Mirror, mirror on the wall

photo credit: oocities.com

photo credit: oocities.com

Who’s the fairest of them all?  Fair, pale, au natural…..even fairy tales love sun-protected skin. I know, I know, that’s not what the Queen had in mind, but this is my story now so indulge me. What was the Queen longing to see when she looked in the mirror? She desired a youthful appearance, like that of Snow White, with a face free of wrinkles, brown spots, dilated pores and blood vessels. I know that’s what I long to see when I look in the mirror, how about you?

Unfortunately, despite my career choice to nurture and protect skin as a dermatologist, as a kid and teenager I was not a skin nurturer, in fact, I was a down-right skin-abuser. I burned, fried and tanned my skin any chance I could get. My sister and I would have contests to see how long we could lay out in the sun before we nearly passed out from heat exhaustion or play the game of “how low can you go” with the SPF factor on our “suntan oil.” Yes, oiling our hide to tan it was the object of the game. Thankfully we quit playing before our hide became leather…. but barely. Instead of leather, I got lots of freckles and moles (a direct correlation of sun-damage), many of which have been biopsied and been proven to be atypical histopathologically. In essence, I am my own skin nightmare with scars all over my body as a constant reminder that I’m not dreaming.

Premature wrinkling, sagging skin, freckles, dilated facial blood vessels and brown spots are manifestations of sun-damage which is referred to as photo-aging or if you want to be fancy, dermatoheliosis. Compared to physiologic (chronologic) aging, the changes seen with photo-aging are accelerated with the end result of having you looking significantly older than your stated age. Sure, as teenagers some of us wanted to look older so we could get into establishments with age restrictions, but as adults I think many of us are thrilled when someone mistakes you for someone’s “younger sibling.” Maintaining a youthful appearance is the reason the cosmetic/aesthetic procedure industries have exploded in recent years with new products and innovations.

The good news is that you don’t have to spend a fortune to maintain your youthful looks! Just a few minor adjustments to your daily routine will help you minimize the damaging effects of the sun on your skin. Daily use of sunscreen, either in your moisturizer, after-shave cream or make-up is a simple way to layer on your sun protection on all your exposed skin. It’s the UVA rays which are the “aging” rays, so make sure the products you buy are labeled “broad-spectrum” so that you get coverage for both UVA and UVB (the burning rays). Remember, UVA rays can penetrate window glass, so while you are driving in your car and sitting by your office window you are still get “sun.” If you have ever noticed that the left side of your face and left arm have more spots and lines on them, this is one of the big reasons as your left side gets bombarded by UVA rays while you are driving. The recommendation is to use products that are SPF (sun protection factor) 15 or higher and I like to use SPF 30 in my daily moisturizer. Choosing products that have zinc oxide and titanium dioxide will minimize irritation for those of you with sensitive skin. There has been much controversy over nano-sized particles of these ingredients, although the research is still ongoing, there are plenty of fantastic products currently on the market that do not use nano-sized particles. Remember, whichever products you choose to use, sunscreens regardless of SPF or active ingredient will break down approximately 2 hours after application, so if you are planning on being outdoors for an extended period of time you need to reapply. There’s no reason you can’t look good while maintaining your youthful appearance right? So wear some fashionable sun-protective clothing (check back with me soon for a preview), a broad-brimmed hat, and don some shades to protect those eyes because ocular melanoma is challenge to treat so prevention is key.

Mirror, mirror on the wall who’s the fairest and most youthful looking of all? My sun-protected shaded bliss fans of course! See you in the shade!

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By the hair of my chinny chin chin….

My dog Beaudi. He graciously agreed to be the model.

My dog Beaudi. He graciously agreed to be the model.

As a kid, hearing about  hair on your chinny chin chin was an amusing part of a fairy tale. As an adult female, having hair on your chinny chin chin is no laughing matter, right ladies? And not to leave the guys out …..having rogue earlobe hairs and feeling like a sasquatch may not be your thing, so the good news is that over the last few decades the options for hair removal have expanded and improved.

