The new “normal”

Hello everyone!

Just thought i’d touch base as I haven’t been writing much in the past week. As we make our way out of Lock Down in the U.K., I feel like everyone’s journey has been so personal as we adapt to the new ‘normal’. Everyone is slowly finding their feet again as shops, restaurants and beauty salones reopen and we begin to slowly socialise more and more.

Last night was my mothers birthday and we had a great time. It was the first time that I had been in a restaurant since February and at first I was reluctant to sit inside, but this anxiety slowly dissipated as we filled the room with laughter and chatter. It got me thinking that socialising is very good for the soul and as the old saying goes “laughter is the best medicine” but I think being around friends and family comes a close second. How have you been finding the transition out of Lock down? Are you visiting shops and restaurants yet?

Another thing that has been on my mind is travel. Initially, I didn’t think that I would go away this summer. However, now that I am feeling less anxious, I will be going to Greece in Mid-August and simply cannot wait! How do you feel about travelling?

Lock down certainly has had some positive influences on my life. It taught me how to have a more relaxed pace of life, be more active, explore my spirituality, start a blog and an instagram page about my passion (skin) and think about the future. I certainly don’t take this time for granted as it’s definitely the calm before the storm. I begin my hospital training in December and i’m sure I will look back on these times and hopefully still manage to infuse some tranquility into a hectic schedule. How has this time impacted your life?

It’s funny because if I reflect on my life in Lock Down, it literally existed within a square mile. I live within a mile of my boyfriend and frequent the park in between by either running, walking my dog, cycling or sitting in the flower gardens with my mum. I hope that this sense of peacefulness and calmness transcends the Lock Down period and becomes a fully integrated part of my life. Which newly formed habits will you bring with you into the next chapter of this year?

Dr Abigail

In Conversation With: Dr Marisa Garshick, Board Certified Dermatologist at MDCS

Great inspiration and tips! Expensive Skin care doesn’t always mean its better.

Science and Skincare

Did you always want to be a dermatologist?

Yes, believe it or not, as early as 12 years old, I told my parents I wanted to be a dermatologist. Even at a young age when I visited my own dermatologist, I appreciated the way as a dermatologist, you could treat individuals as more than just a skin condition and really understand how skin conditions can impact people’s quality of life.

As I pursued my medical training, I always kept an open mind as I knew there were many different specialties, but what continued to draw me towards dermatology is the way it’s a blend of many other specialties while having its own unique features as well as the ability to truly improve a patient’s quality of life by improving their skin. One of my first experiences as a medical student that showed this was with a teenager who had been…

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No, I don’t want no scrub

Today I’m talking about all things exfoliating (chemical vs mechanical). Do we still have to scrub our faces with shards of walnut shell or synthetic beads which ruin the environment or are there better options out there? As one of my favourite girl groups from the 90’s said “No I don’t want no scrubs”.

I remember the days when I didn’t know much about exfoliation and I thought the more abrasive and more vigorous the scrubbing action meant that I achieved better results. Not only is this not true, but it can also cause micro trauma in the skin and the bacteria which naturally live on our skin can displace in these breeches in the skin and cause inflammation and infection. Nightmare! So what we do about dull skin which needs a revamp?

I have seen an explosion of products containing AHAs and BHAs all over Instagram. But do they actually work well? Which one is the best for your specific skin concerns? What about chemical peels?

Chemical exfoliant cleansers use different acids to help slough off dead skin cells by breaking off the bonds which hold the dead skin in place to reveal a healthy glow. In contrast to physical exfoliants, these chemical cousins are often applied after cleansing and left on to gently exfoliate skin without you even noticing it. For those of us who don’t know our AHAs from our BHAs, let me break it down.

Both AHAs and BHAs can be used to exfoliate the skin and remove dead skin cells to reveal radiant skin. Neither are necessarily better than the other so how do we chose between the two?

Well they both a fantastic job of exfoliating skin, decreasing inflammation, improving skin tone and texture and the appearance of pore and wrinkles. they can remove dead skin cells and unclog blocked pores. Sounds great doesn’t it? But why pick one over the other?

AHAs (alpha hydroxy acids) such as lactic acid and glycolic acid are water soluble and generally derived from fruits and can help peel off superficial layers of the epidermis of the skin which is great for combating hyperpigmentation, uneven skin tones and fine lines and wrinkles. They are better for drier skin types as they can enhance natural moisturising factors within the skin.

