Trade Secrets From a Top New York Dermatologist
By Debra Jaliman
St. Martin's Press Copyright © 2012 Debra Jaliman
All rights reserved.
Don't Waste Money on Expensive Cleansers — Spend It on Moisturizers, Sunscreens, and Antiaging Products Instead
Pricey skin-care lines usually include pricey cleansers, but the truth is some of the best cleansers I know are sold on drugstore shelves, so look there first. This is the advice I give to all my patients, even to the celebrities whose faces you see on magazine covers, who can certainly afford really, really expensive cleansers. "You're just washing money down the drain," I tell them. It isn't worth it to spend a lot of money on cleansers. Believe me, you can put your money to better use.
The Right Cleanser Is Key
One of the first questions I ask a new patient is "What do you use to cleanse your face?" The right cleanser can make a big difference; after all, it's something you use twice a day (or should). Far too often, I find that people are using the wrong cleanser. For dry, sensitive, or normal skin, buy a cleanser that is mild and won't strip the natural oils. Neutrogena Extra Gentle Clean is one of my favorites since it is fragrance-free, nondrying, and noncomedogenic (it won't clog pores). CeraVe Hydrating Cleanser is another good choice because it has ceramides and hyaluronic acid, which prevent skin from drying out. If you prefer a cleansing bar, Basis Sensitive Skin Bar or Cetaphil will work. Many of my patients like Cetaphil Gentle Skin Cleanser. I'm not crazy about its gloppy texture, but it's certainly mild enough for sensitive skin. For oily or acne-prone skin, an exfoliating cleanser will help to remove dead skin cells and bacteria. Two good options are RoC Multi Correxion Exfoliating Cleanser and L'Oréal Paris Go 360 Clean Anti-Breakout Facial Cleanser, which contain salicylic acid. Although most of the salicylic acid will be washed down the drain, it does help to remove surface skin and excess oil.
Makeup Removal and Cleansing Are Not the Same
If you use heavy makeup, you have to remove it before cleansing. If you're wearing mascara and eye makeup, wipe that off first with an eye makeup removal product. Remember to wipe gently because the skin around the eyes is very delicate. Now for the rest of the face: Take a cotton pad and moisten it with toner or a tiny bit of water and a dab of cleanser. Make sure to remove all makeup, especially in areas where it tends to collect, such as above and in the eyebrows and in the creases around the nose and mouth.
I appear on TV fairly frequently and if there's one thing I hate, it's the heavy makeup they slather on me before I go on camera. I know it's necessary (the new high-definition technology really brings out every flaw), but I can't wait to get it off. The minute I'm off the air I run to my bag for the cotton squares and the small bottle of toner I always carry and wipe it off as fast as possible. Why toner? Because I find it's faster and more efficient than cleanser. But if you want to use cleanser, go right ahead. Once makeup is off, proceed to cleansing.
Wash Your Face Correctly
In my practice, we always teach patients how to cleanse their faces. The first thing they learn is that their fingers are not enough and will never get their skin really clean. Fingers can't exfoliate and besides, bacteria lurk under fingernails. So use cotton pads or rounds or a fresh washcloth every time you wash your face. Don't scrub; just rub gently, particularly around the nose and on the neck. Try it; you'll be surprised by how much cleaner your skin feels afterward. Use lukewarm water, not hot or icy cold. If you're into gadgets, one of my favorites is the Clarisonic Sonic Skin Cleansing System, which truly does remove more makeup, dirt, and oil than manual cleansing alone. Because it leaves skin cleaner and more exfoliated, serums and treatment products penetrate better. Just be sure to change the brush head every two or three months and choose the appropriate brush for your skin type; when in doubt, use the one for delicate skin. If the Clarisonic is not in your budget, Olay's Professional Pro-X Advanced Cleansing System machine can be found in many drugstores and makes an acceptable alternative. Always use a mild cleanser with any machine.
Remove Makeup Before Going to Sleep
I cannot emphasize this enough: Never go to bed without cleansing your face. If you don't, the result will be clogged pores and breakouts. If the prospect of zits isn't enough to scare you into cleansing, picture what you'll look like in the morning with last night's makeup smeared all over your face. If you're really too exhausted to wash your face with water and cleanser, at least have cleansing pads by your bed and use them to wipe makeup off. Olay and Aveeno both make good cleansing pads that can go into your evening bag, if necessary.
Cleanse Every Morning and Every Evening
In the morning, cleanse your face before you put on toner (if you need it) and then apply moisturizer or sunscreen. Even if you cleansed and removed all makeup the night before, a splash of water in the morning or standing under the shower is not enough. During the night, as you sleep, bacteria build up on your skin, along with a lot of unwanted oil. So the first step is to cleanse your face with a product suitable for your skin type, and then pat dry your face gently but thoroughly. Let me emphasize that the towel should be clean, strictly for your personal use, and changed regularly. In the evening, same thing all over again, only don't forget to apply a serum or antiaging cream afterward.
