Posts Tagged ‘brown spots’

FrecklesIts back on shelves!  Tri-luma, the turbo powered skin lightener is now available after a more than an 18 month disappearance.  There was no FDA recall or explanation from the company.  Nothing.   I discovered that compounding pharmacies could make it up for individual prescriptions, but that option  was just not widely  available.  Then,  without fanfare  or explanation,  Tri-luma  was back– and I’m delighted. 

 How Tri-luma Works

This prescription- only skin lightener  contains three active ingredients:

1.  Tretinoin ( aka Retin A) is famous for its ability to speed up cell growth and exfoliate darkened areas.

2. Hydroquinone which prevents melanin production and is considered one of the most effective  weapons in the  anti- hyperpigmentation tool  kit

3.  Mild corticosteroid to keep  things calm.  Both Retin A and  hydroquinone can be irritating.  Enter  a  mild steroid.  It allows the skin brighteners to do their job  while keeping the skin calm and comfortable

While Tri-luma can be used over the entire face, I needed it mainly  to lighten my dark under eye shadows.   Plain Retin A  is too irritating to be used on delicate under eye areas but mixed with a steroid it can  address  skin darkness without causing more  problems.

Tri-luma was one of the first anti-aging tools I used and I loved the way it lightened  my long standing  dark shadows.  However while plain RetinA can be used continuously for years, most  doctors recommend using  Tri-luma  only for three montha at a time.   The treatment period  should be followed by a three month  Tri-luma holiday and then the  product can be used again for another three months.  To keep it fresh and effective, pharmacists recommend keeping it in the refrigerator.

There is a whole buffet  of skin lighteners including kojic acid, arbutin and soy extract, but Tri-luma  is often the product of choice.   It represents the new thinking about  medical treatment.  Rather than a single  solution to a problem , researchers are looking at different targets  for treatment.  In the case of  hyperpigmentation,  some skin lighteners like retin A a can help the skin shed darkened skin cells while  while ingredients like hydroquinone  can break up existing  melanin.  Combining them in one product can be much more effective than used spearately.  Since Kojic acid seems to prevent melanin production, I would love to see a  product  that combines all four ingredients.  There are so many me-too  products, it would wonderful to see a formulation that uses all of the science  we  now have about treatmenting dark patches and spots.


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     golden globe (2)Watching the red carpet parade of beautiful women at the Golden Globes, I was mesmerized by the flawless chests above the strapless or plunging gowns. While we usually focus on signs of aging around the face and eyes, the skin on chest is often more lined and sun damaged and in need of some TLC. These women who professional lives depend on their beauty clearly knew this and they take great care to create a smooth polished and sexy decollete.

     After trying  out  a wide range of anti-aging tools for my face, I realized that   there was now quite a difference between the skin on my face and the skin on my chest.  Last year  I had most of the freckles  and age spots  on my chest removed by  laser, but one big oddly shaped splotch resisted treatment.   Normally one spot ( even though it was shaped like a medieval serpent)  would  hardly be worth mentioning. But I get so many  questions about the best way to even out chest skin tone, I decided  to explore other tools for this area. 

       I asked Dr Marmur to use  a Fraxel laser  but she pointed out  that  the brown  mark scan0257was  slightly raised and textured ( photo on right).  For this type of  spot she need to zap it with an electro cautery needle.    After  numbing the area  with a tiny shot of lidocaine, Dr Marmur  touched the  raised area with the heated  wired needle.   The skin actually sizzled  as the tip bNEXT DAY (2)urned off the raised  brown  splotch.   It took less than a minute.  The area was quite red and as directed, I dabbed on a bit of Aquaphor and covered it with a bandaid.   When the lidocaine wore off, my chest felt  just a bit sore.

    The next day the area was still red and raw, but not painful ( see photo on left).  Dr Marmur warned  me that the chest skin will stay red for  up to several months.     Since  body skin tends to heal more slowly than on the face, winter time is an HEALINGexcellent time to have  laser work on  body parts hidden by pants and sweaters.  One week later the area  has healed to a slightly  dry,  faint brownish pink splotch ( photo to right).    In a month I’ll post a follow-up pix. If ever find myself walking  on  the red carpet,  at least my decolette  will be ready.

