It is almost impossible to resist the urge to pick at our skin.   When we feel there is something there that shouldn’t be, we are compelled to remove it.  Unfortunately,  picking at a pimple can cause the lesion to worsen by creating an infection and/or eventually leave a scar, called post inflammatory hyperpigmentation. (PIH)

When you “pop” a pimple you can actually cause the localized infection to spread under the skin, leading to more inflammation.  Imagine the sac your body forms around the pus as a self defense mechanism.  (like a blister)   When we open the sac and spread the bacteria and introduce new bacteria, we interrupt the skins self defense and healing mechanism.  The sac does not only open to the surface, it can implode under the surface, spreading the infection and increase inflammation   P. acnes is the bacteria which is commonly in our hair follicles and can mix with dead skin cells and sebum to create inflammation which leads to a pimple, or comedone.   Our body will naturally eventually rid of the lesion by pushing the material to the surface or by reabsorbing the “waste” under the skin.  As tempting as it is to push the process along, don’t.  Let it run its course.  When you pick you are introducing bacteria on your hands, on the skins surface and under your nails to the equation, potentially making it worse.



pimple 1

There are different types of blemishes.  The above diagram gives you an idea of what is going on under the surface when you have a pimple or blackhead.  You can visualize how the contained papule or pustule can spread in the tissue when forced.

Instead, try an over the counter benzoyl-peroxide product (ideally 10%) or a retinol or retinoid.  These products will dry the comedone out, helping to shorten its lifespan without scarring the surrounding tissue.

If the lesion is persistent and feels more like a cyst under the skin your dermatologist can inject a small amount of a steroid.  These lesions typically shrink within a day or so.  We do not recommend doing this unless necessary as there are times when the steroid injected can create a divot in the skin.

Additionally, your skin care specialist or esthetician can perform an extraction using sterile tools specifically designed to  thoroughly extract a blemish without scarring.   If you suffer from frequent enough breakouts it may be worth having a routine facial with extractions.

Being aware of what is causing the breakouts.  Ingrown hairs can be a culprit if you suffer from coarse facial hair growth.  Some cases of facial acne are actually related to folliculitis.  This is when the hair creates inflammation as it makes its way to the surface.  I have seen some patients see considerable relief with laser hair removal. (the hair needs to be pigmented)

Always thoroughly cleanse your skin before going to sleep at night.  Using a cleanser with glycolic acid can be helpful.  I am a huge proponent of using a retinol/retinoid for its anti-aging benefits as well as its ability to control breakouts.  Make sure the products you are using do not clog your pores.  Our products can be part of the problem.

If you have picked enough to cause PIH a series of IPL’s or peels can help to remove that pigment.  We are having success with our new IPL (Intense Pulse Light) at TOC Medical Spa, the Lumenis M22.






Micro-needling, or collagen induction therapy,  has been around for a number of years, but has recently had a new wave of enthusiasm.  I just read an article in the New York Times™ about an at home device called GloPro® which is, apparently, doing very well on the market.


We have been performing micro-needling in office for a number of years and I thought I would touch on the difference between an at-home device versus a medical grade micro-needling treatment.

An at home device has one setting and is not made to penetrate deeply.  It treats the very surface of the skin.  Most people will have slight erythema (redness) which indicates the body is responding to the stimulation.  I believe over time results can be noticed.  However, not to the same extent as with a more aggressive in office treatment.

Eclipse Micropen Elite

We utilize The Eclipse Aesthetics Micropen® device.  This device is automated with a treatment tip consisting of 12 needles.  The provider can choose how deep to penetrate the tissue depending on the area of the face and  the treatment goals.  We tend to be more aggressive on the fattier parts of the face, such as the cheeks.  We adjust the depth of penetration of the needles for each patient, the treatment area,  the patients goals and the amount of social downtime the patient can afford.  We find that even an aggressive treatment, with pinpoint bleeding, can look presentable the next day.

another micrpen

In addition to being able to adjust and personalize the treatment with depth of penetration, we can also personalize which product to apply to help the treatment tip glide easily over the face.  We utilize both a hyaluronic acid and MicroGlide GF™, a growth factor product.

The other option ,which has received a lot of buzz the last few years, is utilizing the patients own isolated platelet rich plasma (PRP).  This is done by drawing the patients blood, utilizing a centrifuge to separated the plasma and then re-injecting the plasma with the micropen device.   Most people  refer to this type of treatment as a The Vampire Facelift®.

