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About Face

Better skin, at what cost?

Retinoids, which are derived from vitamin A, have been used since the 1970s. Their active ingredient, retinoic acid, “is the only prescription topical FDA-approved to treat wrinkles,” says Miami-based dermatologist Leslie Baumann, MD. Retinoids “turn on the genes that do good things, like produce collagen, hyaluronic acid, and elastin, while turning off the genes that do bad things, like break down collagen and cause hyperpigmentation.” They also, says New York City-based dermatologist Patricia Wexler MD, “increase cell turnover and reduce free radical production.” (Retinoid’s less-irritating sister, retinol, commonly found in non-prescription antiagers, works the same way, but since it needs to be converted to retinoic acid by the skin’s enzymes, it takes longer to get results.)

Because my skin is dry, my dermatologist, Manhattan-based Jennifer MacGregor, MD, recommends I start by applying my prescription every third day. Impatient, I use it every other day instead¬—so I’m not exactly surprised when, a week later, my face begins to melt. On Wexler’s advice, I quit scrubs and peels and swap out my night cream for Shiffa Healing Balm, an occlusive salve that pacifies inflamed skin with arnica extract. Still, it takes nearly two months for the flakes to stop falling.

Source: Elle. September, 2016.


Let's talk about Botox

From how much it hurts to how much you'll spend, here's the real deal on arguably the most powerful beauty creation since sunscreen.

Q/ Can it prevent lines?

Getting Botox before you see lines as a preventative strategy can be a receipe for new problems, says New York City dermatologist Patricia Wexler, MD. "When you inject Botox into a young muscle–for many years on end–you risk overweakening it, causing skin to sag," she says. Also, once you've frozen one muscle, your face can "recruit" others to help make the expressions you've just KO'd–leading to new wrinkles, says Dr. Nazarian. There's no rule, but if you're younger than 25, take a beat, says Dr. Wexler.

Source: Cosmopolitan. September, 2016.



The latest alternative to a surgical face-lift comes with strings attached.

Sitting at his desk in his Rodeo Drive office, Harold Lancer, a dermatologist with one of the largest practices in the country (he has more than 30,000 patients in his database), makes a prophetic statement about the future of aesthetic medicine.

"The days of the face-lift are coming to a rapid, screeching halt," he says, elbows on the desk, hands clasped in front of him in a way that emphasizes his silver-haired sensei authority. A small flock of gulls circles outside his window, cawing in agreement. "I predict that in 10 years the surgical face-lift will be a thing of antiquity." Even in Beverly Hills.

When Lancer advises his patients on how best to maintain their faces and figures, his protocol these days includes a strict diet low in salt, sugar, and dairy, and a host of less invasive treatments to delay the knife or avoid it entirely. But compared with resurfacing and skin tightening, which employ machines that look like tiny spaceships and cost a small fortune, Lancer's new favorite procedure, the Silhouette InstaLift (which he calls the Sugar String Lift), is lo-fi verging on retro: It weaves a filament throughout tissue to lift and reposition the planes of the face. "There isn't a single person over the age of 20 who doesn't do this in the mirror," Lancer says as he places his fingers on top of the outer edges of his cheek bones and gently pushes the skin up and out toward his hairline. "Everyone wants just that much of a lift, and that's what this string does."

But the lnstaLift of today sounds distinctly like the thread lift, which experienced a brief heyday and quick demise in the U.S. around 2000. In thread lifting, barbed sutures were sewn into the face. The threads were difficult to remove and susceptible to breakage, and patients were prone to infection as well as irregular or ropy contours in the skin. In the worst cases the blue thread was visible beneath fine, pale skin, and there was visible tugging or pulling where the sutures were attached.

"The old thread lifts had lots of problems for many reasons, and they did not gain wide acceptance among doctors or patients. The methods and materials are vastly improved now, but they're still not used too much in the U.S., '' says Wendy Lewis, an aesthetic medicine consultantand author based in New York City who recommends the InstaLift procedure to clients who are under 55, have mild to moderate skin laxity, and are looking for methods that are one step up from Botox, fillers, and lasers but not as invasive as an incisional face-lift. "Some women will go to great lengths to avoid the F -word," Lewis says.