To Tone or Not to Tone Depends on Skin Type
Companies that make skin-care products would like people to believe that everybody should use a toner, but nothing could be further from the truth. A surprising number of people should stay away from toners. If you have eczema or rosacea, even a salicylic acid toner is not a good idea because it can be too much for sensitive or reactive skin. People with super-dry skin shouldn't use toners, either.
Toners do have their uses, though, especially for oily, combination, normal, or acne-prone skin. If your skin is oily or prone to acne, tone twice a day (morning and night). I always tell my patients that the telltale sign is the four o'clock shiny nose; if that's what yours looks like in the afternoon, you should tone twice a day. If you have normal or combination skin, tone only once daily. If you have sensitive skin and have a hard time finding a toner you can tolerate, but you still want the benefits, here's a tip: Gently wipe some over your face and then immediately rinse it off with cool water. This also works in winter when skin is drier.
Exfoliate, Exfoliate, Exfoliate
Even the best skin in the world will look dull if it is not well exfoliated. You can exfoliate on a daily basis with your cotton washcloth or a disposable cotton pad and a cleanser, or with the use of the Clarisonic machine. If you have sensitive skin and want to use the Clarisonic, make sure to use the blue brush for delicate skin. If you have normal or oily skin, in addition to your daily exfoliation, once or twice a week use something stronger, like a scrub with fine granules or microspheres, such as Avène Gentle Exfoliating Scrub. If you don't want to use abrasive scrubs, toners and pads with alpha-hydroxy acids or salicylic acid work well, too. Just be careful not to go at your face as if you were scrubbing a frying pan. A toner or pad is meant to be wiped gently over the face once — that's it. Two toners that work well are L'Oréal Pure Zone Continuous Action and Clinique Mild Clarifying Lotion. For oily and acne-prone skin, La Roche-Posay Effaclar K is very effective. In my practice we make our own exfoliating pads, but Trish McEvoy's Even Skin Beta Hydroxy Pads work well, too. Stridex Maximum Strength Pads have 2 percent salicylic acid, which is effective on oily skin with blocked pores.
Winter, Spring, Summer, and Fall, Use a Daily Moisturizer with Sun Protection
I find that as patients' skin improves, they change what they put on their faces. Patients who were used to heavy foundations start to prefer tinted moisturizers because they no longer have flaws to conceal. This is a good thing, because tinted moisturizers make people look more youthful and glowing.
For everyday use, a moisturizer — tinted or not — with an SPF of 30 is ideal. There are many excellent products available: Stila Sheer Tinted Moisturizer SPF 30, Josie Maran Tinted Moisturizer SPF 30, Aveeno Positively Radiant SPF 30, Neutrogena Healthy Skin Enhancer Tinted Moisturizer SPF 30, and Lancôme Bienfait Multi-vital SPF 30 are just a few. If you have oily skin, Lorac-ProtecTINT SPF 30 and Clarins UV Plus Day Screen SPF 40 are good choices.
Skin Changes with the Seasons and with the Years, and Skin Care Should Change, Too
Keep in mind that a cleansing routine that works in winter may not work so well in summer. Plus, what worked for you a couple of years ago may no longer be effective because of age or changes in hormone levels reflected in your skin. When it comes to skin care, you should be observant and adaptable. For example, you need to change your regimen when you find yourself using blotting papers throughout the day. I remember having lunch with a friend and by chance found myself staring down into her tote bag. It was a mess of crumpled facial blotting papers, a sure sign that she needed to change to an exfoliating cleanser and toner and reconsider her use of moisturizer. I sometimes tell my patients that if they absolutely feel compelled to use the same moisturizer they used in winter, in the heat of summer, they should at least refrain from putting it on their already shiny noses.
Eyes Are Special and Need Special Products
Some people think they can use any face cream around the eyes. Wrong, wrong, wrong. The skin in the eye area is very delicate and needs specially formulated products. Use only creams and serums that specifically say they have been ophthalmologically tested, and by all means avoid eye creams with fragrances, which can irritate the skin and cause swelling. Be careful when applying creams and serums around the eyes. Pat gently onto the under-eye area and just below the brow, but never put any on the eyelid itself. Eyelid skin is so thin that the ingredients in products can actually penetrate to the eyeball beneath.
Dark under-eye circles can make even young people look old and tired. They can be treated very successfully with prescription topical creams (containing tretinoin or hydroquinone) and lasers. Over-the-counter products with retinol and caffeine can also be helpful. Vitamin K products are useless — don't waste your money.
Those little white bumps some people get under the eyes are called milia. If small, they can be dissolved with an electric needle, but large ones have to be cut out. Do not use heavy creams around the eyes, because they can make milia worse.
