Botox or Laser- Which is Better?

Q&A2Question:  My Mom  reads your blog and  has been talking about getting Botox  or the “lunchtime laser.”  I want to get  her a treatment for Christmas but don’t know which one to choose.  I can afford  only one  and I want  her to see the biggest results.

Answer:  What a great question and you’re a great daughter! Both  Botox and  Intense Pulsed Light  laser  ( also known as the lunchtime laser) will make a major  difference in her appearance.  The choice depends on the condition of her skin.  If she has spent many  happy hours in the sun, its likely that she has lots of freckles and dark patches.  An Intense Pulsed Light treatment  will literally vaporize this aging pigmentation and leave her skin younger and refreshed.  The results are permanent but brown spots will return if she goes out without sun protection.  If she was not a beach bunny and  her skin  has   lines along the cheeks, forehead and  and around the eyes, Botox will erase them– for about 3-4 months.   Because lasers leave the skin extra sensitive for a few days,  you can also give her a stocking  filled with a gentle cleanser ( eg Cetaphil), sunscreen ( Neutrogena for Sensitive Skin)  and soothing water spray ( eg Dermalogica UltraCalming Spray).

The Right Tool  at the Right Time

Which anti-aging tool to use  and when to use it  was the fundamental question   behind the No-Nonsense Beauty Blog.   Initially, I planned to start with  Retin A  to reve up the circulation and skin growth, add Botox to reduce lines and polish things up by removing  large freckles and age spots with a laser.  But  as it turned out,  lasers work best on darkest spots, so I started the anti-aging journey  by removing them with a   traditional laser and then continuing with  my  plan. 

But in the past  few years since I started, there have been so  many new options  that  my new plan has become  an exploration  of new forms of Retin A, new lasers and new machines that  deal  both singly and in combination with a slew of aging issues.  At a recent dermatology  conference at Mount Sinai, the experts  came up with an effective anti-aging game plan  that started with   gentle lasers like Intense Pulsed Light  to brighten and Botox to smooth the skin.

I’d love to hear which treatment you chose.  Happy holidays!

What’s the best way to deal with brown patches?

Darkened areas  on the cheeks, dark circles under the eyes, age spots, and  hyperpigmentation  are all basically  the same problem– excess melanin production in the skin.  It  can happen at any age, but as  we grow older  it becomes more of a problem.  While we often focus on lines and wrinkles as signs of aging, clearing  brown spots and splotches  can erase years from your skin. 

While there seems to be a boatload of options, there are basically two different approaches:

1.  Products that inhibit the skin cells from producting melanin.

2.  Procedures that actually remove darkened skin.

One of the  most powerful tools against hyperpigmentation  has been hydroquinone, but  many doctors use it cautiously.   There were reports of increased pigmentation and  allergic reactions  with hydroquinone and  but according to Dr Wendy Roberts  these problems were often due to contamination of hydroquinone products. Doctors found that it was the addtion of mercury to the hydroquinone in unregulated products from Asia and Mexico that was causing the problems.  Mercury is banned in the United States and is never part of skin lightening products made in the US. 

If you still feel uncomfortable about hydroquinone,   there is a  buffet  of new ingredients including azaleic acid, licorice and vitamin C  that have been demonstarted  some ability to remove pigmentation, but not as effectively as  hydroquinone.  However when the two or even three  are combined they can work better than when  used separately and  with  lower risk of side effects.

Lasers of different sorts  have been used to treat hyperpigmentation and  one of the best new  is intermitment  pulsed light or IPL.  This type of light literally explodes freckles and without affecting  normal  skin color.  Dr  Marmur treated my BFF Judith with IPL and the before and after pix  are impressive.

Often the best treatment plan is a combination of therapies.  A camera shy friend,  used IPL to remove post pregnancy  dark  patches near  her hairline and  made sure they stayed away with  a vitamin C  serum at night  to discourage melanin production.  I used a YAG lser  for my bigger lumpy sun spots,  nightly treatment with Retin A to gradually fade small freckles and IPL to even off  skin  color.   You can seem my results in the photo album on my facebook pages.  Just  click the Facebook button.

Curent wisdom seems to be that  there is no one single silver  bullet for unwanted pigmentation.  Best results usually  occur  when  different  products and tools are used in combintion.  And remember, whatever  you do, you must be diligent  using sunscreen every day.  Even a single sunny day can provoke their return.  I know this the hard way.

My BFF– Best Friend with Freckles

Intense Pulsed  Light (IPL) is a type of photorejuvenation  that uses  a blast of light to remove freckles, unwanted hair and  little red lines on the skin.    Often called the “lunchtime laser”  it does not burn off the top layers of the skin like a tradtional laser and the skin looks beautiful and smooth within a week.    I had IPL  last year in June  with Dr Marmur and was so pleased with the results.  I thought  it made my skin look tighter and fresher and I posted before and after pics on the blog.  My BFF ( best friend with freckles) liked  the changes so much that  she went  for her own IPL date.  I think her results were even better.  Not only does she look 10 years  younger, her skin  has a new radiance.  She is so pleased with the results, that she  has now joined  me in my anti-aging journey.

First we developed a plan.   In the morning  she is using a strong sunscreen  to prevent  the return of freckles.  When she  was in school, BFF was a super athlete.  Her current passion is gardening and she is developing a new style of wall garden.  For either activity  she is often in direct sun, and needs  an uber sunscreen.   At night she is using Retin A to stimulate  circulation and new collagen. After a few months on Retin A, she will have Pelleve and will share the results on No-Nonsense Beauty Blog.  Have you tried out an anti-aging  tool or technique?  It would be wonderful if you could share your experience and before and after photos.  There are so many options out there its hard to know  which work and which are empty promises?  As Mulder would say to Scully–” The Truth is  out there”.

Red Carpet Shoulders

Watching the celebs walk the red carpet during awards season, I began to focus on the flawless  chests and creamy  shoulders of the stars  in their strapless gowns.  Was I  the last woman in America with  age spots  on my upper body?

The short answer is  no.  This is an often overlooked spot until a dress or bathing suit suddenly reminds you that sun damage doesn’t stop at the chin. That’s the bad news.   The good news?   There a buffet of spots removers including skin bleaches, IPL, lasers, Fraxel, peels and  microdermabrasion. The question is  which one  is the best.   According to Dr Marmur, I have several  different types of discolorations that require  different types of treatments.  For example the true freckles can be easily treated with a YAG or Ruby laser– the same type that I used on the freckles ( aka age spots) on my face and hands.  The raised spots are actually skin tags that are best cut off or burned away with electrocauterization.  As you can see  from my before photo, the red spots are atually more numerous and I’ll find out what they are  and how they are treated when I  get them removed tomorrow.  Its a good thing its still scarf weather here, since I  know from past experience that I’ll have a bunch of red scabs  on my neck for at least a week.

New Respect for Retinol

I have often mentioned my reservations about retinols vs the more powerful retinoids like Retin A.  When applied to the skin, retinols have to convert themselves to  a true retinoid before they can be effective. Researchers estimate that a retinol is only 25% as effective as a Retin A.   For example, a .1% Retinol (  a very common concentration) is equal to a .025 Retin A–  which is actually the mildest Retin A on the market.  And then there is the problem that most retinol products don’t say how much of the power  stuff they actually contain.  You can’t know if a  product is to weak to be effective or too strong and irritating. 

I stayed away from retinol products until wandering in the exhibit hall  of a derm conference, I picked up  free samples of .5% Retinol from Skinceuticals. I was intrigued.  A .5% retinol is at least equal to my current .1% Retin A  Micro. ( I know  this is a lot of  math but  staywith  me– its worth it). And then there was the question of price.  .5% Retinol ( they need to work on the name) is just $50/ tube–  a lot better than the $300 price tag of my Retin A Micro.  But price  is not that important if it didn’t  deliver beauty benefits.  After just three days, I  had new respect for retinols.  I could put it on  shortly after washing my face without developing dryness or irritation–yet I could see a fresher, brighter skin.    What I  loved best about Retin A  is that relieved my pale, pasty skin tones and replaces them  with  pinker, happier looking skin. This retinol product delivered the same “pinking” but without the dryness.

To keep my skin from getting bored, I’ve been alternating between .5% Retinol and .1% Retin A  Micro.  I liked the results so much, that when I had finished my samples,  I paid retail for a full size tube.    Next I want to see if I can use  it before and after an office anti-aging procedure.  IPL and lasers  make my skin especially sensitive and I need to suspend Retin A for as much as a week.  Next time, I’m going to see if I can use .5%Retinol the next day to avoid a break in beauty routinue.  What has your experience been  with retinol products.? How did they compare to Retin A for you?  

For more information, I’ve written a   guide to Retin A.  Like my Facebook  Fan Page and you can download   the four page guide for  free.

New Help for Old Hands– Part 2

Judith’s   hands  healed rapidly after her  IPL treatment. On Day One ( top left) the freckles  looked a bit red, but were not painful. Other than a sunscreen, Judith  did not need  to put anything on them   or to wear a bandage. Over the next week (bottom left )  her hand   developed  numerous  small brown spots which were exploded freckles. These   soon rubbed off  revealing  fresh new skin. The bigger freckles developed  crusted  over, which then   fell off to reveal  pale  spots.  After three weeks( bottom right) her  hands  had a  brighter, softer surface with just a few freckles that were much lighter than  before. 

And as an additional bonus, IPL  took care of the fine  lines   which made  her hands fresh and young.  Dr Lefkovits  has scheduled another visit  to totally erase the  remaining  shadows of the old freckles.

Pretty with Pelleve

The first time I went for a Pelleve  treatment with Dr Prasad, I was  anxious that it would be painful. I’m  just  not  a “no pain, no gain” type of person. I was delighted that Pelleve was a very comfortable, even relaxing procedure– and was even more pleased  with  the improvements I could see. This time   I  was pretty mellow  when I went to my second Pelleve appointment.  It was  just as painless and I saw  even more improvement.    In the pair of photos   above, the profile on the left was before any treatment and the profile on the right was just after my second  Pelleve treatment. My  cheeks and chin  are clearly firmer and less flabby.  Its not  nearly as extensive a change as I would see with a surgical lift, but I don’t want to go there. What you can also see  is that my nose does not droop down as much.  It turns out that the loss of collagen in the face means it cannot support the facial features and the nose looks longer.  When the existing collagen is tightened, the nose is returns to a more youthful position. Sweet!

Pelleve does not affect the surface of the skin, so I didn’t have to interrupt  my Retin A useage.  Its also  one of the safest anti-aging tools for women of color.   You can do Pelleve in the afternoon and go  back to work or out to dinner and look  beautiful. Dr Prasad  often does IPL  for the surface of the skin and  Pelleve for firming facial contours in the same visit.

This anti-aging tool is a beauty junkie’s ideal treatment– safe, effective, quick, immediate results and painless.  It is pricy, but unlike too many overpriced creams and serums, you actually get  the results you are paying for.

New Year, New Retin A

I finally got  my new Retin A this week and I’m lovin it.  To recap my Retin A adventures, I  had been using .04% Retin A  micro with wonderful results.  Its the lowest dose of  one of the gentlest forms  of tretinoin and I got good results  without too much discomfort. After about 10 months, I noticed that  I no longer could see  that characteristic yourthful glow you get with Retin A  and  realized  it was time to move up to the next level.  Dr Marmur gave me a prescription for.1%  Retin A– the  turbo powered one, not the micro-sphere stuff.  And here is where I went rogue.  In my local CVS, brand name Retin A was about $200.  I decided to order a generic version from Canada for $40.  I was so proud of all the money I saved.

When my bargain Retin A arrived, I was a  concerned that  it was yellow, not white, but I had faith in the label.  Concerned that  it would be too irritating, I used   a dab every other day for a week.  Nothing happened.  Then I used it every night.  Nothing.  I used two dabs.  Nothing.  I used it for a  month and while I didn’t get irritated, I didn’t see the lovely “pinking”   that I developed with  Retin A  Micro.   I even tried it under my eye.  Nothing.  I did everything but spread it on toast and eat it.  I don’t know what is in this yellow goo, but its not an effective Retin-A.

For my holiday present, I bought myself  .1% Retin A micro.  At $269 at my pharmacy, it was a commitment.  It turned out to be the right choice.  Within a week, I’ve got a little glow again.  I’m still using it every other day without flaking and redness.  My skin feels tight after washing — a signal to keep taking things easy– but I’m back in a good Retin A routinue. 

I’ve used  so many anti-aging tools, I’m running out of body parts.  Its going to get difficult   see  what procedure or product is  responsible  for changes.   That’s why I am so excited that a good friend  has volunteered to join me on this anti-aging exploration.  First  treatment, IPL for the brown spots on her hands.  I used  lasers and we can see  what a different approach can do.   Have a wonderful New Year!

Pelleve Before and After Photos– Day One

These photographs were taken  at the time of my first treatment with Dr Prasad. ( Before on the left and after on the right)  I was a little disappinted that the changes that I saw in the  mirror were not completely captured in these pix.  I saw “girlish” contours that had  been missing for  many years.  Pelleve changes are in millimeters while surgical facelifts alter centimeters of facial contours.  Personally I much prefer the subtle changes  of  less invasive procedures, rather than the unaturally tight and altered appearance of a full face lift.

According to Dr Prasad, Pelleve  helps to restore volume and reduces  crow’s feet around the eyes and smokers lines around the mouth.  I don’t have the latter two problems,  but  by adding volume to the understructure of my lower face, it lifted the shape and reduced  sagging.   Most doctors  recommend 2-4 Pelleve treatments given a month apart.  You can expect these improvements to last  up to 2 years. 

One more fact.  Pelleve is also one of the few anti-aging tools that can be used safely by women of color.  Lasers, IPL and even some forms of Retin A can all lead to  irregular and splotchy dark patches on the skin.  Sub-ablative radio frequency ( the technical name for Pelleve)  because it does not affect the surface of the face, can be confidently and effectively used by women with darker complexions.

The benefits  of Pelleve are supposed to increase in the next few weeks after the procedure.  On Monday I will post before and three week after  photos.  I’ll be really interested to hear if you see the differences I perceive or  if I am just delusional.

My New Beauty Baseline

I got a new high resolution facial imging photo from Dr Bruce Katz  at the Juva Medispa in New York City.  My original image was done with the Reveal   machine– and to be able to accurately judge changes in my skin, I needed to get a new baseline photo from the same machine that I would be using to chronicle the differences anti-aging treatments will make. Equally important, these photos will be “read” by  the same expert  pair of eyes.

The  new photos done on the Visia imaging machine  also provides more information about dark spots, pores, wrinkles and texture.   According to Dr Katz, “the ultra violet light allows you to see what can’t be seen”.  Dr Katz   recommends  that women from 20-80 get a baseline facial imaging to assess the health of the skin– and spot potential skin cancer areas  long before they become a real problem.  Dr Katz  provides this service as part of the care at his skin and laser center (juvaskin.com).  If you want to find  out  where to get facial  imaging in your area, send me your  zip code and I will locate the nearest one to your home.

My new photos were both interesting and encouraging.   The yellow circles are the computer pointing out areas of greatest sun damage that can be measured later.   The darkened areas over  my eyes look  like some kind of permanent smoky eye make-up.   For my age I am in the 79th percentile for age spots and 97st percentile for wrinkles.  This means that out of 100 women, I have fewer age spots than 79% and less wrinkles than 97% of women.  Remember that these good numbers are after a year of Retin A, IPL and various lasers for spots and hair removal.  I wish I had known about this tool before starting my anti-aging project, but I still have  many options to explore.  First on my list is  my big girl Retin A. I have been putting off starting it, but now I’ve run out of excuses.  In about eight weeks, I will return for another UV photo to check for improvements.