Retinoids in the Fall/Winter Season: How to Manage Dryness
Vitamin A, aka Retinoids, have long been a staple in skincare and are widely used as an effective treatment for aging skin and acne among other concerns. They work by increasing cellular turnover, differentiation, and more. This leads to a reduction in wrinkles, texture, acne, and increases collagen production. To gain a deeper understanding of Vitamin A and how it affects your skin, read our Retinol Blog here.
While retinoids are crucial to an effective regimen, the acclimation process can be a challenge especially during the cooler months when our skin is dry. We call this process retinization; while your skin adjusts you can anticipate some degree of dryness, irritation, possible purging (breakouts) and sensitivity, especially during the fall and winter seasons. In this blog post, I will explain how to manage the side effects, acclimate to your retinol routine, and keep your skin vibrant and healthy. Skincare is incredibly nuanced, and there is no one size fits all for this process, however these general guidelines will steer you in the right direction. For a personalized routine you should always opt for working with a professional to be sure that you’re on the right track and reaping the benefits.
Sun Protection – You already knew this was coming, huh? The importance of light protection can’t be overstated, even in the cooler months. Light is always present during the day, therefore sunscreen and UPF protection are always needed. Apply sunscreen that contains an SPF of 30 or higher. At least every two hours. Every day. All year round. This will help with the treatment and prevention of sun damage, protect collagen, and it helps your skin to function optimally to make retinization more comfortable. Despite common myths, retinoids are not photosensitizing and don’t need to be discontinued in the summertime. The summer is actually a great time to begin or increase your dose of vitamin A, as skin is less dry which makes the process smoother.
Start Slow – Dryness, peeling, and sensitivity are all anticipated responses to retinoids, but you can make the process more tolerable by using a step-up regimen. The frequency, dose of product, and timeline for the step-up plan depends on the form of vitamin A that you’re using and what your tolerance is. Generally it’s best to begin by applying a small amount a few times a week, and then gradually increase the frequency over time, followed by increasing the dose. This gradual process will lessen the severity of any adverse side effects.
Manage Your Moisture – Another important aspect of minimizing dryness and irritation is managing your TEWL, aka transepidermal water loss. This can be done both topically and through your environment. Opt for functional moisturizers that will assist your skin barrier and deep hydration such as Skin Ceuticals Triple Lipid Restore or Sente Dermal Repair Cream (Specific product reccomendations are always more successful than general advice, so I recommend booking a product consultation). Humidifiers help with maintaining moisture in the air and mitigating TEWL. To avoid excess dryness, always shoot for lukewarm water in the shower rather than hot. It’s hard in the winter, I know, but your skin will thank you! ♡
Work With a Pro – Skincare is personal, and more often than not the answer to general questions will be “it depends”. This is why most generalized advice isn’t helpful, because there are always multiple factors at play. Compliance tends to be low with retinoids, because the retinization process is difficult to navigate without a professional by your side for guidance and support. It’s important to know when to push through the discomfort, when to pull back, when you need moisture, exfoliation, etc. Having an skincare professional in your corner makes for a much more comfortable and successful retinol journey.
Retinoids are an effective method for anti-aging and improving skin quality, but there is also an art and a science to adjusting to them. Using retinoids in the fall and winter takes a combination of patience, consistency, and proper adjustments to your skin care routine. Working with your esthetician is always the best choice in order to strategically and successfully achieve your skincare goals.
TLDR; Book a consultation with your favorite estheticians at Sapien. See you in the treatment room!
Sadly but truly, the skin on our bodies often gets put on the back-burner compared to our faces. This may not seem like a pressing matter now, but cumulative damage to the skin on our bodies quickly adds up and we’re left with a stark contrast in complexion. This shows up as a neck, chest, and body that present much more aged than the face. Think sun spots, irregular tone, crepey, leathery or lax skin. This is why it’s wise to plan ahead and ensure that all of your skin is paid equal attention in order to maintain healthy skin all over.
How Should I Care For The Skin on My Body?
The skin on your body should be treated more or less the same way that you treat the skin on your face. We want to maintain integrity of the skin and our collagen, and prevent damage. Some general guidelines include;
Cleanse with a gentle body wash daily
Cleanse your neck, chest, and ears when cleansing your face
Exfoliate regularly – This varies (depending on what your skin can tolerate). I love a gentle daily physical exfoliation using the Supracor Bath Mitt
Maintain hydration by avoiding excessively hot showers
Moisturize daily using quality products
Use antioxidants and vitamins a, c, e to neutralize free radicals, increase collagen production and even tone
Bring facial products all the way down to your neck (front and back), chest, and ears
Protect with SPF daily and reapply – *The adequate dose of SPF for the body is at least a full shot glass worth
Avoid excessive light exposure by seeking shade during peak sunlight hours (10am-3pm) and wearing UPF clothing
Avoid inflammatory factors and habits like alcohol, sugar, etc. and get regular sleep and exercise.
Although investing in skincare for your whole body may seem steep up front, it will more than pay off long-term. Treating damage on the body can be costly and uncomfortable, depending on the amount of damage accrued and your skin goals. This is exactly why I recommend UPF clothing to all of my clients, it’s the best foolproof way to protect yourself and requires no effort.
