- Hey guys, its Laura and Dr. S here today.
- Nancy Satur
- With our last Facebook Live of the year,
can you believe it?
- I know.
- I can't believe it's almost 2017,
we've had a lot of fun sharing all these tidbits
with you in the last several weeks that we've
been doing Facebook Live,
and we promise we've got a lot more exciting
things to come in 2017.
So, let's get started with our Facebook Live for today.
- Great.
- Alright, I've got some questions here.
The first one is from Srivandhana,
she wonders, "Why does acne spread from one area to the
"other when it's healing in the first area?
"Is there a reason healing cystic acne could arouse
"non-cystic acne in other areas?"
- I think that's that's a good question, but I would say,
don't worry about the cystic acne spreading
from one area to another,
because we don't consider acne an infection,
as everyone, I think knows.
So there are bacteria involved in the pores,
and yes, I suppose if you squeezed and emptied
a blemish, you could get some bacteria going
onto the adjacent skin, but it's really bacteria
that's already there.
So, I look at it more that, maybe one area of your
face may be more prone to breakout,
because of local factors.
For example, you might be sitting chin in hand
to study or work at the computer,
or some of my patients wear headbands to work out,
or helmets to ride bikes.
And sometimes it's more that, that the whole area
is predisposed for other reasons, not because
it's spreading from one to the other.
So I really would reassure you not to worry about that.
- Mm hmm. I think cell phones too.
- Yes, uh huh. - Especially in this
day and age, so if you're using your cell phone
just on one side of your face,
or if you tend to sleep on one side and one side only--
- You know, anything that increases moisture and friction
will increase a propensity to break out.
So I think that's the answer.
- Sounds good, alright we'll move on to question
number two from Kim, Kim wonders,
"How come my friends can eat like crap and use
"whatever face wash they want, and still have
"perfectly clear skin, but I have to watch what I eat
"carefully, avoid gluten, dairy, unhealthy fats,
"and practice a skin care regiment to avoid
"huge stubborn pimples all over?"
Well, that sounds very frustrating.
And the answer to that is everyone's skin is different.
- That's right.
- And you know, some people are more prone to acne
than others, some people are blessed with beautifully
clear skin and good genes.
- That's right.
- Where they can eat whatever they want
and use whatever they want and they're fine.
And others of us have to take pretty good care,
diligent care of our skin.
- Yeah, I think I would second what you said Laura,
because everybody has a unique
body type or constitution or skin type.
And you can have normal hormones, for example,
women, and still get hormonal acne,
and it's most of the time not because your hormones
are abnormal, but your oil blends are responding
more vigorously to those hormones.
Or for example diet, we know a lot of people flare
with certain dietary indiscretions, more dairy,
especially skim milk, more sugar and simple carbs,
but it's true, some people can eat junk food
and not break out.
So it's just the fact that we're so unique and not
everyone marches to the same drummer in terms of
how they're skin reacts to certain outside influences.
- Absolutely.
- So I suppose it's more the situation of have you
chosen the correct parents, as far as your skin goes?
- Factors we can't control. - Because we can't control
our genetics, but that's a big factor as well.
- Yes, and especially at this time of the year when
you mention Kim, I mean I know I've eaten a lot of stuff
that I'm not proud of this holiday season
and I'm sure I will continue to do so for
the next week or so, so, I might be paying
for that later in the new year, but.
- Moderation in all things.
- Good thing I have my Curology on board
to help me out with it.
- That's right.
- (laughs) Our next question is from Mitzi,
she asks, "I have very oily skin and still break out
"at the age of 60, what can I use?"
What do you think about that one?
- Laura, I think that's a problem for you to solve.
(laughing)
And we're teasing because it's such a difficult problem.
- Exactly, yeah.
- Really I, the one thing I would say, this is I think,
probably a woman,
and we do use birth control pills and an
oral medication called spironolactone to reduce
hormonal breakout, which will also reduce oil.
But as one gets older, those medications may not be
the best things to use.
So it may not be something at 60 that she would have
prescribed to her.
I would say though, in the peri-menopausal or menopausal
years, if a woman is taking testosterone in any way,
either a patch or a pill or an injection,
or any kind of androgen hormones as part of
the estrogen replacement therapy,
I think there's Estratest,
so anything with androgens or testosterone will
definitely increase oil and breakout.
So that could be a factor at the age of 60,
but what about any miracles otherwise for oil?
We don't think anything topical really helps.
- Yeah, not really.