BHAs (beta hydroxy acids) such as salicylic acid are oil soluble and are able to penetrate the deeper layers of the skin deep into the pore to remove dead skin cells and sebum so are great for acne and skin damage. It also has soothing and calming properties for inflammatory skin conditions like Acne and Rosacea.

So can you use both together? Some brands offer exclusively AHA or BHA products, whereas others offer a blend of the two. You have several options depending on your specific skin concerns. You can either buy a blend of the two and simplify your life or you can alternate between the two and get experimental. Try alternating each day or try using one for one week and then switch to the other the following week. If your primary concern is cystic acne, a BHA or BHA/AHa combo could work for you. If you have dry skin and want to get rid of some of the dead cells, why not try an AHA? As with anything in medicine, there isn’t a one size fits all method. There is no right or wrong answer when it comes to chemical exfoliation. It’s all about finding what works best for you and your specific needs.

So what about other types of chemical exfoliations or peels? There are peels which contain other types of acid and usually penetrate deeper into the skin to give more noticeable effects. The medium type peels usually contain TCA (trichlorcetic acid). TCA Is easy either at a concentration of between 20% to 35%. Medium peels may also contain combinations with other agents which can enhance the effect of the peel so it can penetrate the skin deeper and reach the top layers of the epidermis as well as the top layers of the dermis. By reaching these deeper layers they can work to improve skin texture as well as target the pigment producing cells (melanocytes) to relieve the skin  of pigmentation which may be harder to reach with the AHA’s or BHA’s. These medium peels can also no work on precancerous lesions known as Actinic Keratosis to prevent these sites from turning into skin cancer. They do not claim to be effective for deep wrinkles and furrows, but can be effective for finer wrinkles and potentially acne scars (as long as they’re not too deep).

Deep peels as you might imagine target deeper layers of the skin (the dermis). So why opt for a deeper peel?  The deeper peels done in the medical offices mean that you can achieve more effective results in a shorter time frame as they are present in stronger concentrations and may add in prescription strength topical agents to make the peel more effective. Using an acid known as Phenols, they target the deeper layers of the dermis and cause injury. This injury then triggers a repair process and can be used to treat more severe deeper wrinkles as well as photoaging.

Although deeper peels can offer vast improvements, it’s worth noting that there is more downtime associated with these peels, meaning you are redder for longer. If you want to try a deeper or even a medium peel, make sure you don’t have one before an important event.  If you have a client facing job,  get the Peel done on a Friday and have the weekend to let the redness subside to avoid questions at work!

So are peels safe for everyone? Whilst AHA and BHA peels can be done at home and are generally safe and well tolerated for all skin types,  it is advisable to seek out a medical professional who is trained in doing deeper peels  to avoid any risks of complications such as scarring and pigmentation. This is particularly the case if you have darker skin type. Medium and deeper peels do target these deeper layers of the skin where the melanocytes live, and the more pigment the skin has naturally could mean more pigment is formed.

In summary, superficial peels are mild enough to  used daily. There are a great place to start and there are a wide range of options available to suit assorted needs. If you want to progress to something which might help remove more stubborn damage or pigment, then opt for a medium peel and this can be a really great alternative to laser treatment. If you decide to go for a deeper treatment, make sure that you seek out a medically trained professional and and it’s usually advisable to have treatments 3 to 4 weeks apart with a total of 5 treatments altogether.

Here are some of my favorites of each category so that you can give them a try. Do you have any recommendations?

Dr Abigail

AHA

  • T.L.C. Framboos Glycolic Night Serum (Drunk Elephant)
  • AHA product with mandelic acid (The Ordinary): best for sensitive skin

BHA

  • 2% BHA (Paula’s choice)

AHA/BHA

  • AHA 30% + BHA 2% Peeling Solution (The Ordinary)
  • Clarifying Cleanser C2 (Face Theory)

Medium Peel

  • Obagi Blue Peel Radiance

Deeper peel

  • seek advice from your skin provider

Tear troughs: To fill or not to fill…..

Happy Friday!

