What am I looking for when I look at your skin under the magnifying glass and the Woods Lamp? I want to see how much oil you produce, if the pores are clogged, what size your pores are, what the texture of your skin is, if it is dehydrated, the level of sun damage you have --if any--, and if you have sensitive skin. And, yes I can tell all of that by seeing and touching your skin! I will also ask about what you are currently using/doing for your face as your current care influences what I see. From there, I make a plan on what I will do during the facial, and depending on how your face responds as I proceed, I may change the plan. I would also devise a home care routine that would incorporate what you are using currently, unless that is damaging your skin.
Why am I so fascinated with skin? It is the envelope that people remember you as. Skin is your largest organ. It is what separates you from what is not you. Every square inch of your skin is in constant communication with your brain. It lets your brain know a lot about your environment: temperature, pressure, moisture levels, etc. It is your first line of defense, a natural, strong barrier. When I taught student nurses to give injections, we used whole navel oranges. That was because it took as much strength to push through the skin of a naval orange as it does to push through the human skin. Just think how much thicker the navel orange is than your skin. Besides strength, another defense method is skin cells simply falling off from all over your body. When you are young, you loose a whole layer every day. When you are older this slows down. The skin completely renews itself every 21 to 48 days. So every 21 to 48 days you have an opportunity to make your skin the best it can be.
What can you really do for skin that breaks out? There are many contributing factors to skin that breaks out. For true acne, it is a matter of making too many skin cells, making a thick sticky oil, making too much oil, weak walls in the hair follicles, and/or excessive bacteria. In addition to these factors, you may also be inadvertently putting too much oil on your face. By interfering with the individual factors that can lead to breakouts we --you and I together--, can greatly diminish and perhaps completely control breakout. It may take some sleuthing to figure it all out, but I am ready to do just that! For others with occasional breakout, it is a matter of isolating the problem...hormonal, stress, oily product being applied to the face. So I will ask a lot of questions, and you may need to change some products...and have lots of patience. It is a process.
What can I do to help you with oily skin? First, please don't strip your face of its acid mantle. That means no alcohol, no bar of soap, and do not wash it with a cleanser more that twice a day! (Rinsing with a warm wet washcloth doesn't count if you don't use a cleanser.) If you strip this acid mantle, the message is sent to the brain that you are missing your protection, and to "please make more oil". So we want it to be clean but not stripped. From there we turn to products. I have several here at the shop that interfere with the production of oil in the sebaceous gland. Then you can use blotting paper and/or loose powder to absorb oil on the exterior of the skin. The last thing on my list is to make sure you are not adding more oil to your face than your face is making itself. A good way to check your products is to take a brown paper bag and put a drop of your product on the bag. Leave it overnight. If you see an oil ring around it the next morning, you have your answer. Just because a label says "oil free" doesn't make it non-oily. To my knowledge no compact of powder foundation, or blush can be completely oil free. Oil binds the product together. In the United States, a cosmetic company can put a fat in the place of an oil and call it "oil free". The problem is that when you put a fat on the human skin, which is on average at 98.6 degrees fahrenheit, the fat melts to an oil. So, with that being said, are you adding oil to your face?
What can you do to clean out clogged pores (blackheads and pimples)? There are only five groups of ingredients (other than prescription medications) that can clean the hair follicles where blackheads and pimples reside. Interestingly enough, a cleanser will only clean the exterior of the skin. This means that it will not go deep down into the hair follicle where the clogged pore is, which can be sometimes be as deep as a quarter of an inch. If you are depending only on your cleanser to take care of your blackheads and pimples, that would be your first mistake. The five ingredients in the proper format of boosters, masques, or scrubs are:
1) Clay. The oldest ingredient in recorded history for pore cleansing. It works by pulling up impurities out of the pores into the clay. The purer the clay the better. Make sure that your skin is moist before putting on a clay masque, as clay will pull water from your skin if there is no water barrier. Also, put enough clay on your face to cover the pores, as they must be covered in order to pull the impurities. And lastly, leave the clay on only long enough that the outer one inch around your face dries before you rinse if off with a wet, warm washcloth. Leaving it to dry too long will make it hard to remove the clay. Tugging on the skin can increase oil production, and you don't want that.
