Past Advice
566 users have voted.
Tip #
When should I start using Botox?

Before I start, I want to say that when I refer to the brand name Botox I actually mean any botulism toxin. I’m still a fan of Botox by Allergan so that’s what I will refer to when discussing botulism toxin.

So many women want to know when to start using Botox. If you have visible lines on your forehead, between your eyebrows, or “crow’s feet” at rest (meaning they are there when you’re not moving)…you should definitely consider starting Botox, yesterday. ☺ But you don’t have to wait to use Botox to treat wrinkles that are already present. It can also be used preventatively, before wrinkles become more permanent.

Look at your mom: does she have any wrinkles that are present when her face is at rest? Probably…(unless she’s been using Botox!). Your genetics are inevitable, so if you can see something starting on your face—even if it’s not obvious enough to bug you quite yet—you should consider starting Botox treatment. This is especially true for that vertical line in between the eyebrows. I have seen many patients who have waited too long to treat these glabella (between the eyebrows) wrinkles with Botox alone and they have to add filler too.

Botox is not for everyone, but if you have wrinkles that bother you, it could be for you. I am not proposing a frozen look or starting Botox before you are emotionally or financially ready. However, if you go to an experienced dermatologist who understands Botox and how it affects various muscle groups, you can still keep some movement while softening or taking away the wrinkles entirely. I will talk MUCH more about Botox later. But just so you know, I started using Botox when I was 26 before it was even FDA approved for treating wrinkles. I am not at all embarrassed by this. In fact, I feel lucky that I was ahead of the curve. And when you start Botox when you’re younger, you don’t need to use as much or use it as frequently.
646 users have voted.
Tip #
One of the best cosmetic investments you can make: hair laser.

Hair laser is the most effective treatment for the permanent removal of unwanted hair. Effective hair removal typically requires 3-10 treatments (that are best done about 2 months apart), but even after the first few treatments you should notice a big difference. Only people with naturally darker hair in the area(s) being treated are good candidates, so it’s important to be treated before you go gray! Plus, you cannot laser tan skin, nor can you pluck or wax between treatments, so be sure to plan ahead if you plan to get zapped.

There are a few downsides to the treatment: there is some pain involved (but I think it’s well worth it!), and it may get expensive depending on how many treatments you require and how wide of an area you want treated. There will almost always be a few stubborn straggler hairs that won’t go away (I have a few in each of my armpits that I have to pluck a few times per year). So some patients will do a rare touch up over the years.

I think the best places to treat (considering cost and how much time we spend removing hair from these areas) are your upper lip & armpits, but I also recommend treating your bikini line and around your nipples if you have hair there. If you can afford it, treating your legs is a luxury you’ll never regret!

I think this is one of the best cosmetic procedure investments you can make because it’s permanent and can save you so much time over your life…I only have to shave my legs once or twice per year! The younger you are when you do this the more value you will get out of your investment.

P.S. Caucasian ladies should ask for the long pulsed Alexandrite or Diode laser (they are better than the IPL and other lasers or light sources for hair removal) and dark- skinned ladies should ask for the long pulsed NdYAG laser. Dark-skinned ladies should be especially careful as this laser can be very dangerous in the wrong hands!
662 users have voted.
Tip #
Use topical retinoids if you can handle them

Everyone always asks me for recommendations on creams that will help with wrinkles. The ONLY topical creams ever proven to reduce wrinkles are prescription retinoids. Topical retinoids are a class of chemicals related to Vitamin A that increase the production of collagen in the skin. Retinoids treat fine lines, not deep wrinkles, and some discolorations caused by the sun. Anyone who can tolerate these creams should be using them. Unfortunately, unlike hair lasers or Latisse, the benefits of this treatment are more subtle and take months and more commonly years to manifest themselves. Some names are Renova, Refissa, generic tretinoin, Retin A, Differin, Tazorac, and TretinX.

The downside to retinoids can be significant, including redness, scaling and sometimes burning (so if you occasionally see me looking like a molting snake, you’ll know why). Therefore, it is important to find a strength and brand that works best for you, and you may not be able to apply it nightly, which is usually recommended. Moisturizers can also help somewhat with the scaling and irritation. Unfortunately, some women give up on retinoids due to these side effects. They will never be able to reap the long- term benefits that I see in women who have been using them for years.
620 users have voted.
Tip #
Some great sunscreens I recommend if you care about young looking skin.

