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.


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.


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


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 🙂






aging face

Our skin care needs change as we age and it is easy to be overwhelmed by all of the choices out there.  This is a quick guide through the decades.

THE 20’s

In our twenties we are generally enjoying the glow of our youth.  This is a time when we frequently take for granted our smooth and plump skin.  This can be a time when we do a lot of the damage we regret years later.  This is a good time to be committed to a supportive skin care regime.

  • Sunscreen is a no brainer.  Ideally with zinc or titanium to assure long lasting, broad spectrum protection.
  • A topical antioxidant to ward off additional UV and free radical damage. (Vitamin C for example)
  • A retinol or low dose retinoid to keep those skin cells turning over and to help manage occasional breakouts.
  • This is the time to introduce an eye cream.  Remember, an ounce of prevention is worth a pound of cure.  You will thank yourself later in life.
  • For spot treatment of blemishes a product with salicylic acid or benzoyl peroxide can be applied.  More is not better because you may replace your blemish with a dried scab which can then hyper pigment.
  • By now you have probably made the correlation with diet and skin and are aware that a healthy, well balanced diet helps all of your organs, including your skin. (in addition to not smoking!)

THE 30’s

Throughout our thirties we start to see subtle changes from exposure and repetitive muscle movement.  In addition to a supportive skin care regime we might consider extra steps to help during this decade.  We are producing less collagen and elastin by now and are starting to notice.

  • Botox® can be introduced to manage lines from repetitive movement. (frown lines, crow’s feet, etc)
  • Chemical peels can help to lift the outer layers of the skin diminishing pigmentation and fine lines and wrinkles. Collagen is stimulated in this process.
  • IPL’s can minimize pigmentation and redness in the skin.
  • Some patients opt to introduce small amounts of filler in their thirties where they are seeing changes related to volume loss.

THE 40’s

As we begin to experience shifts hormonally and as our estrogen levels drop we lose even more collagen, elastin and facial fat.  Our bones are also shrinking under all of that creating more changes we may not love.  Our sebaceous glands are producing less sebum and dry skin may become more of a concern.

  • Continuing with a skin care regime involving sunscreen, antioxidants and a retinol/retinoid is a must.  You may opt to increase the strength of the retinol/retinoid.
  • Additional moisture is frequently needed.  Look for products with ceramides, for instance.
  • Facial volume loss can be managed with an expanding menu of dermal fillers.
  • Botox® can be used to help “lift” when your injector relaxes the muscles pulling down (depressor muscles) allowing the elevator muscles to lift unopposed.
  • IPL’s and more aggressive lasers (fractionated erbium and CO2 for example) can be utilized to manage skin discoloration and texture changes.  Collagen stimulating treatments, like Ultherapy®, can be used to help combat the loss of collagen.
  • Neck, chest and hands can benefit from all of the above!

THE 50’s , 60’s, 70’s and 80’s (and beyond)

In our fifties  we are likely approaching menopause and are continuing to see age related changes.  As we continue in to our sixties and beyond this becomes more of an issue as post-menopausal skin experiences more age related changes without the support of estrogen.   We probably need to boost our moisture as our skin becomes drier.

  • Continue with the three pillars in skin care: sunscreen, antioxidants and retinol/retinoid.
  • Some find it helpful to cut back on the % of their retinol/retinoid to combat  dryness.
  • Increase moisture as needed.
  • Continue to see your provider to determine if Botox®, filler and various laser modalities can help obtain your aesthetic goals.
  • If surgery is appropriate, find a surgeon you trust and have vetted.







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.






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!






A frequent complaint that I hear from clients is that they can not tolerate retinol/retinoid products.  I have a prior post going in to detail on these Vitamin A derivatives.  Irritation is a known side effect, but worth working through to receive the long term benefits of this proven ingredient. (stimulates collagen, minimizes wrinkles, reduces break-outs, sheds pre-cancerous skin lesions)

Because retinol/retinoids convert to retinoic acid in the skin, they do create irritation as they increase cellular turnover.  I find that the irritation subsides once an individual has acclimated to the product.  I frequently hear clients say they go on and off their retinol/retinoid because of the irritation, but then the benefits are so diminished.  So, here are some suggestions.

Whether it is an over the counter retinol or a prescriptive retinoid it is beneficial to gradually increase the use of the product.  This is a possible schedule to try:

  • Twice a week for two weeks
  • Three times a week for three weeks
  • Four times a week for four weeks
  • Every night as tolerated

It can also be helpful to start with a lower strength product and gradually increase the strength of the product as you get used to it.  This can mean starting with over the counter retinols and then going on to prescription strength retinoids.  With prescriptions there are numerous products available with a range of % of retinoid.  Perhaps starting on a lower % and then increasing the strength if you and your skin care provider think it would be beneficial.

The other factor that can be helpful is that many forms of retinol/retinoid are available in micro-sponge technology.  This is a technology in skin care where the active ingredients are slowly released in the skin.  I find this to be very helpful to clients who are sensitive and have difficulty tolerating vitamin A products.

Finally, one of the effects of retinol/retinoid products is suppression of sebum production (which is why it helps those with acne).  This can lead an individual with normal to normal/dry skin to really struggle with the drying effects of the product.  It is important to moisturize your skin to help alleviate this side effect.  Some individuals find it helpful to apply the retinol/retinoid on top of the moisturizer to minimize the dryness.  Additionally, as you start on a retinol/retinoid and experience areas that are particularly irritated an over the counter hydrocortisone cream can be used to minimize the irritation.

