, we lose collagen and elastin. Retin A stimulates skin cells to turn over old and create new, thus stimulating collagen. Retin A repairs sun damage, can fade freckles, helps with fine lines and remember, it exfoliates too. Every one should try to use it, but if you can't seem to tolerate it, retinols are a milder form, but still beneficial.

Other topicals that stimulate and correct are growth factors and acids.

Besides the well known alpha hydroxy acid, which is made from sugar cane, different plants and botanicals are used to correct pigmentation and sun damage. Kojic acid, emblica fruit extract, and lickerish root help block Tyrosinase. Tyrosinase is what allows melanin to form which then shows up as sun spots and melasma. Botanical ingredients are being used more and more often due to the Hydroquinone issues.
Treatments are often recommended in conjunction with products to give a better more complete result. Treatments that help stimulate and correct include Botox, fillers, various choices of chemical peels, IPL (FotoFacial), and lasers, such as Dual Fraxel.

Hope this is helpful,

Liz

Exfoliating

2011-06-15T10:32:00.000-07:00

Another basic step in good skin care is exfoliation. Exfoliation helps remove dead surface skin cells, dissolve and loosen surface intracellular cement that holds cells together making the skin look smoother and more refined. Some exfoliating can help with stimulating and correcting, improving moisture content and the barrier function of skin, influencing the skin cells. Effects of exfoliating also enables products to penetrate the skin better. On oily skin or acne prone, they work by loosening pore impaction and removing dead skin cells within follicles to treat and prevent hyperkeratosis that can cause acne.

There are several methods of exfoliation. Mechanical means of exfoliating are like microdermabrasion, microdermaplaning (shown in the picture), the use of a Clarisonic brush, and even a wash cloth exfoliates. These treatments are often used along with exfoliating products for a bigger effect.

Glycolic, lactic, tartaric, malic, salicylic, and enzymes all can exfoliate and are used in products of various forms like in cleansers, creams, and peels and scrubs.

How do you know which exfoliants to use?

First, I want to tell you the scrubs with shells, like apricot scrubs, are not a good choice. They scratch your skin and are much too rough.

So, figure out you skin type and desired result, then you and your skin care person can choose which methods and products to use.

My suggestions for the best methods for specific skin types are:

Any skin type can benefit from using a Clarisonic brush…. men, women, teens, sensitive skin, acne prone skin, dry skin, all skin.

Speaking of men, did you know men exfoliate daily by shaving?

If your skin is sensitive, you are best using a Clarisonic brush, use a retinol ,have a microdermabrasion and or mild chemical peels occasionally.

For oily skin types, exfoliating is tolerated easily, but don't over do it. Note to self :) If you dry your skin out or strip the normal oil barrier, your skin could get oilier trying to make up for the loss. Salicylic acid (and acid combinations with SA ) products, peels, microderms, and use of Retin A (Tretinoin), and scrubs are beneficial.

Dry skin and aging skin will benefit using Glycolic and Lactic acids products, peels, microderms, and Renova, which is Tretinoin in a heavier cream base. These products stimulate and correct signs of aging. As I mentioned earlier, exfoliation can help dry skin because it improves the skins moisture content.

Hope this is helpful.

Liz

Changes with Dispensing RX Products

2011-05-31T12:17:00.000-07:00

About a month ago the Texas Department of State Health Services and the Texas Attorney General’s Office expressed concern about the dispensing of prescription strength products from a physicians’ offices across Texas. A doctor can write the actual prescriptions for a patient to purchase from a pharmacy, but they doctor’s office can’t offer it or sell it in their office. Obviously, this has nothing to do with the safety of medical care, but rather is an effort by the pharmacists to control sales revenue. However, this effects convenience and the continuity of care we like to give our patients. Several of my products from, Obagi, Skin Medica, and Neocutis had to be pulled from our shelves. The products involved are Retin A or the generic is Tretinoin, and all products with 4% hydroquinone, like Obagi's Clear and Blender, Skin Medica's Epiquin Micro, and Neocutis' Blanche.

I am also bothered by the inconsistency the pharmacy products will have. This is mainly the generic hydroquinones . as opposed to branded products which are consistent in quality, generics differ in texture and weight. I like to be able to hand select a specific product for a patient. I may be able to prescribe a strength, but won’t always know if it is in a heavy cream or possibly runny? The Obagi people are working at getting this reversed, but I have not heard anything yet.