2) Benzol Peroxide. (NOT hydrogen peroxide in the brown bottle) Benzol Peroxide has been used over a hundred years to clean out pores. I have found it in 2%, 5%, and 10% concentrations. It can be quite harsh for some skins, however it is the best for what is called Closed Comedones (where the pimple is under layers of dead skin cells covering the opening of a hair follicle). It also tends to cause visible flaking of the skin, so I usually have my clients use a facial scrub or exfoliant with the Benzol Peroxide. It will also bleach clothing and bedding that comes in contact with areas of application.
3) Enzymes. Enzymes enter the hair follicle and digest the materials that clog the pore. There are many of these enzymes in the market.
4) Vitamin A or retinol. This ingredient, when applied topically, is the only one we know of that actually strengthens the wall of the hair follicle at its base where cysts form. It also reduces the amount of oil produced. Retin-A was and is a prescription medication used for acne. Now many manufacturers put vitamin A in their products to reduce breakouts. It has been proven to intensify the effects of the sun on the skin, causing severe sun burns in minutes. It is absolutely necessary to wear sun screen daily if using any form of Vitamin A! Vitamin A is also responsible for sensitizing skin with long term use, making the skin blotchy, and causing capillaries to enlarge. Therefore I do not recommend it for long term use except with cystic acne. Please DO NOT self medicate on large doses of oral Vitamin A. Anything beyond the recommended daily requirement needs to be supervised by a doctor, as Vitamin A can be stored in the body with some nasty side effects.
5) Alpha Hydroxy Acid. This is an umbrella term for a number of acids that are generally formed in fruits. Citric acid comes from oranges, limes, lemons, etc. Mallic Acid comes from apples, Turmeric acid from grapes, Glycolic Acid from sugarcane, Lactic Acid from milk, and Salicylic Acid from Willow Bark. These are very powerful in entering the hair follicle and melting down the material that is clogging the pores. They are also good at making the texture of the skin more smooth. Again, these ingredients cause sun sensitivity and therefore you must wear sunscreen daily with their use.
With everyone I have ever treated, we have used more than one of these ingredients to bring about change. It depends on several factors which works best. And sometimes, it takes a little while to figure out the best combination.
What is the safest way to pop a pimple or clean out a blackhead? These are called Manual Extractions. Please only try this if you can see pus or the opening to the hair follicle as with a black head. Reddened, raised areas with no pus are not ready and you will end up spreading infection. Remember that a pustule (zit, pimple) is in a hole in your skin...namely a hair follicle. It is packed with dead skin cells and thick oil. If it's a blackhead, the oil and dead skin cells have oxidized and show a black dot. If there is bacteria, and the body is winning the fight with the bacteria there will be pus. All of this is contained in the hair follicle. If you start squeezing without preparation or you try squeezing cysts (red, raised areas), you can rupture the hair follicle's wall and introduce infection into the body...not to mention the real danger of scaring your skin. If you have cysts we need to talk about product and/or medication. If it's a blackhead or has pus, there are four steps to safe extractions; heat, open, squeeze with Q-tips, and use antiseptic.
1) Heat the area. Take two clean washcloths. Fold them into quarters. Put one washcloth into the sink. Run your hot water as hot as is possible over the washcloth. Turn off the water. Use the second washcloth by laying it over the first washcloth and push down to squeeze all the excess water out of the first clothe. Pick up the first washcloth and put the side that has NOT touched the sink wall onto the area that you want to extract. Leave the washcloth there until the heat dissipates. This should take about 2 minutes. This calls the body to attention, asking that antibodies, white blood cells for fighting bacteria, oxygen, and nutrients for healing, be sent into the area.
2) Open the hair follicle with a sharp, sterile instrument. I suggest a sewing needle kept handy in a medicine jar filled with alcohol. This should be for one person's personal use. Use the sharp end to prick a hole in the opening of the hair follicle or the pus sack. This creates a weak spot in the wall through which the material clogging the pore can safely come out.
