I have been wanting to do an interview with my incredible dermatologist, Dr. Klein at Modern Dermatology, for a long time because the woman is a wealth of knowledge and every time I go to see her I ask a million questions myself. Her skin is perfection and she has introduced me to some amazing products and treatments.
For the last few years, she has helped me figure out what’s best for my skin and it has changed the way I look at skincare and aging.
A few weeks ago, I asked for your skincare questions on Instagram and got hundreds of them. I shared the most commonly asked questions with Dr. Klein and she answered them (in detail!) below.
I also wanted to show you my results from three microneedling + PRP sessions and two IPL sessions. The before picture is on the left and the after is on the right. You can see that texture of my skin looks very different and my dark spots are cut down significantly! I asked Dr. Klein to go over both of these treatments too.
Can you give us a short description of IPL?
IPL stands for Intense Pulsed Light. It is a Light-based treatment, releasing many different wavelengths of light that penetrate to the dermis without harming your epidermis – this means it has less downtime than some of the more aggressive laser therapies that target similar skin concerns. IPL can be used for hair removal, reducing redness from conditions like rosacea, hyperpigmentation/sun spots and veins. It works by targeting the pigment cells and blood vessels in your skin (or hair follicle) and destroying them. The treatment is typically done in a series and sun avoidance following is critical.
Can you give us a short description of Microneedling + PRP?
Microneedling with PRP aka “Vampire Facial” is a process by which your body’s own platelet-rich plasma (the growth factors in your blood) is reintroduced topically to your skin through microchannel delivery with a microneedling pen. The treatment begins with a blood draw from your arm, which is then spun down in a centrifuge to isolate the platelets, which are rich in growth factors, then combined with calcium chloride to produce a platelet-rich fibrin matrix (PRFM). The microneedling pen creates controlled injury and columns of delivery for the PRP to penetrate deeper structures of your skin. Sometimes we also use the PRP/PRFM & inject it as a natural filler during the treatment. Together these modalities encourage collagen synthesis to boost skin texture and tone while improving surface-level issues like depressed acne scars and hyperpigmentation.
Ok let’s move on to follower questions. Get ready, there are a lot!
1. Let’s talk Botox. When do you recommend starting and why?
This is always a personal choice, but I do see the benefits of conservative “pre-juvenation.” By this, I mean starting before static wrinkles have formed (the wrinkles that are present even when your face isn’t moving). Lines get deeper as we age, and need more aggressive (and pricier) treatments to soften them. By starting early we can use low doses (aka “baby Botox”) to soften the process & prevent lines from forming – we don’t want to freeze you; a youthful-looking face should move!
2. What is the best laser for red spots?
While IPL certainly addresses redness, Vbeam is the gold standard for treating concentrated vascular lesions (red spots). Vbeam is a pulsed dye laser (PDL) that treats rosacea, broken capillaries, acne, port wine stains, scars, and photoaging. The energy from the laser targets hemoglobin (the red pigment in blood) where it is absorbed by the red blood cells and destroys them. A series of treatments is required, sun avoidance following is required.
3. I’ve tried every topical imaginable for my dark spots. Is there a treatment that can help?
Most of the over-the-drug store topicals are more so aimed at brightening the overall complexion vs. reversing a concentrated dark spot. We prescribe compounded lightening topicals from a specialty pharmacy that can be much more effective. That said, oftentimes a combination approach is the better plan – chemical peel and/or laser paired with topical skincare products aimed at reducing pigmentation and preventing new damage.
4. Skincare can be so expensive. What is the one thing to do consistently if nothing else?
I’m a big believer in blending drugstore finds with Rx strength products and medical-grade skincare. (we even have an Amazon shopping resource on our website alongside our eShop). The tenants of a good skincare routine include cleansing as well as prevention (antioxidants and SPF) and repair (retinols, AHAs). You don’t have to spend a ton of time or money, consistency with a few great products is your best bet!
5. For those of us with limited budgets, could you share some good drug store products?
Yes! Check out our Amazon Shopping Resource on the website…these are some of our favorite “Drug Store” products that we most often recommend to patients when we help them get started with a skincare routine.
