10 Things Your Dermatologist Says You Shouldn't Do

Here are 10 things I would never do as a dermatologist.

1. Go in a tanning bed… EVER. They are a type 1 carcinogen shown to significantly increase risk of deadly melanoma. And tanning of any kind is just a bad idea. And it should go without saying that any tanning is bad. Contrary to the notion of a “healthy tan” a tan is indicative of DNA damage within the skin.

2. Skip sunscreen - Of course this is on the list but unless you are completely avoiding the sun then sunscreen is essential to protect skin from harmful UV that can cause premature aging and skin cancer.

3. Get injectable treatments from a provider who isn’t a specialist. You run the risk of results you aren’t happy with as well as more serious complications. Unfortunately I’ve seen too many patients regret a decision to go to the lowest cost provider who doesn’t have the necessary expertise.

4. Remove a skin growth at home. This is a definite no. Aside from the potential of infection and scarring, there is risk of improperly removing (or partially removing) a dangerous skin cancer without having it properly diagnosed first

5. Pick, poke or pop (your skin). While it can be incredibly tempting, it’s best not to pop pimples and pick at your skin. This can increase inflammation, swelling and redness, but it also increases your risk of scarring.  In general it is best to keep your hands off your face.

6. Use Neosporin or Polysporin. Yes we all were told to use it growing up but the reality is that it can cause allergic reactions and you are better to just use Vaseline for general wound healing. If the skin is truly infected then a prescription antibiotic such as fucidin or bactroban could be considered

7. Sleep with makeup on. No matter how tired you are, it is best to clean your face of makeup, dirt and oil at night especially if you are acne prone.

8. Pull hair tightly, especially when wet. Regularly wearing a tightly pulled hairstyle can lead to hair breakage and loss. Over time it can lead to permanent hair follicle damage and a condition known as traction alopecia.

9. Give up on your skincare too quickly. We know that skincare and “active” ingredients take time to affect change, so don’t give up after a few days of use.  For most skincare you need at least a few weeks to start to see change and for more therapeutic ingredients like retinol it can take several weeks.  

10. Forget to do self skin checks. It is estimated that 1 in 5 people will develop skin cancer in their lifetime but when caught early, skin cancer is highly treatable. If you notice a spot that is different from others, or that changes, itches or bleeds you should have it examined.

Celebrity Beauty Secret: Non-Invasive Skin Tightening

You have probably seen celebrities who seem to not be aging and yet they claim to not be getting botox or fillers. Non-invasive skin tightening is a great complementary or alternative treatment to help lift and tighten the skin and improve the appearance of lines. In our office we do this with micro-focused ultrasound or radiofrequency which can heat up the tissues to stimulate collagen. The results are natural (it’s just your own collagen!) and long-lasting, hence why they are so popular and perhaps a little “secret” of those who seem to defy aging. In other words it’s not just the olive oil 😉  

Ultherapy utilizes ultrasound to stimulate collagen and is a FDA and Health Canada approved device to lift skin on the neck, under the chin, and on the brow, and improve lines and wrinkles on the chest / décolletage. It is a treatment with little to no downtime where you can see results after a single treatment. Some patients see an initial effect right away, but results generally appear over 2–3 months as new collagen builds and can last long term. 

Thermage uses radiofrequency to heat the tissue beneath the skin, which also stimulates collagen production. The device is also FDA and Health Canada approved for treatment of the eyes, though it can be used all over the face and body. As with Ultherapy, results will appear gradually but can be long lasting.

These devices are generally considered safe for all skin types. They can be used in combination with other cosmetic treatments depending on your goals. It is important to see a knowledgeable and qualified provider for treatment.

What You Should Know About Retinol

If you follow me (and other dermatologists) you have likely heard about retinoids and retinol as a “holy grail” of skincare.  Quick retinoid explainer… All topical retinoids are derived from Vitamin A and have similar properties that can help improve skin texture and tone, and minimize the appearance of dark spots, fine lines and improve acne. Some will have stronger effects, often those by prescription. For people seeking general “anti aging” benefits over the counter retinol (or retinal) products are easy to access and less likely to cause irritation. But for some people prescription retinoids may be the way to go (and less expensive if the prescription is a covered benefit).

Retinol vs retinaldehyde (retinal): These are related molecules that get converted to retinoic acid (tretinoin = pure retinoic acid). Retinaldehyde is one step closer in the conversion process so may be more potent than retinol, yet less irritating than tretinoin. That said, when choosing retinol vs retinal it can be hard to do an apples to apples comparison.

If you have highly sensitive skin or a condition such as rosacea then you may not be able to tolerate even milder retinols (I posted recently some other ingredients to consider) but many people can find a product that works for their skin if you follow best practices for use (e.g. pea sized amount, with moisturizer, don’t need to use every day).

Here are some over the counter products I like (at a variety of price points):

🔹 Neutrogena Rapid Wrinkle Repair and Pro+ (higher strength)

🔹 Olay Retinol 24 offers a number of products in this line

🔹 RoC Retinol Correxion is another good line (my husband loves the capsules)

🔹 SkinMedica and SkinCeuticals offer retinols at various strengths which is convenient to level up if you are using and tolerating well

🔹 Skinbetter AlphaRet is another fave

🔹 Kiehl’s Microdose Retinol Serum has been one of my go-to’s and is a great option for those with sensitive skin

🔹 If you want to try a retinal Avene offers a number of options

Basics of Botox

Botox may not be for everyone but if you’re trying to decide if it’s right for you and want to understand a bit more about it, here’s some more information:

First, Botox is a brand name but the name is often used to describe a whole class of neuromodulators that includes Dysport, Xeomin and others that work in a similar manner. I will use “botox” here to describe these products generally.

With botox, the effect occurs at a specific location where it is injected in the muscle and attaches to nerve endings. Once attached it inhibits the release of the neurotransmitter responsible for triggering muscle contractions. This reduces the strength of the muscle, thereby minimizing the appearance of wrinkles as muscles remain relaxed. The effects will generally last for 3-6 months.

One of the most common uses for botox is to treat lines in the upper third of the face. These lines are formed due to repetitive muscle movement. One location is the glabella, where botox is used to treat the “11s” (the lines made when you frown). Botox can also be used to treat horizontal forehead lines, “crow’s feet” and "bunny lines."  There is a large list of areas that can be treated, both on and off label, but these are some of the most common.

“Baby botox” is a term sometimes used to describe treatment with smaller doses but the number of units needed varies from person to person depending on their goals, the treatment areas and strength of muscles. In general though botox can be used to soften the appearance of lines and wrinkles while maintaining natural movement and not “freezing” the face.

It's important to understand that botox works primarily to treat dynamic wrinkles, not static wrinkles. Dynamic wrinkles appear when you make facial expressions, for example when you furrow your brow or smile. For deeply etched in static lines (present at rest), botox may not help reduce completely and hyaluronic acid fillers could be considered to soften these lines further.