Thankfully, we have a range of treatment options that can correct and maintain healthy skin. The treatments and plan varies depending on concerns, area of the body, age, skin health, etc. With these treatments we can address pigmentation concerns, skin laxity, strengthen collagen, firm and tone. Some treatment options include:
IPL Photofacials/Upper Body IPL
Radio Frequency Microneedling & Tempsure RF
Chemical Peels and Exfoliation
CO2 & Laser Resurfacing
Wether you’re looking for preventative or corrective body care, working with a professional is the best way to stay on track. Stay tuned for the next blog post, where I’ll share some of my favorite body skincare products.
As a business owner and service provider, I can confidently say that maintaining a fair and consistent approach to our cancellation policies is crucial for the smooth operation of our businesses. While it may be tempting to make exceptions on a case-by-case basis, and to ask for them, deviating from established cancellation policies can create a range of challenges and undermine the integrity of our services.
Cancellation policies serve as essential guidelines for service providers, ensuring fair and consistent business practices and it is important to critically analyze the potential biases that can arise when clients request exceptions to these policies. In this blog post, we will explore how seeking exceptions to cancellation policies can perpetuate sexism, classism, and racism, further deepening existing inequalities within our society and demonstrate the importance of upholding cancellation policies and the benefits it brings to both service providers and clients.
Ensures Fairness and Consistency:
Cancellation policies exist to protect the interests of service providers and maintain a fair business environment. By adhering to established policies without exceptions, service providers ensure that all clients are treated equally. Making exceptions on a selective basis can lead to perceptions of favoritism, breed resentment among other clients, and erode trust in the fairness of our services. Consistency in policy enforcement promotes transparency, professionalism, and overall customer satisfaction.
Protects Revenue and Business Viability:
Cancellation policies are designed to safeguard the financial stability of service providers. By establishing clear guidelines, service providers can protect their livelihoods while maintaining a viable business model for their employers and coworkers. Exceptions to cancellation policies can result in lost income, disrupt scheduling, and create inefficiencies that impact the ability to provide quality services. Consistently enforcing cancellation policies helps mitigate financial risks and allows service providers to thrive vs survive economically. We know that when women get paid bread winning wages, our whole community benefits. If a client cancels and they do not give the provider enough advanced notice, then that provider will miss out on their wages and cannot make that up. This compounds as multiple cancellations arise per week. Clients looking for open appointments will typically not log back in if they don’t see the times they want, now will they utilize the waitlist, as they typically just book service times further out on their calendars when no last minute openings are available. Clients also learn that they can’t bet on a last minute openings, so in order to ensure they maintain their treatments, they make a habit out of booking in advance so there are far less last minute bookers than those seeking to cancel last minute. Since most of our services are booked in a series, clients are not flexible with their treatment schedule.
Encourages Accountability and Respect:
Cancellation policies play a crucial role in fostering a culture of accountability and mutual respect between service providers and clients. By enforcing policies without exceptions, service providers communicate the value of their time, expertise, and commitment. Clients, in turn, are more likely to honor their appointments, respect the provider’s schedule, and appreciate the professionalism demonstrated. Upholding cancellation policies encourages responsible behavior, reinforces professional boundaries, and sets a positive tone for client interactions.
Sexism in Requesting Exceptions:
Sexism can manifest when clients, consciously or unconsciously, expect special treatment or exceptions to cancellation policies based on gender. Stereotypes that view women as more emotional or accommodating can lead to women facing additional pressure or scrutiny when requesting exceptions, potentially reinforcing gender-based biases. This perpetuates the notion that women should prioritize others’ needs over their own and reinforces existing gender inequalities.
Classism and Financial Privilege:
Requesting exceptions to cancellation policies can inadvertently perpetuate classism and favor those with financial privilege. Clients who are financially secure may be more inclined to ask for leniency, placing service providers in difficult positions. This can disadvantage service providers who rely on steady income to support themselves or their businesses. It reinforces an unequal power dynamic where those with financial advantages have more influence over service providers’ livelihoods, exacerbating existing socioeconomic disparities.
Racism and Differential Treatment:
Racism can come into play when clients of different racial backgrounds expect disparate treatment regarding cancellation policies. Implicit biases and stereotypes can influence clients’ perceptions of fairness, leading to differential treatment based on race. Service providers who are more susceptible to these biases may inadvertently grant exceptions or apply cancellation policies unevenly, perpetuating systemic racism and further marginalizing individuals from racial minority groups.
Promotes a Culture of Mutual Understanding:
Upholding cancellation policies fosters a culture of mutual understanding between service providers and clients. By setting clear expectations and communicating cancellation policies from the outset, service providers help clients appreciate the value of their time and the importance of honoring commitments. It encourages clients to plan their schedules responsibly and make informed decisions about their appointments. This mutual understanding builds a foundation of respect and professionalism that strengthens the service-provider-client relationship.
Impact on Marginalized Communities:
Requesting exceptions to cancellation policies can disproportionately impact marginalized communities, including women, people of color, and individuals with lower incomes. These communities may face additional challenges when seeking exceptions due to societal biases and limited resources. Stricter enforcement of cancellation policies in these instances can exacerbate existing inequalities, reinforcing systemic barriers that hinder their access to services and opportunities.
Equal Treatment and Inclusion:
To combat sexism, classism, and racism within the context of cancellation policies, it is crucial to promote equal treatment and foster an inclusive environment. Service providers should strive to apply policies consistently and fairly, regardless of gender, socioeconomic status, or race. Establishing transparent guidelines and communicating them clearly to all clients promotes accountability, reduces bias, and ensures a level playing field for everyone. This goes for clients treatment of service providers and small business owners. No employee should be made to feel unsafe when enforcing a policy the client agreed to in advance.
