By Bayardo Aviles
During recent laser convention that Dr. Stover and I attended in Austria, one of the speakers, who happened to be the inventor of the modern cosmetic laser theory, made a statement that reassured our belief in the use of Retin-A. In summary, he said that the best way of generating collagen and elastin in the long term, the two most important structural components of the skin that keeps the skin tight and full, is Retin A.
Retin A is one of the products that falls in the broader category called Retinoids. Included in this group are retinol, retinaldehyde, retinyl esters, and retinoic acid also known as Retin-A. Retinoids are some of the most widely used cosmeceutical ingredients today. The most well known is Retin A.
Retinoids have been extensively studied over the years and multiple studies have reconfirmed their efficacy in the treatment of acne, photodamage, and psoriasis. Studies indicate that retinoids when applied topically, start a chemical chain reaction (it is very complicated to understand it but it has been replicated over and over and it is widely accepted in the scientific community) that stimulates collagen and elastin formation and produce an overall normalization of multiple skin conditions.
Synthetic forms of retinoids
However, these benefits are not without some negative side effects, mainly skin irritation. Also, it cannot be used during pregnancy. Because of this negative side effects and the large amount of evidence of their efficacy, scientists are always trying to replicate the positive effects of retinoids and at the same time minimize the negative side effects. As a result, some synthetic forms of retinoids with less side effects have been developed, but their anti-aging efficacy is not well documented.
Some of these synthetic retinoids are: adapalene and Tazarotene. Both are available with a prescription. Retinoids are also found in many over the counter (OTC) skincare products, but at low concentrations that may not be effective to repair photodamaged skin.
The retinoids found in OTC products include retinoic acid precursors such as: retinol, retinaldehyde, and retinyl esters. Retinoids can also be labled in OTC as vitamin A. Although these retinoic acid precursors cause lower level of irritation, their efficacy is not as good as retin more severe cases of photodamage. We have been recommending Retin A, also known as tretinoin, to our patients since we started our practice in Hawaii in 2001. Typically, we recommend it as a component of the Obagi Nu-Derm system because this skincare system has other ingredients such as alphahydroxy acids and lightening agents that when combined with Retin A, improve overall skin health faster and more effectively.
To decrease the level of irritation caused by Retin A, we start our patients on a lower dose and gradually increase it over time. For patients that want to start even more gradually, we recommend they start with a slow release retinol. Either 0.5% or 1.0% every other day and then move to the lower dose of Retin A 0.025%, then to 0.05% and ultimately to 0.1% if desired. We determine the type of retinoid based on the condition of the skin, the goals of the patients and the timeline that we have to work with.
First step - how much photodamage does your skin have now?
We recommend a complementary cosmetic skin evaluation with the VISIA complexion analysis to document a baseline level of skin photodamage and from that evaluation we customize a plan for each patient.
- If you are not using a retinoid and you are concerned about aging skin, you need to get on one as soon as possible.
- To determine which one of them is the most appropriate for you please schedule a complementary VISIA cosmetic skin consultation and we will make a recommendation.
- If the health of your skin requires more than a cosmetic evaluation, that is if you have scaly, itchy, raised spots, then schedule a general medical skin check and the visit may be covered by your insurance.
"Aloha Dr. Stover!
I’m interested in facial procedures that would rejuvenate my appearance. Should I go step-by-step and do one procedure at a time or is it best to combine treatments. Thanks for your advice!"
Combining facial cosmetic treatments is very often a good choice.
I am asked questions like this nearly every day. The answer is fairly complex and depends upon the patient’s age, condition and what they want to achieve.
For the middle-aged patient who has a high school reunion in 3 months and wants to look their best in a short time, the combined approach is ideal. Possibly a mini-facelift, laser skin resurfacing, Botox and facial fillers in one appointment will freshen up the appearance with typically a short recovery.
For the mother of the bride with a wedding in 2 weeks, then we consider a gentle skin peel, Dysport or Botox to relax wrinkles on the forehead and crow’s feet, and soft tissue fillers like Restylane or Perlane to plump the lips, lines around the mouth and to fill and lift the cheeks.
Start early to minimize the aging process!
For the patient in her 30s or early 40s who wants to minimize the aging process, I will usually recommend doing some minimally invasive treatment every few months.
- Beginning Botox or Dysport at a young age and having regular treatments has been shown to delay the onset of wrinkles to the forehead and around the eyes.
- Beginning early with injectable fillers that have been shown to stimulate collagen such as Restylane, Perlane or Sculptra will delay the aging process.
- Similarly, annual Thermage and Fraxel laser treatments will keep the skin tight and toned and delay the appearance of aging.