3) Squeeze the blackhead or pimple with two Q-tips. Your fingernails are too hard for this job. Fingernails can break the hair follicle deep in the skin, spuing out the clog into the body, which results in scaring. Q-tips are just as effective with no danger of damage. Most of the time you will draw a drop of blood but sometimes just clear liquid. There is a capillary at the base of each hair follicle...that is why you will often draw blood.
4) The last step is to dip one of your Q-tips in alcohol and apply it just to the extracted area. This is the only time I will tell you to use alcohol on your face!
What can I do to help the texture of your skin? I will often have a client touch my face to see how skin is suppose to feel. Smooth, soft, and slightly moist... So texture is mostly about getting rid of the old dead skin cells. I prefer that all my clients use an electric brush or a washcloth with a cleanser to cleanse their skin. If the client has only been using their hands, or only rinsing their face with water, even just letting shower water hit directly with or without cleanser, sometimes it will take several months to smooth out the skin. Depending on texture, past habits, and sensitivity, I will recommend exfolients from daily to once a week. I personally don't like an exfolient that scratches the skin. Again, leaning on my nursing background, anything that scratches the skin is penetrating the skin and therefore possibly introducing bacteria. So I like gentle, yet very effective, exfolients.
When is skin dehydrated? There are two sources of moisture on the human skin: one is oil, produced in the sebaceous gland on the side wall of some hair follicles. The other is water, which is an integral part of each individual skin cell. A skin cell begins when a skin cell divides, becoming two skin cells. The skin cell starts out at 90% water. It will lose down to 10% water as it migrates to the surface of the skin...that is if I have a well hydrated client. The skin is the reservoir of water for the entire body. If it is needed anywhere else it is pulled from the skin. Add to this that water evaporates off the skin more easily in exposed areas. Is it is any wonder that many of my clients complain about being oily and "dry" (they mean dehydrated) at the same time? There are four things that I recommend for dehydrated skin:
1) Do not use a bar of soap or anything that smells like alcohol on your skin. By virtue of the chemical components that make it a bar, that bar will strip your skin of its natural barrier and it will take 20 minutes for the body to replace that barrier using a lot of water molecules. Even if your favorite soap is a moisturizing bar, it will strip the skin, then add oil. Not the best way to cleanse your face. Alcohol also strips the acid mantle and requires a rebuilding drawing water molecules. Notice that I suggested NOTHING THAT SMELLS LIKE ALCOHOL. The reason for that is there are some products such as Witch Hazel that is a natural alcohol and alcohol does not have to be listed as an ingredient. You will smell it though. Also, there are some chemically bounded alcohols that do not smell like alcohol and are actually hydrating to the skin. So reading the label doesn't tell you that it is necessarily dehydrating (unless you know which is which).
2) Drink enough water. How much is enough? Four ounces of water per ten pounds of body weight per day....minimum. If you take medications for your heart, your kidneys, depression, allergies, antibiotics for infections, or more than one vitamin pill a day, add another half ounce of water for each medication per ten pounds of body weight per day. If you exercise more that 20 minutes a day, three times a week, add at least an ounce of water per ten pounds of body weight. You may count any fluid as water with the exceptions of alcohol and caffeine. Neither alcohol nor caffeine bring enough water molecules with them to digest the alcohol or caffeine. Therefore these are dehydrating to the body. I didn't say don't drink them...just don't count these drinks as water. Also note that decaffeinated beverages still have some caffeine...they don't count as water either.
3) Use a facial exfolient or scrub to remove the build up of old, dehydrated skin cells. As a person ages, the turn over of skin cells slows down. When the skin cells hang around too long, they loose water through evaporation as well as re-absorption. These skin cells will look dull. They may flake and they will slurp up moisturizer. Putting too much moisturizer on these old cells glues them down, making it harder to sluf them off. By using a GENTLE exfolient or scrub, you take off the old and the new cells, resulting in the use of less moisturizer or hydrator.
