Recently I had the pleasure of meeting dermatologist Dr. Jacquelyn Dosal at a photo shoot where I was her makeup artist. (and yes she has amazing skin!!) I thought it was a great opportunity to ask her all my burning questions I had about skin care and share them with you on the blog.
- What’s the main piece of advice you’d give women in their 20’s and 30’s to prevent skin aging?
The 3 most important tips I can give young women are: 1) sunscreen, 2) sunscreen, and 3) sunscreen! Skin aging is partly genetic and partly environmental. There is not much you can do to change your genes, but you can change how the environment treats your skin. All of the expensive anti-aging products on the market try to “un-do” skin aging (also known as sun damage), and are working behind the curve. The best treatment is prevention, since all the cream and money in the world can never re-create sun-protected skin (think baby’s bottom fresh skin).
That being said, the next most important product would be a retinol for nighttime. More on that later… There are many other excellent ingredients on the market, including vitamin C, alpha hydroxyl acids, glycolic acids, and antioxidants. These are excellent products to add to your regimen, but consider them the “icing on the cake.” You should only be using them if you are already using a sunscreen and a retinol, which form the foundation of good skincare.
2. Is there a way to improve hyperpigmentation, those annoying brown spots, with skin creams or is it better to do something stronger like laser?
Those brown spots are annoying! It brings me back to my love of sunscreen. If you are going to battle hyperpigmentation, SPF MUST be part of your regimen, even if you have a darker skin type. You must also be stricter than the average person without dark spots – use SPF every day, even when the weather is cloudy or cold.
Next, there are a variety of creams that are great for dark spots. You can start with an over the counter dark spot corrector, but usually you will want to see your dermatologist for a prescription strength product. The most common ingredients are hydroquinone or retinol. If you have strong irritation with these products, there are also hydroquinone-free products that are being developed, and are an excellent choice. Creams usually take a few months to work, but can be done easily and at home.
If you are looking for a quicker solution, laser is the way to go. Depending on your skin coloration, a dermatologist can pick the right laser for you (there is no “one-laser-fits-all” solution). There is some recovery involved, and you must be super strict about sun protection afterwards. As with all treatments, continued sun exposure will make those brown spots return.
3. Do you have any suggestions of inexpensive skin care products that are still effective?
Definitely! There are a lot of great products on the market for someone who is looking for an inexpensive solution. I love CeraVe products. They are excellent moisturizers, and the CeraVe line has a morning facial moisturizer with SPF and niacinamide (good for redness and brown spots) called CeraVe AM. Another great line of products is made by La Roche Posay — they have excellent sunscreens. Finally, you can find over the counter retinols that are a great way to start treating skin aging – brands like Neutrogena, La Roche Posay, Roc, and Vichy are all great choices.
4. So now that summer is here, even though it is summer all year long in Miami, we know we need to protect our skin from the sun. There are so many products on the market. Do you have one you recommend or are there some ingredients we should look for when choosing a sunscreen?
My rule is, if you find a sunscreen that you like, stick with it. There are great products on the market now that don’t feel like sunscreens. Neutrogena has an excellent line of sun protection, as does La Roche Posay. If you find you have skin sensitivity to most sunscreens, try sunscreens with only zinc oxide or titanium dioxide (known as physical blockers). These ingredients are much less likely to cause allergy or irritation.
5. Is self tanner safe to use?
Right now self tanner appears to be very safe. I much prefer patients to use self-tanner over the real thing, which we know causes skin aging and skin cancer. I use self-tanner regularly as a way to get a nice glow. However, I truly believe pale skin is coming back in style! Just look at celebrities like Anne Hathaway and Scarlet Johanssen who embrace their pale beautiful skin.
6. Are tanning beds safe for our skin?
Never! Tanning salons will tell you tanning is safe because they are not using UVB rays that are more likely to burn the skin. There are studies that show a link between tanning and the increased risk of melanoma in young women. Additionally, tanning beds emit UVA rays which are the most aging to our skin (causing wrinkles, blotchy skin, brown spots).
7. How do we assess whether our moles or freckles need to be shown to a dermatologist to be evaluated? Should we put extra protection on our moles?
Everyone should examine their own skin on a regular basis (once a month is ideal). Use a hand mirror to examine all of your spots so that you are familiar with your body, and therefore can detect any changes in moles that occur.
