(翻译ing)推荐一篇好文-美国皮肤科医生答问（转）

关于果酸，A酸
如何去除色素沉淀
LP，La mer等产品值不值这个价格
StriVectin,Kinerase有没有效
应该如何选择有效的护肤品
虽然是英文但是建议大家好好看看，真的非常实用的文
基本上这一篇读完，护肤品的基本功课就做好了，可以省很多冤枉钱

总结下来，医生推荐的护肤还是早上抗氧化+防晒（spf30以上）
抗氧化推荐品有prevage和杜克CEF
晚上A酸或者A醛或者A醇

http://www.washingtonpost.com/wp-dyn/content/discussion/2006/06/01/DI2006060100850.html

Skin Creams: What's Worth It?
What To Know Before You Buy

Dr. Rachel Herschenfeld
Dermatologist
Thursday, June 22, 2006; 11:00 AM
Dr. Rachel Herschenfeld talked about the claims some skin creams make and
which ones live up to their promises.
_______________________

Rachel Herschenfeld: We've all seen the ads for moisturizers and skin serums claiming amazing powers for some new product. This one is even "better than Botox" or that one will smooth all of your wrinkles and prevent any more aging changes. Although
these claims seem too good to be true, who wouldn't want to try something that sounds so good? What about StriVectin, Freeze 24/7, and all those antioxidants? Let's chat about what skin creams can really accomplish, which ones are worth trying, and
which ones are better left on the shelf.

Rachel Herschenfeld：我们都见过吹得神乎其神的护肤品广告。这个说比肉毒素还好，那个说可以抚平你所有的皱纹并且预防将来的老化。虽然这些看起来好得不像真的，但是谁不想尝试一下这些听起来很棒的产品呢？StriVectin，Freeze 24/7和那些抗氧化产品到底怎么样？让我们来
谈谈护肤品到底能做到些什么，哪些产品是值得尝试的，哪些最好还是让它们留在货架上。
_______________________

Maryland:
I'm 25 years old with fairly decent skin that still experiences the occasional breakout. My current routine is to wash my face morning and night with Cetaphil, then in the morning I apply a thin layer of Duac cream (which contains benzoyl peroxide and
clindamycin), followed by Kiehls Ultra Facial Moisturizer with SPF 15. At night I apply Differin Cream before going to bed. Does this sound like a worthwhile routine to you, or would you suggest changes?

Rachel Herschenfeld: This sounds like a very reasonable regimen. You may want to consider using a moisturizer with a higher SPF, especially during the summer. Some of my favorite facial moisturizers with sunscreen include Olay Complete Defense SPF 30,
Eucerin Extra Protective Moisture Lotion SPF 30, Neutrogena Health Defense SPF 30 and Aveeno Positively Radiant SPF 30.

来自Maryland：我今年25岁，皮肤还不错，但是偶尔还是会长痘。我现在的护肤是早晚用Cetaphil洁面，然后早上擦一层Duac霜（含有benzoyl peroxide和clindamycin），然后是Kiehls Ultra Facial Moisturizer with SPF 15。晚上擦的是达芙文。这个护肤routine您看起来觉得怎么样
，需要什么改进吗？

答：你的routine看起来很不错。你可以用个防晒指数高点的防晒霜，特别是夏天的时候。我推荐的带防晒的日霜有以下几种： Olay Complete Defense SPF 30, Eucerin Extra Protective Moisture Lotion SPF 30, Neutrogena Health Defense SPF 30 和 Aveeno Positively
Radiant SPF 30.
_______________________

Washington, D.C.:
Thanks for this topic. Cosmetics aisles are loaded with dubious stuff at
high prices. I asked a dermatologist for a particular ingredient to look
for what was effective in a moisturizer and he suggested urea. But when I
asked a pharmacist, she said not to apply it to the face. What is urea, is
it recommended, and why NOT put it on the face? It's just skin.

Rachel Herschenfeld: Urea is an ingredient that is added to moisturizers
because it helps exfoliate and also binds water. It can be found in over
the counter products such as Carmol moisturizer, and also in prescription
products. There is no inherent reason not to use it on the face, but I
would recommend choosing a low concentration for the face, since higher
concentrations may be irritating. So for the face, try the Carmol 10.

