Oops, I'm Peeling!

Successful acne-clearing and anti-aging routines revolve around exfoliants, as we've discussed in previous posts here, here, and here. For the most part, exfoliating treatments are super-predictable, often down to the day and time of day that you are likely to start peeling. But what happens when your skin doesn't stick to a schedule? And what can you do to minimize peeling when you weren't expecting it?

Peeling on purpose, but you get the picture

Lunchtime peels are not intended to produce visible peeling. The acids are light enough to break apart only the most superficial dead skin cells, allowing them to release cell by cell, without perceptible peeling. Occasionally, lunchtime peels (including microdermabrasion and dermaplaning) may produce some unexpected peeling, especially in the following cases:

• Dry weather
• Increased absorption from pretreatment
• Vigorous exfoliation after treatment

Medium peels are designed to slough off the whole top layer of the skin, while sparing the pink, juicy "live" skin underneath. The exfoliated skin generally peels in small, flaky bits, which are easily removed with gentle cleansing and a washcloth. With medium peels, a few unusual responses sometimes observed are:

• Darkening of the skin, especially over areas of hyperpigmentation
• Starting to peel early, or continuing to peel beyond the usual five days

Intensive and double peels are intended to exfoliate the entire top layer of the skin, while allowing some acid to stimulate collagen production in the underlying dermis. Skin is expected to darken, harden, and peel in large sheets, like a sun or wind burn would(although blistering, scabbing, and oozing, which would indicate a medical-strength peel, are not expected). As with medium peels, skin sometimes peels outside of the usual range of five to seven days, which may be inconvenient for work or social reasons.

In any of these cases, it's a great idea to contact your esthetician if you think you may be experiencing something out of the ordinary. Generally, as long as you are at least two days post-treatment, it is safe to use an ointment. We like Vivant's Recovery Ointment, available at the Skin Studio*, which blends aloe vera juice with the standard occlusive petrolatum. Other good options are Aquaphor and Elizabeth Arden's Eight Hour Cream (the original balm formula, not one of the spinoff cremes). When you find yourself peeling unexpectedly, avoid scrubbing with all your might! Scrubbing at this juncture will leave you with raw, red skin that is almost impossible to conceal. Instead, slather on one of these occlusive preparations. You are essentially gluing down the peely skin. Go as long as you can in the day with just balm on your skin before you need to apply makeup. Then, tissue down the occlusive ointment to the bare minimum needed to keep the peely skin glued down, and apply makeup with a minimum of friction (this is not the time to perfect your blending technique). If prior to applying makeup, the peely skin is reeeaally obvious under the ointment, then you have my permission to wipe your face gently, one time, with a warm washcloth, but proceed with caution - peely skin is always easier to cover than raw skin!

Hopefully these instructions will help in the event that you experience "bonus peeling." Do you have any post-peel photos? Share a link in the comments section below!

*This ointment is available in our online store to existing studio clients when logged in.

Hormonal Acne: Myth vs Fact

I am surprised how often I am asked, "does your studio help people with hormonal acne?"  And my answer is a resounding "Yes!"

The question reflects a widely-held but scientifically inaccurate assumption that somehow "hormonal acne" is different, and that there is nothing topical or nutritional that can be done to clear it up.

In reality, all acne is influenced by hormones.  Acne is the proliferation of comedones (blackheads or whiteheads) leading to pustules, papules, and sometimes cysts or nodules.    Comedone formation is subject to many factors, among them sebum thickness.  A predominance of androgens or male hormones thickens the sebum, while lower proportions of those hormones result in less viscous sebum.  For some women who are both struggling with acne and who wish to be on oral contraceptives, simply using a pill that is higher in estrogen and lower in androgens* can go a long way towards clear skin.  Likewise, certain hormonal birth control, especially those advertised as being low in estrogen**, can be responsible for thickening sebum enough to cause a problem for women who may not otherwise consider themselves acne-prone.  If acne breakouts begin while taking these hormonal contraceptives, in my opinion it's worth a phone call to the prescriber to find out if there might be a more suitable choice of hormonal contraceptive.

Despite what you may have heard about "hormonal acne," though, hormones are not the only factor.  Furthermore, I often see clients who do not want to or cannot take hormonal medications for a variety of personal and medical reasons, and clients for whom the main androgenic hormones acting on the thickness of their sebum are likely to be stress hormones like adrenaline and cortisol.  Unfortunately, I have observed instances in which dermatologists and gynecologists lump these people into a "hormonal acne" header and tell them they have to take birth control pills if they want their acne to clear up.  I know from experience that this does not have to be true, so I think it's important to shrug off the notion of hormonal acne and work on the causes of acne that we can control.  While hormones exert a very important influence on the thickness of the sebum, hormone levels are never the whole store behind an individual's acne.  A comedone forms in a pore when there is a combination of factors present, of which thickened sebum is only one.  The other factors in the development of a comedone (and progression from comedone to pustule or cyst) are:

• the rate at which stratum corneum (dead skin cell layer) cells detach and shed off the skin surface as a whole and the pore lining in particular (determined by genetic and nutritional factors but primarily topical skincare routine)
• the presence of acne-causing bacteria (which can sometimes proliferate excessively as a result of overscrubbing) 
• the overall health of the skin (which can be compromised by exposure to comedogenic substances, UV light, oxidation from sources like cigarette smoke and pollution, and nutritional factors)

The reason that we don't treat "hormonal acne" differently from any other acne at the Skin Studio is that for our purposes, they aren't different!  Our treatment approach does include some minor nutritional adjustments, but is primarily topical, and it's been our observation that even skin that is breaking out under an onslaught of hormonal aggrivators (for example, when corticosteroids have been prescribed after an injury or for an episode of a chronic illness) can remain clear with pro exfoliating treatments and skincare.

*Some examples of birth control pills in this category are Yaz and Yasmin, Ortho TriCyclen, Diane35, and Desogen (Apri).
**These include the Nuva Ring, DepoProvera, Loestrin, and Estrostep FE.

The Skin Studio Now Offering Luxury Body Treatments!

Services Include Mineral Wraps, Scrubs, Cellulite Treatments and Therapeutic Massage

The Skin Studio, located at 725 Joseph St at the corner of Magazine and Joseph in uptown New Orleans, is proud to announce the expansion of its body services menu. The same team of experts you have trusted to give you smooth, glowing skin now brings you deluxe spa body treatments in our beautiful Uptown loft. In the serenity of our indoor garden, you or a loved one can experience blissful relaxation while receiving New Orleans’ most customized care.

Having offered traditional and classic massage therapy in the past, the Skin Studio now offers a range of indulgent body treatments, such as the Body Glow with Relaxation Massage. With this treatment, clients choose one of three professionally formulated scrubs for gentle exfoliation, stimulation and custom results: the Tumeric Neem Glow (for brightening and clarifying); the Lavender Sugar Glow (for deluxe hydration); or the Coffee Salt Body Polish (for brightening and slimming). The treatment includes up to a full hour of relaxing therapeutic massage.

Results-oriented treatments include the exclusive Cellulite Buster with Ultrasonic and Infrared therapy, which targets problem areas with a special kneading massage technique and a cellulite-busting formulation of powerful active ingredients (including caffeine, guarana, carnatine and amino acids). These ingredients penetrate deep into the skin using ultrasonic technology, firming skin and reducing the appearance of cellulite; in addition, clients enjoy a relaxing scalp massage during infrared light therapy.

The Skin Studio’s licensed massage therapists are trained in a wide range of modalities, which are used in combination to best address client needs during each session. Massages can be upgraded to include deep tissue and hot stone therapy.

The Skin Studio’s services also include clinical skincare and cosmeceutical treatments, facials, waxing, lash and brow tinting, and more. For more information, or to schedule an appointment, please call or text 504-717-4466, or email reservations@skinstudioneworleans.com.

The Mother-in-law Request: Free Esthetician Advice?

On a recent visit to my in-laws, my husband's mom had series of anti-aging questions which I think are best answered together.  She asked:

"I have hereditary dark spots on my face.  My dermatologist is willing to freeze them off when I go in for my cancer screenings, so I have had many of them on my cheeks and the sides of my face removed this way.  I am nervous about asking him to remove one that is located on my upper lip because it will look like like I have a sore there.  Is there any other option?  Also, I have some broken capillaries.  Could he do those with a laser, and if so, do you think he could get the dark spot with the laser, and would that prevent it getting scabby?" 

I think this is a great line of questioning because it reflects the concerns many women have about the best approach for the health and beauty of their skin!

I told my mother-in-law that she's thinking along the right lines by endeavoring to consolidate treatments and minimize downtime.  Unfortunately, like the experience she has had with liquid nitrogen, the mechanism by which lasers lighten dark spots always results in the spot darkening, scabbing, and falling off (just like laser hair and tattoo removal, where the pigment molecules are broken apart by the therapeutic light, and must be expelled or reabsorbed), so a laser would not be the best solution to solving the pigment problem without scabbing.

Since my mother-in-law is using a retinoid but not a skin lightener, I recommended that she incorporate Bleaching Cream, from the Skin Studio.  It is a blend of the active retinoid retinyl propionate and 2% hydroquinone, plus citric and kojic acids to provide additional brightening benefit, and aloe to prevent irritation from the active ingredients.  Once skin is preconditioned with a retinoid/lightener/hydroxy acid regimen, great results are possible from peels.  Preconditioned skin will peel and heal even better, with rapid healing time and more complete spot removal.



As for the broken capillaries, lasers can be a great option, but treatments come at a risk of burns or scars.  The risk is minimized by having any treatment performed by someone who has substantial hours logged on the device they are using.  In addition to traditional laser light (in which the light is collimated or focused into one tiny laser point), there are also intense pulsed light treatments, including the noninvasive Radiancy Facial at the Skin Studio, which offer a very low-risk means of reducing redness and homogenizing pigment, especially when you can schedule treatments twice a week for five weeks.

Finally, as mentioned in the previous post, peptide technology can be a great adjunct to traditional means of lightening pigmentation, and can also stimulate skin repair during traditional bleaching treatments.

Lighten Up! An Up-to-the-Minute Primer on Managing Hyperpigmentation

Hyperpigmentation is usually caused by a combination of hormones and sun exposure, but can also be a result of certain types of trauma to the skin, including acne breakouts after healing. Any of these factors can cause the skin to overproduce melanin (skin pigment) in an effort to protect the skin from further damage. If you’re interested in speeding up the rate that your skin pigmentation fades, it’s first helpful to understand the three different types of skin-lightening ingredients--this will help you make a decision about which type or types of lighteners will work best with your skin pigmentation and general health.

The first type of lightener is hydroquinone-based. Hydroquinone-based lighteners also include certain ingredients that are chemically analogous to hydroquinone, such as arbutin (sourced from uva ursi, or bearberry) and kojic acid (a fermentation byproduct of certain mushrooms). All of these ingredients have the same mechanism of action on the cellular level. Hydroquinone and its analogs are the same shape of molecule as an amino acid called tyrosine, which is processed by an enzyme called tyrosinase. Tyrosine is part of any normal diet, and is found in foods like soy protein, seaweed, and egg whites, to name a few. When tyrosinase breaks down tyrosine, the body uses tyrosine to make melanin, or skin pigment. By fitting into tyrosine receptors, hydroquinone functions as a tyrosinase inhibitor, preventing the body from using tyrosine to make melanin, and effectively shutting down the pigment factories found within the skin’s basal layer.

This image shows a protein fitting into a receptor, much as tyrosine fits into its receptor. Notice how the receptor releases a chemical when the protein locks into place: by replacing tyrosine with hydroquinone, we prohibit the receptor from releasing melanin. This receptor blockage is currently the only step of melanin production for which we have found such an effective process of inhibition.

The second type of lightener is exfoliant-based. Exfoliant-based lightening only works if A) you have first removed whatever is causing your excess pigmentation (for example, if you are no longer experiencing hormone fluctuation, UV-induced cellular mutations, or acne or other inflammatory skin conditions that may have been contributing to the production of excess pigment); or B) you have already shut down your pigment factories through the use of hydroquinone or another tyrosinase inhibitor. The reason this prerequisite is necessary is because exfoliants’ main action is to break down skin cells, thereby hastening the production of healthy new cells. When the skin cell turnover is accelerated through exfoliation without the interference of excess pigment-causing factors, the resulting cells contain only the normal amount of pigment: fresh, new skin!

[NB: While the primary benefit of retinoids to the skin is NOT their exfoliant properties, for the purpose of this article, you should understand retinoids to be included in the exfoliant category as supporters of skin lightening.]

Finally, there is also a third type of lightener. Peptide-based lighteners rely on the interaction of peptides, which are small chains of amino acids (like proteins), with cells in the skin’s deep tissue layers. Several peptides that have only recently been synthesized in labs have been shown to have remarkable skin lightening properties. In particular, palmitoyl oligopeptide-68 seems to derive its efficacy from its ability to both prevent the synthesis of melanin and stimulate the production of collagen and hyaluronic acid, which aid in cell repair and reduce inflammation. One of palmitoyl oligopeptide-68’s most important functions is to mimic TGF-Beta (Transforming Growth Factor Beta) proteins. These proteins are vital to cell health throughout the body, as they are responsible for regulating crucial cell activities (like telling cells when to die so that they don’t become cancerous)! This is where the mad science comes in: though scientists know TGF-Beta’s basic functions, they haven’t yet discovered all of its cellular pathways. So palmitoyl oligopeptide-68 was successfully synthesized to mimic TGF-Beta, but we don’t know exactly how it works!

Regardless of the mystery, the benefits offered by a skin lightener that can both inhibit tyrosinase, as hydroquinone-based lighteners do, and stimulate cell turnover, as exfoliant-based lighteners do, cannot be denied. By using this dual-function approach to skin lightening, we can attain results previously only available through the use of both a hydroquinone and an exfoliant-based lightener, with less irritation and within a much shorter time period. Peptide-based lighteners are also a great solution for those who cannot use hydroquinone-based lighteners because of pregnancy or nursing concerns. Certain persistent pigmentation will still require the use of hydroquinone; likewise, on some skin, embedded pigmentation will linger unless treated with alpha hydroxy acids, usually in the form of peels. Nonetheless, we consider this an incredible new low-impact addition to our skin-lightening arsenal, and one that many clients, especially those who haven’t tolerated other lighteners in the past, may wish to explore.

Don't forget to tell us which lightener you'd like to try in the comments for a chance to win a bottle!  Winners will be notified by email on Friday, August 26, 2011.

As always, you can text or call the Skin Studio with any questions or concerns at 504-717-4466; or, click here to schedule your next appointment!