The delivery of an injury to the tissue is what creates the stimulation of the fibroblasts to make new collagen and elastin.  Utilizing growth factors or PRP  further stimulates the induction of collagen and elastin.

Who is an ideal candidate for this treatment?  Virtually anyone wanting to improve the appearance of their skin.  This treatment, when accompanied by a solid skin care routine at home, can make noticeable improvement in the texture, tone and color of the skin.

I think micro needling is here to stay and is an effective modality with little or no downtime.



routine products

We all have the best intentions whether it be related to our diet, exercise program or other goals.  This is about committing to a solid skin care regime.  Just like all other ‘habits’ it can take practice for a new skin care program to become the new normal.   I believe the research shows that it takes 21 days for a new practice to become a habit.  So, how can we make that easier and help insure we will commit?

The easier we can make it for ourselves, the more likely we are to experience success.

First off, decide what your day time skin care should look like for you and what you are trying to target.  Ideally, everyone includes an antioxidant and a sunscreen with zinc every morning.  A night time routine should include a retinol/retinoid and plenty of moisture.  Once you have established which skin care items are going to suite your skin care needs make sure the products are accessible.  It can be easy to want to skip any part of the routine when we are in a rush to get out in the morning or we are exhausted at night.

Have all your must use products easily accessible.  I keep a tray with my current products on the bathroom counter next to my sink.  I am always able to commit in the morning, it is at night, sometimes, when I am exhausted, that I might be less committed.  But once I brush my teeth my products are right there so I rarely skip.

I am a true believer in topical skin care.  I came in to medical aesthetics with pretty sun damaged skin and can honestly say that I turned my skin around.  I once thought tanner was better.  I even used tanning beds back in the day.  Being a pale red head, this was just a bad idea on so many levels.    I believe that what we use topically is a big piece of the “pie” and is worth the money and time.

I tell patients to, at the very least,  commit to an antioxidant, sunscreen and retinol/retinoid.  I am a huge fan of products with multiple peptides these days as well.

Maybe this well help you get on board with a topical skin care routine.

Happy Monday!






What are peptides and why do we want them in our skin care products?

A peptide consists of 2 or more amino acids and are the building blocks of proteins.   There are hundreds of peptides. There is growing research in skin care proving that certain peptides have the ability to assist the skin cells to perform specific functions.  In skin care, the peptides are  used to help trigger the growth of new collagen and elastin.  Although, there are also neuropeptides that have the ability to relax the muscles slightly as well.  (think a very weak version of Botox) There are also certain peptides which researchers are discovering assist in the support of adipose tissue.  (fat, which gives our face fullness that we loose over time)

There is enough proof that incorporating peptides in your skincare regime has worthwhile benefits.  Peptides are best when used in conjunction with other skin supportive ingredients, such as antioxidants.  These ingredients can work synergistically with one another.

When looking at an ingredient deck look for hexapeptides, tripeptides, dipeptides and tetrapeptides.  Think of the peptides as part of a healthy diet for your skin.  Just as you would eat a well balanced, nutritious diet to support the functions of your body.

As always, always have a quality sunscreen with zinc or titanium as a part of your morning routine!

Products I am currently utilizing myself and recommending to clients with peptides include:

Alastin Restorative Skin

Alastin™ Skincare Restorative Complex

Alastin Eye

Alastin™ Skincare Restorative Eye Complex


NeoCutis Microfirm Neck and Décolleté Rejuvenating Complex

As always, the mentioned products are available at TOC Medical Spa here in Austin!


I thought I would share an honest account of the process of having an IPL or photofacial followed by a peel.

*please pardon the mug shots 🙂


This is a before photo the day I did my IPL

I was bothered by hyperpigmentation which was increasing over the last 6 months



The two above photos are the day after the IPL and the pigmented lesions have “peppered” and now appear darker.  This is GOOD!  That is what I was targeting!

After allowing my skin to calm down for 1-2 weeks, I applied a VI Peel® on day 10.  By day 4 I was experiencing peeling that lifted my stratum corneum (the top layer) and any remaining peppering that was hanging on.


The peeling starts around the mouth and spreads out the cheeks over the course of 1-2 days.  This period is itchy and a bit irritated, but the VI Peel® comes with hydrocortisone cream in an emollient base that helps sooth the skin.  I flaked until yesterday which was day 9.

