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Acoustic wave therapy

Dr. Q's Shockwave Therapy

Don't let pain control your lifestyle

Extra corporeal Shock wave Therapy treatment (ESWT) is a clinically proven treatment available for patients presenting primarily with chronic tendon disorders. This is a successful second line treatment for patients who fail to respond to appropriate conservative management including physiotherapy.

What does it involve?
Shock wave is a procedure where sound waves of energy are passed through the skin to the injured part of the body using a special device. The shock waves are mechanical and not electric and work by increasing blood flow to the injured area. This accelerates the body’s healing process.The ESWT application lasts about 5 minutes to deliver the shock wave energy and you must attend for 3 sessions over 3 consecutive weeks.
Indications:
Patients must have an on-going tendinopathy or calcification for more than 6 months and have failed at least one course of conservative treatment such as physiotherapy, injection therapy or orthotics. All patients must have had some imaging to confirm diagnosis prior to ESWT.
Contraindications:

• Pregnancy
• Lung tissue in direction of sound fields
• Presence of a Cardiac pacemaker
• Has had a Cortico-Steroid injection in the area in past 3 months
• Over or near bone growth centers until bone growth is complete
• Malignancy is known to be present in or near the treatment area
• Treatment site has open wounds, skin rashes, swollen, inflamed, or infected areas
• Over ischemic tissues in individuals with vascular disease
• Coagulation disorder or taking anticoagulant/antiplatelet medications
• Infection at the treatment site to avoid the risk of spreading
• History of latex allergy or allergy to coupling solution

Conditions:
- Plantar fasciitis
- Achilles Tendinopathy
- Patellar tendinopathy
- Calcific tendonitis
- Greater trochanter pain syndrome
- Tennis elbow

Referral for shockwaveShockwave treatment is predominantly accessed via our Sports and Musculoskeletal medicine Service.  Your GP can refer you to the sports service via the e-Referral system.  You will initially receive a specialist clinical assessment. Shockwave is not considered to be a first-line treatment option.  You must have had some form of imaging and undertaken a course of conservative treatment, such as physiotherapy, prior to receiving shockwave therapy.

Dr. Q's Modified Shockwave Therapy System

Dr. Q's HIFU Face Lift

HIFU is an advanced non-surgical facial rejuvenation treatment which offers natural real lasting results, without damaging the skin surface!

 Benefits of the HIFU Facelift Treatment

    Stimulates the body’s natural healing process.
    Lifts and tightens eyebrows
    Reduces Wrinkles
    Non-surgical facelifting
    Lifts and firms the chin/jaw area
    Lifts and tighten the cheeks
    Reduces nasolabial folds
    Lifts and tightens the neck area
    No post treatment downtime
    No damage to the surface of the skin

 HIFU (High Intensity Focused Ultrasound) is the next generation in advanced non-surgical facial rejuvenation, providing  deep penetration, real lasting results and no damage to the skin surface! The closest technology available to a true surgical face-lift without surgery.

HIFU is also known as the Ultrasound Facial, Ultherapy or 3D facelift.

 A REAL alternative to needles and surgery

HIFU achieves amazing visible lasting results NATURALLY. Focused ultrasound activates and accelerates the body’s own healing process in the face and neck areas. This stimulates sagging skin to tighten itself and become visibly firmer. It requires no creams, no artificial filler products or toxins. It relies solely on the body’s natural regenerative capacity.              The surface of the skin is not affected, as the treatment targets the deeper muscular layers.

After the treatment, you can simply go about your usual activities. With the advantage of three treatment depths (1.5mm, 3mm and 4.5mm), HIFU has the capability of penetrating to depths only previously possible with surgery.

Shrink Large Pores on Face Permanently

6 Laser Treatments to Shrink Large Pores on Face Permanently

Large pores are a big skin concern. And even if you are trying to hide those large pores with the help of makeup then also it will serve no purpose. It is because large pores emphasize your makeup and thus highlight them more. And if you are suffering from really large and visible pores, then there is seriously very less that you can do. But there are a number of laser treatments available in the market which can help you in case of large pores. Let’s have a look at the following given laser treatments which will help to shrink large pores on face permanently.

 

1. Non-Ablative 1540 or 1440 Laser Treatment:

This involves 3-4 sessions depending on your skin type. Here, the laser goes and penetrates deep into your skin, so that a new collagen production is enhanced and thus, your pores will get disappeared and smaller or it can even get compressed at the same time.