Today I would like to discuss one of the most obvious signs of ageing but notoriously difficult areas to treat: the under eye area (tear trough)

The skin around the eye is very thin (up to five times thinner than the skin of the rest of your face) and does not contain any sebaceous glands which helps to keep skin supple and moist. In addition, there are a lot of muscles around the eyes responsible for various facial expressions including squinting, crying and smiling. Rubbing of the area around the eye can cause the skin to stretch and contributes to laxity which can be difficult for even the best Aestheticians to rectify. Meanwhile, whilst we age, the fat pad beneath our eye which is usually held in place by ligaments can herniate as these ligaments weaken leading to a sunken, hollow appearance under our eyes making us look tired when we are well rested. If this wasn’t enough of a challenge to treat, the dermis (the mid-layer of the skin) which contains collagen and elastin also thins with age due to decreased collagen production and can make this skin even thinner, lax and saggy. So is filler the solution to all of these problems?

The eyes themselves are surrounded by complex vascular and lymphatic systems and when these lymphatic systems aren’t draining properly, this causes fluid to be built up and cause eye puffiness. Some clinics offer tear trough fillers, where they aim to lift out the sunken under eye appearance. However, I personally haven’t seen great results with this procedure as it doesn’t come without some serious risks. Even the best and most well versed Aesthetic doctors who offer this procedure cannot guarantee that the filler will not be injected into the main blood vessel which supplies the back of the eye and there have been cases where this causes permanent blindness. This is due to complex vascular anatomy of the under eye area. Although precautions can be taken to minimise this risk, including using a blunt-ended needle (cannula) to place the filler, it is still not a risk to be taken lightly. If you still decide to proceed, make sure you chose a Doctor to perform this procedure as they are more likely to be familiar with the facial anatomy and place filler in the areas where the vessels aren’t usually present.

During my time working in Aesthetic Clinics, I have seen many cases where the filler looks great initially and then patients call the clinic back complaining of uneven texture, worsening of the appearance of bags and chronic eye puffiness with friends and family persistently asking whether they are tired. The puffiness is often due to the fact that filler in the tear trough area can block the lymphatic system so that there is improper draining of the fluid in this area. As with most filler fails, the practitionner will offer hyalase to dissolve the filler in this area and facilitate drainage but then the client is left with overstretched skin in this area and can look worse off then they did in the first place. I have rarely heard of success stories using tear trough filler and would never personally offer to treat these areas at the expense of my patient to make a quick buck.

I strongly urge you to consider these points if this was a treatment you were considering. Additionally make sure you do your research into who is a medical professional to avoid encountering these risks. So if tear trough filler is a no no, what are the alternatives?

Stay tuned as I discuss treatment for the under eye area in my next blog post.

Wishing you a fabulous weekend.

Dr Abigail

Just breathe!

Happy Sunday morning!

As the quarantine lifted in London yesterday and pubs reopened some of us might be feeling a little worse for wear this monring! I’m still not absolutely comfortable with joining the masses just yet. Instead I have been focusing on trying to stay healthy and this morning I did my first Yoga session in a while on instagram live. During this yoga session, we started off by taking some deep breaths with our eyes closed and ended the session with Savasana. For those of you non-Yogi’s out there, Savasana is possibly considered one of the best parts of the class and it happens right at the end of the session. It entails lying on your back with your legs parted, palms facing the ceiling, eyes closed and relaxing each muscle from head-to-toe and basically just taking a complete time out from the world whilst still in a semi-conscious state (hard to stay awake I know). This part of the Yoga practice is often overlooked and I was quite surprised to hear the Yoga instructor announce that people were leaving prior to this part of the session. She thought that it was sad that people should not spare time for this crucial part of the practice and said that she thought we should reevaluate our lives if we can’t spare a couple of minutes of our day for this. Which got me thinking…

In pre-Corona times, which may feel like a distant memory now, we were so busy rushing around to and from work, to social events, to see friends and family and Corona (albeit terrible) forced us to slow it down a notch (particularly for us city dwellers). It gave us a chance to pause and to re-evaluate whats important to us and also for some us to try relaxation techniques we had never tried before. It gave us a moment to breathe, so why do some us still feel like we can’t relax?

In a study done at Harvard Medical School, they posted an article titled “Relaxation techniques: Breath control helps quell errant stress response”. As mentioned in a previous post, stress not only effects our skin, but also our immune systems and can even cause heart problems when we sustain a consistently high blood pressure. Although stress can be an inevitable part our existence and is often unavoidable, we can make attempts to curb stress and our response to it. Harvard found that invoking a resting state which can be achieved by yoga and meditation can fundamentally improve our stress response contributing to improved wellbeing.