6. Can you explain the advantages of microneedling and microneedling with PRP?
Microneedling will stimulate collagen production and promote skin healing for a rejuvenated appearance. When you add the benefits of PRP you boost these results significantly, providing the opportunity for maximum absorption, reduced healing time and optimal results.
7. What is the best treatment or way to clear blackheads?
I love the HydraFacial for clearing blackheads. It’s a great way to jump-start things and maintain along the way. The other thing critical for preventing blackheads is proper chemical exfoliation to keep pores open, clean and clear. Retinols, AHAs, and BHAs are all great, but so are clarifying clays and charcoal. And of course, stick to non-comedogenic and oil-free skincare products.
8. What treats adult acne and also fights lines and wrinkles?
If I had to pick one…Retinols/Retinoids. It’s no coincidence that retinols are almost always on a dermatologist’s list of must-have products. Retinols work by increasing the rate at which our skin cells turnover and new, healthy cells replace them. When we are in our teenage years this process naturally happens every 14-21 days, but when we are in our 40’s it slows down to 45-60 days and keeps slowing down from there. Retinols boost that cycle by expediting the turnover rate, helping the skin to stay clear from acne, and encouraging collagen and elastin production to plump fine lines and wrinkles.
9. Is there any downside to Botox?
Medically, no – as long as it’s being done by a trained and experienced injector in a safe setting there are no long-term adverse effects. That said, it is important to work with a provider you trust not only with your safety but also with your mental health. You should feel comfortable discussing your goals, concerns, and questions – and your provider should never encourage you to do more than you are comfortable with and on the flip side they should speak up if they feel you have unrealistic expectations.
10. What do you recommend for tech neck? This is definitely a popular concern, with unfortunate growing incidence. I usually combine a few treatments for Tech Neck, the most common ones are:
– Botox in the Platysmal Bands – these are the bands in the neck that pull your jawline and chin down, by relaxing them we can reduce jawline sagging.
– Kybella for Submental Chin – this is an injectable treatment that destroys fat cells in the stubborn pouch of fat below our chin. By slimming it down we can achieve a more chiseled, firm jawline.
– Filler – we can use filler to replace lost volume in deeper neck creases as well as along the jawline to improve tone and contour.
– Fraxel and/or Genius Microneedling with Radiofrequency: these modalities improve texture and tone as well as stimulate new collagen and elastin in the deeper skin structures for longer-term rejuvenation.
– Topically – spread your skincare down your neck, including SPF!
11. What treatment or product is best for undereye bags?
Firstly, it’s important to understand the root cause of the “bags.” Sometimes it truly is a “bag” of excess skin, in which case lower blepharoplasty is the best treatment. This is a surgical procedure done by a plastic surgeon to remove the excess skin.
Sometimes the bags are a temporary puffiness that can be addressed with topical products containing caffeine, and lifestyle changes like increasing hydration, decreasing alcohol and avoiding salty foods.
Sometimes what people refer to as “bags” are really dark circles, which are primarily caused by one of three things: 1) Lost Volume. The fat pads under our eyes diminish as we age, creating a hollowed appearance that not only makes the vascular structures below the skin more visible but also casts a shadow making them stubborn to conceal with makeup. 2) Medical Condition. Some medical conditions can contribute to dark undereyes, these include but are not limited to: Allergies, Anemia and Hypo/Hyperthyroidism. 3) Crepiness and Textural Abnormalities: these often require laser resurfacing (fractional or CO2 ablative) to stamp out imperfections.
12. How do I get that dewy look on my face?
This really comes down to skin hydration! Start by drinking plenty of water – roughly half your body weight in ounces daily. In the winter you can also run a cool-mist humidifier in your bedroom at night to add moisture to the air. Topically you want to be exfoliating dull, dead skin cells with a retinol and supplement with chemical exfoliation (AHAs) 1-2x weekly — this keeps the cells at the skin’s surface healthy and glowing and allows for better product penetration overall. Start your skincare with a hyaluronic acid serum to clean, dry skin and layer on products with peptides and ceramides, which support a supple and healthy skin barrier (the outermost layer of your skin). If you’re starting out dehydrated and dull, you can try an in-office HydraFacial to exfoliate and hydrate and get you started!