Supports Time Management and Efficiency:
Cancellation policies are vital for effective time management and operational efficiency. Service providers rely on accurate scheduling to optimize their productivity and provide quality service to clients. By adhering to cancellation policies, service providers can minimize disruptions and maximize the utilization of their time and resources. This commitment to efficiency benefits both service providers and clients, as it ensures a seamless experience and allows for reliable planning and delivery of services.
Alternatives to Cancellation Policies
The only way to get around cancellation policies is to raise prices for everyone at least 30%, but we can’t compete as a small business at those prices, especially when we guarantee living wages (unlike the majority of spas who pay low wages plus optional tip). Something has to give and I think we can agree that working class women’s wages are not negotiable and they should not be expected to forgo their paycheck whenever a client has an unforeseen conflict. There is never a case where the customer isn’t legally obligated to pay their bill because they had an unforeseen circumstance, and service providers are not an exception. Accountability for the customer is the only fair and ethical solution, and it’s not too much to ask that clients honor the contracts they sign without abuse such as arguing, threatening, manipulation and demanding the providers time and energy.
Requesting exceptions to cancellation policies can inadvertently perpetuate sexism, classism, and racism, reinforcing existing inequalities within our society. Recognizing these biases and their impact is essential for service providers to foster inclusive and equitable practices. By promoting equal treatment, enforcing policies consistently, and challenging systemic biases, service providers can create a more inclusive environment that contributes to dismantling sexism, classism, and racism, ultimately fostering a fairer and more just society.
Consistency in enforcing cancellation policies is essential for service providers and business owners to maintain fairness, financial stability, accountability, and efficiency in their businesses. By upholding these policies without exceptions, service providers create a transparent and professional environment that fosters trust and respect between providers and clients. Emphasizing the importance of adhering to cancellation policies benefits both parties and contributes to the overall success and reputation of the service industry.
Thank you for your time, your willingness to educate yourself and for supporting ethical female owned and operated businesses. We are proud to fight for working women and to do our part to create a better business for our clients and our staff.
Written by Stephanie Powers, CEO & Founder of Sapien Skin & Beauty
Guaranteed Fair Wages for Promoting Equity and Dignity
The practice of tipping within the salon and spa industry has long been considered customary. However, a critical examination of this tradition reveals a oppressive history.
Study after study demonstrate the inherent sexism and racism that perpetuate inequalities within the workforce. Salons and spas should consider abolishing tipping, focusing on the detrimental effects it has on gender and racial equity, but also attract higher quality workers who benefit from employer protections. By eliminating tipping, employers can foster a fairer and more inclusive environment for both their employees and customers.
Sexism in Tipping Culture:
The beauty industry has historically been associated with gendered stereotypes and expectations, and the practice of tipping exacerbates these biases. Female service providers often face a double standard, as customers tend to tip based on their appearance or perceived attractiveness rather than the quality of their services. This objectification diminishes their professional expertise and reinforces the idea that their worth is tied to their physical appearance. Moreover, women in the industry are frequently subjected to sexual harassment and inappropriate behavior, with tipping acting as a conduit for the power dynamics that contribute to such misconduct.
Racial Bias and Tipping:
The intersection of tipping culture and racial bias is a concerning issue within salons and spas. Studies have shown that service providers of color often receive lower tips compared to their white counterparts, even when delivering exceptional service. This racial disparity perpetuates systemic inequalities, as it limits economic opportunities for people of color and reinforces harmful stereotypes. Tipping practices can inadvertently perpetuate discriminatory behavior, with customers being influenced by implicit biases and societal prejudices, leading to unequal treatment and compensation.
Financial Stability and Professional Growth:
By relying on tips, salon and spa employees face significant challenges in achieving financial stability and professional growth. The unpredictability of tip amounts creates an inconsistent income stream, making it difficult for service providers to budget and plan for their financial futures. This lack of stability can hinder their ability to access benefits, save for emergencies, or invest in professional development opportunities. By transitioning to a fair wage system, salons and spas can provide employees with a stable income, enabling them to focus on their careers and well-being.
Creating an Inclusive Environment:
Abolishing tipping in salons and spas promotes inclusivity and equal treatment for all employees. Implementing a fair wage structure ensures that service providers are compensated fairly; regardless of their gender, race, or appearance. This shift allows professionals to be recognized and rewarded based on their skills, expertise, and dedication to their craft; rather than arbitrary factors. By cultivating an environment free from the biases perpetuated by tipping, salons and spas can foster a culture of respect, dignity, and professionalism.
Alternatives to Tipping:
Several alternatives to tipping have been suggested within the salon and spa industry. Implementing a no-tipping policy and instead including service charges in the pricing can help ensure fair compensation for employees. Additionally, providing employees with a higher base wage or commission-based structures can create financial stability while incentivizing exceptional service. These alternatives shift the focus from individual acts of generosity to a more equitable system that values the expertise and labor of service providers.
The practice of tipping in salons and spas perpetuates sexism and racism while hindering financial stability and professional growth for employees. By abolishing tipping and implementing alternative compensation models, these establishments can foster an inclusive and equitable environment. It is crucial for the industry to recognize and address these systemic issues to promote gender and racial equity and ensure that all employees are treated with the respect, dignity, and fair compensation they deserve.