In our day to day lives, we often breathe quite shallowly breathing from our chest as opposed to our abdomen. Shallow breathing means that less oxygen fills our lungs, causing us to feel short of breath and subsequently more anxious. We rarely take the opportunity to breathe deep into our lungs, fill our bellies and give our bodies the adequate oxygenation required and to slow the pumping of our hearts as well as lower blood pressure. I must admit, I rarely take deep breaths throughout the day and only really become conscious of my breathing at the end of the day when i’m in bed or if I make a conscious decision to do a Yoga session.

So how do we go about improving our breathing techniques? The best way is to come up with a ritual that works best for you. I recommend finding a quiet place in your house, most often I use my bedroom which I have tried my best to turn into a sanctuary. Then I usually light a candle. I like lying on a yoga mat on the hard wooden floor to ground myself. Then I take a deep breathe in through my nose, feel my chest and belly expand and then breathe out through my mouth (and try to relieve some tension with it!). Some people may find it helpful to count 4 seconds in and 4 seconds out but I personally don’t like doing this. You can lay here breathing for 10-20 minutes and hopefully make it a part of your daily routine, devoid of glaring screens and background chatter. When you’re ready to rejoin the world, wriggle your fingers and toes to invite life back into your body and then turn to one side and sit up slowly and in your own time.

If meditation or yoga is something you haven’t tried before, then why not give it a go. It costs nothing, takes a small part of your day but can be excellent for your health and wellbeing.

Dr Golban

Hair today gone tomorrow…

There are many reasons we may want hair removal ranging from low self esteem to medical conditions such as hirsuitism (excessive hair growth seen with polycystic ovaries). Whatever your personal reason for wanting hair-free skin, I would like to discuss some options with you which I have found to be the most effective.


As mentioned in my previous blog post, I don’t particularly recommend IPL for hair removal as I have not seen great results and it is contraindicated in people with darker skin types. That being said, what options are available and for whom and what are the precautions we need to take?

The two lasers I’m going to discuss today are Alexandrite used to treat dark hair/light skin and nd yag used to treat dark hair/dark skin.

Alexandrite is used to treat Fitzpatrick type 1-3 skin and works on dark hair only. It uses the principle of photo (light) thermo (heat) lysis (destruction) so uses heat and light to destroy the hair follicle. It is not recommended if you have an active tan as it can destroy melanin and give you white patches on your skin (hypopigmentation). Much like IPL, no anaesthetic is generally required, you wear goggles and the sensation feels like a snapping elastic band. Afterwards an ice pack or aloe Vera can be used to soothe the skin. Take care not to scrub or exfoliate the skin after treatment as the hair should shed of its own accord and may take a few days to do so. If the area treated is in a sun exposed location e.g your upper lip, make sure to wear sunscreen to avoid post inflammatory hyperpigmentation.

Next up is Nd:YAG, a laser which has a wavelength of 1064 nm which means it has the capability to penetrate deeper layers of the skin than other lasers. It can reach the mid-layer of the skin (the dermis) and creates a beam of high energy focused light which again creates heat and destroys cells of the hair follicle causing the hair to fall out. The Nd:YAG laser can be used to treat darker skin types (Fitzpatrick 4-6) as it can distinguish between subtle tones in colour so can distinguish between the melanin in the hair from the melanin in the skin, not burning the skin and causing hypopigmentation. The theory is that as YAG has a longer wavelength, it bypasses the pigment in the skin to target the hair follicle located in the dermis. However, always check with your provider if you are of a darker skin type and always request a test patch on a inconspicuous area of skin to see how their laser works for you.

Both of these methods of hair removal are considered temporary although they can have considerably lasting effects. The rate of regrowth depends on your hormones. It is recommended to have 3-6 sessions, 3-8 weeks apart and to shave between each treatment. The reason several sessions are required is because there are three stages of the hair cycle and one session on one given day may not target all of the hairs as they may be in different stages of the growth cycle. After your initial course of treatment, you may require yearly top ups. As with any laser treatment, try to avoid sun exposure and fake tanning products prior to treatment and if you have an underlying hormonal imbalance such as polycystic ovaries, expect that the hair growth may be more difficult to combat.

I hope you have found this article useful and when laser clinics reopen, perhaps you can finally get round to throwing away your razor (once you’ve completed your course of treatment of course).

Dr Golban

is IPL good bang for your buck?

Continuing the theme of lasers this week, I would like to discuss IPL with you and how it fairs with other resurfacing and rejuvenating treatments out there.