 

2. 2940 Ablative Fractional Laser Resurfacing:

This is a non-ablative treatment which is very much like an actual laser skin peel. Your entire skin will be peeled and it will remain red for some 5-7 days. But this treatment is much gentler when compared to the old CO2 laser resurfacing.

 

3. Fractional Laser Technology:

This is the newest form of laser treatment. Here, new collagen production is boosted so that your larger pores are shrunk and there is new skin production. This has proven to be very successful even with the sensitive and mature skin type.

 

4. AFT Technology:

This is a light device which is perfect and gentle to be used on all skin types. This device deeply penetrates into the skin and helps in the production of new collagen so that your overall skin is much brighter, smooth and refined. Also, pores also eventually shrink down with this technology.

 

5. Pixel Perfect Technology:

Here, the skin goes under a self-exfoliation technology. The old skin which had pore issues goes away or is rather scrubbed away and, in return, you get a new skin which is incredibly soft and is much brighter.

 

6. Clearlift:

This is a US-FDA approved technique which helps in boosting the skin. This is specifically targeted towards skin having pore issues. This induces collagen production into the skin which makes the skin much more elastic and also makes it brighter over time.

So, these were some of the best and extremely effective laser treatments to shrink large pores on your face. Do add if you know some more laser treatments in the comments down below.

Dr Q's HIFU

What is HIFU Skin Treatment

 

High intensity focused ultrasound otherwise known as HIFU, is a treatment to reduce the telltale signs of ageing. This is a non-invasive, painless and innovative alternative to a surgical facelift and is also a good treatment for those who have had surgery and would like to rejuvenate some of the effects.

HIFU delivers precise ultrasound to the correct depths of the skin without damaging the epidermal layer. Muscles are stimulated and new collagen is produced. This treatment uses thermal energy that heats up the tissue, tightens the skin and forms new collagen. HIFU affects the dermis and SMAS; the same layer that is pulled tight during a surgical facelift, but without the pain and scarring.

This procedure is a very effective treatment to lift and tighten a sagging jawline, neck, cheeks and brows. HIFU results can be seen after one treatment, leaving you with a rejuvenated and a much more healthy, youthful appearance.

The results from HIFU continue to improve for up to three to six months after the treatments. You will have a younger, fresher appearance for around 12-24 months, after which time, follow up treatments are recommended to maintain results.

There is no downtime involved with HIFU treatment and it is painless, although some people notice a slight discomfort during the treatment which subsides soon after the procedure. Due to no fillers or other toxins being used, there are usually no side effects. A slight flushing or occasional swelling can sometimes occur, but these are completely normal and these effects subside within an hour or two. It is recommended that a good sunblock is used to look after the skin after treatment.

This is a treatment which is suitable for most people with mild to moderate skin sagging, as it is non-surgical and requires no downtime; allowing people to get back to their daily lives immediately. HIFU is an exciting development in the field of aesthetic medicine due to its long-lasting effects and cost-effectiveness.

HIFU is not a replacement for a surgical procedure, it is an option for those who do not want to go under the knife. It is a good choice for people who have noticed their skin maturing, sagging or just looking looser than it previously did. It is also a good option for somebody who wants to stay ahead of the game and hold back the effects of time or maybe just wants an uplift instead of a facelift. Both men and women between 30 – 50 years old are suitable candidates for this treatment.

Having been used for over 50 years in the medical field, ultrasound has a proven track record and is clinically safe making HIFU one of the skin tightening treatments available.

Lifting, tightening, toning and brightening give the skin a whole new vitality making HIFU one of the most sought-after lifting treatments available today. This procedure can also be combined with laser treatment or fillers. This is a much more cost-effective, safe way to look and feel confident and more youthful than a lot of surgical procedures.

The treatment of pigmentary skin disorder.

High intensity focused ultrasound as a potential new modality for the treatment of pigmentary skin disorder.

 

BACKGROUND/PURPOSE:

The clinical skin tightening benefits of high intensity focused ultrasound (HIFU) have been established, but its mechanism of action in pigmented skin disorders remains unknown. We microscopically and histopathologically investigated dermatological changes after HIFU at different exposure doses in a U VB-induced guinea pig model of hyper pigmentation.