There are numerous methods available for hair removal, some of which are very temporary and some of which have the potential to permanently reduce hair growth. Notice I didn’t say permanently remove hair. I am a New Yorker to my core, despite living on the West Coast for many years,  I’m gonna tell it like it is…if it sounds too good to be true, it most likely is…so I’m not going to try to convince you otherwise.  As a dermatologist it is my job to provide facts, details and opinions so that my patients can make informed decisions. So even though this site is not intended to treat, diagnose or cure any disease or ailment, and as readers you are not patients, I am committed to providing clear, concise (well maybe not that concise, I am known to ramble a bit) explanations of issues in hopes of being helpful.

So let’s start with the basics of hair. I am sure many of you have tweezed, shaved, waxed, threaded,  sugared or “been lasered” only to be befuddled by the fact that some hairs stay gone and others rear their wiry heads way too soon. This is due to the fact that hair grows in three phases: the actively growing phase (anagen), which comprises about 80-90% of hairs. On the scalp this phase lasts about 2-6 years, whereas on the arms, legs, eyelashes, and eyebrows the phase is only about 30-45 days which helps explain why hair in these areas is much shorter than the scalp. The next phase or  transitional phase known as catagen comprises 3% of all hairs at any time. This phase lasts for about 2-3 weeks. The last phase is the resting  phase (telogen) which comprises 10-15% of hairs and last approximately 100 days. It is during the telogen phase when “shedding” occurs and about 25-100 telogen hairs are shed each day. The kicker is that hairs are not in sync with each other and while some hairs are growing, others are transitioning or falling out.  Moreover, it’s only when hairs are in anagen (growing hairs) that they are responsive to removal modalities (i.e. electrolysis, laser).

Now that we have the basics down, how do you choose the best hair removal method? There are several factors to consider: convenience, pain threshold (a very subjective factor), cost, goal for temporary vs. more long-lasting results and anatomic location. Most of these factors are intimately intertwined.

For instance, shaving is very convenient as you can do it yourself, in your home, cost is lower (although the cost of razor blades these days is nutty), pain is minimal but the results are very temporary as you have to shave every few days because you are only trimming the hair not removing it.

Waxing/threading/sugaring: convenient as the service is readily available and it’s quick, cost is relatively low, can be done on most if not all external anatomic locations. The downside is that it can be painful and the results usually only last about 3-6 weeks. With repeated treatments the hair follicles may be disrupted/ damaged  which may lead to permanent hair loss (but most likely patchy at best).

Electrolysis: So how does it work? An electric current is applied with a very fine needle-shaped electrode, or metal probe into each hair follicle to destroy the root. The pros are that this method has a good track record for permanent hair reduction and in some cases permanent removal. Since it targets the follicle itself, this method can be used on most skin types. The cons are that it can be painful, requires many treatments (can be upwards of 15-30)  and can be expensive. Also operator dependent so results can vary.

Laser: Laser hair removal is one of the most commonly performed cosmetic procedures in the U.S. A beam of  highly concentrated light penetrates into hair follicles. It is the pigment in the follicles that absorbs the light and this destroys the hair.  The technology of lasers has advanced so that patients of color can safely have laser performed without damaging skin tone. As with other methods, only the anagen follicles are targeted so treatments need to be repeated every 6-8 weeks to capture more and more of the anagen follicles until the desired level of hair reduction is achieved.

The pros are that laser can be done relatively quickly depending on the site treated and the results are long-lasting. Treatments literally can take as little as 5 minutes! The cons are cost, number of treatments required (usually 6-12) depending on body part treated and pain. I can attest to the fact that current lasers are way less painful than lasers used in 2008 even, and that is saying a lot because I am a big wimp. Risks of treatment other than pain , include swelling at treatment site, burns (go to someone with expertise and experience, and have a test spot done first: settings can be adjusted to avoid this). Although with the advances in technology this does not happen as often, but lightening or darkening of the skin in the treated area can occur.  The other issue with lasers are that they are best used on course hair: legs, back, bikini, underarm, men’s beards. Although they are used for women’s facial hair, the light colored, peach fuzz found on women’s cheeks, chins and lips is unlikely to respond as well. Lasers target a color and the lighter the hair the less there is to target.