IPL stands for Intense Pulsed Light and it is a non-invasive, non-ablative treatment which can be used to treat a multitude of skin complaints from wrinkles and sun spots to port wine stains and even hair removal. It works by using light to target hemoglobin (the reds) and melanin (the browns) making it effective for vascular and pigmented lesions respectively. But does it really work?

The IPL machine uses light and converts this energy into heat which can target and damage the area you wish to have treated. The machine uses many different wavelengths instead of just one and filters can be used to make the wavelength being targeted more specific to enhance penetration and the overall outcome.

As with Fraxel (mentioned in my previous post), IPL is also considered a resurfacing treatment and given the fact that it is non-ablative (penetrates the dermis or mid-layer) and leaves the epidermis intact, the results aren’t as effective as Fraxel which targets both the dermis and epidermis. However, both Fraxel and IPL can be done in the same sitting and can work synergistically to provide skin rejuvenation. The advantage of IPL is that there is minimal down time as it’s a non-ablative treatment and also it costs a fraction of what Fractional laser costs.

Moving on to it’s specific uses, as I mentioned it can treat three main categories; vascular lesions, pigmented lesions and hair removal. I will now talk about each of these in turn.

Vascular lesions include Telangiectasia’s more commonly known as thread veins or spider veins as well as port-wine stains and birth marks. It targets the red hemoglobin in these lesions and destroys it whilst leaving surrounding pigments and structures in tact.

Pigmented lesions include age spots, freckles and melasma. In these cases, IPL targets melanin, the pigment produced by melanocytes and again destroys it. The freckles or age spots may initially become darker after treatment as the pigment disperses, but then it gradually fades over time and with repeated treatments.

IPL can also be used for hair removal, although I don’t necessarily recommend it for this purpose as there are better options available (more on this later). It works by targeting the hair in the follicle, damaging it and subsequently the hair is lost. Considering it needs to target pigment to be effective, the darker the hair the better the result, with light skin and dark hair being the combination which is most effective. The reason being is that dark hair contains the most pigment and if the skin is too dark (Fitzpatrick 3 or higher), the laser cannot distinguish between the pigment in the skin and the hair and can infact cause burns on the skin! If you have a darker skin type, there are other options available and I will describe this in separate post.

If you are considering IPL treatment, it is advisable you avoid sun exposure as well as fake tan products for a month prior to treatment to avoid burns to the skin. It is a much more tolerable treatment than Fraxel so does not generally require topical Anaesthetic. I would describe the sensation as an elastic band pinging on your skin. I think that is more the element of surprise about when the sensation springs up on you as you have your eyes covered by goggles so it makes it difficult to know when it’s coming. If this surprise is too much for you, you can ask the practitionner to do a countdown before each shot is administered. It can cause your skin to feel quite heated so a cooling gel is applied throughout the duration of the procedure and aloe vera can be applied afterwards. The procedure itself doesn’t take long (roughly 20 minutes) and you don’t need to wait for anaesthetic to work so it can be a great lunch time procedure and you can return to work afterwards (albeit a bit red).

Some things to bear in mind is that it is generally a safe and effective procedure, however, as with anything in life there are risks involved. The machine prompts the practitionner to select the patients skin type and sun exposure and adjusts the strength of the laser accordingly. It is crucial to be honest and open with your practitionner about recent sun exposure or tanning products to avoid burns and blisters from forming i.e. be a good patient! As IPL detects pigment and isn’t the most targeted treatment out there, it may destroy pigment in other areas surrounding the area being treated causing paler or darker patches known as hypopigmentation or hyperpigmentation respectively. Additionally, some hair may be lost (i’d see this more as a bonus than a deterrent)

All in all, IPL is one of the treatments which provides the greatest bang for your buck. I would highly recommend it for photoageing and reversing sun damage as well as for vascular lesions. You can potentiate the effects by using it with Fraxel for maximally flawless skin. I am still skeptical about it’s use for hair removal as there other options available out there. For the best results aim for 4-6 sessions every 3-6 weeks and I would advise doing this during the winter time when there is minimal exposure (unless your fortunate enough to have a winter break of course).

What are you experiences with IPL? Is it something you’d be interested in trying?

Dr Golban

Are facial resurfacing treatments worth the cost?

Today I would like to talk about resurfacing treatments, namely fractional laser (Fraxel).

Fraxel is a non-invasive resurfacing treatment which targets both the superficial layer of the skin (the epidermis) as well as the mid-layers of the skin (the dermis) for both ablative and non-ablative effects. But is it really worth the money? How painful is it? What are the risks involved?

