All posts by Nurse Karen

Million Dollar Skin on a Budget

Million dollar skin is every woman’s desire but can come with a hefty price to achieve and maintain. But it doesn’t have to, I’m going to show you how.
I have worked for a plastic surgeon for over 34 years, in the operating room for 16 of those years. In 1994 I was selected as one of the nurses to be trained to do Collagen injections in a pilot program. There were very few of us that were selected so I was very excited to begin that journey. After about 2 years of injecting patients I was asked if I would like to train nurses and doctors. I accepted and trained doctors and nurses how to inject Botox, Collagen, and on to the new fillers when they came on the market, which continued for almost 20 years. Then I returned to school to become a nurse practitioner which didn’t leave time for anything else. I still continued to do injections, as well as talking to patients about their skin and how to take care of it after facelifts and other facial surgeries. In 2018 I was honored to receive the Outstanding Achievement in Facial Aesthetics from Daytime Hollywood Beauty Awards for my years of practice and my love for educating and helping patients look and feel better.
I have been given more skin care product to test than I can even remember. Some I did and some I didn’t. The ones I didn’t try were either too expensive so I wouldn’t be able to continue using them or they smelled funny. Smell is a huge one for me because it will smell all day and I am in people’s faces literally, every day. If I don’t like the smell, I know patients won’t. The ones I did try had pretty packaging! I know that sounds funny, but women tend to choose the appearance of a product as seriously as the ingredients it may have. I have some very cute bottles as counter decorations but the products weren’t very effective at all!
I have come to discover that age, lifestyle, diet, daily skin care routine, and budget makes a difference in what someone is willing to use and how much time they are willing to devote to a routine. Remember, we all have that drawer full of expensive and slightly used products!
I have some secrets for every skin type and tailoring your regimen to you. It starts with what you already have in your drawer.
If you were in my office for a consultation, I would ask what products you are currently using. Then we would talk about adding or subtracting items and replacing them with products that would be more effective for your skin. When you do it one at a time it is much easier on the pocketbook.
Let’s start….take your products out of the drawer and look at them. What are they supposed to do for you? Are you using them in the correct order? What are you trying to accomplish with these products? Do you have cleanser, toner, active ingredients, sunscreen, etc?
Cleanser- is it for your skin concern? Oily, dry, normal? Creamy or foaming? You can use what you have, to decide what type you like best.
Toner- balances your skin Ph. There are different kinds, so you want the one for your skin concern. If it is just a normal astringent type you can still use up the bottle. It will still help your skin even if it isn’t addressing the concern.
Tools- used right after toner and before your active ingredient. I use a microneedling roller (more info to come on this, keep reading). There are other tools that help stimulate the skin, relieve lymphatic congestion, and ease redness. Those are fine, I just don’t use any of those. I like the fact that my products can be delivered right to the cells for that cell turnover/collagen producing effect.
Active ingredients in your products: Retinol, Vitamin C, or Hyaluronic acid, to name a few. We can make it work.
Hydration/moisturizer- this is where certain products are better than others, but to find out which one is best, pick one and see how you like it.
Sunscreen- you need a good sunscreen and most everyone has some in the said drawer. Some makeups do have sunscreen in them but generally it is not enough for your daily protection especially if you are out in the sun. UVA/UVB is the best coverage. Remember to reapply it when you are out in the sun.
This list is the order of your product use. First cleanse your face, then apply toner, use your roller, then apply the active ingredient, hydrate/moisturize, then sunscreen.
Now we can talk about tools. I have a microneedling roller and I love it. Home use rollers are 0.25mm or 0.3mm. Anything longer than that is generally best done in a professional setting. But it still works.
If you don’t have one, they are sold everywhere (Amazon is my favorite shopping place). I use the one that comes with my products and it is a 0.3mm roller and lasts a year. I do have a 0.75mm (from Amazon) for once a week, but I don’t recommend it until you are a seasoned roller. I noticed significant changes in my skin within one month and even more changes at 6 months. The use of a microneedling roller increases the benefits of your products by 40% and more. It makes microchannels in your skin so the product can get below the surface and cause cell turnover and collagen production. Without it, you are simply layering products on the top of your skin. If you don’t use your products in the right order, they won’t work. For example: moisturizers have larger molecules than the active ingredients and will block them from doing their job.
There are many over the counter products that can be effective, but I have found as I age the less effective they were. I had to switch to big girl products!
With a drawer full of products it can be confusing. If you need guidance you can email me. I can help you through the process.

What If There Were Only Happily Ever Afters?

Life changes. redefine_girl_grey_hair_derm_hero

And skin changes.

But WHAT IF you could control your skin’s destiny?  You can.  You control 80% of your skin’s future (only 20% is genetic).  And that’s great news! The choices you make today will affect the way you look and feel tomorrow, next year and well into the future.

WHAT IF you could always be a few steps ahead, anticipating your skin’s biological needs?  You can.  With the right care, your skin can visibly improve with age so you can look even better tomorrow than you do today.

WHAT IF you had two world-renowned doctors, a bio-scientist, a private consultant (everyone should) and an entire regimen devoted to your skin’s every whim 24/7?

You do.  With 30 years of combined research and experience, Dr. Katie Rodan and Dr. Kathy Fields developed their philosophy of Multi-Med® Therapy. This regimen-based approach treats specific skin concerns by combining the most effective ingredients within an optimized formulation, applied in the right order. Stick to the Regimen that’s right for your skin and you, too, can experience transformative results.

WHAT IF you felt good about your neck?