Lynn, M. (2008). Determinants and consequences of female attractiveness and sexiness: Realistic tests with restaurant waitresses. Archives of Sexual Behavior, 37(1), 72-78.
Lynn, M., & Thomas-Haysbert, C. (2003). The tipping experiences of black restaurant servers. Journal of Applied Social Psychology, 33(2), 246-263.
Lynn, M. (2008). Racism in the restaurant: Shaping customer perceptions of restaurant servers. Journal of Black Studies, 38(5), 665-681.
Tomlinson, T. M., & Adegbite, E. (2015). Racial and ethnic differences in the customer service and satisfaction of restaurant consumers: Evidence from the tip it! study. Journal of Black Studies, 46(2), 169-192.
Weeden, K. A., & Grusky, D. B. (2005). The case for a new class map. American Journal of Sociology, 111(1), 141-212.
Jayaraman, S., Reich, M., & Thompson, S. A. (2018). Behind the kitchen door. ILR Press.
Lynn, M., & McCall, M. (2000). The psychological impact of tipping: A brief overview. International Journal of Hospitality Management, 19(1), 99-111.
Azar, O. H., & Yosef, S. (2012). Do we need to tip in restaurants? Journal of Applied Social Psychology, 42(11), 2779-2794.
Lynn, M., & Grassman, R. E. (1990). Restaurant tipping: An examination and partial replication of Lynn’s study. Journal of Applied Social Psychology, 20(16), 1357-1371.
Jayaraman, S., & Thompson, S. A. (2010). The impact of restaurant labor practices on the lives of low-wage workers. Berkeley Journal of Employment & Labor Law, 31(1), 1-36.
Lynn, M. (2018). It’s time to abolish tipping: Seven arguments against tipping in restaurants. Cornell Hospitality Quarterly, 59(4), 325-335.
Treating pigmentation concerns effectively can be difficult as it requires patience, consistency, and a solid plan in order to achieve satisfying results. Dark spots may be caused by a variety of factors like sun exposure, hormonal changes, and genetics. Whatever the reason may be, these dark spots can be effectively treated and lightened with the right products and plan. As a skincare professional, I have tested many products, and have found that the best approach is of course a combination of home care, professional treatments, and a solid strategy for light mitigation above all. In this post I’ll be sharing the best products for dark spots and hyperpigmentation.
What type of products help with hyperpigmentation?
Tyrosinase inhibitors are common ingredients found in skin care products designed to treat hyperpigmentation. These inhibitors work by blocking the enzyme tyrosinase, which is a necessary factor in melanogenesis aka the production of melanin pigment in the skin. When this enzyme is blocked, the production of melanin decreases, resulting in lightened skin with fewer dark spots, and it also prevents future overproduction of melanin.
Sapien Favorites for Hyperpigmentation
Skin Ceuticals Discoloration Defense – This serum is ideal for all skin types and is specially formulated to target discoloration and even out skin tone. Its key ingredients include antioxidants and pigment fighting ingredients like tranexamic acid, niacinamide, and HEPES. These ingredients work together to improve skin clarity, reduce the appearance of dark spots, and prevent future discoloration. This serum has a lightweight texture and is perfect for daily use.
Zo Skin Health Brightalive – This multi-functional brightening cream is perfect for those with sensitive, dry, or aging skin, however it isn’t recommended for acne prone skin. It contains a unique blend of enzymes that work to break down pigmented cells, revealing brighter, more radiant skin underneath. It also features retinol and resveratrol, which work to prevent future damage. Regular use can help improve skin texture, fade dark spots, and prevent new ones from forming.
Skin Better Science Even Tone Serum – This serum contains a powerful blend of ingredients like gallic acid, hexylresorcinol, and kaduku plum extract. These ingredients work together to improve the appearance of uneven skin tone, reduce the appearance of dark spots and yellowing of the skin, and brighten overall.
Hydroquinone and Tretinoin – Hydroquinone and Tretinoin are the gold standard of hyperpigmentation treatment. These compounds work together to reduce the production of melanin, which causes dark spots. Hydroquinone is a potent skin-lightening agent that works by suppressing the production of melanin that causes dark spots on the skin. Tretinoin is a retinoid that helps to promote skin cell turnover, even tone, and improve skin texture among other benefits. These prescriptions should only be used under the supervision of a skincare professional.
iS Clinical Extreme Protect – This moisturizing sunscreen provides ultimate protection to the skin from UV rays and environmental stressors which lead to and exacerbate hyperpigmentation. Its unique blend of antioxidants and broad-spectrum sun protection helps to reduce the appearance of hyperpigmentation and protects against further damage. The sunscreen is non-comedogenic, fragrance-free, and water-resistant, making it perfect for all skin types.
Bluestone Shield – This product is a must-have for those who are prone to hyperpigmentation. It is a UV protective visor that covers the entire face, making for a perfect shield of protection along with your sunscreen of choice. I highly recommend these shields to all of my clients, both for daily use and for high exposure activities like driving, running, hiking, etc.
Dealing with hyperpigmentation and dark spots on the skin can be challenging, but these products can help you lighten and even out your skin tone. From serums to sunscreens and prescription treatments, the right products can significantly improve the appearance of hyperpigmentation. Remember to use these products consistently, protect your skin from the sun, and always consult with a skincare professional before starting any treatment. Need a plan? I’ve got you. Book here to get started.