The new procedure uses a soluble material–a polylacticoglycolic acid resin, which is essentially a string of sugar–that looks like thick surgical suture material studded with small bidirectional cones. The string is woven through the tissue to create tension and hoist the sagging skin around the nasolabial folds and jawline (albeit by only a few millimeters). The small cones on the strings keep it suspended in the tissue without being connected to a bone. A pleasant side effect is that the tissue's natural response to the foreign material is to heal around it, which creates springy new collagen. So far the results have been mostly temporary (24 to 36 months) but impressive. Two more bonuses: Its relatively low cost (Lancer charges around $1,500 to $5,000, depending on the number of strings used), and the procedure takes only about 30 minutes to complete.

Despite InstaLift's successful outcomes, many doctors who practiced in the '90s and early 'OOs can't shake their memories of the thread lift. "There was a study released in 2009 that stated that as many as 60 percent of thread lift patients reported complications," says Patricia Wexler, a New York-based dermatologist. "Sixty percent! "That's not good. Personally, I've never met a patient who was pleased with the results of a thread lift. But then again, the happy people don't come to me to be fixed." She points out that there's no guarantee that even the new, absorbable materials will dissolve at the same time, which could lead to unpleasant facial drooping or asymmetry.

The attitude toward threads in Europe is far more positive. About a decade ago doctors there (the Italians were most enthusiastic about it) started using a new and improved version of the procedure, which has some similarities to InstaLift; the more advanced materials were dissolvable and more sterile and hence less prone to infection. "For a person in her forties or fifties with mild to moderate signs of aging, who doesn't want surgery because of the expense or for medical reasons, it’s a simple and safe procedure," says Yannis Alexandrides, an American and British board-certified plastic surgeon who is the founder and medical director of the III Harley Street cosmetic surgery clinic in London. "The material creates a reaction that helps to build connective tissue that holds the skin up, making it stronger and thicker. 'The results we see outlive the time it takes for the thread to dissolve.”

The Soft Thread Lift that Alexandrides uses, which is fairly standard in Europe (with some variation among providers), involves weaving 30 to 40 fine threads under the skin, which are stitched through tiny needle incisions near the nose and along the outer edges of the face and jawline, and sometimes along the brow. Alexandrides says there's typically minimal swelling and bruising following the procedure, and he claims that it doesn't create scar tissue, which could make it difficult to go back in and do again. He says that because the results are temporary, most patients expect to have to repeat the process.

In the meantime Lancer is chipping away at his 30,000-patient roster, performing dozens of InstaLifts in his office with "uniformly wonderful" results. He is optimistic–and not only because he is one of approximately 25 physicians currently performing the procedure in the United States. The lnstaLift is FDA-cleared only for the midface, but Silhouette's parent company, Sinclair, is looking into the possibility of lifting other body parts, including brows, breasts, and knees (basically anything subject to gravity's whims¬—so, everything). In any event, it's not an overstatement to say the potential for this low-cost procedure with minimal downtime is huge.

"The results I have seen, by some very experienced surgeons, are quite good," Wendy Lewis says. "I saw a few live cases at the Instituto de Benito in Barcelona. The results were instant, patients walked off the operating table and were comfort-able, and you could already sec the results before all the swelling set in." Lancer is an lnstaLift pioneer in America, but he's confident that others will soon be on board. "This face suspension with string," he says, "it's the future." As long as you're willing to forgive and forget its past.

Source: Town & Country. May, 2016.


The summer items Donna Karan can’t live without

Donna Karan and her legendary city-girl aesthetic may be synonymous with Manhattan, but since stepping down from her namesake company last summer, the legendary designer has had more time to focus on her other stomping grounds: the hamptons.

Karan’s beachy pursuits include dining at Tutto il Giorno (the Southampton-by-way-of-Tribeca hot spot co-owned by daughter Gabby Karan De Felice and son-in-law Gianpaolo De Felice); holding court at her luxurious East Hampton home; and keeping tabs on her lifestyle brand, Urban Zen, and its Sag Harbor boutique.

Here, she shares a page from the next chapter of her fabulous life.



"I love Pat, and love this all-you-need eye cream. Berta [Camal], who does my makeup, introduced me to it." Patricia Wexler M.D. Dermatology Intensive 3-in-1 Eye Cream, $33 at

Source: New York Post's Alexa. May 18, 2016.


Your Summer Beauty Reboot: 13 Ways to Upgrade Your Routine

For all the rejoicing that comes with the arrival of summer, we know that warmer weather brings a new set of beauty concerns: humidity-frizzed hair, newly exposed skin begging for additional SPF, and a problem area or two aching for exfoliating and toning after being covered up for months. Below, the sunscreens, hair products and spa services to get you ready for the season.