METHODS:

We applied HIFU irradiation at 0.1 and 0.2 J/cm(2) to U VB-induced spotty hyper pigmentation in guinea pig skin. The therapeutic effects of HIFU were judged based on gross appearance using photography, dermoscopy, and chromametry during a period of 3 weeks after HIFU irradiation. Histological assessments were performed using Fontana-Masson staining 1 day before and 3 weeks after HIFU irradiation.

RESULTS:

Macroscopically, UVB-induced hyperpigmentation was significantly reduced 2 weeks after HIFU with 0.2 J/cm(2) , and 3 weeks after HIFU with 0.1 J/cm(2) . Histopathologically, the heavy deposition of melanin in the epidermis induced by UVB exposure was reduced 3 weeks after HIFU irradiation.

CONCLUSION:

We confirmed that HIFU has a positive effect on UVB-induced hyperpigmentation as well as mechanical destructive activity. We suggest that HIFU may be useful as an alternative modality for human patients suffering from skin pigmentary conditions.

 

Dr. Q’s HIFU Laser Skin Treatments

Overview

High-intensity focused ultrasound (HIFU) is a relatively new cosmetic treatment for skin tightening that some consider a noninvasive and painless replacement for face lifts. It uses ultrasound energy to encourage the production of collagen, which results in firmer skin.

HIFU is most widely known for its use in treating tumors. The first reported use of HIFU for aesthetic use was in 2008.

HIFU was then approved by the Food and Drug Administration (FDA) in 2009 for brow lifts. The device was also cleared by the FDA in 2014 to improve lines and wrinkles of the upper chest and neckline (décolletage).

Several small clinical trials have found HIFU to be safe and effective for facial lifting and refining wrinkles. People were able to see results in a few months after treatment, without the risks associated with surgery.

While the procedure is also used for overall facial rejuvenation, lifting, tightening, and body contouring, these are considered “off-label” uses for HIFU, meaning the FDA has yet to approve HIFU for these purposes.

More evidence will be needed to find out who is best suited for this type of procedure. So far, HIFU has been found to be a promising treatment that could replace face lifts, especially in younger people who don’t want the risks and recovery time associated with surgery.

HIFU won’t work as well for people with more severe cases of sagging skin.

 

 

HIFU facial

HIFU uses focused ultrasound energy to target the layers of skin just below the surface. The ultrasound energy causes the tissue to heat up rapidly.

Once the cells in the targeted area reach a certain temperature, they experience cellular damage. While this may seem counterintuitive, the damage actually stimulates the cells to produce more collagen — a protein that provides structure to the skin.

The increase in collagen results in tighter, firmer skin with fewer wrinkles. Since the high-frequency ultrasound beams are focused on a specific tissue site below the skin’s surface, there’s no damage to the upper layers of the skin and adjacent issue.

HIFU may not be appropriate for everyone. In general, the procedure works best on people older than 30 with mild-to-moderate skin laxity.

People with photodamaged skin or a high degree of loose skin may need several treatments before seeing results.

Older people with more extensive photo-aging, severe skin laxity, or very saggy skin on the neck aren’t good candidates and may need surgery.

HIFU isn’t recommended for people with infections and open skin lesions at the target area, severe or cystic acne, and metallic implants in the treatment area.

 

 

Benefits of high-intensity focused ultrasound

According to the American Society for Aesthetic Plastic Surgery (ASAPS), HIFU and other nonsurgical alternatives to facelifts have seen a major increase in popularity over the last few years. The total number of procedures performed has increased 64.8 percent between 2012 and 2017.

HIFU has many aesthetic benefits, including:

• wrinkle reduction
• tightening sagging skin on the neck (sometimes called turkey neck)
• lifting the cheeks, eyebrows, and eyelids
• enhancing jawline definition
• tightening of the décolletage
• smoothing the skin

Study results are promising. A 2017 study involving 32 Korean people showed that HIFU significantly improved skin elasticity of the cheeks, lower abdomen, and thighs after 12 weeks.

In a larger study of 93 people, 66 percent of those treated with HIFU perceived an improvement in the appearance of their face and neck after 90 days.

 

 

 

 

HIFU for face procedure

There’s no special preparation needed before having an HIFU procedure. You should remove all makeup and skin care products from the target area before treatment.

Here’s what to expect at your appointment:

1. A physician or technician first cleans the target area.
2. They may apply a topical anesthetic cream before starting.
3. The physician or technician then applies an ultrasound gel.
4. The HIFU device is placed against the skin.
5. Using an ultrasound viewer, the physician or technician adjusts the device to the right setting.
6. Ultrasound energy is then delivered to the target area in short pulses for roughly 30 to 90 minutes.
7. The device is removed.