Ultimately, the benefits of using a retinol/retinoid are well documented and have been considered an important tool to use in skin care to help with the signs and symptoms of aging skin.  I encourage MOST of my clients to be on one of these products. (there are exceptions, such as an individual with Rosacea)

We carry several retinols at TOC Medical Spa.

  • Neocutis Nouvelle- A 0.6% retinol which also contains skin brightening ingredients.
  • SkinMedical Retinol- Both a 0.5% and 1% retinol also contains antioxidants and anti-irritants.

If you are not currently utilizing this star product I would reconsider.  Discuss with your skin care provider what would be a good starting point for you.



Retin a

Retinoids and Retinols (derivatives or metabolites of Vitamin A) have been around for years and are proven to stimulate collagen production.  They  help with diminishing pigmentation, reduce lines/wrinkles, tighten pores, increase blood flow to the skin, fight acne and improve acne scarring.  They can also help diminish the appearance of stretch marks!

Retinoids (tretinoin) are retinoic acid and are available in various strengths.  Retinols are applied and are converted in to retinoic acid in the skin.  The ingredient deck will likely  include retinol or retinyl palimitate.  They are both converted into retinaldehyde and then retinoic acid in the skin.  Products with retinyl palimitate are the weakest and might be appropriate for individuals with very sensitive skin, as they need to go through several conversions to become retinoic acid.

For the history buffs, Retin-A was patented in 1967 after being developed by Dr. James Fulton and Dr. Albert Kligman at The University of Pennsylvania during the 1960s.  Kligman coined the term “photo aging” back in the ’60s. (funny we continued to sun for years and years!)   In skin care we frequently prescribe a topical treatment called Kligman’s Formula which contains a combination of Retin-A, hydroquinone, Fluocinolone and Kojic Acid for photo aging.   Originally Retin-A was for acne and hyperkeratic conditions, such as actinic keratosis.  Over time the anti-aging benefits were realized and a new patent was obtained in 1986 for wrinkle reduction. Additionally, retinoids have been shown to be beneficial for decreasing basal cell cancers.

So, how to introduce a retinoid to your skin care regime?  If you have sensitive skin starting with an over the counter retinol (or even retinyl palimitate if very sensitive) would be beneficial, ideally a 0.1% Retinol.  Once acclimated to the over the counter version a prescription strength product can be introduced as needed.  There are numerous formulas on the market and your dermatologist or skin care provider can help to select which formula would be best for your skin type.  The number one problem with retinoids is compliance.  There tends to be irritation/flaking as the product is introduced (resulting in  increased cellular turnover)  which leads to individuals ceasing the use of the product.  Ideally a product is slowly introduced and frequency of use is gradually increased.  For instance: 2x/week for 2 weeks, 3x/week for 3 weeks, every other night for 4 weeks and then every night if tolerated. Retinoids are applied at night because the sun can destabilize the product.   You may find it beneficial to have a more emollient night cream as the retinoid can dry the skin.  These products do not make you more sensitive to the sun despite this lingering stereotype.  As a matter of fact, many providers find starting a retinol or retinoid in the summer to be beneficial as the more humid air helps with the side effect of skin dryness.

Once on a retinol/retinoid it can take 3 months to acclimate to the product.  It can also take this long to start to realize the results, although I think most people see improvement almost immediately.  If you start on a product and find it too irritating, even with a titrating schedule, you may want to try a weaker formula.

Once on a retinol/retinoid be aware that your skin is more sensitive.  If you wax you should stop using your retinol/retinoid for 5+ days prior to waxing.  If you are having other skin care treatments done make sure to let your provider know you are using a retinol/retinoid.

*Pregnant and breast feeding women should not use these products.







This is the time of year when we tend to consider new beginnings and come up with resolutions for the upcoming year.   If you’re feeling like you look tired and could use a pick-me-up, consider revisiting your skin care routine, and consider aesthetic treatments to compliment your appearance.

Here are a few suggestions to consider:

  • Make sure you are using a sunscreen with zinc or titanium EVERY DAY.  (Love Elta MD® SPF 40 Daily for normal/dry skin and Elta MD® SPF 36 Clear for normal/dry skin: both contain 9% zinc)
  • Incorporate an antioxidant on a daily basis as there is unequivocal  evidence that our skin benefits from this. (SkinCeuticals® CE Ferulic® is great for normal/dry skin, while SkinCeuticals Phloretin CF® is a good choice for normal/oily skin)
  • Add a Retinol or Retinoid to your routine because, again, there is unequivocal  evidence that it benefits our skin. (love Neocutis® Nouvelle+ which also contains a skin brightening complex)
  • If you are really noticing the effects of aging on your skin add a growth factor and use if for a full 3 months before you decide if you love it or hate it.  I recommend Neocutis Bioserum® or SkinMedica TNS Essential Serum®.
  • Drink plenty of water or uncaffeinated beverages every day as our skin thrives with hydration.  (try for an 8 oz serving every hour or every other hour)
  • Consider renewing your skin and thinning the stratum corneum (the non-living layer of cells on the surface)  which will brighten your complexion and fade hyperpigmentation.  (a series of peels such as the VI Peel®)

Most of us (at least based on my informal survey of those I know) have resolutions regarding our weight and diet  (year after year after year).  Be encouraged that eating well and incorporating the “good fats” and omegas in to our diet also has skin benefits.  Food is medicine, and our skin usually gives away whether we are feeding it with a healthy diet as opposed to a lot of junk food which increases inflammation and can ultimately break down collagen and elastin.

I hope 2016 is everything you want it to be and that you are successful with your resolutions!  Cheers!  Celebrate safely!

As always, the mentioned products are available at TOC Medical Spa 🙂