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Answer:  I love new beauty ideas that are based on good science and BB creams are just such a concept.  BB stands for ‘blemish balm”  where blemish is defined as a skin defect ( eg dark spots and splotches and acne scars), not  just  traditional breakouts.

The original BB creams were developed by a Korean dermatologist to help his patients care for laser treated skin.  After having both IPL and frying off my freckles with a YAG laser, I had difficulty finding  appropriate  moisturizers and sun protection products.  The treatments made my skin especially vulnerable to sun damage, yet traditional chemical sunscreens were irritating while  zinc based formulations left my  skin with a weird white sticky film. 

BB creams are a genuinely clever idea.  They are a zinc based high SPF moisturizer/sun block combo that have a flattering tint.  The result?  On the skin it looks  like a traditional, flattering foundation rather than  mime  make-up.  Most of them are enriched with anti-aging ingredients  like anti-oxidants and peptides that also promote healing.

BB creams from Dior, Mac, GArnier and Estee Lauder are promoted not so much for post- laser sensitive skin but as a skin brightener to erase dark spots and splotches.  By coating the skin each day with a high 40-50 SPF, the existing melanin in the skin will be breaking down and new melanin will be prevented.  The results should be a fresher, clearer complexion.

There is good theory here but does it really work?  General skin lightening aka brightness or luminosity, is a hard thing to measure and even harder to capture in a home photograph.  To see if  BB creams can actually make a difference, I am going to take a  Visia imaging scan that can actually see the melanin deposits in the skin.(  I’ve posted this type of photo  before and there results are  pretty startling.)  Then I will use a BB cream for a month and then do another Visia photo.  If the BB cream actually changes the melanin content of the skin, we’ll all see it.

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Question:  I have heard so  many horror stories about IPL, but you had great results.  Can you tell me what machine was used and at what settings?

Answer:  I had IPL with Dr Ellen Marmur of Mount Sinai School of Medicine, so I  asked  her to answer this question.  Dr Marmur used the Luminis IPL with two handpieces– the 560nm and the 590nm.   “Both  of them focus on red spots, blood vessels and brown freckles”  she explained.  “The treatment settings vary from patient to patient based on skin color and the amount of the target to be removed.  For example, I use  lower settings for freckles to avoid over-heating the skin.’    Dr Marmur also warned against getting IPL when tanned ”   You need to avoid the sun for at least wo weeks prior to IPL treament ” she warned.

IPL Road Rules

IPL or Intense Pulsed Light is a form of light that is related to laser technology, but  far less invasive.  It operates in the top layers of the skin and can remove unwanted hair, small red lines and spots as well as freckles,brown spots,  and dark patches.    It is practically painless, and leaves the skin a bit red rather than burned and oozy like true lasers.

But there are reports of problems with IPL.  Because the light focuses on pigments in melanin,  women  with darker complexions are most at risk of developing irregular pigmentation.  Even  dark olive complexions  should  proceed cautiously with IPL. 

Choosing  the right setting, device and timing of applications is a learned skill.  I met Dr Marmur though a smart, well-connected  friend  and I have found this type of one to one reccomendation is a great  way to getting  someone  you can trust.  I would also check out  a doctors credentials  to be certain that they have the training they need  to  give you healthy,  beautiful results. For more info on IPL you can also check out an earlier post IPL- Five Top Questions.

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  Here is the two step  jar of Elure, the new skin brightening agent.  The jar is divided into two compartments.  As per instructions, I used the first little spatula to put a dab of cream from the first side on  the BIG FRECKLE, waited a  minute then spread the same amount from side two on the same spot.  Totally simple, but I’ve yet to get into a routinue to do it twice a day.  So far, I’ve put  on about half  the recommended doses.  I’ve got to step up my game to give it a legitimate chance to work. I keep forgetting to put it on  either in the morning or evening.  I think that if I was using  on my face, it would be easier to remember, and just add it to my skin care routinue– but I’m not  used to treating my forearm twice a day. Guidelines are also to top the treated areas with a sunscreen but since sweater weather is here, the arms are not exposed to the skin, and I skip this step.

