MENOPAUSE AND YOUR SKIN 101

MENOPAUSE

Menopause can take a toll on us.  The hormonal shifts have both emotional and physical effects.  Some of it is out of our control, but a lot of it can be managed.

As our estrogen levels drop we notice changes such as hot flashes, changes in our skin and hair, difficulty sleeping, fatigue, irritability and decreased sex drive.  (to name just a few)  As an aesthetic nurse I am frequently asked what can be done to help with some of the skin changes.

Obviously, it goes without saying, that having a healthcare provider to help you manage the medical aspects of “the change” is in your best interest.  HRT (hormone replacement therapy) is a viable option for many of us, but not everyone.  Some individuals may have contraindications for HRT.  If it is an option, estrogen replacement can help alleviate many of the symptoms of menopause.  Each individual has to look at their own medical history and determine what is the best approach for them.

ESTROGEN AND OUR SKIN

As our ovarian function declines,  we lose estrogen production.  A side effect of this is the loss of collagen.  Estrogen helps the body with the production of Collagen I and III.  Additionally, estrogen supports oil gland activity, elastin and subcutaneous fat.  We notice this as we discover our skin thinning, new wrinkles, sagging, dry skin and less volume.  We can provide support to our skin as it experiences menopause related changes.  Here are a few ideas….

  • Eat a healthy diet full of antioxidants. (eat lots of colors!)
  • Try to incorporate soy into your diet.  The isoflavonoids in soy mimic estrogen.
  • Drink plenty of water/stay hydrated.
  • Try to sleep 8 hours a night.  (easier said than done, I know)
  • Wear sunscreen every day, rain or shine!  UV rays break down our collagen.
  • Use a topical antioxidant prior to your sunscreen every day.
  • Utilize a retinol/retinoid (Vit A) product topically at night.  Studies show this helps stimulate new collagen.
  • Utilize peptides in your skin care.  It is proven that various peptides help support the production of collagen and elastin.
  • Use a gentle non-stripping cleanser.
  • Exfoliate your skin.  A physical exfoliant or lighter chemical peel exfoliant.
  • Look for hyaluronic acid in your skin care.
  • Utilize fillers/fat transfers to replace lost volume.
  • If dryness is an issue, make sure your moisturizer is replacing enough moisture so your skin feels comfortable.

There are other issues I hear complaints of related to menopause.  Facial hair growth is a common complaint.  (as estrogen levels drop and our androgen hormones become more dominant)  If there is pigment in the facial hair, laser hair removal is a fantastic option.  If the hair is light or has no pigment, electrolysis is a better option.  There are  also prescription creams that can decrease facial hair growth.

Acne can be a problem that resurfaces at this point.  Again, due to the dominance of androgen hormones our skin can have thicker sebum production.  Retinoids/retinols can be helpful.  For more serious issues your health care provider can help you decide if Spironolactone (a prescription) is an option for you.  The Spironolactone helps suppress the androgen hormones, helping both with hair growth and acne.

Estrogen also helps control our melanocytes.  As we lose the estrogen, hyperpigmentation can become more of a problem.  So, this brings us back to sunscreen and topical antioxidants to protect from UVA/UVB.

For those wanting to go the extra steps to help with collagen production and repair prior damage, there are numerous laser modalities available that make a considerable improvement and difference.  I am currently a fan of  HALO™, IPL’s and Ultherapy®.

I read that we spend 1/3 of our lives in menopause based on the average life expectancy in the developed world.  We can make it feel good and look good ladies!

I’ll finish with a current list of favorites.

SUNSCREENS

The entire line of Elta MD® sunscreens are excellent sunscreen options.

c-e-ferulic

The Skinceuticals line has excellent antioxidants.  Both CE Ferulic® (for drier skin) and Phloretin CF® are great options.

alastin retinol

Alastin® Retinol at night is effective, yet gentle.

Alastin Restorative Skin

The Alastin® Restorative Skin Complex has numerous peptides and antioxidants.  This stimulates collagen and elastin.

