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 🙂






There are several programs offered by the aesthetic pharmaceutical companies that are meant to drive patients back in for additional treatments.  They are effective for the companies AND they save the patient money.

I think it is worth utilizing these programs if you are a consumer as it does save you $ on something you were probably going to do anyway.


Allergan, the makers of Juvederm®, Botox®, Kybella™, SkinMedica® products and Latisse®, has a program called Brilliant Distinctions®.  You accrue points by receiving treatments with your provider, purchasing skin care, and in the case of Latisse®, filling a prescription at your pharmacy.  You simply sign up at  When you receive an aesthetic treatment with an Allergan product remind your provider to issue you points at check out.  When purchasing SkinMedica® products also ask the person checking you out to issue points on your skin care purchases.   Check your account before your treatments to see how many points you have accrued and create a coupon.  The coupon are worth anywhere from $10-$80 depending on what you have accrued.  (I have seen patients have more than $80 in their banks)  Points do expire after 9 months so keep an eye on them.  Brilliant Distinctions® also has an on line mall where purchases from participating retailers can also create dollars in your account.  The list of retailers is extensive and includes many commonly shopped businesses.  Maybe your holiday shopping is going to pay for your next Botox® treatment!


Another program, from Galderma, the makers of Restylane® products, Sculptra® Aesthetic and Dysport®, is called Aspire.  Once again, you accrue points as you receive treatments.  Go to to sign up.  You are also able to accrue points in Aspire by taking monthly quizzes, participating in surveys and referring friends.  The Aspire program points last longer than Brilliant Distinctions® points,  although they do eventually expire.

Both programs have smart phone apps that make it that much easier to access and utilize.

If you are a fan of medical aesthetic treatments check these out.  It can only save you money!



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.


With continued use the skin improves even more,


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.




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 🙂



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.




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.