- I mean, I think there are some things on the horizon,
and you'll find a few isolated reports of something
helping, but not a consistent, agreed,
conclusive study that says, aha, this particular
product or ingredient topically will decrease oil.
So, there is no feedback we think.
I think this area is being studied quite a bit now.
So we may have something different to say in 2017.
- We might, and that brings us to another question
we get frequently from our Curology patients is that
you know, they think that with their oily skin,
their skin is really dehydrated, so they keep
piling moisturizer and oils on top of it,
thinking that that's why it's dry.
So you were talking about the feedback loop,
and that we don't really think that that exists,
so that is another myth that we've talked about
with our patients, much like the pores opening
and closing, that myth that we shed light on
earlier this year, and broke a few hearts that way.
We might be breaking some more with that myth too, so.
Our next question, we've gone back and forth about
a little bit it's pretty fun.
- Yes.
- Julia asks, "What do you think about facial exercises?
"Are there any of these face yoga tricks that you
"recommend doing daily to slow aging?"
- Well, I'll say at age 63, if you find any that work,
please send us the link, email them, I'd love to try them.
But I will say, you know it's common sense
that exercise changes muscle and the skin that's draped
over the muscle, although you're not gonna work
a miracle, it'll look better, so those saggy arms
when you're working out, and the skin may still
be a little crepey and a little wrinkly,
but it sure looks better draped over some muscle
than not, so I,
it's intuitive that facial exercises will change
the musculature in some way.
The problem is, what if it's doing something that
doesn't look good?
I mean, I don't know, I would think of course
you're not gonna want to frown as part of
your facial exercises, or you're wear some
vertical lines there.
But I don't know which ones to do that would help.
I wouldn't think that you'd wanna mimic
expressions that are negative, like frowning
or pursing your lips, and creasing in those lines.
So I think it's an interesting subject,
but one that I would like to know more about.
- Yes.
- And I can't, I have no experience personally.
- Right, so we don't have a great definitive answer,
but maybe, we're open to it.
- I'd like to do it on one side of my face only,
for about three months and see if I can tell a difference.
And then I'll have to catch up.
- We should try it, in 2017, we'll give that a try
and then we'll see if you guys can notice a difference
between one side of my face--
And like you said frowning lines,
also smile lines, we have patients ask about their
smile lines, those are good lines.
- Yeah, and these are good lines too.
Crow's feet are smile lines as far as I'm concerned.
- Yeah. - Yes.
(speaker too far from microphone to be heard)
- Sure. - Oh.
- [Speaker] Layla commented, "Do you think extended
"use of Tretinoin will thin out the skin or make it shiny?"
- Hmm, that's a great question.
- You want me to take that one.
- Sure, yeah.
- That's a good question.
I think that it, many people think that chronic
use of Tretinoin may thin the skin,
but the part of the skin, on the layers of the skin
if you were to look under the microscope,
we don't have our diagrams in this room.
- No we don't.
- Or our models of skin, but the part of skin that is
getting thinner is the dead, dry, dull stratum corneum,
the cells that aren't living and are going to be shed
anyway, and it doesn't really matter if that layer
is thick or thin.
And thin is better 'cause you're not flaking
once it's shed,
and your skin is more vibrant.
What counts is the dermis, or the layer that gives
the skin, the collagen layer that gives the
skin it's firmness and it's resilience,
and that layer actually thickens with Tretinoin.
So it's a good thing,
I've been using Tretinoin more on than off
since my early 30s I think, and I will continue
to do so, so I,
it's my foundation after sunscreen,
it's the two things that I don't miss every day.
Oh you said, you also asked, does it make the skin shiny?
Over-exfoliated skin can be shiny.
So if you're overusing Tretinoin, you may
temporarily get shiny, especially if you're using
something abrasive to get the flakes off.
Would you agree?
- I would definitely agree, if you're using Tretinoin
daily, which many of our patients do,
in addition to chemical exfoliants, AHA, BHA,
and physical exfoliants like Konjac Sponge
and Clarisonic, you know, that's a whole lot of
exfoliation going on there, and if you see that your
skin is shiny but now quite oily,
it's that shiny but not quite oily skin that we're
talking about that patients will see.
And I've had it happen to me a couple times,
and you just back off on your exfoliants
and your Tretinoin, and that usually goes away.
But yes, we do see that with Tretinoin.
- And it's pretty easy to reverse, you just,
as Laura said, you just kinda go, hmm,
I think I better skip that today.