来自华盛顿：化妆品货架总是堆满了价格昂贵却不知道有没有效果的东西。我问过一位皮肤医师什么样的成分的面霜比较好，他回答说尿素。但是当我问一个药剂师的时候，她说最好不要把它用在脸上。尿素是什么，你推荐使用它吗，还有为什么不能用在脸上，不一样都是皮吗？

答：尿素添加于面霜中可以帮助去角质和锁住水分。很多柜台能买到的面霜都有这个成分，例如Carmol润肤霜。处方产品中也有用这个成分的。并不是说不能用在脸上，但是我建议使用比较低的浓度，因为高浓度可能会比较刺激。所以面部使用的话可以选择Carmol 10。
_______________________

Alexandria, Va.:
I am 32 and have combination skin. But now I'm starting to have wrinkles,
too -- especially those lines that go from the bottom of my nose around to
the corners of my mouth! Is there a skin cream that can help prevent these?
Thanks for any help you can give me.

Rachel Herschenfeld: The lines from the nose to the corners of the mouth
often need more help than a cream can provide. These lines are caused by
loss of tissue volume in that area, and also by repetitive motion, and
usually respond best to injectable fillers such as Restylane. All the
creams that claim to erase all of your lines are usually overstating the
case, and don't work that well in that area.

来自Va：我今年32岁，混合皮。现在我开始有皱纹了，特别是鼻翼到嘴角的部分！有没有面霜可以改善这个？谢谢。

答：这个是法令纹（我自己加的，卡卡），不是面霜能解决的问题。这个是因为局部的组织变得不那么丰盈，同时反复的面部动作的拉扯也是原因之一。通常最好的办法就是注射，例如Restylane等等的透明质酸填充剂。那些宣称能去皱的面霜一般都是夸大其词，而且对于法令纹是不管用
的。
_______________________

Anti-aging creams and sun exposure:
Hi, There are a million products out there that contain agents that
supposedly slough off dead skin and remove fine lines for younger- looking
skin, e.g. retinol and alpha hydroxy. I've heard, however, that those
products can increase the effects of sun exposure. Is this true, and can
you recommend any product or active ingredient that is effective but not
harmful?

Rachel Herschenfeld: There are so many products to choose from, but there
sre definitely some ingredients that are better than others. The two that
you mention are actually very good choices for anti-aging effects.
Alpha-hydroxy acids can help to exfoliate and even out pigmentation. They
do thin the top layer of the skin a little bit, and so there have been
concerns about whether this makes you more sun sensitive. I recommend using
products with alpha hydroxy, and also using sunscreen. Retinol is another
ingredient that helps smooth fine lines. In either case, adequate
concentrations of the ingredient need to be in whatever formula you choose.
Here are some recommendations: MD Formulations makes excellent alpha
hydroxy moisturizers. In terms of retinol containing products, try
Neutrogena Health Skin Anti Wrinkle Cream or Roc Retinol Actif Pur.

关于抗皱霜和防晒：你好，我看市场上关于去角质和去皱抗老的产品实在是太多了，例如A醇和果酸。可是我听说这些产品会增加对阳光的敏感性。是这样吗？您能推荐有效又没有副作用的产品吗？

答：的确可以选择的产品很多，但是有些比其他的好是肯定的。你提到的这两个成分实际上都是非常好的抗老产品。果酸可以去角质，均匀肤色。他们的确会使得角质层变薄那么一点点，所以有人顾虑说它们会让皮肤变得对阳光更敏感。我推荐同时使用防晒霜。A醇也是一个去细纹的好东
西。两者都需要使用合适的浓度。我推荐MD formulation家的果酸霜。开架的retinol（a醇）我推荐Neutrogena Health Skin Anti Wrinkle Cream 或者 Roc Retinol Actif Pur。
_______________________

Washington, D.C.:
Hello Dr. Herschenfeld., I was wondering if La Prairie face creams are as
good as everyone says. I started to use them a couple of years ago (at 30)
and loved them til I got pregnant and now I find it makes my skin greasy.
Lancome Hydra Zen is always a winner, but I'm wondering if I'm buying into
the marketing too much and there's something cheaper/better I should be
using? I have normal skin and am 32 years old.

Rachel Herschenfeld: La Prairie is a good line, but you don't have to spend
that much to get a good moisturizer. In terms of specific products, the
caviar containing creams won't do much more than creams that don't contain
this ingredient. Some of their sunscreens are good, and many of their
moisturizers contain anti-oxidants, which can be found in good drugstore
brands such as Olay Regenerist.