If additional treatments are needed, you will schedule the next treatment.

While the ultrasound energy is being applied, you might feel heat and tingling. You can take a pain medication if it’s bothersome.

You’re free to go home and resume your normal daily activities right away after the procedure.

 

HIFU treatment for face side effects

HIFU is considered very safe if performed by a trained and qualified professional.

The best part about this treatment is that you’re able to resume your normal activities immediately after you leave the provider’s office. Some slight redness or swelling may occur, but it should subside quickly. A light tingling sensation of the treated area may persist for a few weeks.

Rarely, you may experience temporary numbness or bruising, but these side effects usually go away after a few days.

Before and after

The takeaway

HIFU is considered a safe, effective, and noninvasive procedure for tightening the facial skin.

Its advantages over a surgical face lift are hard to deny. There are no incisions, no scarring, and no required rest or recovery time. HIFU is also far less expensive than a face lift.

Most people see full results three months after their final treatment.

If you’re looking for a treatment that is quick, painless, and noninvasive, HIFU is an excellent option compared to a surgical face lift.

Of course, HIFU isn’t a miracle cure for aging. The procedure is best suited for patients with mild-to-moderate skin laxity, and you may need to have the procedure repeated in one to two years as the natural aging process takes over.

If you’re older with more severe skin sagging and wrinkles, HIFU may not be able to eliminate these skin issues.

 

Dr. Q's Miracle Mask Beauty Therapy

 

Dr. Q's Miracle Mask Beauty Therapy

• SPA QUALITY SKIN TREATMENT AT HOME: This is your one stop, solution to all your skincare needs. Inspired by Korean Beauty, Dermashine's light therapy mask provides you 7 different light colors to treat a myriad of skin problems. Our UV Free non-heat producing LED’s penetrate your facial tissue to boost collagen, clear and tighten your skin, reduce lines and wrinkles, improve skin color, and much more.
• SAFE, NATURAL, COMFORTABLE, AND SIMPLE TO USE: Our light therapy face mask uses the latest in light irradiation technology and quality materials making it safe, comfortable, natural, and reusable. Your skin absorbs the light energy, which then treats your skin condition depending on the color that is used. Use for a maximum of 15-30min per day to see results. (NOTE: Do not use if you have a thyroid condition)
• NEWEST LED LIGHT TECHNOLOGY: 150 LED lights upgraded to emit the most optimal wavelengths with 5 levels of intensity. Red Light- Increased Blood Flow and Collagen Production | Blue Light- Calms and Tightens Skin | Green Light- Improve Pigmentation, Fine Lines, and Anti-Aging | Yellow Light- Smoothes Skin and Reduces Redness | Purple Light- Relaxing, Improves Lymph Metabolism | Light Blue Light- Soothing, Can Help Allergies | NEW White Light- Accelerate Tissue Metabolism

Doctor Q's Summer Offer

Doctor Q is the best n top only Cosmetic Physician in Islamabad Pakistan

Doctor Q's Programm about High Blood Pressure

Doctor Q's Skin Management

Doctor Q's best Non-Surgical solutions

Skin care in the aging female: myths and truths

 

Abstract

I recently had the opportunity to visit a very relaxing and beautiful day spa during the middle-of-the-day break from the sessions at a Keystone meeting. I was having a very tranquil and restorative day, when I went in for my final treatment — a facial. The very chipper and cheerful esthetician began examining my skin and applying various creams, when I then heard her say something that nearly ruined my experience: she claimed that the topical treatment she was about to apply would, in her words, “cleanse my liver.”

As a scientist, I know better. The bulk of the over-the-counter potions that day spas use are harmless and are meant to cleanse the skin and increase transient moisture retention, and to cleanse anything more than my skin seemed a mighty claim. So I decided to embark on a difficult assignment for the sake of the JCI readership: to determine whether a facial or other topical treatments are worthwhile investments to keep skin healthy and wrinkle free. And to see whether or not it is even possible for a topical treatment to cleanse the liver. In pursuit of this goal, I spoke with four dermatologists (Figure ​(Figure1)1) and two estheticians. Here are their perspectives on how to keep your skin (and liver) in the best state possible.

The estheticians’ point of view

Given that the skin is our largest organ and certainly the most visible one, most of us would agree that taking care of it properly is important. In fact, the skin-care industry estimated Americans alone spend over $43 billion per year (1) on topical creams, cosmetic enhancements such as Botox, and spa treatments (spending in this industry alone is over $12 billion; ref. 2).