The “ABCDEs” of melanoma is a mnemonic that can help you remember the symptoms of melanoma. “A” stands for asymmetry – meaning one half is different from the other. “B” stands for border irregularity – meaning the edges are notched, uneven, or blurred. “C” for color – there are more than 2 colors present. “D” is for diameter, meaning that it is greater than 6 millimeters (or the size of a pencil eraser). “E” is for evolving – meaning a changing mole. If one of these symptoms are present, you should have your dermatologist evaluate your skin.
As a rule of thumb, moles don’t need extra sun protection, but like the rest of your skin, they should always be protected. I don’t recommend “spot” treating moles with SPF – it leaves you with a funny looking halo of whiter skin around the mole next to tan skin. Additionally, melanoma is less likely to develop from an existing mole than to develop out of the blue from normal skin (although it is still possible for a mole to evolve into a melanoma). All your skin needs sun protection.
8. What is the difference between using a serum and a cream or lotion ? Do we need to use both?
The difference between serums, creams, and lotions are the vehicles, meaning the ingredients that give the agent its texture. Creams are thicker and help re-hydrate dry and lifeless skin. Lotions are lighter, better for oiler skin, and spread easily. Serums are usually good for all skin types (except for possibly acne-prone skin: beware and read labels – look for products that are non-comedogenic). You may like one formulation better than another, and generally there are no hard or fast rules.
9. I read that it was ok to use face products around the eyes, that you didn’t really need a specific eye cream. Is this true?
Around the eye is a special area on the face. The skin is very thin, prone to irritation, and doesn’t have the same concentration of oil glands that are present on the rest of our face. Ideally using an eye cream would be optimal, but you don’t need to spend a fortune on the eye cream. More expensive is not necessarily better. That being said, most facial creams can be safely be applied under the eye and around the sides if you are a minimalist. Even facial creams with retinol can be applied around the eye.
10. What can we do to prevent skin aging on our body?
Great question! You know my first answer –sun protection! Sun protection can help prevent the blotchiness we see on aged hands/arms (also known as sun or liver spots). If you look at sun damaged skin, you notice uneven skin tone, thin wrinkly texture, and easy bruising. All of that comes from chronic low level, day to day sun exposure, such as driving to work, going to the grocery store, etc. Although the beach is not great for our skin, it’s the daily low level exposure that ages us.
I also always recommend moisturizing after the shower. Our skin tends to lose it’s ability to hold on to moisture. Moisturized skin helps avoid any irritation, itching, and looks plump and firm. Chronically dehydrated skin looks much older.
Finally, taking care of your body inside will reflect on the outside. Be sure to drink 8 glasses of water daily, have a balanced diet with fruit, vegetables, and omega-3 fatty acids (the good fats, found in salmon, nuts, flax seeds). Regular exercise will also improve your overall health, making you feel better and look better.
11. Your practice specializes in laser, are there other skin conditions that laser works well for?
Absolutely! Lasers are a great choice for sun spots, rosacea, broken blood vessels, and aging skin. Your dermatologist can help guide you for the best treatment for your skin.
12. During our makeup session we talked about Sculptra as a filler. What areas are this filler best for and are there new fillers that you feel get great results?
Sculptra is an excellent filler for global facial volume loss. Everyone naturally looses a little bit of fat as well as bony volume, which then allows the overlying skin to sag and cause noticeable wrinkles and folds. Rather than chasing specific wrinkles, Sculptra fixes the underlying problem of aging. It can give beautiful results that don’t look overdone.
Another excellent new filler is Voluma, by the makers of Juvederm. It is intended for mid face rejuvenation, or people who have lost volume in their cheeks. Unlike Sculptra, which works gradually, Voluma is immediate, and can last up to 2 years. Voluma has been an exciting new product in the market, and my patients have loved its results!
13. Can lasers help to remove acne scars?
Absolutely! There is a new generation of fractional lasers that have less downtime and safer results. The lasers cause microscopic holes in the skin to help stimulate collagen and smooth out the surface of the skin. Generally a series of treatments are needed for great results.
14. Botox is still very popular of course and I hear of younger people getting botox as a preventative measure. Do you agree or should we wait until we see the first signs of wrinkles?
The decision to get Botox is very personal, but overall, there is some benefit in starting early. Repetitive facial expressions cause deep etched in lines that are harder to get rid of in the mature years. By starting early, we can keep a soft, youthful look for much longer, and prevent those deep lines. I have many patients in their early thirties starting with Botox.
Thank you Jacquelyn for taking the time to answer our questions. We wish you a wonderful summer.
Dr. Dosal practices at Miami Dermatology & Laser Institute in Miami