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Happy New Year! And to kick off 2011, I have a real treat for you today: An exclusive interview with Dr. Cynthia Bailey, M.D.! Dr. Bailey has been a board-certified dermatologist in California for over 20 years. Now based in Sebastopol, California with her own skin care line, OTB Skin Care, Dr. Bailey is willing to share her own anti-aging skin care secrets with FutureDerm.com readers.
Welcome, Dr. Bailey! What do you tell patients to look for most in skin care – any key ingredients or formulations?
Picking the right skin care product is all about picking the right ingredients for your skin. With medicated skin care products and cosmeceuticals you also need to know something about the quality of the company that made the product because the right ingredients won’t work if the product was made incorrectly or dispensed poorly. You need to know if the company tests the effectiveness and stability of the product after it’s made and placed in its container, if their chemists are really good at formulating effective products, and if the quality of their ingredients are ‘top notch’. Collecting this information is a huge task, so I recommend people simplify the process by: 1. creating a list of key ingredients for their specific skin problems 2. finding a small number of companies they trust for their most important skin care products.
In terms of specific product ingredients, my opinions regarding the most important key skin care product ingredients are:
First and foremost is using a high quality, broad spectrum sunscreens. I’m biased as a dermatologist and sun protection tops my list for the most important skin care step a person can take for their skin health. I’m a big mineral sunscreen fan because the data suggests that they provide the best and most reliable protection. I tell people to use a product with 5% or more micro sized zinc oxide. Sunscreen product formulation is tricky and even the protection you get from a 5% micro zinc oxide sunscreen will vary depending on what else is in the product. This is one of those important areas where the quality and the integrity of the company matters so chose a reputable mineral sunscreen brand that you trust.
Next are cleansers, which are the most commonly used skin care products. For sensitive skin I like sodium laurel sulfate free cleansers, especially glycerin based products. It’s important not to over-dry the skin in the process of trying to clean it. Glycerin cleans without drying, which is why I recommend glycerin based cleansers. Naturally made soaps retain their natural glycerin and these are great options. Non-foaming liquid glycerin based cleansers are excellent choices too. Oily skin, on the other hand, benefits from the foaming action of sodium laurel sulfate plus the exfoliating effect of glycolic acid to help lift oil and dead skin debris from the skin surface.
The anti-aging products to treat wrinkles and age spots are my absolute favorite category of skin care products. The most effective product ingredient in this category is prescription tretinoin/Retin A cream. I’ve collected patient stories that still amaze me for how effective Retin A is at keeping the skin young looking. I’ve used it myself for over 25 years and I’m sure that my 52 year old skin would look older if I hadn’t. Glycolic acid products with 10% or higher concentration and pH of under 4 are the second most effective anti-aging skin care products. Third are vitamin C products with L-ascorbic acid concentrations of 10% or higher, a pH of 3 and dispensed in airtight containers that also prevent the entry of light.
It’s now widely accepted in the dermatologic community that skin care products containing antioxidant ingredients benefit the skin’s health and provide some environmental protection. The specific benefits, however, have been hard to identify and measure by scientific study. I’m most impressed with the data on high concentration green tea polyphenols and caffeine and that’s the ingredient combination that I recommend. I have many patients using this combination of ingredients and I’ve seen it quiet-down chronically inflamed facial skin. Even more impressively, I’ve seen it decrease the number of facial precancerous skin lesions on patients compared with their prior office exams. As new antioxidants hit the skin care market I keep my eyes open for additional ingredients to add, but at this point I would only add them; there are none that I would substitute for green tea and caffeine.
Skin hydration with hyaluronic acid/sodium hyaluronate benefits everybody’s facial skin. Regardless of one’s oil level, this oil free, moisture binding ingredient is soothing for all skin types; it plumps up the skin to smooth the appearance of wrinkles and soothe skin dryness. It feels great on the skin so ideally at least one product on your skin should contain a generous amount of hyaluronic acid.