Both SkinMedica® and SkinCeuticals offer hyaluronic acid products that effectively boost hyaluronic acid in the skin.

triple lipid restore

SkinCeuticals Triple Lipid Restore is an excellent hydrating cream for those with drier skin.

All of the mentioned products are available at TOC Medical Spa.

We have a sale this month too!

10% off one product

15% off two products

20% off three products

Hope this is a little informative 🙂

 

 

 

 

VYCROSS TECHNOLOGY

 various vycross

It has been a while!  I hope everyone had a good summer and that the new school year is off to a good start!

I thought I would do a quick blog on some of the newer HA (hyaluronic acid) dermal fillers that have come on the market.  As an injector I have been utilizing Allergan’s offerings with Vycross® technology.  These products inject very smoothly, have good malleability and moldability and tend to create less swelling for my patients. (not ZERO swelling, but less)   As an injector it makes my job easier and for my patients the treatments are well tolerated.  Additionally, the product lasts longer due to Vycross® technology.

The Juvederm® family of products have been available for a number of years.  Juvederm Ultra® XC and Juvederm Ultra Plus® XC utilize hylacross technology, the predecessor to the newer line of products.   Vycross® technology blends different molecular weights of hyaluronic acid and have enhanced cross linking to increase the duration of the product in the dermis.   The newer products, Juvederm Voluma®, Juvederm Vollure™ and Juvederm Volbella® have given injectors and patients more options to choose from.

The products have differences which make them suitable for different areas of the face.  Voluma® has 20 mg/ml of Hyaluronic Acid, tends to be very cohesive and is frequently utilized in the mid face to replace lost volume and to create lift.  Vollure™ has 17.5 mg/ml of Hyaluronic Acid and tends to be much less cohesive than Voluma® and works well in areas where finer correction or more subtle volume is desired.  Volbella® has 15 mg/ml of Hyaluronic Acid and works well in fine lines, such as perioral lines (smoker lines).  Volbella® smooths very easily once injected.  In general, the less the HA concentration the softer and smoother the product.   You and your provider can determine which products to use to achieve your aesthetic goals.  It may be that you can benefit from several of the products.

vycross face

All of the products mentioned have 0.3% lidocaine added to make the injections less painful.  I also pretreat with topical numbing and use ice during the treatment.  There are also occasions when a 2% lidocaine dental block is helpful.  For example, lip injections.

The duration of the products varies patient to patient and the companies literature tends to promise more than it can deliver.  BUT, I do find these products are outperforming their predecessors and longevity has improved.  All of the HA fillers have a good safety record and have minimal side effects.

 

DON’T BE SCARED

injection

I received an email from a client this weekend referencing an article which ran in the New York Post on July 7th.  She asked, “Should I be scared?”

The article, “Doctors warn popular cosmetic procedure may cause blindness”, written by Rebecca Sullivan, addresses some of the worst, and rarest, complications with injectable fillers.

One of these very rare complications is blindness.  There have been approximately 100 cases documented of blindness related to the injection of  dermal filler world wide.  These cases, statistically, are extremely rare.   The incidence has been highest when injections have been performed deep in the glabella area.  (between the eyes)  There have also been cases involving injections into the nasolabial folds and the nose itself.  When filler is injected deeply it can be introduced to one of the facial arteries and then can make its way to the retinal artery, resulting in blindness.  Blindness has not been reversible in the documented cases.  This rare adverse event has been reported with the injection of autologous fat and dermal fillers, such as hyaluronic acid fillers.  (Restylane®, Juvederms®, for example)   The occlusion of an artery can also cause soft tissue damage or tissue death (necrosis) . Although, still very rare, there have been more cases of this adverse event reported than blindness.  Infections have also been reported and are also very unusual.

Just the prospect of any of the above can make someone think twice before pursuing facial injections.  Here are a few pieces of information to put you at ease as a patient.