Topical therapy: A serendipitous discovery of hair loss was noted when using an anti-malarial drug (eflornithine). The medicine is formulated under the trade name Vaniqua which is a prescription cream used to reduce facial hair growth in women. The mode of action is to block the enzyme that leads to hair growth. This ” blockage” is gradual and can take up to six months to take effect, during which time other hair removal methods would need to be continued. It’s a twice daily application and the downside is that once you stop using it…the hair growth is no longer blocked and hair will eventually return.

So as you can see there are many options…this is a good thing. The best expected outcome is permanent hair reduction and in some cases permanent hair removal may occur. Now don’t get me wrong, I’m a glass half full kind of a girl (and if the wine is really good, fill her up’) but when it comes to issues in medicine I am a realist, and I hope armed with this information you will be too so that you can decide which if any of these modalities might work for you and you will not be disappointed with the result. If none of these float your boat, au natural is beautiful too!

Smelling like a rose, or at least like lavender and rosemary

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What’s in a name? That which we call a rose by any other name would smell as sweet. -William Shakespeare

Roses. They conjure up so many images. Images of love, romance, beauty. It’s amazing really that a simple flower can conjure up complex emotions; the promise of new beginnings or the celebration of established relationships and reminders to cherish all that we already have with the well-known saying of, “take time to smell the roses.” Sound advice which I am trying to follow in my new digs.  Same with blossom where you are planted. That’s a good one too. Easier said then done of course, but I am working on it!

I have roses on the brain because last night my sweet husband brought home not one, but two dozen roses for me (see pics above) because he thought I sounded a little, shall we say, blue. I can’t even recall what was going on at the time that would have provoked his assumption, but honestly it was a welcome surprise and reminds me of how lucky I truly am…literally I am smelling the roses.

This quote and recent turn of events brings me to the whole point of this post actually, which is the smell of roses. The smell of things in general for that matter, including your armpits which is a great topic. What a segway right? I just dove right in there huh? You bet I did. So now let’s dive right into that topic. Smelly armpits! I know, not exactly glamorous or what you want to read about while sipping a glass of wine or drinking your morning coffee, but let’s be honest, we all have the ability to excel in this department. Some are higher achievers than others (those who shall not be named), but we are all participants in this club.

So, my new journey into reading labels has not been limited to food ingredient lists. I have been reading cosmetic and medicinal labels as well. After nearly 15 years of practicing medicine, I am opening my eyes and my mind to not just accepting what’s on the shelves and the teachings of my mentors. There is a lot of “stuff” on the shelves, even marketed as “natural” that I can’t even pronounce or understand. How is that good for you? So, as a result of this discovery as a skin professional, I feel it is my obligation to make a change. I have been researching what other people have tried, reading about natural alternatives and experimenting with my own recipes.

As a dermatologist, I am trained to be an expert of the skin. Most of my career has been focused on diagnosis and management of skin cancer (especially melanoma) both clinically and histologically but at the moment, I am retraining myself in many ways and for now I am retraining to be an expert on the health and smell of armpits. Mine and yours if you are game.
I am on day 5 of my new “deodorant” and I am smelling like a proverbial rose if you will. With a blend of shea butter, pumpkin butter, a few other butters, corn starch, baking soda, and an essential oil blend of lavender and rosemary I have kickboxed, kettle belled and pilateed (don’t know if that’s a word but just roll with it) without knocking out my classmates with stink. My husband ( I did mention he was a saint didn’t I), even stuck his nose right in my armpit to test the power of my concoction and he didn’t flinch. I smelled like lavender and rosemary!
The current deodorant version is predominantly a solid, so I will be working on the formula to make application a bit more user-friendly over the next few weeks and will keep you posted with the specifics in case you want to experiment on your own.

So what’s in a name? These days it’s hard to know when reading labels of food and personal hygiene products, but when you make it yourself there is no question. It can be simple, easy and you can come up smelling like roses….or at least like lavender and rosemary in my case. More to come, I promise….