- Yep.
- And just use your judgment every day.
- Absolutely.
I think we've got one more question here from Adecha,
she asks, "I have dark circles and I would want to know
"how to make them fade away."
Don't we all.
- We get that question a lot, and it's not related
to acne, which is our primary mission,
but it certainly is related to
skin appearance and aesthetics.
I will say that most of the time dark circles are genetic.
I actually had my dark circles, people commented
upon them when I was maybe 12, 13, and on.
So, I've had them forever, as just a genetic
kind of tendency.
And when you think of what causes them,
I think of three things.
So, one is a shadow.
And as we get older, so not someone your age Laura,
but as we get older, sometimes the fat pad
will bulge a little bit here.
And then you'll have a hollow and then a bulge here,
and you've got kind of a festoon effect.
And it catches light, depending on which way
the light's coming, and you get the shadow
that can make, accentuate the dark skin,
and the, other than surgery, fillers could possibly
help that, you know a minor procedure in
a dermatologist's office.
So other than volume lost or volume change
in shadowing, what else could a dark circle be due to?
Well the second thing is vascular,
and by that I mean plumbing,
the little pipes that are carrying red blood cells.
And they can be tiny pink capillaries close to
the surface of the skin, or they can be dusky,
larger veins, a little deeper.
I had some pretty prominent veins that would
just make me look almost bruised here.
And quite a few years ago, I had laser treatment
for my dark circles, but primarily targeting the vein.
And we, back in the day when I was using lasers
and not doing telemedicine, we would tell patients
to expect maybe 30% improvement.
And I think I had that,
or maybe 30, 40% after two treatments,
and so I don't see that big vein there anymore.
And the third, and oh, by the way, there are different
lasers that target different vessels.
So, you might be using a laser in a different way,
or a different laser for a deeper blue vein as opposed
to a more superficial pink blush.
And then the the final factor is melanin, which is pigment.
And so our patients want to use things on the surface
to help the melanin, and yeah you probably can get,
I think you can get some improvement, I think certainly
that's, I cover my under eye circles up and treat
them with Tretinoin, but.
- Me too.
- Well, we're not gonna expect a miracle 'cause we're
not addressing the red primarily, right, and the shadow.
So what do you tell your patients to use when they complain
of under eye circles?
- So I, I address primarily the melanin component
because I think that's what most topical products,
they're looking for a topical solution and not
everyone is wanting to jump to the laser treatments
right away so, you said, there are Curology
medication, you know Niacinamide, Tretinoin,
things like that can help with pigmentation,
as well as sun protection,
keeping that area protected from the sun
with both sunscreen and sunglasses, hats.
- That's right.
- So that's usually what I address the most.
- Yeah, and Vitamin C, Niacinamide, are other ingredients,
over the counter retinols, because sometimes that thin
eyelid skin doesn't tolerate a prescription Tretinoin.
So starting with an over the counter retinol,
there are many brands, would be not a bad idea.
And my under eye cover up that I typically use
every day is SPF 20, so I'm killing two birds
with one stone because I'm covering up my shiners
and also blocking sun.
Oh and that reminds me, another cause of dark under eye
circles, we call them allergics to shiners,
and people who tend to have allergies and eczema
and Hay Fever, tend to have dark circles.
That's not the cause of mine, but it is another
type of skin that gets dark circles.
- Yep.
- [Speaker] One last live question if you're up for it.
- One last question. - Absolutely bring it on.
- [Speaker] Selena asks, "Is it possible to have more
"clearing of acne on one cheek than the other?
"I use the same amount of my Curology all over my face,
"but for some reason, one cheek has gotten
"much more clear than the other."
- That's a great question.
And that kind of bridges back to what we were
talking about before with local factors.
You know there, think about Selena, if there is something
that you are using on that cheek that
is more broken out, like your phone,
like laying on that side to sleep,
or you're putting your hand in your,
in your, face to your hand if you are sitting
at your desk or something like that.
So those are the biggest things that I can think of,
can you think of any other?
- No I think, I think you've hit it there, so yes,
we're not symmetric.
- Yes.
- Unfortunately, so I think we're
just about set. - So I think we're all set.
- So I'd like to end on one final note.
(sleigh bells jingling)
I hope the bell still rings for you,
may all your angels have wings,
and we'd like to say,
peace on earth.
- Peace on earth.
- [Both women] Goodwill to all.
- Bye - Happy Holidays.
- See you in 2017. - See you next year.
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