来自华盛顿：医生你好，我想问问LP的面霜是不是像别人说的那么好。我几年前刚30的时候开始用的，当时挺喜欢的，结果怀孕后停了，现在再用就觉得很油。兰蔻的水分缘也很好用，但是我总觉得我是不是把钱都付给了他们的marketing，是不是有其他更便宜更好的东西我可以用？我现
在32岁，中性皮肤。

答：LP是个不错的牌子，但是事实上你不需要花那么多钱来买一个不错的润肤霜。事实上，含有鱼子酱的面霜并不会有什么特别的功效。他们有些防晒霜还不错，很多面霜也有抗氧化成分，但是你在有些好的开架品里面也能找到，例如玉兰油的Regenerist。
_______________________

Fairfax, Va.:
Two pregnancies in three years have left me with all sorts of exciting new
skin issues, but the two that are driving me nuts are the dark blotches
across my cheeks and nose, and facial hair that my OB/GYN promised would
disappear when my hormones settled down (he lied). Is there anything over
the counter that would reduce either of these issues?

Rachel Herschenfeld: There are over the counter creams that can help with
pigmentation. First of all, creams containing hydroquinone work to fade
spots. Over the counter preparations usually contain 2% hydroquinone. An
example is Porcelana. Otherover the counter ingredients that can help to
fad pigmentation include: alpha hydroxy containing creams such as
AquaGlycolic face cream, and possibly products containing soy extract,
which is found in many products including Aveeno Positively Radiant
moisturizer. I would recommend checking with your doctor if you are
pregnant or nursing before starting new products. You couls also always
seek help froma dermatologist for stronger prescription treatments.

来自Va：两年怀了三次孕，搞得我皮肤出现很多问题。最郁闷的是两颊和鼻子上的妊娠斑，还有面部毛发。我医生说这些毛发在我荷尔蒙稳定下来的时候就会消失（他骗人）。有没有非处方的东西能解决这两个问题？

答：色素沉淀可以购买含有hydroquinone的霜。非处方的通常是2%的浓度，例如Porcelana。其他非处方的可以改善色素沉积的成分有：果酸（例如AquaGlycolic面霜），含有大豆精华的面霜可能也有帮助（例如Aveeno Positively Radiant moisturizer）。如果你还在孕期或者哺乳期，
你需要在使用新产品之前咨询你的医生。你也可以找医生开更加强力的处方产品。
_______________________

Adelphi, Md. :
I have very fair skin (usually use SPF 50). How many times a day should I
be putting on sun screen? How long do I have to wait before I go out into
the sun after applying?

Rachel Herschenfeld: Ideally, you should reapply your sunscreen about every
2 hours to make sure you don't lose any protection. Once you put it on,
you're good to go. You don't really have to wait to get the protection, but
it may help to let a product dry on so it won't rub right off.

来自Md：我皮肤很白，通常用spf50的防晒。我一天应该涂几次防晒？涂好后出门之前要等多久？

答：理论上每2小时补一次防晒可以保证你得到更好的防护。涂了就可以出门了，不过等它干了的话会比较不容易被蹭掉。
_______________________

Reston, Va.:
We had a health fair at work last week and one of the vendors said that my
skin was dry (based on a screening by a machine that indicates dry skin by
glowing purple). Is there a brand or type of moisturizer that will keep my
face from being dry but won't make it oily (I have a T-zone complexion)?

Rachel Herschenfeld: You should probably choose a light moisturizer, such
as Olay Complete Defense. You may also want to try an alpha hydroxy
conatining formula such as AquaGlycolic. If your skin tends to get a little
oily, stick with lotions, rather than thicker creams.

来自Va：我们上周有个health fair，有人说我的皮肤很干（用个机器测的）。有没有面霜可以补水又不会太油的（我T区比较油）？

答：你不要用太厚的面霜就好了，例如可以用Olay Complete Defense。也可以用含有果酸的面霜例如AquaGlycolic。如果你觉得油，就用乳液不要用厚重的霜。（这一条好废话啊）
_______________________

Washington, D.C.:
Hi and thanks for taking my question. I am 30 years old and fortunately,
have no wrinkles except for a few small lines right under my eyes. I want
to help maintain this so here's my question. What is your opinion of the
Oil of Olay Total Effects line? I've been using the eye cream and it's
actually helped soften some of the finer lines I've had underneath my eyes.
I am finishing up a bottle of a different moisturizer, but once it's done
I'm going to start using the total effects daily moisturizer with
sunscreen. Is it worth trying?

Rachel Herschenfeld: Olay Total Effects has a good blend of moisturizers
and anti-oxidants, which will help the skin look better, but won't actually
reverse aging changes. The anti-oxidants may help slow some age-related
changes by helping to prevent damage from sun exposure. The moisturizer
with sunscreen will do even more to prevent UV damage, so I would recommend
trying it.