A steady diet of intelligent skincare is the foundation of skin that looks young and healthy. The Rodan and Fields REDEFINE Regimen is a comprehensive skincare solution that layers cosmetic ingredients and potent peptide technology. This formula helps to defend against and reduce the visible signs of aging for noticeably firmer, smoother, flawless-looking skin.

 WHAT IF having flawless skin wasn’t an accident?

REVERSE Regimen is an effective, full-face solution that tackles dullness and uneven skin tone. REVERSE provides a long-term solution for a radiant, more even complexion. It exfoliates dulling dead skin, helps even and brighten discolored skin, reduces the appearance of fine lines and wrinkles, and protects against further UV damage.

 WHAT IF you could break the vicious acne cycle?

UNBLEMISH Regimen was created as a continuous solution that addresses the acne cycle—clogged pores, trapped oil, bacterial attacks and inflammation. This daily, full-face system combines cosmetic and active over-the-counter ingredients that unclog pores to eliminate most acne blemishes before they are visible on the skin’s surface.

WHAT IF your skin wasn’t so sensitive?

SOOTHE Regimen combines clinically tested active over-the-counter ingredients with our exclusive, patent-pending RFp3 peptide technology to shield against the environmental aggressors associated with dry, chapped, sensitive skin. So effective, the SOOTHE Regimen can decrease visible redness, peeling and dryness. The result? A healthy-looking, even-toned complexion every day.


authored by Derm RF on

The Newest Microneedling Technology is Here

microneedling-picYou may be familiar with microneedling tools—small roller-like devices with tiny needles that roll over your skin to stimulate new collagen. The trend of microneedling has been on and off the grid for the past few years (and the results have been questionable), but now it’s back.

“This time, microneedling is different because the technology has improved a great deal,” says Nashville, TN, dermatologist Michael Gold, MD. In addition to the at-home devices (like Rodan + Fields Redefine Amp MD Micro-Exfoliating Roller), the newest treatment done at doctors’ offices combines microneedle pens with radio-frequency energy. Recently, EndyMed introduced the Intensif procedure, a fractionated radio-frequency and microneedling treatment (a typical session lasts about 45 minutes) that targets depressed acne scars and wrinkles.

“I think needling is here to stay—we’re going to see more and more in years to come. It’s a great treatment for remodeling skin tissue because it destroys existing bad collagen and then replaces it with rejuvenated collagen to improve your skin,” says Dr. Gold.

By NewBeauty Editors |

Quick Tips for Flawless-Looking Fall Skin

fall-redefineAs the seasons change, so do our skincare needs. Hot, humid months turn crisp and cool, exposing skin to a variety of environmental stressors. Stay ahead of the seasonal skincare curve with easy tips and effective products that keep your complexion looking flawless all year long.

  • Swap facial soaps for hydrating cleansers. Wind and cooler temperatures can dry out skin and cause redness or sensitivity, so switch up your cleanser game and keep clean with gentle products. Start by removing your makeup, then use SOOTHE Gentle Cream Wash to combat dry, chapped, cracked skin.
  • Remember the importance of exfoliation. Exfoliation is a necessary step for healthy skin, even in dry months. A gentle exfoliant helps remove dead skin cells and clears the way for skincare treatments. Plus, it helps refine and soften the skin’s surface—and silky skin is always in style.
  • Keep your smacker supple. Your lips deserve just as much attention as your complexion. Give them the ultimate moisturizing treat with REDEFINE Lip Renewing Serum. Each capsule helps restore and maintain a fuller, younger-looking pout. All the better to be smooched over a pumpkin spice latte.
  • Hydration is your friend. Moisture, moisture, moisture (paging Jan Brady). As temps start to dip, help your skin out and amp up the hydration. Avoid tight, flaky skin by choosing thicker creams and lotions during the day, and don’t forget overnight treatments.
  • Don’t skip the SPF. Just because you’re accessorizing with scarves instead of sunglasses doesn’t mean harsh UVA and UVB rays aren’t coming your way. Before you head out the door, continue to slather your skin with a high quality sunscreen like ESSENTIALS Broad Spectrum SPF 30 Body Sunscreen.

Follow the tips above and keep your complexion glowing no matter what weather you find yourself in.

SHARE these autumn skin-saving tips with friends and family who live in colder climates.

Skin, An Owner’s Manual

Skin, our body’s largest organ, has simple tastes. The best products Ask Nurse Karenare found in the kitchen, not the bathroom cabinet.

At some point in our lives, many of us come to the realization that – gasp! – we aren’t ageless. For some, this unwelcome wakeup call may be triggered by a glance in the mirror, perhaps revealing the first signs of “crow’s feet,” or laugh lines that are visible long after we stop laughing. Many women take good care of their skin from the time they are young, but others of us wait until the first signs of age propel us into action. This is when many people start the skincare research process — or at least the skin care product purchasing process.

If certain skincare products work, how do they work, and how can we figure out what is truly helpful from all the hype?

Protecting one’s skin from the sun is perhaps the single most important thing we can do to keep our skin youthful and healthy. But what about “anti-aging” emollients, scrubs, creams, and cleansers?

There are literally thousands of tempting options on the shelves these days for slowing the aging process. It seems like every other week there is a new ad for a cutting-edge product, promising to remove the signs of age and turn back the clock. To make matters worse for the consumer, some products come in diamond-encrusted packaging, cost hundreds of dollars, or use science-y-sounding (often made-up) words in their names.