As I mentioned earlier this week, when you go to buy a sunscreen, it’s important to consider not only the SPF which will help guard against sunburn and skin cancer, but also a sunscreen’s protection against UVA. UVA contributes not only to skin cancer but also premature aging. Unfortunately, there is no grading system to evaluate UVA protection in sunscreens. However, starting this December the FDA will require sunscreens that are labeled “broad spectrum” protection to have a certain level of UVA protection. (Finally!!!) But it will still be difficult to compare UVA protection between different sunscreens since there is no number or scaling system to rate the relative level of UVA protection. So you basically have to know what to look for in sunscreens beyond the “broad spectrum” labeling in order to find sunscreens with the very best UVA protection.

My favorite sunscreen is La Roche Posay Anthelios with Mexoryl, and my personal favorite is Fluide Extreme Anthelios XL. This is the one product in my medicine cabinet that I would not give up. Mexoryl is the most effective organic UVA filter approved by the FDA. In addition, it is photostable so it doesn’t start degrading the second it’s exposed to sunlight which is a problem with some UVA sunscreens. So if you want a top-notch UVA sunscreen that protects against photoaging, look for Mexoryl!

Inorganic sunscreens such as titanium dioxide and zinc oxide are considered physical “blockers” of the sun. They typically reflect the sun rather than absorb it like the organic (chemical) sunscreens. Inorganic sunscreens are photostable but the downside is that they can make you look white. Inorganic sunscreens with smaller particles (nanoparticles) of titanium dioxide and zinc oxide make you look less white but tend to be less effective. If you are worried about chemical organic sunscreens (yes, organic sunscreens are chemical sunscreens) or have very sensitive skin, you may want to opt for an inorganic sunscreen such as Elta MD. I like this one because it has a tint to it that hides the white and my husband describes the look as “giving a glow” to my skin. However, most inorganic sunscreens are not really totally chemical free since the list of inactive ingredients usually contains chemicals ☹. But they are the way to go if you want to stay away from “chemical sunscreens.”

Other notable sunscreens with superior photostable UVA protection include Neutrogena’s Helioplex and Aveeno’s Continuous Protection. These sunscreens are readily available at stores and really great organic sunscreens!

I keep all of these sunscreens around. My typical routine is Ultra Fluide Anthelios XL on my face and chest every morning; it doubles as my moisturizer. If I’m going to work I will put my make-up on over my sunscreen. If I’m not wearing make-up that day, I will add Elta MD before going out to give myself a more natural look while giving me a second application of sunscreen. During nicer whether, I use Neutrogena with Helioplex on my body in the morning before getting dressed and I still use Anthelios Fluide Extreme on my face, neck and chest. This regime isn’t for everyone…the Fluide Extreme can cause a shine which I hide with a little powder. Elta MD doesn’t have any shine so you can try that instead or another Anthelios product with Mexoryl. FYI, Mexoryl XL isn’t available in the US yet so you’ll have to get it online, but Mexoryl SX is available…it’s great too but XL is slightly better at UVA protection. When XL and SX are used in the same product you get ultimate UVA protection!
662 users have voted.
Tip #
Shaving your legs may save your life!

Do you know where the most common place for a women under the age of 60 to develop melanoma—the most deadly type of skin cancer—is? If you think it is in the areas where you get the most sun, you are wrong. It’s on the legs! Why? It is felt that areas that are usually covered but then intermittently get intense sun exposure are more susceptible to melanoma.

So…the next time you are shaving your legs, use your razor as a reminder to look for any new or changing moles, and take note of any lesions that are there so that you can “get to know them” and know if they are changing. Look at your entire body because melanoma can occur anywhere! Don’t forget to get in front of the mirror and look at your back, buttocks and the backs of your thighs too. The great thing about the vast majority of melanomas is that they develop in places you can see—but you have to be looking. And remind your mothers, sisters, daughters and friends not only to do monthly breast exams, but also monthly skin exams. If you see something suspicious, call your dermatologist today!!!