Pump Up Your SPF

To make applying SPF more appealing, there are new sunscreens that aren’t creamy or streaky. “It’s all about functionality,” said Patricia Wexler, a dermatologist in Manhattan. “There are new formulations that make using SPF much less invasive than it used to be.” Dr. Wexler also advises regular exfoliation, which can help ensure that sunscreen is evenly distributed.

Fresh Sugar Sport Treatment SPF 30 is a thick, waxy stick that comes in a tube reminiscent of the shade of an Hermès shopping bag. It’s a tweak of the popular Sugar line of lip balms, but designed to be used on the face and body as well, providing a higher level of sun protection. The water-resistant formula includes moisturizing avocado and black-currant-seed oil.

Soleil Toujours, a line of sunscreens that is sold at stores like Barneys New York, is adding several new products to its offerings next month. Set & Protect Micro Mist is applied over makeup. It leaves the skin looking pleasantly matte while providing broad spectrum SPF 30 sun protection. Another addition to the line is an SPF 30 mineral body lotion that comes in transparent and tinted formulas.

Zelens Body Defence Sunscreen was formulated by a plastic surgeon with a practice in London. It is an oil that has common sunscreen ingredients like octinoxate and avobenzone added for broad spectrum SPF 30 protection, along with squalane to moisturize and vitamin E. The texture isn’t greasy, and it blends quickly into the skin. It can be used on the hair as well as the body.

Dr Russo Sun Protective Day Cleanser SPF 30 was conceived by a dermatologist based in Britain. It works counterintuitively: a milky face wash that leaves a protective layer of sunscreen on the skin after the product is rinsed off. In the United States, where it was introduced a few months ago, the cleanser is available exclusively at Space NK.

Read the full article here.

Source: New York Times, May 18, 2016



Best new buys for a great complexion at every age.

1. Hydrating cleansers
Oil molecules in Garnier SkinActive Micellar Cleansing Water ($8.99) lift makeup with the swipe of a cotton pad, says New York dermatologist Patricia Wexler. For dry skin, try Laneige Fresh Brightening Cleansing Oil ($35)

4. Hi-tech at home
Radio frequency treatments in derm’s offices firm skin, as heat triggers fresh collagen. Tale the tech home at a lower power with this handheld. Expect results in 30 to 60 days, says Wexler

7. Zero irritation peel
Chemical exfoliation reveals bright skin while it “stimulates cell turnover, tightens pores, and prevents breakouts,” raves Wexler. If skin is sensitive, try Exuviance Firm NG6 Non-Acid Peel ($68)

Source: Harper's Bazaar. April, 2016.


Pigment Erasers: Simple solutions that really work

Call it what you will–freckles, hyperpigmentation, age or sunspots–discoloration that appears on the surface of the skin stems from one thing and one thing only: an overproduction of melanin.

The sun, hormones and inflammation can all send your skin’s melanin production cycle into extreme overdrive, causing your complexion to be unevenly toned. But, there are ways to eliminate unwanted discoloration once and for all.

Why skin becomes discolored…
We all have melanin in our skin. But some of us have more of it than others. According to Beverley Hills, CA dermatologist Zein Obagi, MD, all skin types contain the same number of melanocyte cells, but the quantity and the type of melanin produce varies—darker skin generates more black-brown melanin pigment than lighter skin. “Melanin is produced by melanocytes as a way of protecting the skin from the sun, resulting in a darkening of the skin when it’s exposed to UV rays,” says New York dermatologist Julie Russak, MD. Regardless of skin color, the cause of  discoloration is the same: A trigger (sun or inflammation) sends a signal to melanin-stimulating hormones to activate the enzyme tyrosinase. After the enzyme has been “turned on,” the melanocytes produce pigment. Pigment containing cells are dispersed through certain areas of the skin. The end result: pin-size spots or patches of discolored skin that can be pink, red,  brown, or even black.

Q Will it fade away?

One common misconception about discolored skin is that it will fade away by itself. Some types of pigmentation, like those caused by acne, can lighten up over time (it may take a few months, if not longer.) But the majority of discoloration needs to be treated with high-powered active ingredients and in-office treatment to eradicate spots on the surface of the skin. How deep the discoloration goes into the skin will determine how long it will take to lighten up naturally. “Once your skin experiences pigmentation, you’ll always have a tendency for it to occur, especially with things like melisma,” says New York dermatologist Patricia Wexler, MD.