But is it really possible to slow aging? What processes are going on that can make skin look, duller, thinner, and more wrinkled over the years? If certain skincare products work, how do they work, and how can we figure out what is truly helpful from all the hype?To help us understand some of these issues, we talked to two well-known experts in the field. Melanie Grossman, MD is a board-certified dermatologist and Assistant Clinical Professor of Dermatology, College of Physicians and Surgeons of Columbia University. She is affiliated with New York-Presbyterian Hospital, and has a private practice in Manhattan. Monica Halem, MD is also a board-certified dermatologist in Manhattan and Assistant Clinical Professor of Dermatology at Columbia University.

First, let’s look at the “architecture” of skin, and how the body’s largest organ functions in the first place, and then go on to consider whether it is possible to slow skin’s aging process with skin care products and if so, which ones (hint: they’re more likely found in the kitchen, not the bathroom cabinet).

Skin 101: The Basics of the Largest Organ

Skin is a multitasking organ. That’s right, it is an organ that needs to be fed and cared for like any other and serves a variety of important functions. Skin’s most obvious role is as an infection-preventing barrier between the body and the outside environment. It regulates body temperature, water and electrolyte balance, houses the millions of nerve endings that give us our sense of touch, as well as our ability to detect pressure, respond to pain, and sense texture. The skin also synthesizes Vitamin D when the ultraviolet rays of the sun hit it, making it an important part of how the body creates and uses this essential vitamin.

Skin’s most obvious role is as an infection-preventing barrier between the body and the outside environment. It regulates body temperature, water and electrolyte balance, houses the millions of nerve endings that give us our sense of touch, as well as our ability to detect pressure, respond to pain, and sense texture.

The skin is made up of three layers: the epidermis, dermis, and fat layer. The epidermis, the outermost layer, is largely made up of cells called keratinocytes, which are thicker on the palms of the hands and soles of the feet. Cells that produce melanin (melanocytes) are also in the epidermis and give skin its various colors and protect it from the sun’s damaging rays.


The epidermis acts as a barrier, protecting the body from foreign invaders (bacteria and viruses). The dermis houses all the important goodies, like many different kinds of nerve endings, sweat glands, blood vessels, oil glands, and hair follicles. It is made up of hardy yet flexible tissue, comprised of elastin, collagen, and fibrillin (some of which are frequently targeted with skin products). The fat layer, which naturally thins with age, lies beneath the outer two layers of skin and helps keep the body warm, serves as padding (some of us have more than others), and acts as an energy store.

Aging from the Outside in and Inside Out

As most of us notice, the skin changes a lot over time. Aside from the external factors (like sun and smoke) that damage skin, there are other, natural changes that would occur even if we never set foot (or face) in the sun. These changes can begin as early as one’s twenties, though they may not be obvious till much later.

New skin cells don’t replace the old ones as rapidly as they once did as we age, and it is this which can also contribute to the duller look of age.

Skin naturally becomes thinner as we age, as it loses its underlying fat layer. The amount of oil the skin produces also decreases with age, and can make skin drier. As we age the elastic fibers in skin, like collagen and elastin, are not produced as quickly, which can cause skin to lose some of its bounce. It’s also true that new skin cells don’t replace the old ones as rapidly as they once did as we age, and it is this which can also contribute to the duller look of age. Of course, gravity also plays a role in the aging process, as it causes all body parts, face included, to sag a little more.

It’s external factors – factors completely independent of the internal changes associated with age – that age us prematurely, however. Dr. Grossman underlines that one of skin’s biggest enemies is the UV rays of the sun, which can lead to wrinkles, age spots, and the general “leathery” lined appearance of aged skin. Smoking also leads to similar changes, she says, and is one premature ager that we have truly the power to remove from our lives.The simple act of resting one’s head on the pillow can, over the years, lead to “sleep lines,” or wrinkles that don’t go away after you get up. All of these factors, internal and external, can lead to the appearance aged skin, and while we can’t prevent the passing of time, there are some simple things we can do to help our skin stay a little softer and look a little fresher.

Simple Skincare Products That Work

While the many of products out there may not be worth their salt, some products can actually help skin retain its youth longer. There are certain ingredients that one should target when choosing skincare products: ingredients that work with skin’s biological processes. While no product will be a facelift in a jar, here are some cosmetics, according to the experts, that may help decrease the appearance of wrinkles, protect the skin, and maybe even take a couple of years off.

The One-and-Only FDA-Approved Ingredient: Tretinoin

There are two things that Dr. Grossman tells us to look out for when choosing skincare products. One of the products that she tells us may improve the look of skin is the only FDA-cleared skincare drug: tretinoin. Tretinoin is the only “proven” drug to increase collagen in the skin, which can make the skin appear less wrinkled and younger. In other words, this is one treatment that works. Over-the-counter (OTC) versions of the treatment are also available; A relative of tretinoin, retinol, is the active ingredient in OTC products.

Just because it says “clinically proven” on the package, does not mean that it has stood up to rigorous scientific testing.

Dr. Grossman brings up an interesting distinction, and one that is important to remember when thinking about any kind of skincare treatment. Just because a product is “proven” in a lab, it doesn’t mean that it is proven in skin. She points out that “there are products that have been proven in the test tube, but we’re making a leap to whether they work in the skin. There are lots of newer ingredients, from antioxidants and peptides to growth factors and ‘DNA repair’ enzymes. All of these things may be proven in test tube, but they may not have been shown to make biological changes in the skin. Does it go from test tube to topical? That’s the real question.”

While it’s not always possible for consumers to access the scientific studies that show whether products have been tested in humans or not, your dermatologist can help you determine which products are likely to work on your skin.

Skincare Secret #2: Sunscreen

Another product that Dr. Grossman recommends is sunscreen. Because the sun is one of the most damaging things to the skin, sunscreen is a “must” for the long term. And if you want to kill two birds with one stone, some products like moisturizers have sunscreen in them, which can make the morning skincare routine a little easier.