On the plus side, I didn’t have any irritation or rednesss that has been a problem with other skin lighteners.  Doctors also recommend  combining Elure with other brighteners   such as glycolic acid, kojic acid and arbutin.  I’m going to try that in the next  round, but right now I want to see  what this contender can do all by itself.

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Here are the pix I took before  and three weeks after my Pelleve procedure. To my eye there is a visible difference in contours of the face.   The smile  lines are not as deep   and  my jaw line a little tighter.   I don’t look in my twenties or  even in my thirties– but to my eye I just look more like the person I remember. 

I really like these subtle changes  much more than the  more drastic changes of a full face CO2 laser.  While that bad boy can erase decades of  lines, wrinkles and age spots, I find  the post -laser face looks waxy with a  pale  shiny appearance.  Its the  strange face you see on some of the women on The Real Housewives of You  Name the City.


Because Pelleve does not affect the surface of the skin,  you do not need to change your skin care routinue.  I was able to do  the  Retin A and my regular  sunscreen  routine the  next day.   While  its safe, painless and provides quick results, Pelleve  has one drawback– its expensive.  A full face treatment is $1800, a specific area is $900 and  usually 2-3 treatments are needed.  But I believe that its something worth saving for.  For example, brown bagging   lunch saves at least $10/day.  In three months that’s $650.  Cut back on one dinner out a week ( @$30/meal) and you save another $360. 

                                                                                                                AFTER PELLEVE

In six months, you’ll  have the cash  for two regional treatments– and probably  saved enough calories to drop a few holiday pounds. 

One final thought.  Most of the comments  and questions I get are from women in their twenties and  thirties who are concerned about  preventing aging.   I’m not that comfortable  recommending  high octane  anti-aging tools at such a  young age– I mean    you need to save a little something for menopause. By contrast,  it turns out that Pelleve’s subtle changes are  an excellent option  for thirtysomethings.  A  neighbor who is in her late thirties and pregnant with her third child,  is looking forward  to her post pregnancy Pelleve treatment.  It makes a perfect ‘push present’.

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1.  Can I use Tri-luma on  my chest?

In theory, yes but its not going to be that effective.  A chest with lots of freckles and age spots will need more help than Tri-lima can  provide.  Once areas of hyperpigmentation become raised and lumpy, you’re going to need some kind of  laser or IPL to deal with them. 

2. Can I use Tri-luma and Retin A together ? 

It  depends. Tri-luma already contains Retin A to increase cell turnover, hydroquinone to break down  and discourage pigment formation and a steroid to keep down inflammation.  If you are using Tri-luma  under  your eyes, you can  then apply Retin  A to the other facial areas.  If you have areas of discoloration on your cheeks and forehead, you can use Tri-luma on these areas, but not at the same time you are  using Retin A. It won’t do a  better  job and will  make you skin terribly irritated.

3. Can Tri-luma make your skin worse?

Sad but true.  For some  skin types, Tri-luma  may cause irritation that will actually trigger pigment  formation.  Women of color are especially at risk ( including Hispanic, Asian, Indian and African American skin) and may show a darkening of the areas treated with Tri-luma.  This is why you need to be under the supervision of  dermtologist when using Tri-luma to spot signs of  trouble before they can develop into new  dark patches.  

4. How long can I use  Tri-luma?

Unlike  Retin A which can be used for years, Tri-luma cannot be used for more than 3 consecutive months.  Then you need to take a “Tri-luma holiday” for the next three months before using it again. 

5. Should I put an eye cream over Tri-luma?

After you put Tri-luma under  your eyes at night you can top it with a  little dab of  a very mild formulation to  lessen irritation. Look for an eye cream without alpha hydroxy acids, vitamin C and retinols– all good ingredients,  but  they can be too irritating when using Tri-luma.  During the day, you don’t use Tri-luma, but you should use an eye cream with a sunscreen  to protect the skin from UV damage.

All these does and don’t   kind of  take the fun out  anti-aging, but Tri-luma is  not  as easy to use as Retin A.  It can  deliever some very nice results, but  its a high maintenance remedy.  It did a great job  on my dark blue/grey under eye shadows, but   they crept back when I had to go on  my  Tri-luma hiatus.  I’m glad to  be using it again, and I see  results after only a week. Let me know if you have additional Triluma issues.

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