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 🙂






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!





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!



I am pretty sure my audience is mostly women, but I wanted to do a quick blog on skin care for men.  Honestly, every post I do for women would also apply to men ,but I thought I would highlight a few treatments and products that male patients  utilize and inquire about.

  1. Skincare– A solid skincare routine can benefit anyone.  A topical antioxidant and sunscreen every day are no brainers.  Male clients tend to like SkinCeuticals antioxidants.  Phloretin CF®, CE Ferulic® and Resveratrol B E are all quality topical antioxidants that can be incorporated in to a daily routine.  The antioxidants support collagen production, protect from free radical damage, protect from UVA/UVB radiation and can help minimize redness by strengthening vessels.  Additionally, there are studies showing that utilizing a topical antioxidant can prevent the development of certain skin cancers.  An antioxidant followed by a quality sunscreen would be the two most important components of a skin care regime.  Ideally, the sunscreen would contain at least 7% Zinc Oxide.  Protecting from the suns radiation is the most important step in any skincare regime. (I would argue that, if nothing else, EVERYONE should be using sunscreen) Elta MD® UV Clear SPF 46 seems to be the most popular sunscreen for men at TOC Medical Spa.  A great moisturizer that men seem to like is SkinMedica® HA5 Rejuvenating Hydrator.  This is a weightless moisturizer, blending five forms of hyaluronic acid, which help to diminish the appearance of fine lines and wrinkles.  Men can also benefit from the use of a retinol/retinoid to increase the skins cellular turnover and stimulate collagen.


  1. Botox®/Fillers– Male clients are no stranger to these mainstays in aesthetic medicine.  Botox® for men is becoming more and more utilized everyday. (one in ten Botox® clients are male)   Maybe as men see their female counterparts experiencing the benefits of these minimally invasive treatments they are wanting to get on board.  In my experience, my male patients seeking Botox® treatments are frequently aging in the work force and feel it gives them a certain edge to keep looking their best.  Allergan has a great resource online for those who are interested,  The same goes for fillers.  Men can benefit from the addition of lost volume.  The midface is the most frequently treated area.  Hyaluronic Acid fillers and Sculptra are great options for men.
  2. Kybella®–  This is new to the tools we have at our disposal in aesthetic medicine.  Kybella® (there is a whole blog on it a few months back) can make a huge difference in the sub-mandibular fat (under the chin).  I see a lot of men who could benefit from this treatment.  Essentially,  fat is dissolved with an acid (deoxycholic acid)  and the appearance of the submental area and jawline are dramatically improved.  I have been very impressed with the results of this treatment.


These are just a few examples of what is available for men seeking aesthetic treatments.  I know women are not the only ones wanting to slow down the appearance of aging as the years go by 🙂



Niacinamide is an ingredient receiving some well earned attention lately in skin care.  Studies have been conclusive that niacinamide has numerous skin benefits.  If your skin care does not include a product with niacinamide, you might consider adding one.

Niacinamide, vitamin B3, can be applied topically (ideally at least a 5% concentration) to skin once or twice a day for the following benefits:

  • Decrease moisture loss by increasing barrier function
  • Improve cellular communication
  • Fade hyperpigmentation
  • Increase Collagen
  • Increase skins elasticity
  • Decrease acne
  • Decrease inflammation
  • Fade the skin discoloration acne blemishes can leave behind
  • Decrease redness associated with Rosacea
  • Decrease oxidative damage (similar to an anti-oxidant)
  • Increase cellular turnover

A house favorite here at TOC Medical Spa is Skinceuticals® Metacell Renewal B3.  This daily corrective moisturizer has 5% niacinamide, 2.5% tri-peptide concentrate and 15% glycerin.  I can safely say that every staff member here is using this at least once a day if not twice a day.  Most of us are on our 3rd and 4th bottles.  It is emollient without being heavy feeling at all and works well under makeup during the day.

You will likely see niacinamide popping up more and more in skin care products, and hopefully this review will help you understand why 🙂



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 🙂




As the cooler weather arrives and we have to turn on the heat many people are prone to dry and itchy skin.  This can be minor for some people and more of a disaster for others who struggle with dry skin to start with.  It can lead to flare ups of atopic dermatitis (eczema) and create cracks in the skin (creating a break in the barrier and possibly leading to infection).   There are numerous approaches to minimizing and alleviating the problem.

You may need to alter your skin care routine from the warmer months to the cooler months.  Using a milder cleanser and avoiding toners with alcohol is a good start.  If you are a fan of exfoliating, a more gentle approach may be helpful.  Finding a cleanser that is moisturizing for both your face and body is also helpful.

As tempting as it is to take a long steaming hot shower or bath when you are chilled to the bone, it will only make your skin drier by breaking down your skins lipid barrier.  It is recommended to minimize the amount of time bathing and to avoid temperature extremes.  Additionally, putting a moisturizer on immediately after bathing when the skin is still slightly damp can help to trap in the moisture.

Ingredients to look for in moisturizers include:

  •  Glycerin
  • Sorbitol
  • AHA
  • Petroleum/Petrolatum
  • Urea
  • Lactic Acid
  • Olive Oil
  • Jojoba Oil
  • Shea butter
  • Hyaluronic Acid/Sodium Hyaluronidase
  • Dimethicone
  • Lanolin
  • Aloe Barbadensis
  • Tocopherol (Vitamin E)
  • Mineral Oil

It is also helpful to avoid heavily fragranced products.

A few face/neck/décolleté creams we love and recommend here at Toccare/TOC Medical Spa include:

There are products that are specific to body areas.  For instance, hand creams tend to be heavier than face creams.  Our hands (and feet!) have fewer oil glands so require more moisture replacement.  Make a habit of moisturizing at bedtime as this allows the skin to absorb the moisture during your sleeping hours.

Lips can be a particularly irritating area when they loose moisture.  Sealing in moisture and always maintaining a barrier is the best way to treat lips.  We tend to lick our lips more as they become irritated.  This actually makes matters worse by breaking down the barrier even more.  Keeping a lip balm on your person is the best defense.  I love Lip Drink™ by Jane Iredale.  It is moisturizing, has an SPF from titanium dioxide and tastes like lemonade!

Diet is part of the solution as well.  Eating foods rich in Omega-3 fats can help your skin maintain a lipid barrier.  Avocados, fish, nuts, olive oil, flax seed/flax seed oil and sardines are all sources of Omega-3 fats.    Additionally, drinking plenty of fluid is helpful.

If an area becomes particularly dry and irritated it may be time to try over the counter hydrocortisone cream.  This usually manages minor irritation and eczema.  If irritation persists, it is advisable to seek the care of a dermatologist.