Looking for the most effective way to manage facial or body hair may feel like a daunting task. With so many options available, it can be difficult to decide which one is right for you. From waxing and tweezing to laser treatments and chemical depilatories, there are a variety of methods that can help you achieve the hairless, smooth skin of your dreams. In this post, we’ll discuss the differences between six popular hair management methods with the goal of helping you navigate through them and find which option best fits your needs.
Laser hair reduction: Laser hair reduction involves the use of laser energy to target and destroy the stem cells in hair follicles on the face or body, preventing hair regrowth. This process is usually requires a few sessions to achieve the desired result. Although laser hair reduction may be relatively expensive, it is a long-term hair removal solution opposed to shorter term therapies such as waxing, sugaring, or shaving. Laser hair reduction is a favorite pick at Sapien, due to the fact that it is so effective and long lasting as opposed to waxing, shaving, and sugaring which don’t impact the root of hair growth. Click here to read our full article on laser hair reduction.
Shaving: Shaving with a razor or electric shaver is an affordable and painless hair removal method. Shaving is a form of depilation, which is a method of removing hair from the surface of the skin. These types of hair removal methods have no impact on the growth of the hair as it doesn’t affect the follicle. However, shaving can be very irritating and it may not be the best option for everyone as it could cause razor burn or bumps which can result in PIH (post-inflammatory hyperpigmentation) for those who have more sensitive skin or darker skin tones. In order to minimize irritation, it is helpful to shave in the direction of hair growth vs. going against the grain and shave after your evening shower/bath while skin is softened.
Dermaplaning: Dermaplaning involves the use of a professional blade to manually exfoliate the skin and remove vellus hair (aka peach fuzz) from the face. This differs from shaving because the main purpose is exfoliation, it is appropriate for only fine hairs rather than coarse body/beard hair, and it is done with a single use sterile blade. This process is best done by an expert and leaves the skin looking smoother and brighter with increased absorption of topical products. Dermaplaning is the most beneficial when it is combined with a full customized facial.
Waxing: Waxing involves the use of hot or cold wax to remove hair from the root. This is referred to as epilation, where the entire hair is removed from the follicle rather than just the part of the hair growing above the surface of the skin. The results of waxing are longer lasting than shaving or dermaplaning, as it takes longer for the hair to recover and fully grow back. Waxing can be done every 4-8 weeks, depending on the area of the body. Over time with continuous waxing sessions, the hair may become more sparse and grow in slowly. Although, it isn’t considered a long term solution whereas laser hair reduction and electrolysis are more permanent.
Tweezing: Tweezing involves using a tweezer to pluck out individual hairs from the root. This process is done by hand and can be time-consuming, especially for individuals with thick hair on the face. Tweezing may not be the best option for individuals prone to ingrown hairs.
Electrolysis: Electrolysis involves the use of a small needle to target the hair follicle and destroy it using electricity. This is a very effective and long lasting hair removal option, although it is fairly uncomfortable as each individual follicle is targeted one at a time. This makes for longer appointment sessions compared to laser hair reduction. This process is done by a qualified electrologist and may require several sessions to achieve the desired result but it’s known to be very permanent and effective.
Remember that there is no one size fits all approach as each individual’s skin and hair texture differ. Be sure to consult with your dermatologist and aesthetician to choose the best hair removal method that suits your skin and hair type. To receive personal recommendations, book a consultation here.
If you have been battling with acne, then chances are you’ve heard about Accutane. You no doubt have a lot of questions about the potential outcomes, risks and side effects, and with good reason: Accutane (also known as isotretinoin) is one of the most effective yet controversial treatments for clearing up chronic or severe acne. But just what is it? How does it work? Why is there so much fear surrounding it? And perhaps most importantly, should you use it? To answer all these questions and more, we asked two experts in their respective fields on skin health: dermatologist Dr. Carly Roman, MD, FAAD and master esthetician and President of Sapien Aesthetics, Stephanie Powers.
What is it and how does it work?
Stephanie Powers, LME: As a common treatment for severe acne, isotretinoin has long been hailed as a miracle drug for those with persistent skin issues. At its core, isotretinoin is a type of retinoid, a group of compounds derived from Vitamin A. Think tretinoin, but stronger and in a pill.
Its mechanism of action isn’t totally understood, but scientists think it work by targeting several different factors involved in the development of acne.
One of the key factors is that isotretinoin reduces the production of sebum, the oily substance that is produced by the skin’s sebaceous glands. Sebum is known to contribute to the development of acne by clogging pores and providing a favorable environment for the growth of acne-causing bacteria.
Isotretinoin also has anti-inflammatory properties, which can help to reduce the redness, swelling, and pain associated with acne. It is thought to do this by inhibiting the production of certain inflammatory molecules, such as leukotrienes and prostaglandins.
Another way that isotretinoin may work is by affecting the differentiation and proliferation of the cells that make up the lining of hair follicles. This can help to prevent the formation of new comedones, the plugged hair follicles that are characteristic of acne. Although scientists are still learning how it works, we all know that it works.
When do you prescribe isotretinoin to your patients?
Dr. Carly Roman: Isotretinoin has been traditionally reserved for severe nodulocystic acne but can also work well in any patient failing more conservative therapy. These therapies can include prescription topical medications, oral antibiotics, birth control pills, or spironolactone.