来自华盛顿：我今年30，没什么皱纹，除了眼下有几条小细纹。我想保持目前的状况，所以我的问题来了：你觉得Oil of Olay Total Effects系列如何？我用了那个眼霜，觉得对细纹有点效果。我的一个其他牌子的面霜快用完了，我想试试total effects的带防晒日霜，你觉得怎么样？

答：玉兰油total effects系列的面霜有抗氧化剂，所以会让皮肤看起来更好，但是并不会实质上逆转老化。抗氧化成分可能可以通过预防阳光产生的损害来延缓老化。它其中的防晒成分事实上更有帮助一些。可以试试这个产品。
_______________________

Bethesda, Md.:
How about the Kinerase line? And La Mer? They cost a fortune; do they
produce the results they promise?

Rachel Herschenfeld: So, are these products really worth it? I don't think
so. In terms of La Mer, the supposedly magical active ingredient is seaweed
extract. I do not know of any well conducted trials which have been
published that show this to be an effective treatment to reduce facial
lines and wrinkles. Kinerase contains kinetin, which also hasn't yet been
proved to reduce lines and wrinkles in any well conducted trials. There are
some ingredients that have been shown to make a difference in aging skin by
reducing fine lines and evening out pigmentation. Retinoids such as
tretinoin, which is found in RetinA and Renova, are among the most
effective.

来自Md：（我喜欢这条，，，）Kinerase系列怎么样？La Mer呢？他们贵的要死，真的有效吗？

答：这些产品真的值那个价吗？我不觉得。对于La Mer，所谓的magical活性成分就是海藻提取物。没有任何可信的实验证明这是一个去皱抗老的有效成分。Kinerase的有效成分是kinetin，同样这个成分也没有被证明过能抗老去皱。相反，有很多其他成分是被证明了对老化皮肤有效的，
它们能改善细纹，均匀肤色。A酸类，例如tretinoin（RetinA 和 Renova里面有），是最有效的成分之一。
_______________________

Washington, D.C.:
I have used the Bath and Bodyworks Dr Wexler system and it works but is
highhly expensive. What is the "best" system for a woman in early forties,
fair skin with many freckles and some sun damage?

Rachel Herschenfeld: Some of the products in Dr. Wexlers' line are good,
and some aren't. I think this is the case with most product lines. For fair
skin, early 40s, some freckling, there are a few key recommendations. First
of all, broad spectrun sunscreen with an SPF of 30 or greater every day.
UVA even comes through window glass and contributes to aging changes. I
think anti-oxidants are a good idea; these include vitamin C, vitamin E,
green tea extract, alpha lipoic acid and others. Then if your skin can
tolerate it, use a retinoid such as Retin A, or a retinol containing
product over the counter.

来自华盛顿：我用BBW家卖的Dr Wexler系列，效果挺好的，但是就是太贵了。对于一个四十出头，皮肤比较白，有很多雀斑和一些晒伤的女人来说，什么护肤比较好？

答：这个系列有的东西还不错，有的不行。很多牌子都是这样。对于你的情况来说，首先要每天使用spf30以上的防晒。UVA可以穿透玻璃，导致老化。同时，用抗氧化成分也是不错的选择。例如VC，VE，绿茶萃取，叶酸等等。另外如果你的皮肤能承受的话，使用A酸，比如Retin A，或者
非处方的含有retinol A醇的产品。
_______________________

Retin-A (renova):
Is there any better cream to use than this for anti-aging? I have used
that, and sunscreen daily for over ten years and am 40 but most folks think
28-30. Am I on a good path or is there something better.

Rachel Herschenfeld: Renova is the gold standard for anti-aging creams.
That being said, there are other related creams that you may want to try.
Top on my list is Avage or Tazorac, which contains Tazarotene. if you
haven't added any exfoliation to your regimen, I woudl try that as well.
Either an alpha hydroxy or beta hydroxy cream (MD Formulations, Skin
Medica, Neutirogena Age Defying) would be a good choice. Also,
anti-oxidants. They won't get rid of your wrinkles, but the evidence
suggests that they'll help prevent some UV mediated damage. Olay Regenerist
has some, SkinCeuticals makes great antioxidant products such as C E
Ferulic.