- The daily use of a physician-strength skin care system such as Obagi has been scientifically proven to maintain the elasticity of skin.
Older patients may require more invasive cosmetic procedures.
For patients in their 60s and 70s who have significant facial laxity and wrinkles due to excess skin, fat and/or loose underlying muscle will typically benefit from more aggressive combined treatments.
I will probably recommend a traditional facelift with liposuction to the neck, upper and lower eyelid tightening surgery and a brow lift.
These patients will usually also benefit from rather aggressive laser resurfacing of the skin, particularly to soften the fine lines around the mouth and eyes.
I commonly see patients in this category in my practice on the Big Island of Hawaii. They have usually spent a great deal of time in the sun. They did not use or even know about the need to use high SPF sunblocks in their younger years.
The many years of sun exposure have damaged the collagen and elastin in the skin of the face and arms resulting in a weathered, wrinkled and loose appearance.
No matter what your age or what changes you want to achieve, the good news is that we have many surgical and non-surgical options to rejuvenate the face.
To age gracefully, it is best to begin young and have a combination of many small treatments over time.
To find out what treatment plan is ideal for you, call for a complimentary consultation today!
By Bayardo Aviles
This is part two of my blog post on Obagi sunscreens where I continue my review of Obagi sunscreen products. As I said in the first part of the blog post, I have had the opportunity to use all of the Obagi sunscreens since I started using Obagi products 13 years ago, so I am speaking from my own personal experience. As promised, I will also answer the second most frequently asked question about Obagi sunscreen products that I get from my regular Obagi patients, "Why is my friend using a different Obagi sunscreen than me?"
Sun Shield SPF 50
Obagi Nu-Derm Sun Shield SPF 50. A sunscreen that
combines high UVB absorption and dynamic UVA blockage in an elegant, matte finish with 10.5% zinc oxide and 7.5% octinoxate. Non-whitening, PABA-free, and fragrance-free for all skin types.
This is Obagi’s newest sunscreen. I actually used it today for my drive home. I was able to get out of the office early and the sun was still shining so I ran into my office and applied this sunscreen. It goes on very light and although it has a substantial amount of zinc oxide (10.5%) it goes on clear. What I liked about it is that it has a matt finish and so my face does not look oily. I think this will be a great option for patients with oily skin. The matte finish hides the oily shine. I would not recommend it to patients that are looking for a moisturizing sunscreen. I will keep trying this one and it may become a favorite since I have oily skin.
Obagi Rosaclear Skin Balancing Sun Protection SPF 30
This sunscreen was formulated for patients with rosacea and facial redness. It is very similar in composition to the Physical SPF 32 in the Nu-Derm line. It contains 15.5% zinc oxide and 2% titanium dioxide.
Both of these ingredients are very gentle and do not irritate the skin. To camouflage some of the redness associated with rosacea, a tint was added to this sunscreen. However, the tint does not look good on brown Hispanic, Hawaiian and Filipino skin. It makes the skin look reddish white. Not a good look on dark tanned skin, but it is great for patients with fair skin. This sunscreen is very dear to me since it was my chosen sunscreen when I hiked Mt. Killimanjaro and on an African safari last March. You can go to our Facebook page for Cosmetic Centers of Hawaii to see some of my pictures and see what I mean about the white/reddish face. The best thing is that it kept me protected and I did not get a sunburn.
C-Sunguard SPF 30
Contains 9% micronized zinc oxide and 7.5% octinoxate.
Prevents premature aging from UVA/UVB radiation. Protects skin radiance.
This sunscreen was introduced as part of the Obagi C Rx line. This line was introduced a few years back to target patients that were looking for a product line that was better than the over the counter products they were using but not as aggressive as the Obagi Nu-Derm, Obagi’s corrective skincare system. This product line is simple to use and the products contain hydroquinone for skin lightening, alpha- hydroxy acids for exfoliation and Vitamin C for protection. The sunscreen in this skincare line looks and feels exactly like the Healthy Skin SPF 35, except you can smell the Vitamin C. This product is moisturizing and it goes on the skin very nicely. However, your skin may look a bit shiny for the first 5 minutes while the products are penetrating. I recommend this sunscreen a lot for people that are outside a lot because of the added protection of the Vitamin C. Vitamin C is an anti-oxidant that protects the skin from free radicals formed as a result of sun exposure.
Why is my friend using a different Obagi sunscreen than me?
