vi peel

Entering the fall months is a good time to undo some of the damage done over the summer months.  No matter how much sun screen we wear (although it is immensely helpful) if we have active lifestyles that take us outdoors a lot we end up with some sun damage.

We tend to have less and less sun exposure in the fall and winter months so it is a good time to target pigmentation with combination treatments.   Myself and several of my coworkers all agree upon a series of 2-3 IPL’s (or photofacials) combined with skin peels.  I personally like to do an IPL followed by a peel within 1-2 weeks once a month for 3 months.  This is very effective at lifting the pigmentation that developed over the summer.  There is some “downtime” with these treatments, although it is minimal.

The IPL creates what we commonly refer to as “peppering” which literally looks like pepper flakes on the skin.  These tend to develop over the first 12-24 hours and then flake off in 7-14 days.   These “pepper flakes” are pigmentation that has been brought to the surface leaving behind either faded pigmentation or complete clearance of the pigmented lesion.

A peel is a controlled surface burn of the skin using a combination of acids.  The peel helps lift pigmentation, shrink the appearance of pores, minimize fine-medium lines, firm and improve overall texture.  When a peel is done about a week after an IPL it helps to lift any of the peppering that is hanging on to the skin.  There are lots of peels on the market, from very light peels to deep peels.  We tend to use medium depth peels and find the results to be predictable and well tolerated.  The “real” peeling with these types of peels tends to occur on days 3-5 and then flaking can last 7-10 days.  The “real” peeling does create cosmetic and social downtime as the skin peels noticeably and one  looks like they are molting for 2-3 days.

We use SkinMedica Peels and VI Peels at Toccare.  I am a huge fan of the VI Peels.  They are well tolerated on most skin types and seem to go just a little deeper than the other medium depth peels I have used.  Additionally, VI peels can help minimize acne outbreaks and treat melasma.

So if you ended up getting a little too much sun and are unhappy with how it has left your skin color and texture consider the above treatment plan.  Here’s to beautiful healthy skin!


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A “liquid facelift” is a non-surgical option for facial rejuvenation.  The objective is to restore lost volume, correct asymmetries, relax muscles that pull down and restore more youthful contours to the face.  Ideally the apex (or high point) of the face is the lateral  cheek below the lateral brow.   We tend to lose this volume as our facial muscles, fat pads and skeletal structures shrink and shift underneath the skin.

EVERY person has an individual plan of care with a unique set of concerns.  After discussing these concerns with your provider and hearing their expert opinion you can prioritize what areas to treat first and move forward from there based on your budget.   Frequently we recommend starting with the upper and mid-face as once these areas have received volume restoration the lower areas are improved as well.  For instance, I frequently have patients come in concerned with their nasolabial folds (from the nose to the mouth) or their oral commissures and  marionette lines. (from the side of the mouth down along the lateral chin) These areas can see marked improvement by building the volume loss in the cheeks and/or temples.  It is after filling temples and cheeks that we can fine tune the other areas.  The mid-face has become increasingly popular to fill as the benefits go beyond the cheek alone.

Treating muscles in the upper face with Botox or Dysport can also create lifting when the correct muscles are injected.  For instance, a brow lift can be achieved by relaxing the muscle that pulls down on the lateral brow .  At the same time muscles which help to lift our features (elevator muscles like the Frontalis muscle/forehead)  such as our brows need to be treated conservatively to avoid the brows and lids looking heavy.

We can also turn up the downturned corners of the mouth which can make us look unhappy or mad.  This can be done with a combination of filler and treating depressor muscles which pull down on the lateral mouth with Botox.

Definition along the jaw line and lifting can be acheaved with what  is called a Nefertiti lift.  We inject the platysmal muscle, which pulls down on the lower face along the mandible/jaw bone, with Botox.

As a provider I find restoring mid-face volume to be one of the most satisfying treatments.  Patients get a big bang for their buck with cheek augmentation with filler.  We gravitate towards Voluma (my favorite), Radiesse and Sculptra to achieve mid-face volume as these are longer lasting and produce more volume.  Fillers tend to last longer in the upper and mid-face as we tend not to have as much mobility in these areas as we do in the lower face.  Patients can maintain correction for up to two years in mid and upper face with filler whereas the lower face may need re-correction at 8-12 months.

Using these modalities to restore the appearance of the face is a great option with minimal downtime.  A patient can expect to re-touch the filler treatment every 8-12 months as needed.  Sometimes the touch ups are minimal and help the remaining filler to last longer. Botox touch ups are more frequent at 3-4 month intervals.   Rarely does a patient need to make as much of an investment at follow up appointments as they do at the original treatment.

Pain is minimal during the treatments as topical numbing is typically used and the products have Lidocaine mixed in.

Just in case you have ever wondered what a Liquid Lift was 🙂



Quick blog about an interesting article in the NYT’s this week.  The article discussed the stability of face products and the best way to package a product to keep the active ingredients from oxidizing.  The gist of the article was that products (that we spend A LOT of money on) are best packaged in airless pumps.  Airless pumps maintain product efficacy by keeping actives (such as retinol and Vit C) from exposure to air and minimizing oxidation.

Numerous companies are catching on and many products are now available in airless pumps.  The days of luxurious face creams in jars is perhaps going to be history. (unlikely as women love a pretty jar on the bathroom counter :-))   The active ingredients are too sensitive to oxygen.  They are also sensitive to light.  You may notice some products come in darker glass packaging which also helps protect the “actives” from light.

When purchasing skin care take the packaging in to consideration.  Products in jars are more likely to degrade earlier, have bacterial contamination and require more preservatives.  You are also more likely to overuse a product in a jar when scooping it out.

It is worth considering.  Although, I have to admit one of my favorite moisturizers that I go back to over and over is in a JAR! SkinMedica Dermal Repair is a long time favorite, even if the packaging does not help preserve the antioxidants inside.