Due to these changes, I have been aggressively working with Dr. Barton and have added some different products to my office. Two lines, Vivite and Neocutis have excellent skin brighteners and lighteners. We feel these lighteners will give comparable results to hydroquinione. This is exciting and I think everyone may benefit with some change. I will fill you in the details of the new products soon!

Cleansing Your Face

2011-05-20T09:04:00.001-07:00

Does it really matter what you wash your face with or for that matter, even if you wash your face?
The answer is a big YES!
It always surprises me when someone tells me they don't wash their face. Everyone should cleanse their face in the morning and at bedtime. Oils, make up, and just yuck build up on your face throughout the day and night and need to be removed, otherwise, you will have dirty skin with get clogged pores, and dead surface cells.
How to choose a cleanser right for you.....
Rule #1 Don't use your deodorant body soap on your face. Bar soaps are basically detergent.
A lot of information about soap is not available to the average consumer. Soaps don't list their pH, but a soap's pH is around 9 or 10, which is alkaline. Soaps strip your skin of a necessary oil barrier. Even if you have very oily skin you need the barrier and washing off the oil on the surface, cannot change oil production by washing with a strong soap. The pH tells a lot about mildness and harshness. Healthy skin is naturally acidic, with a pH between 5.5 and 5.8. All this is really telling you is don't use Lever or Lava soap on your face, it is too harsh.
So what is right for you?
If you are dry or a normal skin type, you can choose a cleanser with Glycolic or Lactic (both AHA's). Believe it or not, these acids help dry skin, plus, you get some anti-aging benefits.
If you have sensitive skin, find a milky, creamy cleanser like Cetaphil or CerAve found at the drugstore or cleansers found in a physician's office like Skin Medica's Sensitive Skin Cleanser or Obagi's Gentle Cleanser.
If you have oily or acne prone skin, look for cleansers with Salicylic Acid, resorcinol, benzoyl peroxide, or sulfur in the Active Ingredients. My very favorite is cleanser is Obagi Clenziderm Cleanser. It is very refreshing! I had problem skin as a young adult and now have Rosacea and so like using an acne type cleanser, but some Rosacea patients may need something for sensitive skin. Rosacea will be another topic.
Washing with just finger tips is typically recommended by dermatologists. If you wash with a wash cloth, use a clean one and be gentle. Another neat tool is the Clarisonic Cleansing brush. It is a gentle way to thoroughly wash and exfoliate.

Boston Meeting

2011-05-16T16:46:00.000-07:00

Every spring I attend a skin care meeting (SPSSCS) which is held in conjunction with a plastic surgery meeting (ASAPS). This year it was held in Boston.

I always look forward to it because for several days I am with 200- 300 people that do what I do. Dr. Barton, the Plastic Surgeon I work for, started this organization maybe 15 years ago. He knew skin care was important and nurses and aestheticians needed to stay current on treatments, products and science. Now, years later there are over 400 members from all over the world. I heard some really good talks. I went with Dr. Barton to one of his sessions called Hot Topics. There was a lot regarding the future of using fat for procedures like a breast aug. Never knew you might be glad you have a little extra fat!

My friend Joan, a nurse from Baton Rouge, met up with me and we took a few additional courses on lasers and injectables (Botox and fillers). Besides sharing Botox and vein techniques, Joan is the bad girl that got me playing words with friends! Dang, it is about as addicting as Botox!!

Anyway, I am glad to be back in my office applying some of my new knowledge and it’s just nice to be home.

I will get back to my series next week…cleansing your face.

Skin Care Basics

2011-04-28T13:37:00.000-07:00

To understand how to care for your skin, you need to know the fundamentals of good skin care.

The basic steps are cleansing, exfoliating, cell stimulation, and sun protection. In my next few entries, I will explain the best way to do each step. Stay tuned….

Why should you read my blog?

2011-04-01T06:29:00.000-07:00

The media inundates us with so many new lotions, potions, miracle lasers, and 1-hour facelifts. It is hard to know what really works. I am a nurse with 30 years experience in dermatology and plastic surgery. I work with lasers, skin care and injectables. My philosophy, and that of the doctor I work for, is to really check things out scientifically and then be honest with our findings …this means you might not always like what I say. Each week I will post cosmetic information I hope is helpful and interesting.