关于retin-a（renova）：有没有比这个更好的抗老产品？我用这个+防晒已经10年了，现在40，但是大家都觉得我只有28-30。我这个组合可以吗，或者是不是有更好的？

答：Renova是抗老霜的黄金标准（这样啊……- -b）。虽然如此，还是有其他类似的产品你可以尝试。我推荐Avage或者Tazorac，还有Tazarotene。如果你没有用去角质产品，也可以加一点。果酸和水杨酸都可以（MD Formulations, Skin Medica, Neutirogena Age Defying）。还有，抗
氧化剂。它们不能除皱但是有证据表明它们可以预防一些紫外线造成的伤害。Olay Regenerist有相关产品，杜克家有很棒的抗氧化产品，例如C E Ferulic。
_______________________

Baltimore, Md.:
What, if anything, can I expect from a series of six 50 percent gylcolic
acid treatments performed at a day spa? Thanks.

Rachel Herschenfeld: Hard to know what to expect. The results depend on the
strength of the peel, which depends not only on the concentration of AHA,
but on the pH of the solution, it's other ingredients, and how it's
administered. In general, I recommend getting such treatments under a
doctor's supervision. You'll probebly get a stronger treatment and better
results. When done properly, these peels can smooth the skin, and help fade
brwon spots. But be patient! Usually it takes a series to get results.

来自Md：在美容院做一系列6次的50%浓度果酸焕肤能带来什么改善？谢谢。

答：这很难讲。焕肤的强度决定了效果。不仅仅是浓度，ph值和焕肤的方法也很有关系。一般来讲我觉得在医生指导下进行会比较好，你可以使用更高的浓度，得到更好的效果。做得好的话可以平滑皮肤，改善黄褐斑。但是要有耐心，通常要做完一个系列疗程才有效果。
_______________________

Fairfax, Va.:
I am 30 and recently started to see broken capilliaries on my face,
especially my cheeks. Are there any over-the-counter products I could use
to prevent them or reduce their occurence? What causes them? I was
wondering if I should see a dermatologist?

Rachel Herschenfeld: Broken, or more accurately, dilated capillaries, are
one of the things that don't respond well to creams. See a dermatologist to
discuss laser or intense pulsed light treatments.

来自Va：我现在30岁，发现皮肤上特别是脸颊上有红血丝。有没有非处方的产品可以改善这个的？这个是什么原因造成的？我应该看医生吗？

答：护肤品对于红血丝没有什么效果。（哎，我就是红血丝……医生没讲怎么形成的，我讲讲我的research结果吧，一般是遗传的，后天的话暴晒什么的都可能造成）你可以看医生，了解一下激光或者intense pulsed light疗程。（据说V-beam的激光最好，我已经打算做了。）
_______________________

Rockville, Md.:
Hello, Dr. Herschenfeld, and thank you for taking my questions. Shiseido
sells a compact powder that offers sun protection (I use one with SPF 45).
Can their powder work as advertised in terms of protecting the skin from
the sun? Is it better to stick with a moisturizer with SPF protection?
Currently, I apply Olay's moisturizer of SPF 15 followed by the Shiseido
compact powder. Also, what do you think of Neutrogena's Ultra Sheer
sunblock?

Rachel Herschenfeld: If you apply enough of the powder, it can provide an
SPF of 45. I always prefer a sunscreen first, to make sure that all areas
get good sun protection. Then you can apply the powder so it looks good,
instead of in a thick uniform layer to get the sun protection. I really
like Neutrogena's Ultra Sheer sunblock. Excellent broad spectrum protection
from both UVB and UVA, not too greasy, and not too expensive.

_______________________

Washington, D.C.:

Olay Daily facials (they look like a soft $4 gauze pad). Worth it, or would
a face flannel do just as well?

Rachel Herschenfeld: The face flannel is probably just as good, but if you
like the feel of this product, there's nothing wrong with it.

_______________________

Washington, D.C.:

What about Strivectin? Does it work for stretch mark? wrinkles?

Rachel Herschenfeld: The whole StriVectin thing is hard to understand.
There is no good data to support the assertion that the active ingredient,
palmitoyl oligopeptide, greatly decreases facial lines and wrinkles or
reduces stretch marks. Despite this, it seems to be wildly popular. Until
we have that data, I don't recommend it, unless you like the feel of the
product- then go ahead and use it as a moisturizer, but not more than that.
Don't expect any miracles.

_______________________

Woodbridge, Va.:

I have crow's feet near my eyes, and a line above my nose in between my
eyes that I'm pretty sure I got due to being in the sun and having to
squint (or wearing glasses and not having the proper shades). Are there any
creams I can use to make these imperfections not as noticeable? I'm 32,
fair skinned, and I wear sunblock religiously (although, admittedly that
wasn't always the case).