To find out more about facials, I spoke with two estheticians (neither of whom wanted to be named for this article) at spas in New York City. I also spent some time reading esthetician blogs and other skin-care articles on the Internet. According to the estheticians consulted, a professional facial usually includes some variation on these steps: a thorough cleansing of the skin; a skin analysis by the facialist; exfoliation; extraction of blackheads, clogged pores, and pimples if necessary; a facial massage; a treatment mask; and the application of serums, moisturizers, and sunscreens. Sometimes the facial includes a hand and arm massage, all in the pursuit of both healthier skin and relaxation. In order to preserve youthful skin (in women), they advised quarterly facials, beginning around the age of 25.

One facialist I spoke to said that by getting a proper analysis of your skin, you will learn your skin type so as to properly address your skin’s needs. She claimed that most people are using the wrong products for their skin type and that this causes the skin to become sensitized. Online, I found an esthetician blog that was quite emphatic about how a facialist is better placed than most to recommend topical products and treatments, stating “estheticians have available to them a wide variety of skin-care products that are professional-only products and estheticians know how to use these products properly. Without the training and knowledge of a licensed esthetician, finding the right products for your skin can just be a downright futile endeavor” (3). This is a message I can certainly agree with — the cosmetics sections of most department stores or even most drugstores have a dizzying array of options, and the marketing and packaging can seduce even the most logical of scientists. Splurging on the fancy packaging and boutique skin care can feel wonderfully indulgent, which in and of itself can have psychological benefits.

This is a point the estheticians came back to again and again — the psychological impact a facial can have. They claimed that the relaxing effect of the facial does nothing but benefit your skin and your overall mental and physical health. One claimed, “The stress of daily life shows up in your skin, so taking an hour to relax and focus on yourself will help you physically and emotionally. Sure, facials are a luxury because of the money and time spent, but think about the fact that you have over an hour of protected time without your cell phone ringing and your e-mail buzzing. There is no way to underestimate the power of a little rest, relaxation, and rejuvenation.”

So just how much can relaxation do from a scientific point of view? In my experience, much of the relaxation comes from the massage component of a facial. Again, from the blog, “Massage is a big part of a professional facial. Massage will help you to relax and will also reduce the stress hormone cortisol in your body. If cortisol is left to run amok in the body, it will only hurt you over time, and additionally, massage releases oxytocin, which is one of the body’s feel-good hormones” (3). Unfortunately, the point about cortisol is not completely true — a recent study showed that massage therapy’s effect on cortisol is “generally very small and, in most cases, not statistically distinguishable from zero” (4). Nor is the point about oxytocin completely accurate: two studies point to near minimal changes in oxytocin as a result of tactile stimulation (5, 6).

The estheticians I spoke to and blogs I read went on to discuss other medical benefits to facials: regulation of the immune system, detoxification, reduction in fluid buildup, exfoliation, and lymphatic drainage. Antioxidant facials were claimed to contain free-radical–fighting nutrients that would help remove pollutants from the body (perhaps cleansing my liver?). High frequency electrical currents were also touted as being effective as part of a facial, with claims that they would enhance blood circulation, increase collagen and elastin production, eliminate toxins and bacteria, encourage lymphatic drainage, exfoliate dead skin cells, and improve skin-care product absorption. I approached the bulk of these claims with suspicion.

The dermatologists’ point of view

Given my hesitation about the medical benefits of topical skin treatments, I approached four dermatologists — three academic dermatologists (George Cotsarelis, John R. Stanley, and Michael Detmar) and one Fifth Avenue clinician (Adarsh Mudgil) in my neighborhood to answer some questions about facials and skin care.

We began with a quick primer on skin: just how deeply could a topically applied product available from a spa penetrate the skin (Figure ​(Figure2)?2)? Apparently, a typical ingredient in an effective skin-care product can break up the dead stratum corneum cells and can cause a reactive proliferation of the basal keratinocytes, but most creams do not penetrate through the epidermis. Something like a protein won’t go anywhere past the surface. All the dermatologists spoke at length about retinoids, a class of chemical compounds that are related to vitamin A that can actually pass further into the dermis, including into the blood vessels, which then could have systemic effects. In fact, tretinoin (also known as retinoic acid or Retin-A) is often used in the treatment of dermatological conditions, from photoaging to acne and psoriasis (7). 