How effective is isotretinoin?
Stephanie Powers, LME: The remission rate after isotretinoin treatment varies depending on several factors, including the severity of the acne, the dose and duration of treatment, and individual patient factors. In general, studies have shown that isotretinoin is highly effective at achieving long-term remission of acne. One study published in the Journal of the American Academy of Dermatology found that 85% of patients achieved complete or near-complete clearance of acne after a single course of isotretinoin treatment, with a mean duration of remission of 10.9 months.
Another study published in the British Journal of Dermatology found that 95% of patients had sustained clearance of acne six months after completing a course of isotretinoin treatment, with a median duration of remission of 18 months.
It is important to note that acne can recur after isotretinoin treatment, and some patients may require additional courses of treatment to achieve and maintain remission.
When combined with lifestyle changes, proper skincare, and regular facials, patients experience the best outcomes.
Is isotretinoin dangerous?
Dr. Carly Roman: Isotretinoin is an oral medication that can be safely used to treat acne. There are a few situations in which this medication should be used cautiously.
A woman of childbearing age should not get pregnant during the isotretinoin course (average of a 6-month course) and one month after to not harm the developing fetus. The risks to a fetus exposed to isotretinoin are significant. Fifty percent of those exposed will have some defect including cardiac and bony abnormalities.
The other consideration is in those with a diagnosis of depression. It is not an absolute contraindication, and it can still be used if the depression is well managed and there is trust and open dialogue among the patient, dermatologist and treating psychiatrist.
Stephanie Powers, LME: Although isotretinoin, like all drugs, have risks and side effects, there are a lot of myths about its use and safety. One common myth is that isotretinoin causes inflammatory bowel disease (IBD). In reality, there is very weak scientific evidence linking the drug to IBD, but acne itself is linked with the condition. Similarly, many people believe that isotretinoin causes permanent liver damage, but studies have shown that any damage done to the liver is generally mild and reversible. Finally, while there have been reports of depression and suicide linked to isotretinoin, studies have not found any direct causation between the drug and these outcomes, and there is only a weak correlation. We have to consider the fact that acne itself is strongly linked to increased rates of depression, and isotretinoin helps improve acne dramatically for most patients. The benefits outweigh the risks for many people. Talk to your doctor about any concerns you may have, but don’t believe the hype on the internet. The evidence is clear: isotretinoin is safe and effective for everyone but fetuses.
What is the history of isotretinoin?
Stephanie Powers, LME: Isotretinoin, a powerful acne medication, has an interesting backstory that spans several decades. NIH’s Senior Investigator Gary Peck discovered, in the 1970s, that a powerful drug called isotretinoin (or 13-cis retinoic acid) was effective against treatment-resistant severe acne. Isotretinoin eventually gained FDA approval in 1982 and became commercially available under the brand name Accutane. While the drug has faced controversy and legal battles over the years, it remains an important tool in the fight against acne and its painful symptoms.
Approved by the FDA in 1982 under the brand name Accutane, and quickly became very popular due to its effectiveness. However, it also came with fear about potential side effects such as depression, IBS, liver damage and birth defects. In 2009, the brand name Accutane was discontinued in the US market due to generic alternatives becoming available. Today, isotretinoin is still prescribed for severe acne under various brand names and is highly regulated due to its history.
What are your thoughts about the perceived risk vs the evidence and data?
Dr. Carly Roman: The two major concerns regarding isotretinoin are the risk to a developing fetus and mental health concerns.
In patients with childbearing potential, it is important to either adhere to strict abstinence or use two separate forms of birth control to prevent unintended pregnancy. One may safely get pregnant one month after completing their isotretinoin course with no consequences to the fetus.
There is a proposed but highly debated potential association with isotretinoin and depression and suicide. Systemic reviews and meta-analyses have concluded that the data is inadequate to establish a causal relationship. Some literature suggests that mood symptoms improve while on the medication as their acne improves as does self-image.
Would you take isotretinoin yourself?
Dr. Carly Roman: Yes! I have a thorough understanding of the risks and benefits and believe in the right person it can be a game changer. It is the closest option we have to a ‘cure’ for acne. Even if there is acne recurrence in the future, the severity is dramatically reduced. I’ve had patients refer periods of their life as ‘pre-accutane’ and ‘post-accutane’ because it was such a defining and life improving treatment.
Stephanie Powers, LME: Not only would I, but I have under the care of Dr. Carly Roman! Acne is a chronic inflammatory skin condition that is hard to manage, and isotretinoin is as close to a cure as I can get.
What is iPledge?
Stephanie Powers, LME: The iPLEDGE program, which was implemented in 2006 to prevent pregnancy and birth defects caused by the drug Accutane, has been met with controversy due to its gender based discrimination. Under the program, women of childbearing age must undergo monthly pregnancy testing as well as a questionnaire, and adhere to strict contraceptive measures while taking the medication regardless of whether they are sexually active or not. With the government monitoring the sex lives of women without any proof of the efficacy of this program, iPledge has been widely criticized. It is evident that the iPLEDGE program, while well-intentioned, is in dire need of reform in order to address these issues of sexism and inefficacy.
What can I do to manage the side effects?