Rachel Herschenfeld: The crow's feet and the frown lines are what we call
dynamic lines- produced by repetitive motion. Creams may help a little with
mild crow's feet- in particular I would recommend retinol or a prescription
retinoid such as Renova or Avage- but not with the frown lines. You're
heading towards Botox territory to be truly effective.

_______________________

Start Early?:

I'm 26 and am fortunate to have a nice complexion, no real problems or
blemishes. Currently I just use an Origins face wash and Dove moisturizer
with SPF 15. Should I be using more creams to help with wrinkles now? What
I'm doing now works great for me, but I imagine there will come a time when
I should do more.

Rachel Herschenfeld: Prevention is so important when we talk about aging
changes in the skin. You're doing great if you're using a facial
moisturizer with sunscreen every day. Yes, even in the winter! But I prefer
an SPF of 30. Also, think about anti-oxidants: they probably help prevent
damage too. Look for vitamin C, vitamin E, green tea extract, soy
isoflavones, ubiquinone (or CoQ10) and others.

_______________________

Washington, D.C.:

How about Idebenone? Is this as effective as Retinoid?

Rachel Herschenfeld: Idebenone is a good anti-oxidant that is found in
Prevage. It is a derivative of ubiquinone, which is also used as an
anti-oxidant in many skin creams. I recommend anti-oxidants as part of any
daily skin care regimen, and this one is great, but there isn't any
compelling evidence that it is better than all the other ones out there.

_______________________

Washington, D.C.:

There are a number of over-the-counter microdermabrasion products available
now. From your perspective, what are the benefits and negative effects (if
any). I have used one, and my skin looks great that day. However, I wonder
if it is too harsh?

Rachel Herschenfeld: Many of these products have small beads in them that
can gently exfoliate your skin when they are used properly. Just follow the
directions to avoid irritation from over use. Also, remember your sunscreen
after.

_______________________

Washington, D.C.:

Do you think Philosophy moisturizers (Hope in a Jar, When Hope is Not
Enough) are worth the price, or is Olay just as good?

Rachel Herschenfeld: I think Olay is just as good.

_______________________

Paul, Tex.:

Do products with elastin really help with skin elasticity? For instance,
the skin below my eyes.

Rachel Herschenfeld: In a word, No. Any elastin that you apply topically
can't get into the skin where it might help.

_______________________

Arlington, Va.:

Can you please recommend a good all-around eye cream? I have fine lines,
dark circles, and puffiness in the morning.

Rachel Herschenfeld: There are several eye creams that I like: PrimaC eye
balm, Matis eye balm, Skin Medica Illuminating eye cream and Vichy RetiC.

_______________________

Montgomery County, Md.:

I'm 28 with dry, fair skin, not really prone to breakouts. I've found that
my skin looks the best when I don't use any soaps (but do wash my face in
the morning with warm water and a washcloth), and use Cetaphil cream twice
a day and Kiss My Face spf 30 in the mornings. I don't wear makeup, so
there's nothing to take off at night. Is it ok for me to not use a facial
cleanser? I can't seem to find one that doesn't dry my skin out and make it
flaky; even Cetaphil is too strong. But I don't want to harm my skin in the
long run just to have it look nice now.

Rachel Herschenfeld: There is no magic in a cleanser, so if water and a
washcloth work well for you, that's fine. You're not depriving your skin of
anything essential.

_______________________

Baltimore, Md.:

Can you recommend a product or a regimen that includes all of the
ingredients you've been recommending; SPF, Retin-A, antioxidants, etc.?
What do you use? I like to take care of myself, but I would also like to
take care of my family.

Rachel Herschenfeld: There's no one product that does it all. here are some
things I like: Renova or Avene Retrinal(a little gentler)at night, along
with Aquaglycolic facial cream or SkinMedica AHA/BHA cream. During the day,
antioxidants such as Prevage or SkinCeuticals C E Ferulic with a sunscreen
such as Aveeno Positively Radiant or Neutrogena Ultra Sheer SPF 55 or
LaRoche Posay Anthelios.

_______________________

Facial waxing w/ Retinol products:

For how long should I discontinue using Retin-A prior to getting my
eyebrows waxed? In the past, when I have not discontinued use, the waxing
resulted in some loss of skin (ouch!) where my brows were waxed, along with
prolonged redness.

Rachel Herschenfeld: This is key: stop RetinA or Renova or Avage 1 week
before waxing on the face to avoid burns.

_______________________

Washington, D.C.:

Have you heard of Frownies, which look like little pieces of cardboard that
you stick to your face at night? I got the ones for mouth-nose lines. I'm
22 but I have recently started seeing those lines. Can they be caused by
sleeping on your side?