Dr. Grossman believes her skin is in better shape than it might otherwise be for having used sunscreen for the last 30 years. Dr. Halem also doesn’t leave home without it, stressing that the rays that damage your skin are present all the time, even on overcast days: “They come through the clouds, through the windows. You don’t even know you’re being hit. I always recommend SPF 30 or higher.” A broadband sunscreen with both UVA and UVB protection should be used on your body. For your face, choose a sunscreen that is noncomedogenic — especially formulated not to clog pores.

Dr. Grossman acknowledges that there is controversy regarding vitamin D depletion with the use of sunscreen. She suggests monitoring vitamin D levels with your doctor. If levels are found to be low, he or she can suggest the right type of supplement. In general, the experts agree that protecting your skin from the sun is one of the best things we can do for our skin.

Other Products With Mixed Evidence

There are other products that according to the American Academy of Dermatologists (AAD) have some evidence of being effective against aging. These include:

  • Alpha hydroxy acids
  • Azelaic acid,
  • Certain (but not all) growth factors
  • Hydroquinone
  • Kojic acid
  • Peptides (some but not all)

Dr. Halem recommends the alpha hydroxy acids (AHAs), which include salicylic, lactic, and glycolic acids, and have been shown to be effective in research studies. She uses them herself and has been impressed by the results. She also recommends vitamin C, a powerful antioxidant that has been shown to help the appearance of skin, and is an ingredient in some topical skincare products. She adds that some evidence is beginning to mount that growth factors may be beneficial (they could be the next big thing, she says), but it’s still too early to tell.

The rays that damage your skin are present all the time, even on overcast days: ‘They come through the clouds, through the windows. You don’t even know you’re being hit. I always recommend SPF 30 or higher.’

The AAD points out that just because it says “clinically proven” on the package, does not mean that it has stood up to rigorous scientific testing. Some “clinical” tests are conducted by the very companies that make the product: they might give the product to volunteers for a few weeks and then ask them to rate whether the product helped their skin or not. This is not in any way a rigorous, unbiased, scientific test. So don’t be sucked in to these types of promotions.

And finally, as the AAD warns, just because it’s expensive does not mean it works! For example, moisturizer can be an important part of a basic skincare routine, as it adds hydration to skin and helps protect against the loss of moisture. But the most expensive parts of moisturizer are the fragrance and packaging, not the moisturizer itself. Some of the best moisturizers are very inexpensive and can do a lot for the complexion.

In fact, in many of the products that promise younger, brighter looking skin in short amounts of time, the secret ingredient is not some exotic anti-aging serum: it’s moisturizer. So be a discerning consumer when it comes to skincare products, and again, talk to a dermatologist if you have any questions about the effectiveness of specific ingredients.

Skin Care Products to Avoid

So now we’ve talked about how to choose helpful products, are there any skincare products that are harmful? There’s a lot of talk these days about parabens and other preservatives in cosmetics that may post dangers to consumers. But is there any truth to these concerns?


FDA does not have to regulate what ingredients are used in cosmetics, with the exception of a few compounds that are prohibited. Parabens are used as preservatives in cosmetics to protect against microorganisms and prevent the products from degrading.

The FDA’s stance on parabens is that they are safe in cosmetics in levels lower than 25% – most products use far less than this – 0.01-0.3%. Parabens weakly mimic the effects of estrogen, which is linked to a higher risk for breast cancer. However, studies have shown that the parabens are 10,000-100,000 times weaker than naturally-occurring estrogens in the body. As a result, the FDA continues to certify parabens safe for cosmetic use, though they are keeping an eye on the research as it unfolds.

Phthalates are another class of chemicals used in cosmetics, shampoo, and lotions (not to mention plastics , vinyl flooring, and adhesives) that have gotten attention recently. Some studies have linked certain phthalates to increased breast density, which is a known marker for breast cancer, though there’s no evidence that phthalates are actually linked breast cancer. Phthalate exposure during pregnancy may be related to hormone problems during development and to behavioral problems in children, but the evidence is inconclusive, so phthalate use in cosmetics remains unrestricted.

The bottom line is that the research on these questionable cosmetic ingredients is inconclusive. Some products advertise that they do not include parabens, phthalates, or other compounds that have raised questions in the past, so if you’re concerned stick with these products. And as always, you should talk to your dermatologist about product safety, since he or she can give you an educated opinion on specific ingredients.

Eating for Your Skin

Taking care of your skin from the inside out is at least as important as using products that work from the outside in. What we eat affects our organs, metabolism, brains, and, not surprisingly, the health of our skin. Eating foods rich in antioxidants like blueberries, strawberries, blackberries, apples, oranges, grape, and dark leafy greens helps repair all the cells of our bodies, skin included.

Antioxidants work by attacking free radicals, damaging compounds formed when oxygen interacts with certain molecules. Once formed, these highly reactive radicals can start a chain reaction, like dominoes. If they manage to damage important parts of cells such as DNA, or the cell membrane, they can destroy (and prematurely age) our cells. This cellular damage is a common pathway for cancer, aging and a number of diseases.

Antioxidants scavenge for free radicals. They attach themselves to these unstable compounds and prevent them from damaging cells by making them less reactive. Because skin comes into contact with so many harmful compounds (sun, smoke, air pollutants, and harsh cleaning chemicals) that can generate free radicals, it is especially important to eat foods that will help repair damage.