When I perform a skincare consultation I try to find out as much as possible about the lifestyle of the patient as I can. This helps me determine which sunscreens to recommend. When a patient starts the Obagi Nu-Derm system, pretty much everyone starts with the Sunfader, since most patients are trying to improve some type of discoloration. Or for patients that are in the sun a lot, I then recommend an additional sunscreen. Which sunscreen I select, mainly depends on the skin type and skin color of the patients. Typically, the Healthy Skin SPF 35 and the C-Sunguard SPF 30 are the most popular. For patients that are very sensitive to the sun and are trying to remove discoloration caused mainly by hormonal influences (Melasma) I recommend the SPF 32. For patients with oily skin, I now recommend the Sun Shield SPF 50.
I hope this document clarifies some of questions you may have had about the different Obagi sunscreens that we carry in our practice. You may also want to visit the new Sunscreen Bar in our Kamuela office. There you can feel, smell and test about 20 of the best sunscreens in the market.
By Bayardo Aviles
My regular Obagi patients frequently ask me two main questions about Obagi sunscreens:
1. What is the difference between the different Obagi sunscreens?
The easy answer to question one would be to give you a list of the main ingredients for you to read, but that does not help much. At least it would not help me. Fortunately, I have had the opportunity to use all of the Obagi sunscreens since I started using Obagi products 13 years ago. Here, I will share my personal opinion of them. However, please remember that we all have different taste and that different lotions look and feel better on different skin types, so do not use only my opinion to make a decision if a specific sunscreen is adequate for you. For each sunscreen I will give you a technical description (main active ingredients) followed by my personal experience.
Obagi Nu-Derm Sunfader SPF 15 (6)
A topical prescription treatment that helps to protect skin from ultraviolet damage with 7.5% octinoxate and 5.5% oxybenzone, while correcting uneven surface skin color and brown spots with 4% hydroquinone. 2.0 fl ox (57 g).
This is the sunscreen that is included in the Obagi Nu-Derm starter kit. It is an essential component of the Obagi system when trying to remove brown discoloration. It contains 4% hydroquinone to lighten sunspots, acne-caused discoloration or scarring and freckles. After application of this sunscreen, the skin stings a bit since it contain two active chemical ingredients. To alleviate the stinging, I typically use a hand fan and fan for a few seconds until the sensation goes away. For those of you that use the Obagi system, you know that this is the last product you apply in the morning so the skin feels saturated and looks shiny, but it slowly penetrates the skin and your complexion looks better.
Healthy Skin Protection SPF 35
Obagi Nu-Derm Healthy Skin Protection SPF 35 (6). A sunscreen with 9% micronized zinc oxide and 7.5% octinoxate helps to protect newly transformed, younger looking skin.
This is the sunscreen that is included in the Obagi Nu-Derm starter kit as a one-ounce sample. It is recommended to apply this sunscreen after applying the Sunfader SPF 15, especially if you suspect you will be in the sun for an extended period of time. I typically tell my patients to go ahead and apply it all the time since we live in a sunny place and it is better to prevent. This is the sunscreen I personally prefer to use on a daily basis. It is moisturizing, goes on my skin smoothly and it gives me great protection without leaving my skin too white since the zinc oxide is micronized (very finely grounded). Typically, this is one of the sunscreens I recommend once patients enter the maintenance phase of their skin transformation with the Obagi Nu-Derm system.
Physical UV Block SPF 32
Obagi Nu-Derm Physical UV Block SPF 32 (6). A sunscreen with 18.5% zinc oxide helps to protect the newer, healthier skin created by your skin transformation. 2.0 oz (57 g).
This is the sunscreen we recommend the most after any type of moderate to aggressive laser or chemical peel procedure. Because it only contains zinc oxide, it does not irritate my skin at all. This is the sunscreen I use the most when I go to the beach to read or go for a hike. Now, some patients do not like this sunscreen because it contains a lot of zinc oxide (18.5%) and it goes on your skin white and stays white for a while. I do not recommend massaging it too much into the skin because this diminishes the SPF protection. There are other sunscreens available now, with similar zinc oxide and titanium dioxide contents that are tinted and go on the skin more elegantly than the Physical SPF 32, but I still prefer the Physical SPF 32 because I can clearly tell if I missed a spot. This sunscreen is packaged in a very firm plastic container to prevent breakdown of the ingredients and you must have strong hands to squeeze the product out once you get close to the end of the container.
Look for part two of my blog post on Obagi sunscreens next week where I will review a few more Obagi sunscreen products. In that article I will also answer the second most frequently asked question my regular Obagi patients ask. You may also want to visit the new Sunscreen Bar in our Kamuela office. There you can feel, smell and test about 20 of the best sunscreens in the market.
(Read part two of this Obagi sunscreen blog post here)