Rachel Herschenfeld: I actually think the Frownies aren't too helpful, but
they won't hurt you. The lines are probably not from the way you sleep: sun
damage, genetics, and early aging changes have more to do with this.

_______________________

Washington, D.C.:

Thank you very much for your straight answers. It is rare to get such
objective no-nonsense advice.

Rachel Herschenfeld: You are welcome!

_______________________

Fargo, N.D.:

I just wrote in. I am 33 and I have been using Neutrogena Copper Night
cream (not the right name -- I can't think of it), Vanicreme soap for my
face (mild, no irritants) and a mild scrub. I also use a broad spectrum,
SPF 30 lotion for my face every day. Does green tea work to reverse signs
of aging? What do you think about that for people with roseacea?

Rachel Herschenfeld: Copper peptide, found in Neutrogena's Visibly Firm
line, has been shown in one study to increase some collagen synthesis.
Whether or not it will really reverse any aging changes is an open
question. Again, no good data on long term anti-aging effects. I would
prefer a retinoid at night to get some real results.

In terms of green tea- it contains great anti-oxidants. These will not
reverse aging changes, but can probably help prevent some UV related skin
damage, so I would recommend products containing these ingredients. Just be
realistic in terms of your expectations. I think green tea extract is a
good choice for people with rosacea because it doe not tend to be
irritating.

_______________________

Alpha-hydroxy:

I use a Neutrogena face cream daily that contains alpha-hydroxy and is
SPF-15, but I'm confused by the fact that the product recommends also
wearing sunscreen, even though it is sunscreen! Do I need an additional
sunscreen with this, do you think? I'm 30 years old.

Rachel Herschenfeld: I think it's fine as it is. The point about AHAs and
sunscreen is that there's been some concern that AHA's may increase
sensitivity to sunlight, so if you use one, you should use a sunscreen.
Just remember to re-apply sunscreen. The exfoliating effect of the AHA may
last all day, but the sunscreen won't.

_______________________

Boston, Mass.:

Is the retinoid in Differin an effective anti-aging agent? Also, are the
claims that Differin can help reverse some of the effects of sun damage
true?

Rachel Herschenfeld: Differin is a retinoid- same class as Renova and
Avage- and retinoids all have anti-aging effects.

_______________________

Washington, D.C.:

What's the best thing for pouchy under-eyes? I don't have dark circles, but
do have bags.

Rachel Herschenfeld: Creams probably won't help very much. When there are
truly pouches under the eyes, surgery is usually the best option. I would
recommend consulting a plastic surgeon.

_______________________

Woodbridge, Va.:

I'm 54 and have noticed that my pores have gotten larger over the years.
What do you recommend to help shrink them and keep them clean?

Rachel Herschenfeld: Pores are so hard to treat! There isn't any cure in a
jar, but there is some data that suggests that Avage- a prescription
retinoid- may help. So see your dermatologist to discuss it.

_______________________

Washington, D.C.:

I have read that long-term use of retinols like Retin A can undo past sun
damage at the cellular level? Is there any truth to this, or is this just
wishful thinking for those of us who had a few too many sunburns in our
youth?

Rachel Herschenfeld: There is some truth to this, but no retinoid can undo
all past sun damage. Retinoids can reverse some aging changes and improve
fine lines and pigment irregularity. There is also evidence that they may
prevent some ongoing UV damage and help prevent precancerous lesions on the
skin. I strongly recommend using retinoids, particularly for people with a
lot of sun damage.

_______________________

Annapolis, Md.:

I cannot use anything with paraben. I use La Mer because it does not have
paraben. Do you know of any other lines, less expensive, that are paraben
free?

Rachel Herschenfeld: Vanicream is a great product line that is free of
parabens and a lot of other irritating and sensitizing ingredients. Check
out their website: www.psico.com .

_______________________

Washington, D.C.:

Kiehl's makes a great face cream with lycopene, which I love. But it is
very expensive. Do you know of any lower-cost alternatives?

Rachel Herschenfeld: You can try one of the facial creams by Paula Begoun-
her Paula's Choice line tends to be very good.

_______________________

Washington, D.C.:

How long does restylane last? Is it safe? No after-effects?

Rachel Herschenfeld: Restylane can last 6 months and sometimes longer. But
it's not a cream! It works great for lines around the mouth and between the
nose and corners of the mouth. It's very safe, and after effects are
usually limited to transient swelling, mild redness and mild bruising.

_______________________

Tyson's Corner, Va.:

Does drinking water actually prevent wrinkles? Some of my coworkers swear
by this but I am skeptical.