 

Given the original impetus for writing this article, I couldn’t help but ask the team of dermatologists if it was possible that a product applied topically by a spa technician could cleanse my liver. All replied with an emphatic no. Detmar in particular commented, “In the concentrations available to spas, it is not really possible for a compound to get to your liver to ‘cleanse’ it. I think that statement belongs more to voodoo than to reality.” Two exceptions were mentioned: steroids applied topically can enter the circulation and can suppress the adrenal-pituitary axis, and carbon tetrachloride can also penetrate — but that compound is toxic to the liver when put on the skin and would be an unlikely component to a spa treatment. So, essentially, I could end the article here: it is sadly impossible to cleanse the liver at a spa, because as Stanley mentioned to me, “It is safe to assume that anything being applied in a spa is unlikely to penetrate far enough to enter the circulation and hence reach the liver, because if they were applying things that entered the circulation, they would be considered to be drugs and that would have to be regulated by the FDA.”

We turned the conversation away from the liver and back to the face; I asked them if there would ever be a case in which there would be a medical benefit to getting a facial. The primary clinician in the group, Mudgil, said, “I never recommend this to my patients. Whenever you have darker pigmentation, and the facialist squeezes out whatever is there — pimples and the like, they can do a lot more harm than good, in the sense that you can end up with hyperpigmentation which can take months to go away.” Cotsarelis added that there is no benefit for people with normal skin — which is the greater part of the population. The only one to disagree was Stanley, saying that a facial can achieve desquamation of dead cells. “The stratum corneum flakes, and you could take off the very superficial layer — if there is a little scaling, a facial can remove that. And there are certain types of facials that a dermatologist could do — with glycolic acid and that can cause inflammation, and with inflammation you get a little temporary edema, and with edema in your face, you look better because you see a transient improvement in fine wrinkling.”

I quoted to these experts the online estheticians’ claims about the major health benefits of regular facials: regulation of the immune system, detoxification, reduction in fluid buildup, stimulation of lymphatic drainage, exfoliation, and stress relief. Stanley said they got it partly right, “I can certainly see how getting a facial could aid in stress relief — and I guess you could say that relaxation modulates the immune system, but a facial is not going to have a direct effect on immune cells. And note that what we said before is in direct opposition to what they’re saying: facials can cause inflammation and then edema, and they’re saying that a facial causes less fluid in the skin. If you have less fluid in your skin, you look dry.”

On the point of fluid build up and lymphatic drainage, two of the academics saw different sides. “I don’t actually understand what is meant by ‘reduction in fluid buildup’ as pertains to the skin unless they mean edema from heart failure — but your kidneys do that for you, not your skin,” said Cotsarelis. “And when do you even have lymphatic drainage problems? If you do, you’re certainly not going to get a facial to solve them. A normal person does not have lymphatic problems on their face.” In contrast, Detmar says there is a constant flow of lymphatic fluid in our skin. When fluid leaks from blood vessels, it is taken up by the network of lymphatics: that is the normal flushing system in our bodies. During aging, especially if you have sun-damaged skin, then lymphatic function deteriorates and you have fewer lymphatic vessels (8, 9). He commented, “You might be able to make a case that you could reduce fluid buildup by having a facial to encourage drainage when your skin has fewer lymphatics. So promoting lymphatic flow can have benefits. Whether or not this is achieved with a facial is a different story.” 

The scientific study

I decided to conduct my own scientific study wherein I asked Dr. Mudgil to assess my skin before and after a facial (though I did not tell him what I was going to have done to my face) to determine whether there was any noticeable difference. Mudgil noted, “You have the benefit of having a fair bit of pigment in your skin, so your skin is very youthful — you have the skin of a 20-something year old, even though I’d wager that you are more likely to be in your mid to late 30s. It can be very hard to tell with darker skinned Asians or Africans how old they are based on their skin. Your skin is really perfectly normal, so I’m not sure I’m going to be able to tell a difference at all in subsequent visits of whether you’ve had anything done.” 

On the advice of several beauty-conscious friends, I chose a medi-spa run by a dermatologist in downtown Manhattan for a basic facial. My facialist (one of the estheticians who did not want to be named) claimed I had “a little bit of congestion in your T zone, and you actually seem a bit dehydrated. I would say you have combination skin where it is oily in your T zone and dry everywhere else. Your nose and cheeks also have some sun damage.” She recommended that I start using an exfoliator with beads or enzymes to help “brighten the skin and bring new cells up.” She also advised me to use an eye cream, as “you’re a little dry in that area. You have no major wrinkles, but you really want to keep that area hydrated in order to prevent them from appearing.”