Treat it all at the doctor’s office

Intense Pulsed Light (IPL)
A popular choice for targeting sun-induced discoloration, IPL involves light-based energy pulsed into the skin while simultaneously targeting blood vessels. The light seeks out the discoloration in the skin to lift it up and out. Expect for the treated areas to turn dark and flake off in a few days. “We sometimes do an IPL treatment following two laser treatments to really clear up the skin,” says Dr. Wexler.

The best discoloration erasers
No matter which pigment-busting ingredient you choose to use, these have a proven track record.

Licorice extract
Good for: Sunspots and acne scars (and acne)
For more of a natural approach, consider licorice extract. “The main ingredient is licorice is glabridin, which inhibits tyrosinase activity to lighten discoloration,” says Dr. Wexler. Another benefit of licorice: It’s an anti-inflammatory, so any active breakouts will subside and your skin will be less susceptible to further pigmenting (inflammation is a precursor to discoloration).

Find it at: Sisley Paris Phyto Blanc Lightening Hydrating Emulsion $200,
Perfect for acne-prone skin, this lightweight, mattifying hydrator gives skin a perfectly even glow, almost like it’s been airbrushed.





Beauty School

The ultimate guidebook to effortless hair, multitasking makeup, glowing skin, and truly game-changing advice.

Don’t forget your neck and chest!

We gotta tell you: These two areas are wondering why on earth you’re ignoring them. They’re delicate, they’re the first place to show wrinkles and sun damage, and they’re next-door neighbors to your face. Thankfully, it’s never too late to start a little TLC that will seriously turn back the clock.

One of the main culprits for chest wrinkles may be your snoozing position—especially if you’re busty. “The bigger your breasts, the more likely you’re going to get lines on your upper chest,” explains New Orleans dermatologist Mary Lupo, M.D., a clinical professor of dermatology at Tulane University of Medicine. “If you’re a side sleeper, the breasts fold over and create creases in the skin.” Same goes for resting on your stomach: “This can accentuate the horizontal bands on your neck, because your chin is tucked down,” says dermatologist Patricia Wexler, M.D., an associate clinical professor of dermatology at Mount Sinai Medical Center in New York City. For the most skin-friendly shut-eye, rest your head on a pillow made for back sleepers, then tuck another pillow under your knees to help prevent rolling over during the night.

We know what you’re thinking: a whole separate product just for your neck? But it’s a good idea, because while it’s true that neck creams and face creams contain essentially the same anti-agers, “your face products may be too harsh for this very dry, sensitive area,” says Lupo. “Neck creams are designed specifically for the thin skin here—much like how body wash and face wash formulas are quite different.” Wexler recommends picking one with hyaluronic acid or seaweed to moisturize; peptides to build collagen; niacinamides or Niacyl to strengthen skin and reduce redness and brown spot; and firming extract like rye to combat sagging.

Since you’re already applying broad-spectrum SPF on your face every morning (riiiiiight?), take an extra few seconds to rub another big dollop on your neck and upper chest. “The skin here is much thinner than the skin on your face, so it’s more vulnerable to sun damage and skin cancer,” says Wexler. “This area also has fewer oil glands, so it can age prematurely.” For those reasons, Wexler recommends sunscreen or moisturizer with a minimum SPF 45 (SPF 30 may not be enough for such thin skin), “and look for one that has antioxidants such as niacinamide, vitamin C, or Vitamin E for extra protection.” Wexler likes EltaMD UV Clear Broad-Spectrum SPF 46, which contains niacinamide. “It’s also fragrance-free and uses only physical sunscreens, so it won’t irritate sensitive or acne-prone skin,” she notes.

Source: Redbook. May, 2016.


What's happening to women's faces?

Pricked, plumped, and puffed to perfectionsome say it's sexy, others call it fillerexia.

A strange phenomenon is happening among young women. Some of them look older than a Real Housewife, but you'll struggle to find a single wrinkle. Their skin is as smooth as a Madame Tussauds figure, cheeks as plump as Baby George's. Their pout? Hello, Angelina. While the intention was likely sexy, the caricature-like proportions look neither young nor old. Just strange.

To blame: too much dermal filler, a substance injected into the skin to smooth lines and boost volume. While FDA-approved fillers have been available and used predominantly by women over 40 since 1981, they now have a fan club among those who need them least — women in their 20s.

The New Face of Filler

"The people who are coming to see me for filler now can be as young as 19," says Anne Taylor, M.D., a plastic surgeon in Columbus, Ohio. According to stats from the American Society of Plastic Surgeons, filler usage among twentysomethings has spiked by nearly one-third since 2009 to more than 64,000 procedures in 2014. While injections aren't surgery, they can be painful … and pricey. So what's the appeal? Celebrities, according to every doctor interviewed for this article.