Today is 10 days since  I applied my peel and I now have clear, smooth and rejuvenated skin.  My pores appear smaller, the pigment is significantly improved and any fine lines have been minimized.  Makeup applies very smoothly after recovering from these procedures.


Here is todays mug shot!

(without makeup on face as evidence by my uncamouflaged breakout! just eye makeup)

I wish I had a picture from 12 years ago before I started taking care of my skin. Once upon a time I was a red head who wanted a tan!  I was covered in freckles and “age spots”.  I try very hard to protect my skin these days.  However, even with my efforts, I end up with some sun from long walks with my dog or hiking with friends.

Anyway, I am a huge fan of these modalities for skin rejuvenation and thought I would share these photos as an example of what one can expect!  I try to do this 3-4 times per year.



There are a few stand-out products from 2016!

Alastin Restorative Skin

The Alastin Restorative Skin Complex® has become a part of my daily routine.  I have found an improvement in the texture and tone of my skin using this product regularly.  The skin around my eyes (especially under my eyes) has firmed and there are fewer fine lines.  This product has peptides that help your skin grow collagen and elastin.  Restorative Skin Complex has been written up in numerous publications and has been recommended by multiple dermatologists and plastic surgeons.   It is worth every penny.


Skinceuticals C E Ferulic rotates in and out of my regime, and has for years.  There is unequivocal evidence that this product, loaded with antioxidants, helps neutralize UV and free radicals.  Used with sunscreen, your protection is improved significantly.  90 % of visible premature aging is caused by environmental free radicals.  Sunscreen alone is not enough.  Adding an antioxidant such as C E Ferulic or Phloretin CF gives the skin significantly improved protection.


Elta MD® UV Daily Broad-Spectrum SPF 40 is always on my bathroom counter, in my purse and in my car.  With 9 % zinc oxide, the sun protection is superior to any chemical sunscreen.  The formula is not at all heavy, and with  hyaluronic acid , it is hydrating.   I love this sunscreen.


Skinceuticals Metacell Renewal B3 is also always in my rotation.  This product helps with hyperpigmentation and, with niacinamide, redness as well.  It has a smooth and hydrating feel without feeling heavy or greasy.  Great product.


Allergan Juvederm Voluma™ has become one of my favorite dermal fillers.  It is FDA approved for filling the midface, although I use if off-label in temples, tear troughs and lower face.  This filler is wonderful at restoring lost volume while looking very soft and natural.


And, as always, the tried and true merits of Botox® and Dysport® can not be disputed.   The preventative and corrective effects of both of these botulin products are proven in terms of efficacy and safety.  They are here to stay, and when in the right hands, can create a rested appearance.  We have all seen a “Botoxed” face, but that is not how it has to be.  There can be movement and expression  when the muscle activity is minimized rather than frozen.  A rested appearance is the ideal outcome.

Botox cropped


One more product I have enjoyed this year, and in previous years, The Vi Peel.  In a perfect scenario we would all have a peel every 3-4 months.  Peels help to lift damaged and dull skin, stimulates collagen, fades hyperpigmentation and clears stubborn breakouts.  I love my skin 10 days after the peel is applied.  The Vi Peel is strong enough to see a difference ,but not so strong that there are weeks of downtime.    Great glow!


All products and services mentioned are available here at TOC Medical Spa in Austin!

I hope your 2017 is off to a great start!  Here is to your health and happiness!



Looking for a last minute gift idea for under the tree, or a stocking stuffer?

Here are a  few suggestions (which won’t break the bank, mostly:-) ) from TOC Medical Spa.

A product that would work for any recipient is Elta MD® UV Lip Balm Broad Spectrum SPF 31.  ($10)  This lip moisturizer tastes good (minty) and gives lips the protection they need.  This is a great product to have in your pocket when you’re skiing!


Another idea  is a Jane Iredale® Puregloss lip gloss ($24) in a universal tint.  Both Tangerine and Snow Berry look beautiful on their own or as a gloss over lip color.


The Jane Iredale® line also has a universal blush that I have yet to find a person it does not look beautiful on.  Awake Purepressed Blush ($27) literally makes you look like you have had a quick walk or a kiss under the mistletoe.


A more indulgent gift could be a Clarisonic® Mia facial cleansing brush ($129).  This facial cleansing brush thoroughly cleanses the face using sonic technology.  I have yet to meet an adult or teenager who does not love their Clarisonic®!


Just a few last minute suggestions!  Happy Holidays Y’all!!!!