I went back to see Dr. Mudgil the day after having the facial to see whether he could ascertain what, if anything I had done to my face, but he noted that whatever I had done was subtle. Given that I had some subtle erythema between my brows, he postulated that I did something that was exfoliative — something perhaps like a chemical peel. When I revealed that I had just had a basic facial — and told him my esthetician’s evaluation of my skin (combination skin), he agreed, but said, “Essentially everyone has combination skin, and I would say you’re on the very low end of that spectrum — your skin is extremely normal all over. The area of the face with the greatest density of sebaceous glands is in your T zone — your nose probably has the most.” When I asked him whether he noted any sun damage on my nose and cheeks, he disagreed with the esthetician’s assessment, saying, “Your skin is amongst the least sun-damaged skin of any of my patients in your age range. People with more pigment in their skin tend not to harbor as much sun damage.” However, this pigmented skin has limits to its benefits. Mudgil mentioned, “as much as your ethnicity can be a sun protectant, you are going to be plagued by your genetics. Indians tend to have deeper-set eyes and more discoloration under their eyes.” So, alas, the esthetician’s tip to keep my under-eye area better hydrated may be in vain.

My visit to Dr. Mudgil ended with some tips: don’t get facials, as they can do more harm than good. He recommended a daily facial moisturizer with an SPF 15 in it, even if it is raining or snowing outside. He also added that I should wash my face twice a day with mild multipurpose acne wash — even if I don’t have acne. Then after I reach a certain threshold of “wisdom,” to use a retinoid at night.

  psychological effect from spending more,” noted Stanley. “One of my female relatives buys according to the advertisements — she says the products work better and sometimes if it costs more, she likes it even better. Even if I tell her the items on the label aren’t making it into her hair or her skin, she doesn’t care. So much of skin and hair care is based on psychology.” Costarelis did have one addition to this argument, though. He said that if a product comes from a big company, the chance of having an adverse reaction is much smaller and the product is more likely to work as advertised, as the bigger companies tend to do more extensive testing before launching a product in the market. He said, “The marketing branch of these companies is the one doing studies on what is most effectively going to appeal to buyers — the marketing can be really slick and can twist things in ways that aren’t completely dishonest, but are fairly far from what the scientists actually showed.” Regardless, he still recommends buying products from a brand name that you know and have prior experience with. He went on to say, “When you see some of the herbal tinctures and new brands pop up, you have no idea what is actually in the products. Each batch is also probably quite different.”

So what about products that are branded as natural or organic — are they more effective or safer to apply to the skin? “I think you’d be deceiving yourself a little bit there by thinking that just because it is natural, it is going to be more effective. There are caustic acids in lemons,” noted Cotsarelis. Stanley went on to note that juice from limes can cause a photodermatitis that is severe in people that have gin and tonics: “You see it all the time in people drinking those by the pool. It can be a severe pigmentation problem and can cause a bad reaction. And that is a natural product. Natural doesn’t mean it’s not going to hurt you if you put it on your skin. Poison ivy is a natural product, and you don’t rub that on your skin.”

Last but not least, the ultimate goal for aging females like me: I asked the panel whether there are any topical treatments to reduce or prevent the appearance of fine lines and wrinkles, and unsurprisingly, it all came back to retinoids. Mudgil said, “A retinoid is very important to use, and there are formulations that are not as drying that I use for my acne patients or even for my Botox patients that want to maintain youthful skin.” Detmar noted the oldest trick the cosmetic industry has: “You can very easily reduce the appearance of wrinkles with the use of a moisturizer. Most of the cosmetic treatments are variations on moisturizers; they immediately reduce the appearance of fine lines by 15%–20%. Preventing their appearance is a different issue. The daily use of retinoids can prevent the appearance of wrinkles; they penetrate into the skin, can work on the extracellular matrix — the collagen and elastin fibers.”

Final lessons: use sunscreen, Vaseline, and retinoids; don’t bother with facials; don’t rub poison ivy and citrus juices on your skin; and don’t be seduced by fancy packaging and high prices. Easy enough!

Footnotes

Conflict of interest: The author has declared that no conflict of interest exists. 

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Articles from The Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation