Custom-Made Tri-luma for me– and you too

Tri-luma was a popular combination of tretinoin ( the generic name for Retin-A), hydroquinone  to lighten the skin and a medium strength steroid  by the name of flucinolone. The tretinoin  would hasten skin growth and exfoliation to shed darkened skin; the hydroquinone would  decease melanin production and the steroid would avoid redness and swelling from the other two turbo driven ingredients. It worked  well  for my under eye shadows and was the go to-product for brown patches  known as melasma.

It would take  at least three weeks  to see results  for Tri-luma, but when it worked, it WORKED.  You had to be complusive about sunscreen using at least a 30SPF during and after Tri-luma  since  the ingredients increased sun sensitivity to the sun.Then one  day Tri-luma seemed to disappear from pharmacy shelves.    THere was no FDA recall, no  clear statement from the manufacturer.  Nothing.

Then I started hearing rumors  on the web  that specialty  pharmacists could compound it individually for their customers who brought in a  prescription from their dermatologist. I asked my go-to dermatologist Dr Albert Lefkovits  about the idea and he was wonderfully supportive.  It turns out that the   Tri-luma formula was actually  developed by Albert Kligman, considered  by many  to be the father of cosmetic dermatology.

Dr Lefkovits made a slight change  in the Kligman formula substituting a  milder steroid called desononide.  One of the concerns about Tri-luma was  the strong steroid could cause  thinning of the skin and lead  to the development of rosecea.  Using desonide takes down the risk of these problems.

I never had a personally compounded product before  and I was excited to pick it up at Caligor pharmacy in NYC near Bloomingdales.   The small elegant store  had  it ready for me.  Rahter than a tube, the custom compound was in a small jar.  The pharmacist suggested that I keep it in the frig  to maintain potency.  What a good idea. I had noticed that my $300 tube of Tei-luma soon turned yellow and started to small like rotten eggs. 

The strange smell  was due to the deterioration of the sulfite preservative  and was so aunappealing I stopped using  the tube when it was still half full.  Refrigeration will stabilize  the formula so I’m hoping to be able to use it to the last drop.  Oh, and the best part?  My own personal Tri-luma like cream was more than $100 less than  the brand name product. Let the bleaching games begin.

Does Everything Cause Dark Circles?

Apparently in addition to genetics, stress, age, salty foods, sunlight and skin type, allergies  can also trigger  dark under eye shadows.  I  had brought my dark circles under control with Triluma, a combo of Retin A,  hydroquinone and a steroid to keep things calm.  After three months of  use, you could see a real change.  However  Triluma can only be used for three months at a time and then  you need take a three month holiday before it can be used  again.  Its that strong.

In the meantime, I made sure to use a 20SPF sunblock under my eyes and avoided  pizza  and chinese food– two high salt foods– that were big dark circle triggers for me.   When my  three month Triluma holiday  was over, I  didn’t need  to  use it again.  

 I was feeling  pretty smug about  by under eye managemnt when the worst allergy season  in a decade hit the New York area.  And along with coughing and congestion,  allergies bring on  under eye shadows.  After  a few weeks of sneezing, my shadows came back in force.   ( see pix above)  Allergies cause blood vessels to swell, and under the eye,  swollen blood vessels  increase the red/blue   skin tones.  And  allergies are the gift  that keeps in giving.  In addition to  shadows that look like I haven’t slept for a week, the extra fluid  is causing  under eye bags.  If these  continue, the skin will become stretched out and the bags will be permanent long after the last grain of pollen has drifted away.  

Not to panic, I popped a Zertec  for allergies and plucked out  my trusty tube of Triluma.  But when I opened the tube, the once white  cream had turned a lurid yellow and it smelled like rotten eggs.  According to  my pharmacist,  sulfur is used as a preservative and the color and ssmell  indicated that the Triluma  had “expired” — their word not mine.  These things happen, but Triluma is $300/tube and  according to my calculations, I  had wasted about $270.  Instead of getting a new tube of Triluma I decided to try another  approach to dark circles.  Clarisonic which makes an incredible facial brush also has a serum in a unique delivery device. Called the Opal Sonic Infusion System it  promises to reduce puffiness and dark circles.  The serum contains a host  of effective antioxidants, vitamin C  and caffeine–the later known to constrict blood vessels.  Allergy induced dark circles are due to swollen blood vessels and caffeine  should encourge  these vessels to shrink back to normal.    Sounds plausable.

I am going to  try the device for a month and post  the before and after pix.  I’m asking alot  of  this little device to deal with under eye shadows  in an allergy season, but  I hope we’re both up to the challenge.

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 (  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.

Anti-Aging Skin Care- The Fabulous Fourteen

When I started exploring anti-aging options a few months go, I had  just three go-to products.  It wasn’t that I didn’t care — I just didn’t know what my skin  truely needed. Too many times  I would be vulnerable  to  great sales pitch and find that the expensive “miracle cream”  either did nothing or  made my face break-out.  Now that I am testing out wrinkling fighting tools and techniques, I had to try out  an endless buffet of skin care products.  Trial and lots of error  has resulted in a group of cleansers, moisturizers and sunscreens that deliever on their  promises.  I call them my “Fabulous Fourteen” and today I have uploaded that list in the blog tab ” Beauty Tool Kit”.  I explain  how to use  them, how they  work and  how much they cost.  I have only one face and can’t try out everything, so I would love to hear about your go-to products.

Beauty Dangers of Book Clubs

This week I had my monthly bookclub meeting which meant  great conversation, a perfect brie  and of course  several glasses of  a crisp Pinot Grigio.  The next morning I was reminded what  alcohol does to the skin.  My under-eye circles which  had nearly faded way ( thanks to Tri-luma) had now  suddenly  made an encore appearance.  The reddish/blue shadows were a clear sign  that  alcohol had caused minute leaking  from tiny blood vessels. under the eye.  I now have to wait until the body can breakdown this hemoglobin for the color to fade.   To help things along, I applied a compress of cold Lipton tea bags.  The cool temperature and tannin in the black tea  should shrink the swollen blood vessels– and shrunken  vessels won’t leak anymore blood and fluid.  Within 48 hours, the lurid color  had faded a bit and I can cover it with a dab of green Dermablend cream  under my regular concealer.  But I know  what lies beneath the make-up.

This experience  reminded me  that what we drink and eat ( salty crackers with the Brie)  has a huge impact  on how  we look.  It made me think– what other factors in my diet are affecting my hair and skin?  Any suggestions where I should start?

Under Eye Shadows and Allergies

Sometimes there are simple answers to complicated problems.  I was bummed out that  most of the improvements I had seen with Tri-luma were reversed by seasonal allergies.  But yesterday I went to an  allergist who gave me such a simple and effective solution– a saline nasal rinse.  You simply spray a salty solution into each nostril and blow.  I did it before  going to sleep  and  by morning,   the newly returned shadows  were noticably lighter.  I have to keep using the saline nasal spray   all summer, but its wonderful to have such an easy,  low-tech solution. 

This just goes to my  core belief that we need to get to the causes of  beauty problems to really  see a difference.  If  we don’t deal with  changes in the  body that are driving the problems, then attempts to fix the problem are just a frustating waste of time… and money.

Progress On Under Eye Circles

 I had been on Tri-luma for almost three weeks and was pleasantly surprised by what I saw.  The under eye shadows had lightened considerably.  Only the area closest to my nose still had dark blue smudges.  I made plans to take  some  great “after” photos after I got back from a weekend in the country.  And that’s where it all unraveled.  Saturday morning I woke up sneezing and by Monday my eyes were swollen and red.  And the under eye circles?  They’re back! 

When I  had blogged about the causes of under eye circles in March, I explained  that congestion of allergies causes pooling of fluids and hemoglobin under the eyes — and here I am the poster girl for under eye  allergy shadows.  I am hoping that  when I get  past this allergy episode, Triluma will  lighten my under eye shadows again. 

The good news here is that Tri-luma seemed to work as promised.  The bad news? Its not permanent.  THe underlying issues that cause shadows in the first place still exist and can cause new  problems.  Package inserts for Tri-luma recommend not using  it longer than 3 months.  Does that mean three months at a time?   In a year?  I need to get clarification.

Allergies and Aging

We all know that spring allergies can make us sneeze and itch– but did  you know spring allergies can make you look older?  Seasonal allergies produce daily inflammation that trigger dark circles under the eyes.  Blood vessels swell and leak fluid that pool under the eyes.  The result?  Eyes become puffy and swollen.  A bad allergy season  can lead to permanent  bags  and wrinkles under the eyes. 

With seasonal allergies, the  best offense is a strong defense.  When you see the trees and flowers blooming, start taking a daily non -sedating anti histamine like Zyrtec  or Claritin. Your body needs  several weeks  to build up allergy- fighting levels of medication for the months of pollen heavy air  that are coming.

Make you own home  an allergen-free zone.  To keep pollen from building up inside, close windows and turn on the A/C.  If you wake up with swollen eyes and congestion, try to eliminate stuff that attracts  pollen and dust — thick rugs, heavy drapes and the well-named dust ruffle.  (Actually it should  be called  a ‘dust magnet’).  In the morning use a saline nasal spray to prevent build-up of fluid that will quickly lead to puffy eye bags.  When  you come home after work or school, leave shoes outside to avoid tracking in dirt and pollen.  Two hours before bedtime, turn on a HEPA style air filter to clean the environment  that you will be breathing all night long.

This might sound like  alot of work  but its so worth it. Many women who seem to age faster  just  have uncontrolled seasonal  allergies.