"Girls in my office have repeatedly said, 'I want lips like Kylie Jenner's,'" says Norman Rowe, M.D., a New York City plastic surgeon.

"I'd be lying if I said she wasn't the inspiration," says Kara, 28, a Minnesota-based writer who got injections in both lips last year.

Like glossy hair or perfect abs, these hyper-smooth, sexualized features are seen as aspirational. And now, they're increasingly accessible.

When Did Needles Become NBD?

One of the biggest reasons for fillers' popularity: ubiquity.

"There are more FDA-approved fillers on the market than ever," says Sachin Shridharani, M.D., a Manhattan-based plastic surgeon, referring to products like Juvéderm Voluma, Restylane Silk, and Belotero Balance.

"Dentists, ob-gyns, and other medical professionals are offering fillers because they see how lucrative it can be," he says.

"I had my upper lip plumped by a physician's assistant," says Kim, 32. "I work at a pharmacy in Queens, and she did it for a bunch of the girls there."

To Dr. Shridharani, going to anyone other than a board-certified derm or plastic surgeon for injectables is "about as wise as seeing me if you're having a heart attack." Last year, the FDA issued an alert about soft-tissue fillers. If they're improperly injected, potential side effects can be blindness and stroke, among others.

In the right hands, fillers are generally safe and increasingly less of a commitment. Certain older collagen versions required allergy testing (as they were made with animal by-products), and liquid silicone (which has never been FDA-approved for cosmetic purposes) is permanent. But today, most fillers are made with hyaluronic acid, a natural compound that usually dissolves between 6 and 12 months.

"It's the gold standard," says Dr. Shridharani. It has less potential for irritation, and mistakes can be "erased" with injections of a (pricey) enzyme. With its modern user-friendly rep, filler seems more like a throwaway beauty treatment than a risky medical procedure. And it doesn't hurt that many experts position filler like they do Botox: as preventative medicine. While Botox inhibits you from making the expressions that create wrinkles, some fillers are proven to help spur collagen production. Suddenly, a Big Ang–approved beauty regimen sounds almost sensible. No wonder filler has about as much stigma as getting your hair colored.

Too Much of a Good Thing

There's a certain logic to filling the 40-plus crowd. "They've lost collagen and fat over the years, so they're looking for allover fullness in the face, sometimes lips," says Dr. Shridharani.

Here's the trouble: Some docs tend to use the same amount of filler on a young patient as they would on older ones, he says. What may be a bit of filler on a 60-year-old is "like a drop in the ocean," but on a 25-year-old? Chipmunk City.

Too much filler doesn't just make a young person look bizarre, it can also make her look older. When someone's face has zero contour because it's practically inflated and her lips are pumped like bike tires, it looks, well, like work. Historically, "older women are the ones who get these procedures," says Dr. Shridharani, so we're conditioned to think someone with similar features looks middle-aged.

Of course, this OTT aesthetic isn't always an accident. Often enough, it's at the patient's request.

"For some, it's a status symbol," says Dr. Shridharani. "It shows you have your Louis Vuitton bag and your lips — obvious fillers can complete the look of affluence."

And for some patients, it can be a slippery slope. "The mind has an incredible way to recalibrate itself," says Dr. Shridharani. He often sees this with patients who get breast augmentation. After the initial procedure, they're on a high. Once their eyes adjust, the buzz wears off … and they want to go bigger. The same attitude applies to fillers, "which is why they have an addictive nature." Call it fillerexia.

His advice? Ask yourself if you're really upset with your natural face or if you're just chasing a trend. If it's the latter, "keep these procedures in your back pocket for when you've actually lost volume — they're not going anywhere."


Ditch your celeb inspo

Requesting to look like a specific celeb can be a receipe for disappointment, says Dr. Shridharani. "everyone's face is different, so it's not fair to compare," he says.

Avoid chipmunk face

It's scary how many derms erase nasolabial folds [the lines that run from the sides of your nose to the corners of your mouth] by filling them out. Big mistake, says Patricia Wexler MD, a New York City derm. It gives you a bloated look," she says

You want SOME contur

It's logical to equate roundness with youth, but overplumping looks artifical, says Dr. Wexler. "Less is more."

It's all about baby steps

Go easy on your first visit, says Dr. Shridharani. Do less than you planned, then come back if you need more, he says. If a doc tried to coax you into doing it all at once, move on. A pushy, time-pressed doctor is a red flage, he says.




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