Medicated cleansers with 2% pyrithione zinc treat a skin yeast germ that we all have and that commonly causes pimples and scaly red skin on the face and upper body. This yeast germ called pityrosporum lives in our pores from the waist up. A little of this yeast is normal, but a lot causes skin problems including some forms of acne and seborrhea. On skin exams, I often see these issues in patients who have no idea that their skin problems all boil down to one little germ. Control the germ and we control the problem skin. I often recommend soaps, shampoos and cleansers with this ingredient for routine skin care of the face, scalp, back and chest.
For acne, I like benzoyl peroxide at 5 or 10% concentration. This single nonprescription ingredient kills p. acnes better than topical antibiotics because the germ has become antibiotic resistant. Benzoyl peroxide also unclogs pores to treat blackheads. The caution is that some people find it irritating to their skin. It also bleaches colored fabric. For stubborn acne, adding salicylic acid and glycolic acid ups the risk or irritation, but really powers-up the treatment results; this triple treatment combo is the best nonprescription therapy for acne.
What do you feel are the most invaluable cosmetic procedures for men and women? At what age or stage of life, in general, do you believe they should start?
The best cosmetic procedures today are the non-surgical rejuvenation procedures. If I had to pick one it would be IPL for Fitzpatrick skin types 1 to 3. This simple light procedure requires a not so simple machine and a series of treatments, but it clears unwanted brown and red colors from the skin. It also refines skin texture, helps control rosacea and seborrhea and generally beautifies the skin. I think that uneven skin color has such an impact on a person’s appearance, and IPL treatments are a highly effective way to even skin color.
My second favorite procedure is Botox for the upper face. Both IPL and Botox give the best results if you start treatments just before you really need them. They’re both great preventative treatments. In my practice, the optimal age for a person to begin these treatments would be the 30’s. Definitely by the 40’s most people are starting to see degenerative skin changes worth slowing down, and Botox and IPL help do this.
Third are fillers which give fun results, especially around the mouth area. They can recreate a sweetness to the shape of the mouth, which otherwise develops a down-turned and puckered-in look as we age.
Lastly the fractionated ablative lasers are a brilliant modification of laser technology and can help to reverse fine wrinkles. They create tiny channels in the surface of the skin that are large enough to stimulate collagen formation, but small enough not to cause the shiny, red, burn look characteristic of the first laser procedures in the 1990’s. Unlike the old laser procedures, fractionated lasers don’t get rid of all the wrinkles, but the skin itself will have a more natural appearance. Fractionated laser procedures border on what most people would consider a ‘surgical’ cosmetic procedure because there’s typically some down time after treatment.
In addition to the non-surgical cosmetic procedures, there are good supportive skin care procedures that are done by aestheticians. Regular maintenance treatments at 6 to 8 week intervals keep skin looking its best. The most effective of these procedures, in my opinion are microdermabraision, mini peels and facials.
The best anti-aging skin program includes these 3 components: state of the art skin care, non-surgical rejuvenation procedures and maintenance aesthetician treatments. Phew! It’s a lot of work but for most people the natural course for our skin is that it gets wrinkled, spotty and lusterless as we age and it’s ‘work’ to slow this down. On a final note, I have to say that you can’t ignore the effect of diet and life style on the health and beauty of your skin. Remember a healthy diet and regular exercise belongs in every beauty regimen.
What do you feel are the most commonly made mistakes in skin care? How do you feel these can best be avoided?
The biggest mistakes I see my patients make are simply picking products based on claims, not ingredients. They also buy poorly made products because of price or a cleaver sales pitch. Like I mentioned above, a person should: 1. create a list of key ingredients for their specific skin problems and 2. find a small number of trustworthy companies for the most important skin care products that they use. Your site has a great reference section on current popular product ingredients and consumers should refer to it and look for ingredients that address their particular skin needs.
What caused your interest in dermatology?
I simply loved it. When I rotated onto my dermatology elective in medical school it was the perfect ‘click’ for me.
Do you have any advice for aspiring dermatologists?
Look at your patients as a whole person; don’t just focus on their skin problems. People schedule their dermatology appointments because of a specific skin problem but that problem doesn’t exist in a vacuum. Lifestyle, diet and emotional health all contribute to the state of their skin. In dermatology practice, there’s a tendency to book quick appointments, but take the time, get to know your patients and address them completely, your career will be so much richer and your patients will be really appreciative.