Vitamins C and E act as antioxidants, helping repair the cell damage that comes from free radicals. Vitamin C is found in citrus fruits, berries, and almost any kind of vegetable. Vitamin E is abundant in wheat germ oil, as well as in nuts and seeds. Eating foods rich in these nutrients may be helpful in keeping skin at its healthiest.

Green tea may also be beneficial to skin cells. It contains high levels of polyphenols, plant-derived compounds that act as powerful antioxidants. Green tea has been shown to protect the skin from skin cancer by boosting its natural DNA repair mechanisms. (Some cosmetics also contain green tea extract.) Tea is beneficial for another reason. When the body is dehydrated, skin becomes dehydrated, too, and loses some of its resilience.

You can give your body retinol, a relative of the product mentioned earlier, tretinoin, by eating foods that are rich in vitamin A. This is because different forms of vitamin A, such as carotenoids, can be converted to retinol. Generally, orange vegetables (like carrots and cantaloupe) and dark green ones (spinach and kale) are the best sources of carotenoids like beta-carotene, which is most easily converted to retinol.

Hydrate, Hydrate, Hydrate

Water makes up more than 2/3 of our body weight, and serves a variety of purposes, including flushing toxins out of the body and shuttling nutrients to their destinations. Because we lose so much water in urine, sweat, fecal matter, and even respiration, it is important to replenish it. When the body is dehydrated, the skin becomes dehydrated. And when skin lacks moisture, it loses a bit of its resilience, so that wrinkles may become more obvious.

One of the easiest ways to check for dehydration is to pinch the skin. If it quickly bounces back and returns to its smooth state, it has enough water. If the pinched skin remains noticeable for a few moments, you are dehydrated. When that happens, wrinkles may become more likely and more obvious. Keeping well-hydrated keeps the entire body healthy, and the skin looking livelier and plumper (in a good way). Drinking adequate amounts of water – about eight 8-oz glasses a day, or more, if you’re active – is a key to dewy skin.

Final Words for Saving Face

Skin care products can help reduce the signs of age, but let’s face it, they’re not going to reverse the clock. The FDA-approved retinoids are most likely the best way to slow the aging process. There may also be other products that help, but the jury is still out on whether they actually work in living skin cells.

Dr. Grossman recommends having a balanced attitude towards skin care. Again, she says that products with sunscreen are often a good bet, since the sun is a major culprit in skin’s aging process and says that when it comes down to it, the advice your mother gave you is probably pretty accurate: have a healthy, balanced diet, get enough sleep, exercise, and drink plenty of water. And, as much as possible, reduce stress! Dr. Grossman says, “the most important thing is to pay attention to your own skin and take care of it like you take care of the rest of your body. Protect it from the environment.”

Skin looks best when it’s healthy. There’s no make-up or age-defying potion that’s going to hide the dehydrated, damaged, or poorly-nourished skin. The best way to keep skin looking its best is to keep it simple. Use some basic moisturizer, sunscreen, and a little retinoid or retinol if you want. Otherwise, feed it, water it, and protect it, to keep it healthy and happy for many years to come.


Clean the Slate Post Summer

With summer days behind you, it’s time to see how your skin has slatefared after long, sunny afternoons of soccer games, poolside fun, family picnics, and beach getaways. Even with your daily dose of sunscreen, your complexion may be looking less than lustrous right about now. Before you send dull skin on its way, consider what’s going on above and below the surface.

We often pay more attention to evidence of the sun’s scorching UVB rays (hello sunburn), but it’s the aging UVA rays that can do far more insidious damage to the texture, quality and tone of our skin. For example, every time unprotected skin is exposed to UVA rays, skin cells in that area produce more melanin (or pigment), resulting in dark spots and a drab, uneven complexion.

Since evidence of sun damage is cumulative, it often shows up more dramatically in our twenties and thirties. Even if you feel like you’ve had that sprinkling of spots on your nose, cheeks or forehead forever, think again. No one is born with freckles. While there is a genetic tendency to develop dark areas or uneven pigmentation, sun exposure is a critical factor in bringing out freckles and it greatly accelerates visible signs of aging.

Now’s your chance to perk up post-summer skin. Just remember that sun exposure doesn’t just appear (or disappear) overnight, so be patient. Make sure your daily skincare routine includes exfoliation (to remove dead dulling skin), and look for ingredients like Vitamin C to help even out skin tone. REVERSE Brightening Regimen is an effective way to clean the slate, evening and brightening tone while reducing the appearance of fine lines and wrinkles—so you can look forward to younger-looking skin this fall.

Share this skin wisdom now to brighten someone’s day. Plus, check back all month long for more expert advice and one woman’s journey to healthy-looking skin for her wedding day.



Your Derm RF Support Team


The Science Behind Skincare


As the science behind skincare formulation evolves, we are finding new and innovative ways to create products to treat a multitude of skin conditions. However, even with innovation, there are basic tenets of cosmetic chemistry that must be followed to produce effective products. Unfortunately, there are skincare companies today that make unsubstantiated claims about products that are unstable and ineffective. Trusting the science behind the efficacy of certain time-tested raw materials in addition to exploring new and exciting offerings is an important first step; having a solid understanding of what other categories of ingredients are necessary to create an excellent formulation is paramount. In this article, we will explore a number of categories of commonly used cosmetic ingredients, as well as the components necessary to create outstanding skincare formulations.

Formulations as a whole

One common misconception regarding topical skincare products is that the results come from one key ingredient. In actuality, the formulation as a whole leads to a product’s ability to deliver its purported benefits. Cosmetic products consist of a range of components:

  • Key ingredients determine a product’s greatest topical benefit
  • Skin conditioning agents improve the skin’s surface and provide a soft, smooth appearance
  • Functional ingredients create the end product (cream, serum, lotion, gel) and act as a vehicle, or carrier, for the key ingredients
  • Multifunctional ingredients provide some topical benefits and also assist the vehicle.