4)Choose the right moisturizer or hydrator for your skin. Most "moisturizers" have oil in them- some more than others. If you are a person who lacks oil in your skin (dry skin), then you need a moisturizer. If you are a person who lacks water moisture in your skin (dehydrated skin), you need a hydrator. A hydrator will have a yeast or sugar component to bind water from the air around your body to your skin. Hydrators will be liquid or gels. Moisturizers will be lotions or creams. And, yes, some people need both all over the face. Others need a hydrator in part or all of the T-zone and moisturizer on cheeks and throat.
What is the big deal with sun damage? There are two concerns I have as an esthetician. First is the very real danger of skin cancer. The second is its contribution to aging. There has been a lot of research now on aging skin. We know that overexposure to the sun (as a guideline: more than a half hour a day) leads to a breakdown in collegen and elastin in the skin. These are the two elatitized fibers that give you stretch and glide. Yes, collegen and elastin can be manufactured by the body right up until you die, however it is a matter of keeping up to the level that you are losing. When more break than you are manufacturing, you have sagging skin. Most of my clients say they don't mind being old, they just don't won't to look old or feel old! For those of you who want to know the chemical reponses in the body that make me shiver when someone I know and love tells me they MUST sunbathe, I will write a couple of paragraphs on that later. Meanwhile what can you do about the sundamage you already have?
1. Wear sunscreen or sunblock on the most exposed parts of your body...face, neck, and backs of your hands. All sunblocks and most suncreens have antioxidents in their chemical or natural ingredients. These antioxidents will help your skin recover from past sundamage and the suncreen or sunblock will help prevent new damage.
2. If you are going to be out in the sun more than a half hour, reapply your sunscreen every time you visit a restroom. Or every three to four hours, whichever comes first. I personally don't recommend a suncreen over 30spf. Anything higher is likely to make your facial skin sensitive due to the harsh chemical components necessary to achieve high levels of screening. Remember that facial and neck skin is much different from most of the body. Many people can handle the irritating chemicals in a body sunscreen that would hurt the face and throat. Although I no longer carry Dermalogica products, they have several 50spf sunscreens that I trust. I particularly like Dermalogica's Sports 50 for active people in the sun.
3. Use products in your daily routine that helps restore elasticity, keeps you hydrated, and possibly interfers with the body making more melanin in the darker areas (that which colors your skin). You might need help chosing these products because for some it is complicated by oilyness or the lack of oil, dehydration, and or sensitivity.
4. There are treatments that I do in facials that greatly reduce sundamage more quickly: L.E.D. Light treatments, BioActive Peels both work to eleminate sun damage in the epidural tissue, Pro-Cell Microneedling, and Oxygen Treatments. L.E.D. light has no ultra-violet light which is what caused your sun damage. Rather the green L.E.D. light triggers an enzyme that your body already makes to specifically target pools of melanocytes (dark spots) and digest them. The red L.E.D. light draws collegen into the area under the light and begins rapid repair as well as stimulating both collegen and elastin fiber production. The BioActive Peel is an extrememly effective chemical peel that can be done with little or no side effects. Done in a series of three to six treatments. These clean the epidermal tissue of inclusions but can only be done in the Fall, Winter, and Early Spring months. Microneedlling is primarily a treatment that stimulates the turn over of skin cells and the making of new elastin and collagen. A side effect of the microneedling procedure is the movement of pools of melanin (dark spots) to the surface to get rid of them. The Oxygen treatment is done with a mask made for brightening the skin and both the oxygen and the mask are healing to the facial skin.
What can be done for sensitive or sensitized skin. If you were born with sesitive skin, then I can teach you how to find products that work with your sensitive skin rather than products that leave you red, itchy, or flacky. If you are worried about allergies to product, I can do muscle testing to determine what you are allergic to and avoid products that your skin will not tolerate. I have three different product lines, Eminence Organics has two full lines for sensitive skin, and both Dermalogica and Hydorpeptides have a sensitive line. We can find things that will work for you. Sesitive Skin is something that is part of your heritage, senstized skin comes about from the environment...maybe allergies, maybe harsh chemicals, maybe product. (For example, many people have been using Vita A, retinol, or Retina on their faces for a year or more may start having redness, blotchiness, or "broken cappilaries". That can come about from long term use of the Vitamin A.