Rachel Herschenfeld: Drinking water doesn't really prevent wrinkles.
Although getting totally dehydrated can make the skin temporarily slack.

_______________________

Boston, Mass.:

Dear Dr. Herschenfeld, I am a skin cream skeptic. With a typical red-head's
complexion, I've settled on Dove unscented soap and Oil of Olay sensitive
skin lotion for my face's "beauty" regimen. I don't like the idea of alpha
hydroxy or other acids on my skin, and I really don't like spending a lot
of money for water plus glycerin plus the latest fad ingredients. Is there
really any justification for trying anything other than sunscreen, good
diet, exercise, and sufficient water (and NO SMOKING)?

Rachel Herschenfeld: The measures that you mention are crucial to
maintaining good health and keeping your skin looking good. As I've
mentioned already, there is good data for some other creams as well. In
particular, the retinoid family truly helps reverse some aging changes in
the skin including fine lines. Ingredients such as hydroquinone, soy
extract, and alpha hydroxy acid can truly help fade brwon spots.
Anti-oxidants also add another layer of protection to prevent sun damage.
That being said, you don't need to spend a fortune on these things if you
don't want to. You may be blessed with good genes (never under estimate the
importance of this!) and your skin may look great if you just keep up what
you are already doing.

_______________________

Boulder, Colo.:

Because I live at high altitude and am often outdoors, I choose not to use
my Retin-A during the summer months. However, my chin always ends up
breaking out (this is my tough zone). What do you recommend I do during
summer months?

Rachel Herschenfeld: I would use the RetinA and also apply a good
sunscreen, such as Neutrogena Ultra Sheer SPF 55, and keep re-applying it
during the day. If your chin is the only problem area, maybe you could just
use the RetinA there in the summer. Talk to your dermatologist and see what
he or she thinks.

_______________________

Alexandria, Va.:

I've been wearing La Mer lifting serum, followed by its moisturizing
lotion. But when I stopped using it for a week last month, my skin quickly
became dry and started to break out. This might sound funny, but is there
such a thing as skin addiction to a certain product after a long period of
use?

Rachel Herschenfeld: You didn't become addicted, but your skin may need
regular moisturizing. I expect that if you substitute another moisturizer,
your skin will improve again.

_______________________

Washington, D.C.:

I was wondering about those moisturizers that allow you to self tan. I use
a Retin-A product and metrolotion on my face. Can I still use a self-tanner
like these? Do they actually work?

Rachel Herschenfeld: Self tanners do work, and can be used along with the
products you mention. Self tanners contain dihydroxyacetone, which binds to
skin proteins to produce its color. This is really the only safe way to
tan. Also, it provides a tiny bit of sun protection, but not enough to
replace sunscreen.

_______________________

Arlington, Va.:

I understand that the new sunscreens with Helioplex really do provide
longer protection, maybe 4 hours instead of 2, since they don't degrade as
quickly. But I just picked up some Sea and Ski sunscreen that claimed to
last 8 hours! Is this really possible?

Rachel Herschenfeld: No sunscreen is going to provide 8 hours worth of
protection. They all rub off at some point, and need to be reapplied.

_______________________

Bowie, Md:

Do scar removal creams with Vitamin E work? My toddler son fell over a year
ago and he still has a slight scar on his chin. The scar tissue doesn't
have pigment, I assume, so that's why it's lighter than the rest of his
skin.

Rachel Herschenfeld: Vitamin E does not work to improve scars. It is a good
anti-oxidant.

_______________________

New York, N.Y.:

Hi, Dr. Herschenfeld. I'm not sure if this is the type of issue you are
covering today, but my question is: I have tiny blackheads across my nose
and the cheek area right around my nose. I've tried "pore refining"
cleansers, hoping to get rid of them that way, but with no luck. It's the
only place on my face that I can actually see my pores, and it drives me
crazy. Is there anything I can do to eliminate them? Thanks.

Rachel Herschenfeld: You'll never get rid of those pores, but they may be
more obvious if they're clogged. Here's what may help: try a retinoid such
as RetinA or Differin- you'll need a prescription from a dermatologist.
Also, most pore refining products contain salicylic acid, which can help to
decrease balckheads, but not get rid of them. It may also be helpful to
have a gentle extraction done by a licensed esthetician, preferably under a
doctors supervision.

_______________________

Rachel Herschenfeld: Thank you for all of your questions. I hope that all
of this information will make it a little easier to choose products that
will help keep your skin looking great.

_______________________

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