Each of these components is essential to a product’s function and benefit. Product performance depends on the key ingredients’ biocompatibility, the use of appropriate product vehicles and delivery systems, and the stability of all of the ingredients within a formulation. Table 1 depicts all categories, as well as examples of ingredients for each.

Trust the science

It can be tempting for consumers to choose a skincare product based solely on the new, exciting ingredients it offers and the promises the manufacturer makes; however, scientific data supporting the efficacy of the key ingredients is one of the most important considerations when choosing topical products. The chemist must vet ingredients prior to their inclusion in a formulation and the clinician should also ask the companies from which they buy their products for this science. Although, newer ingredients may seem intriguing to us all, patients ultimately need products that work. Many of the most effective cosmetic ingredients are time-tested over decades and typically have significant research backing their benefits.

Retinoids, for instance, include all derivatives of the vitamin A family, such as retinoic acid, retinaldehyde and retinol. Although retinoic acid is the form of vitamin A that interacts with the retinoic acid receptors (RAR) in the skin, it can be topically sensitising for some patients. Fortunately, retinaldehyde and retinol are successfully converted into retinoic acid within the skin. This conversion makes it possible to achieve the results of retinoic acid without inflammation1. Studies have found that retinoids stimulate the production of collagen, hyaluronic acid, and elastin. They are also an excellent choice for treating hyperpigmentation, as they help to inhibit the process of melanogenesis at multiple points. Retinoids also encourage cell turnover, bringing youthful, evenly pigmented cells to the skin’s surface2. Acne sufferers benefit from retinoids’ ability to prevent follicular impaction as well.

The only bioavailable form of vitamin C for the skin is L-ascorbic acid. Esters of vitamin C, such as ascorbyl palmitate, do offer antioxidant benefits, yet they do not provide the collagen-stimulating, anti-ageing benefits of L-ascorbic acid. The additional antioxidant, anti-inflammatory, and ultraviolet (UV) protective benefits provided by L-ascorbic acid make it an excellent choice for virtually all skin types and conditions3.

Peptides — the key building blocks of nearly all living tissue — encompass a large category of topical ingredients; however, very few have been legitimised in scientific studies. The topical use of peptides is still relatively new to the industry and, while many are being marketed, the most substantiated agents are used in the treatment of ageing skin. Neurotransmitter-affecting peptides, carrier peptides and signal peptides, work in different ways to improve the integrity of the skin:

  • Neurotransmitter-affecting peptides include acetyl hexapeptide-8, a chain of six amino acids that inhibits neurotransmitter release. In vivo studies found that twice-daily application of acetyl hexapeptide-8 for 30 days resulted in a 30% decrease in the depth of dynamic wrinkles4
  • Carrier peptides include copper peptides that increase the uptake of copper by cells when paired with a tripeptide (glycyl-I-histidyl-l-lysine). Copper is used owing to its involvement in collagen deposition through the activation of lysyl oxidase. Research suggests that the copper peptide increases collagen, glycosaminoglycan and adhesive protein production5
  • Signal peptides are used to initiate specific responses within the skin. A number of age control signal peptides are currently available, yet only a few are backed by legitimate studies:
  • Palmitoyl pentapeptide-4 refers to lysine-therine-therine-lysine-serine paired with palmitic acid. In vitro studies show a stimulation of types I and III collagen, as well as enhanced production of fibronectin6
  • Palmitoyl oligopeptide is a combination of valine-glycine-valine-alanine-proline-glycine and palmitic acid. Studies suggest that this long-chain peptide stimulates the production of multiple dermal fibroblasts7. Palmitoyl oligopeptide can be used alone or in conjunction with other peptides.

Although the body has its own endogenous free radical-quenching mechanisms, daily application of topical antioxidants provides significantly heightened protection against matrix breakdown and the visible signs of facial ageing8,9. Antioxidants function in three ways: primary antioxidants or electron donors; secondary antioxidants, which chelate metal ions; and co-antioxidants, which facilitate other antioxidants. Many offer multiple protective benefits, such as preventing and reversing free radical damage10. Many antioxidants offer more than one free radical quenching benefit. All skin types benefit from antioxidants, as they are an important line of defence against UV induced cellular damage, photoageing and the development of certain cancers11.

Stem cell extracts

Analysis table

Scientific research supports the use of certain plant stem cell extracts, but further research may be needed to support the efficacy of others. At this time, much of the research focuses on the photoprotective properties of dietary botanicals, citing the potential of topical products that use plant extracts with the same characteristics. Keeping abreast of plant-derived stem cell research as it evolves is essential for making optimal treatment choices as plant stem cell technology is more frequently incorporated into anti-ageing skin care.

Before considering the addition of plant stem cells into cosmeceuticals, it is critical to understand the role of stem cells in the skin. The majority of skin stem cells reside in the basal layer of the epidermis. Their primary function is to replenish the skin as it undergoes normal homeostasis and wound repair12.

Like all stem cells, those in the epidermis are undifferentiated, capable of dividing themselves for extended periods of time and differentiating into multiple lineages based on their tissue origin13. When a stem cell divides, the daughter cells have the potential to either remain a stem cell, like the parent cell, or they can differentiate into cells with a more specialised function, known as progenitor cells.