Stephanie Powers, LME: Some of the most common side effects of isotretinoin include dry skin, chapped lips, dry eyes, and nosebleeds. Patients can use a variety of moisturizers and lip balms to combat dry skin and chapped lips, and your Dermatologist or esthetician can help you find the right one for you. Eye drops can relieve dry eyes, and nasal saline sprays can relieve nosebleeds, as well as sleeping with a humidifier (game changer!). Awareness of potential side effects can help patients make an informed decision about whether or not Accutane is the right treatment for their acne.
What would you like to say to people considering isotretinoin for their acne?
Dr. Carly Roman: Talk to your dermatologist about it. Be upfront with any of your concerns regarding side effects. Most of my patients do great with the medication and experience only the cutaneous side effects (skin and lip dryness) and mild achiness after exercise. Be open with family members or roommates about being on the medication so that if they note any concerns, they can bring it to your attention, and you can notify your care team.
To book a consultation or appointment, click on the provider below.
Dr. Roman is a board certified dermatologist originally from the Midwest. She grew up in Michigan and Ohio, which is where she completed her undergraduate and medical school education. She started her westward journey by moving to Chicago and completed her internship and dermatology residency at the University of Chicago. During her training, her interests in acne and women’s health led to authoring several papers and a book chapter on the topic. Within dermatology, her interests include acne, rosacea, hair loss, psoriasis, women’s skin health, Botox and cosmetics. She recently relocated to the Pacific Northwest to join the Modern Dermatology family. In her free time, she can with her young family and pup!
Stephanie is a certified Mast Esthetician in the state of Washington, and the President of Sapien Aesthetics and Sapien Skin and Beauty, a med spa in Seattle. She moved to Seattle for esthetics school, and after 13 years she has built a following with her results-driven treatments, straightforward approach, meticulous practices and a deep commitment to serving her clients. She specializes in medical aesthetics providing treatments and customized plan to her clients. She loves art, science, psychology and is a curious creature to her core. She stepped into the role as a business owner when she opened Sapien Aesthetics in 2017, and has been determined to solve the problems ever since, both for her clients and employees. Stephanie is a lifelong nerd and continually seeks the best science, information, mentors, skills and tools in order to serve to the clients she adores.
When she’s not at work you can find her wandering around the city, hitting up local parks and museums along the way
Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jun;76(6):1068-1076.e9. doi: 10.1016/j.jaad.2016.12.028. Epub 2017 Mar 11. Erratum in: J Am Acad Dermatol. 2017 Nov 14;: PMID: 28291553.
Lee, Stephanie Y.a; Jamal, Mohammad M.c; Nguyen, Emily T.b; Bechtold, Matthew L.d; Nguyen, Douglas L.a,c. Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. European Journal of Gastroenterology & Hepatology 28(2):p 210-216, February 2016. | DOI: 10.1097/MEG.0000000000000496
Ben-Shoshan D, Gomolin A, Litvinov IV, Netchiporouk E. Time to Change Guidelines for Laboratory Monitoring During Isotretinoin Treatment. Journal of Cutaneous Medicine and Surgery. 2020;24(1):92-93. doi:10.1177/1203475419879882
Kovitwanichkanont T, Driscoll T. A comparative review of the isotretinoin pregnancy risk management programs across four continents. Int J Dermatol. 2018 Sep;57(9):1035-1046. doi: 10.1111/ijd.13950. Epub 2018 Mar 6. PMID: 29508918.
Fine lines and wrinkles are among the most frequent concerns discussed when it comes to addressing aging or preventative care. The two terms are often grouped together, however they aren’t necessarily interchangeable. Fine lines and wrinkles are both visible indications of aging, but they differ in appearance, causes, and treatments for improvement.
What are fine lines?
Fine lines are thin, shallow lines that occur in areas of the face where the skin is more prone to movement, such as around the eyes and mouth. The severity of fine lines can increase or decrease based on a number of factors including hydration, UV exposure, exfoliation, etc. You may notice that during dry winter months, or if you’ve skimped on sunscreen applications, fine lines can appear to surface. Fine lines are not as severe as wrinkles and often are very responsive to home-care and treatments such as retinoids, SPF, collagen induction therapy, lasers, and consistent facials.
What are wrinkles?
In contrast to fine lines, wrinkles are deeper, more pronounced, and more set in the structure of the skin. Wrinkles are the result of cumulative UV damage, breakdown of dermal proteins and structural support of the skin, volume loss, and repeated muscle movement. They can occur in areas of the face that are regularly exposed to the sun along with our most commonly used facial muscles, such as the forehead, eyes, nasolabial fold, neck, and chest.
It is essential to note that while both fine lines and wrinkles are normal signs of biological aging, factors such as smoking, alcohol consumption, and sun exposure aka damage can also exacerbate their appearance. Therefore, adopting healthy skin habits and protecting the skin from harmful environmental and inflammatory lifestyle factors can help prevent fine lines and wrinkles from forming prematurely.
The best plan for treatment is a holistic plan, accounting for both treatments, home care, and tailored to your skin’s specific needs based on where you’re at. Beginning by booking a consultation is always the best place to start. See you in the treatment room!
If you want to minimize or avoid wrinkles, dark spots, sagging, and volume loss (and also avoid spending thousands of dollars on painful corrective treatments and procedures) then start a skincare routine sooner rather than later.
Although investing in a quality skincare routine is spendy upfront, by making a few smart choices, your health, complexion and your bank account will be set up for success in the long run.