  • Seek out a provider with experience and an extensive understanding of facial anatomy.
  • Seek out a provider at an established and reputable office, ideally with a physician  on site.
  • Ask your provider if they have hyaluronidase in the office.  This is an enzyme which breaks down hyaluronic acid fillers.  If can be utilized in an emergency, but most often is used in outcomes that the patient or provider want to reverse.
  • Know that the majority of complications (such as swelling and bruising) are mild and self limiting.

Even in the hands of the most experienced injectors, risk still exists.

As a provider:

  • Know your facial anatomy!
  • Avoid deep injections in high risk areas.
  • Have an emergency protocol and kit available should the need arise. (hyaluronidase, nitro paste, ASA)
  • Aspirate before injecting.
  • Inject slowly
  • Only place boluses on periosteum.
  • When appropriate, utilize a cannula, especially in high risk areas of the face.

I have seen several references to this article on social media.  I think it is important to inform the public that facial injections have a long and safe track record.  I think that the article referenced does shed light on the fact that facial injections are not without risk and a patient should be educated and informed.  Choosing a provider wisely is so important.

But, in the right hands, you should not be scared!

 

 

MICRO-NEEDLING

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.

glopro

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.

 

FEELING DRY?

ha55

As fall is in full swing and the temperatures are dropping, (except here in Texas!) we need to heat our homes.  This is when more people start to complain of dry skin.  SkinMedica® has an answer to dry skin, with their hydrating product, HA5.

HA5 is a clinically tested hydrating serum containing 5 forms of hyaluronic acid.  These different forms of HA work synergistically together to hydrate the skin, diminishing  the appearance of fine lines and wrinkles.  The product packs a punch of hydration for a light weight feeling product.  The HA is in a sustained release formulation which provides hydration throughout the day. Additionally, HA5 supports the skins ability to replenish its own hyaluronic acid.  We lose HA as the years pass.  We have 50% less by the time we are 50 than we did when we were 20.  This product works well with other products and helps to retain moisture in addition to the moisture it provides.  In addition to the hyaluronic acid this SkinMedica® product contains Vitiscensce™ Technology, a combination of stem cell extracts, antioxidants, peptides and plankton extract.

HA5 has a light silky feel.  It is meant to be used twice a day.  Think of it as an additional dose of moisture during these drier months.  It can be used anywhere to boost hydration so don’t forget about your neck and chest!  The results will be softer, smoother skin with fewer lines.  Rough skin will appear markedly softer.

before-and-after-ha5

With continued use the skin improves even more,

before-and-after-ha5-2

This product is available at TOC Medical Spa.

Here are the ingredients, for fellow ingredient deck analyzers!

HA5 Ingredient Deck

Water/Aqua, Dimethicone, HDI/Trimethylol Hexyllactone Crosspolymer, Glycerin, Butylene Glycol, Bis-PEG-8 Dimethicone, Polysilicone-11, Sodium Acrylate/Sodium Acryloyldimethyl Taurate Copolymer, Sodium Hyaluronate Crosspolymer, Hydrolized Hyaluronic Acid, Sodium Hyaluronate, Vitis Vinifera (Grape) Flower Cell Extract, Vibrio Alginolyticus Ferment Filtrate, Alteromonas Ferment Extract, Porphyridium Cruentum Extract, Whey Protein, Plankton Extract, Trehalose, Urea, Serine, Algin, Caprylyl Glycol, Pullulan, Disodium Phosphate, Potassium Phosphate, Pentylene Glycol, Polymethyl-silsesquioxane, Glyceryl Polyacrylate, Sodium Citrate, Sea Water, Sucrose Palmitate, Tocopheryl Acetate, Hydroxyacetophenone, Polysorbate 60, Propanediol, Potassium Sorbate, Citric Acid, Isohexadecane, Polysorbate 80, Silica, Decyl Glucoside, Tromethamine, Ethylhexylglycerine, Phenoxyethanol, Disodium EDTA.