In recent years, researchers have identified naturally occurring botanicals with substantial antioxidant activity proven to protect skin stem cells from UV-induced oxidative stress, inhibit inflammation, neutralise free radicals, and reverse the effects of photoageing. Consequently, cosmeceutical products containing extracts derived from plant stem cells have the ability to promote healthy cell proliferation and protect against UV-induced cellular damage in humans14.

Product penetration

Asking about a product’s delivery system is becoming a more common question from clinicians and patients. It is a valid question, although it is more useful to understand when a delivery system is actually necessary to a product’s efficacy. Certain active ingredients, such as retinoids and L-ascorbic acid, are typically more effective if a delivery system is employed. Delivery systems include ingredient encapsulation in polymers or liposomes, and micronisation or formulating with very small ingredient particles. These delivery mechanisms are used to ensure a product’s active ingredients reach the level of the skin where they will provide the most benefit. While delivery systems of this kind certainly have their place within the industry, most skincare products do not need them to be effective.

A product’s vehicle is created by using ingredients from the multifunctional ingredient category, and is most often what assists with product penetration. A vehicle refers to a product’s base, which is an emulsion, a suspension or a gel. Emulsions have a creamy consistency and are formulated to ensure the active ingredient is evenly distributed throughout the product; they combine water-soluble and oil-soluble ingredients, leading to penetration into both the aqueous and lipid environments of the skin. In some cases, thick creams can impede active ingredient penetration, as travelling through the product’s base itself requires a significant amount of a molecule’s energy. For this reason, emulsions are typically better suited for moisturisers, versus corrective topicals.

Suspensions are usually in liquid form and separation of a suspension’s ingredients is typical. Agitating the bottle is necessary to redistribute the ingredients throughout the product, ensuring the key ingredients penetrate into the skin properly. Suspensions are used when a product’s ingredients will not dissolve when mixed with oil or water. Often, cleansers will be suspensions.

A gel base is commonly used in serum products. Gels are transparent semi-liquids that are either completely water-soluble or completely oil-soluble. Gels are thinner and typically penetrate easier than emulsions, making them the more common vehicle for corrective products.

Ensuring stability

Stability pertains to three important aspects of a product: chemical breakdown of its key ingredients, physical stability of the product, and the prevention of abnormal microbial growth. Some think of preservatives as a negative; in fact, preservatives protect the product and the consumer by preventing the growth of harmful bacteria, yeast, and mold. In actuality, all products that contain water must have some type of preservative system in place. Certain multifunctional ingredients offer preservative properties as well as other benefits, allowing for misleading ‘preservative-free’ claims.

If a product breaks down, or oxidises, it loses efficacy. Oxidation involves the altering of an ingredient’s molecule. In some cases, this alteration is beneficial. For example, the conversion of retinol into retinoic acid in the skin involves oxidation of the retinol molecule. This type of oxidation must be assisted by certain enzymes and occur within the skin, not in the bottle, in order to make it effective. Oxidation is negative when a product oxidises before it is able to interact with the skin. The most obvious indication of product oxidation is darkening in colour over time. Many of the most effective topical ingredients, including retinoids, L-ascorbic acid and a number of sunscreen agents, are inherently unstable and prone to oxidation. Oxidation typically occurs when a fragile ingredient comes in contact with an oxygenating agent in the presence of air, water or light. Special steps must be taken to ensure products that contain unstable ingredients are able to maintain their stability and functionality.

Esterfication is a process that involves the binding of one molecule to another. Ester molecules can be effective, but the skin must be able to break apart the ester and free the actual active ingredient. One example is the esterfication of peptides with fatty acids in order to make them lipophilic, thus enabling them to penetrate through the stratum corneum to reach the epidermis and dermis. Another example is ascorbyl palmitate, which combines L-ascorbic acid (vitamin C) with palmitic acid. While this seems like a logical way to stabilise the active L-ascorbic acid, the skin lacks the mechanism to free it; therefore, these esters do not provide all of the ingredient’s topical benefits.

Encapsulation is a protective casing that shields the active ingredient from contact with air, water or light. This method of stabilisation is widely considered the most effective, as the ingredient is still in its most active form. The casings are easily broken upon manipulation or contact with skin, thereby releasing the active ingredient.

Synergistic activity, or formulating with complementary ingredients that are able to protect one another from breakdown, enhances a formulation’s stability. The most common form of synergistic activity is the use of L-ascorbic acid with vitamin E. When formulated together, these ingredients replenish each other’s activity15.

Choosing the appropriate components when creating skin care formulations is an important job for the chemist. Creating efficacious topical products for the clinician to provide to their patients is a rewarding part of the cosmetic chemist’s job. Though it can be difficult for the clinician and patient alike to determine which is best among all of the product options available, understanding select fundamentals of cosmetic chemistry can help significantly. Trusting the science behind skin care is much more useful than listening to marketing messages, which are often over-blown. When well-formulated, the skincare topicals of today are capable of producing excellent, visible results.

Ivana Veljkovic

Research and Development Manager, PCA SKIN®,

Member of the American Chemical Society

Understanding Microneedling

dr-sandersAlthough microneedling has been around for nearly 15 years, it is currently receiving quite a buzz in skin care and beauty circles. Designed to give the skin a smoother, more even texture and a radiant glow, the non-invasive treatment is available with Los Angeles-area plastic surgeon George Sanders. In this blog post, Dr. Sanders shares what you need to know about microneedling to give you an idea of whether it might be right for you!

What Microneedling Accomplishes

Microneedling achieves two objectives: it stimulates the production of collagen for firmer, smoother skin, and it helps the skin absorb topical products more deeply. It is helpful for smoothing wrinkles, softening acne scars and improving other problems with skin tone and texture.