As we learn more about aging and skin health, most of the damage we acquire on a daily basis can be prevented through effective topicals and lifestyle changes.
Why Is Skin Important?
From a practical stand point, skin is our largest organ, acts as a waterproof, insulating shield that protects us against external aggressors and damaging UV radiation, and senses our surroundings.
The importance of skin from an emotional and social understanding must also be considered. If you have ever suffered from acne, a physical injury, scars, wrinkles, or aging, you can easily understand how distressing it is to feel uncomfortable in your own skin. This can lead to emotional distress, psychological issues and even social isolation.
How Should I Care for My Skin?
Aging is synonymous with damage. UV exposure, pollution, smoke, dryness, stress, sugar, alcohol, inflammation are all examples of how we accumulate damage daily. These factors create a breakdown in our DNA, leading to weakened facial tissues which contributes to fine lines, wrinkles, volume loss, pigmentation, skin cancer, and other skin abnormalities.
Luckily, there are key preventive skin care steps you can commit to at home that will slow down the aging process. Some key essentials to slow aging include:
Cleansing twice daily
Maintaining proper external hydration using quality moisturizers
Applying enough sunscreen 365 days of the year (reapplying is a must)
Using Vitamin A (retinol) and its derivatives daily to increase collagen, decrease fine lines, and increase cell turnover
Use vitamin c to neutralize free radicals and increase collagen production
Avoiding inflammatory foods and alcohol
Avoiding light exposure by wearing hats, upf clothing, and seeking shade
How Can I Prevent Aging Using Facial Treatments?
Most of us have not been lucky enough to stave off aging entirely, (not yet at least!) and have already acquired damage. Thankfully there is a wide array of treatment options that can help turn back the clock:
•Microneedling and PRP
• IPL & Laser resurfacing
• Chemical Exfoliation and Peels
• Radio Frequency and Radio Frequency Microneedling
Remember, always work with a professional and stick to the plan if you want to minimze and reverse aging. It’s never too early or too late to start, and it takes a lifelong commitment of choosing yourself again and again.
Are you looking for a way to reduce wrinkles, skin pigmentation and sun damage without having to deal with drastic downtime? The Cool Peel CO2 laser treatment could be the perfect fit. This minimally-invasive procedure offers a gentler approach than traditional CO2 treatments, while rejuvenating your skin and treating stubborn signs of aging. In this blog post, we’ll dive into the many benefits and discuss why we are so excited to now offer this amazing treatment to our clients!
What is cool peel?
A CO2 (carbon dioxide) laser is an ablative laser that delivers intense infrared light to the outer layers of the skin. It is used to remove the visible signs of sun damage, aging, scars, wrinkles, and benign skin growths like moles and skin tags. Fractional ablative CO2 laser treatment is a popular skin resurfacing procedure because it involves minimal discomfort, quick recovery, and significant improvement in skin quality without the risks of surgery.
Cool Peel CO2 laser technology is a revolutionary way to achieve beautiful skin without the downtime and discomfort of traditional resurfacing lasers. It works by using a patented fractional scanning technique that delivers tiny laser spots, known as “dots”, into the layers of your skin to create controlled damage in order to target wrinkles, acne scars and other signs of aging. The dots cause micro-injuries which stimulates your body’s natural healing response. This increases collagen production leading to smoother and younger looking skin with improved texture and tone. Additionally, CoolPeel helps reduce pore size and even out pigmentation for an overall brighter complexion.
How is it different?
Ablative resurfacing using CO2 lasers is currently regarded as the most effective technique for skin rejuvenation. However, it involves lengthy recovery periods and persistent redness. For patients seeking quicker recovery times and structural improvements in the epidermis, fractional ablative resurfacing is a more suitable option. This fractional technique is ideal for patients with mild sun damage, and those who require partial restructuring of the epidermis and the formation of new collagen. The use of a scanning system that generates thermal effects in a small fraction of the skin’s surface enhances skin healing and minimizes recovery time, with only a 3-7 day period of persistent erythema. Additionally, the second-day re-epithelization restores the skin’s protective barrier, allowing patients to resume their daily activities sooner. Fractional ablative resurfacing provides an effective and safe means of achieving healthy, glowing, and youthful-looking skin at a faster pace, with reduced side effects compared to traditional resurfacing techniques.
Why are we obsessed?
This treatment is a revolutionary procedure that uses the latest technology to improve skin without the extensive downtime associated with traditional Co2 lasers. Cool peel works differently, by using a quick burst of light to administer high levels of energy to your skin while controlling the overall thermal injury, it delivers the results of an aggressive laser peel without the downtime and side effects. Because of this ‘cool’ factor, this treatment is suitable for all skin tones. The pulses of laser energy are delivered deep into the skin, stimulating a natural wound healing process and promoting the formation of new, healthy tissue and collagen leaving you with fresh, younger looking skin.
Benefits of Cool Peel
By targeting just the superficial layer of skin tissue, damaged skin is removed revealing younger and healthier looking skin. CO2 lasers are the gold standard in treating wrinkles, age spots, acne scars, and other blemishes as well as tighten skin and balance tone. Damaged skin tissue is removed, or ablated, stimulating new collagen production.
Cool Peel Improves:
The overall appearance of skin
Delivers a youthful, radiant complexion
Fine lines & wrinkles
Scars and acne scarring
Loving the idea of Cool Peel as much as we do? Book a consultation by clicking here to get started.