Ditch the Fake Lashes and Grow Real Ones Instead
Fake eyelashes of any sort, including lash extensions, are a terrible idea. The glue damages the delicate skin of the eyelid and pulls out eyelashes, often permanently. Dyeing your lashes is an even worse idea and is illegal in many states for good reason, since the dye can severely damage the eye and even cause blindness. Prescription Latisse (bimatoprost), on the other hand, is one of the few products that actually lives up to the hype. In a matter of months, lashes truly do grow fuller, longer, and darker. They grow so long, in fact, they can even irritate the cornea. To avoid this, apply Latisse only on the outer half of the upper eyelid, never on the half closest to the tear duct and never on the lower lid. It's best to apply it in the morning, when there is less risk of transferring it to the lower lid or your pillowcase. That way, you reduce the chances of side effects, which include darkening of the eyelid, redness, itchiness, and even changes in the color of the iris (although this last one is rare). A tip: Latisse works very well on bald spots in eyebrows.
A couple of over-the-counter products appear to work almost as well as Latisse. The active ingredient in RapidLash is similar to the one in Latisse. Several of my patients who've used it are very happy with the result, especially because it is a less expensive alternative. RevitaLash also has its fans and is less expensive, too. A new process, called Lashdip, increasingly available in salons, coats the lashes and gives the appearance of wearing mascara for several weeks. It appears to be far safer than dyeing lashes.
Everybody Needs Sunscreen, but Moisturizers Are a Different Story
If your skin is oily or acne prone, you may not need a moisturizer, especially in warm weather. Just use a lightweight sunscreen lotion or powder instead. Some sunscreen lotions are designed to provide a matte finish for oily or combination skin, such as Clarins UV-Plus Protection Day Screen SPF 40 and Journée Bio-restorative Day Cream with PSP SPF 30. Colorescience Sunforgettable Mineral Powder Brush SPF 30 or SPF 50 comes in a self-dispensing brush. You can take it everywhere and reapply it whenever you need sun protection or a matte finish. It's popular with both my female and male patients because it is so easy to carry around.
It's the Sun That Ruins Skin, Not Age
People think that crinkly skin, liver spots, and wrinkles are all part of normal aging. They're not — they're just signs of sun damage. I'll never forget the patient who came in with her elderly mother. My patient had the alligator skin that comes from baking on too many beaches, and she required many expensive treatments to repair it. Her mother, on the other hand, was a Southern belle who at the age of eighty-four still had porcelain skin with remarkably few wrinkles. Her secret? She had avoided the sun all her life, she had used sunscreen and big, beautiful hats to protect her face, and, as she told me, "I've always walked on the shady side of the street." We'd all do well to copy her example.
The American Academy of Dermatology recently changed its recommendations and now calls for a minimum SPF (sun protection factor) of 30, so for daily use a sunscreen with SPF 30 is fine. Remember, sun damage is cumulative; even ten minutes of exposure a day over the course of a lifetime is enough to cause major problems.
Vitamin D Is Good, but Not When It Comes from the Sun
I spend a lot of time in my practice debunking the "sunlight is good for you" myth. I can't begin to count how many patients have told me that they've heard on television that to get vitamin D they absolutely have to go out every day without sunscreen and catch some rays, even if only for ten minutes. What makes it worse is that some of these patients have already had skin cancers removed from their faces.
Let me be absolutely clear: Everybody needs vitamin D and it would be very hard to get enough of it from food alone. But the best way to get an adequate amount of vitamin D is not through damaging your skin, but through a much cheaper, easier, and effective daily supplement. I recommend that adults take at least 1,000 milligrams a day. This is especially important for people with dark skin, but even the blondest, most fair-skinned person needs a vitamin D supplement.
Choose Sunscreens Carefully and Learn Which Ingredients Are Right for You
Sunscreens come in two general types, chemical and physical. Chemical sunscreens are effective, but some people are allergic to the main ingredients. If you do opt for a chemical sunscreen, look for one that contains avobenzone (Parsol 1789) or Mexoryl. In Europe, Tinosorb is a widely used ingredient that seems to do an excellent job, but it has yet to be approved for use in the United States. One that is available here and that my patients like is Anthelios SPF 30 Lotion by La Roche-Posay, whose active ingredient is Mexoryl SX.
I prefer physical sunscreens that contain zinc oxide and titanium dioxide. They block more of the spectrum and have less potential to cause an allergic reaction. For people with rosacea or sensitive skin, physical sunscreens have an added benefit: Zinc oxide soothes irritation (that's why it's used on babies with diaper rash) and reduces redness. Same thing goes for people with eczema. There are many excellent physical sunscreens on the market, and most moisturizers now have a good degree of sun protection. One of my favorites is Vanicream Sensitive Skin SPF 30, which is gentle enough to use on babies, although adults may find it a little oily. For acne-prone skin, Elta MD UV Clear SPF 46 or Neova Z-Silc SPF 30 are very good alternatives. (Continues...)
Excerpted from Skin Rules by Debra Jaliman. Copyright © 2012 Debra Jaliman. Excerpted by permission of St. Martin's Press.
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