Microneedling uses a device to create tiny holes in the skin. The device looks like a miniature paint roller, covered in tiny spikes that measure between 0.2 and 1 mm. The device is rolled over the skin, creating tiny pricks and narrow channels. These channels close almost immediately, but the wounds activate the body’s natural healing. As the skin works to repair itself, the body produces collagen and elastin, which are two proteins vital to healthy, beautiful skin. As collagen and elastin are generated, the skin gradually starts to thicken and soften. After treatment, topical products can penetrate the skin more easily. These creams contain various growth factors, which are substances that further stimulate collagen and elastin formation

The treatment is safe for all skin types. It is not painful, but depending on the length of the needles, it can feel like sandpaper running over the skin. After treatment, the skin may look like it’s sunburned and be slightly sensitive; acidic products should be avoided for about a week.

Depending on the specific skin care problem, several microneedling sessions may be needed to achieve the desired results. With continued use, microneedling can give the skin a smooth, even texture and a radiant glow.

At-Home vs. Professional Microneedling Treatment

Microneedling devices can be purchased and used at home; but a plastic surgeon or dermatologist can deliver deeper and more effective treatment. During an in-office professional microneedling session, the doctor can customize treatment to your unique needs by modifying the needles’ depth. The ability to customize treatment is helpful for targeting specific skin care problems and adjusting the aggressiveness of the treatment.

Dr George Sanders Board Certified Plastic Surgeon


When I Grow Up I Want To Be a Registered Nurse

photo(1)Many young people choose the field of nursing. We spoke to Karen House-Milburn RN, BSN, CLNC an expert in the medical profession and asked her the pros and cons of the vocation. Karen, who currently works with plastic surgeon Dr. George H. Sanders M.D., specializes as a plastic surgical nurse. As the Director of Nursing for the past seven years, her responsibilities include overseeing all facets of the surgicenter. She is also certified in all esthetic procedures including Botox, Collagen, laser hair removal, KTP laser for facial telarigectasias and leg veins, leg vein injections, steroid injections for scars, and chemical peels. Fraxel laser, Titan laser, and IPL laser are also procedures performed in the office.

How do you know you have what it takes for this vocation?

I love working with people. I seem to have a knack for listening and understanding what is going on with a patient.

When did you decide to become an RN?

When I was 3 I told my parents I wanted to become a nurse and make people feel better. They bought me a doctor’s kit and I was off and running. I would take dolls apart to see how they worked. My sister wrote a poem about me going from taking the limbs off all our dolls to running through the hospital halls.

What kind of education is required to become a nurse?

I did two years of LVN (Licensed Vocational Nurse) school part-time, then used the hospital clinical experience to do two years of RN school. I then went on to get my BSN (Bachelor of Science Degree in Nursing).

How many years does it take?

Four years total from LVN to RN/BSN.

Does your training start in a hospital?

Most of my training was in the hospital. I did do some training in a center for developmentally disabled clients and in nursing homes.

What is a typical work schedule? When you first start do you have to take the night shift?

My first job as a nurse was in a locked unit at Woodview Calabasas Psychiatric Hospital. Then I started working with Dr. Sanders in plastic surgery. I did do night shifts at the psych hospital and then would do surgery with Dr. Sanders during the day. My work schedule varies depending on the patients and surgeries. I start early two days a week and work late three days a week, and work many Saturdays as well.

Are there different types of nurses?

There are many different avenues a nurse can explore. Many different areas in a hospital, surgery centers, clinics, spas, insurance, home health, rehab centers just to name a few. There are certified nurse assistants, licensed vocational nurse, medical assistants, registered nurse, nurse practitioner and doctorate level.

You are working with a plastic surgeon at this time. What are your responsibilities?

I see all of the pre-op and post-op patients with the doctor. I do Botox, fillers, and laser for the patients. I also work in the surgery area when needed. I did the surgicenter full-time for 16 years and when the aesthetic practice became very busy, as well as treating many post-op patients, I am now up front with these patients most of the time.

How do you train for a specialty such as injections?

I trained with the Collagen Company many years ago. I had to inject quite a few patients with a supervisor before I could do it on my own. When it became very popular for nurses to do the injections, I was asked if I would train them because I could do it “hands on” being a nurse myself. I have trained many doctors in the art of Botox and fillers. I also trained for the Esthetic Skin Institute for many years.

Do you have an ongoing training that you “MUST” attend to?

Yes, the Allergan Corp. requires ongoing training for me to be a trainer and the reps for every area provide ongoing course and meetings we can attend.

How rewarding is it?

Doing all that I do is very rewarding from the plastic surgery, facial aesthetics, and home health nursing. I am helping people every day to feel better and look better.

What are the drawbacks of the profession?

You can’t please everyone or heal all of them and sometimes they are less than grateful for what you try to do. It is very disheartening when you try to help someone and they turn on you when it doesn’t work out.

What was the hardest moment you had to go through as a nurse?

Having a patient come in for a purely cosmetic procedure and finding out they have cancer. I cry every time we have to tell them.

Throughout her career, Karen has received a great deal of recognition such as:

Certified by Medicis (2005) and Inamed/Allergan (1999) as trainer in injection technique, named to Who’s Who in American Nursing since 1990, Who’s Who in Human Service Professionals since 1991, Who’s Who in the West since 1992, named as a Fellow of the American Biographical Institute in 1995, as Women of the Years in Nursing 2000 and 2009, one of the 2000 American Notable Women since 2001, and Certified Medicare AAAASF Inspector since 2003.


Michele Elyzabeth

Publicist LATF USA