Cystic Acne, Dark Circles, & Oily Skin | Ask the Skin Care Experts

– 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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