Sadly as we age, our epidermis thins and blemishes become more apparent. Paired with loss of collagen in the dermis, this can lead us to look more aged, wrinkly and have poor skin texture and quality. Luckily, fractional laser targets both of these layers and can restore our skin to give it a more youthful appearance. Win win!

However, it can be a costly procedure to consider (in the UK it costs £500 for the full face and around £1,500 in the US) so it’s worth knowing more about it before taking the plunge.

Fractional laser has a whole host of indications from scars to anti-ageing. Due to it’s collagen stimulating properties, it can be used for resurfacing scars following acne, surgery or trauma. This has had some really successful outcomes and can be done in conjunction to IPL lasers if there is any redness in the scar (more on this topic in later posts). It also has anti-ageing properties and can stimulate collagen production in the dermis as well as target and breakdown pigment in the skin by targeting the pigment producing cells (melanocytes) in the epidermis. Additionally, Fraxel has the potential to treat the notoriously difficult area under the eyes to combat wrinkles. However, this depends on the experience of the practitionner as there is a small risk of causing blindness. If you wish to treat the under eye area, chose your practitionner wisely and enquire whether they offer this service and how they go about doing so. Fractional laser tightens but doesn’t lift. This means it can make skin feel more taut and improve the texture and quality, but it won’t give you gravity defying effects such as lifting jowls, so make sure you adjust your expectations accordingly. It can be done anywhere on the body but is most commonly done on the face, neck, decolletage and hands. In short, it’s a multi-beneficial skin restoring, anti-ageing superstar when done and managed correctly, it can give you a glowy boost that no other potions and lotions can.

With any procedure there can be risks involved, however, the risks with Fraxel are minimal. Although it can be used on skin types Fitzpatrick 1-6 and often aims to alleviate skin conditions with hyperpigmentation, it can unfortunately also cause post-inflammatory hyperpigmentation in some cases. This is of particular concern to those with darker skin types and those who suffer from melasma. To minimise this risk, the laser machine takes into accounts various parameters such as age, skin type, sun exposure and area of the body treated and adjusts the settings accordingly to err on the side of caution. However, I would still avoid Fraxel in patients with Melasma as it’s potentially not worth the risk of exacerbating this condition.

If you are considering booking appointment for this procedure, it is worth avoiding using retinol-based creams for a month prior to the procedure as well sun exposure to the affected area. You can wear make up on the day of your appointment as this will be cleaned off beforehand.

Upon arrival to the clinic, your skin concerns are addressed, the procedure is explained, informed consent is obtained and a series of before photos of the areas to be treated are taken. This is followed by a topical numbing cream which is applied for up to an hour prior to the procedure, unless you are extremely brave. Then the face is cleaned and a white pencil is used to sectioned off the face into smaller segments. Your personal parameters such as skin type and sun exposure are entered into the machine and we have lift off! A small rolling pin is rolled across each segment of the face in 3-4 different directions known as “passes”. Sometimes there is a crackling sound, this is the moisture that is left in your skin following the anaesthetic or the cleaning solution evaporating from your skin and is nothing to be concerned about. A full face takes around half an hour and the third or fourth pass of the laser over one area of skin may become more sensitive, particularly on more bony areas such as the jaw. It’s nothing too unbearable though. Once completed, I generally like to apply a soothing aloe Vera lotion as you may feel as though you have sunburn. Then of course I apply sun cream liberally over the treated area and recommend you continue doing so daily, forever and forever.

Usually 3-5 sessions are recommended, with each session lasting half an hour and each session should be done a month apart. The results are cumulative, so don’t expect perfection from the first session, it will come with time. Particularly as it takes a few days for collagen synthesis to be stimulated and occur. Expect to look and feel sunburnt immediately afterwards. For me this lasts around 2-3 hours. It is advised to avoid exercise for up to a week afterwards. This is because your skin may be red and swollen for a couple of days afterwards and you don’t want to aggravate this further. If the Fraxel is done particularly aggressively, you may experience crusting on the skin for 1-2 weeks post-procedure. Try not to pick any scabs as it could cause scarring and send you back to square one. I personally have not experienced a significant amount of crusting but I did notice my skin was relatively dry from around day 3 afterwards and I could feel that my skin was slightly rough to touch, which isn’t surprising considering it is a resurfacing treatment. This is nothing to worry about and generally subsides within a week or two. I would recommend using a gentle cleanser afterwards such as Cetaphil or CeraVe, as well as an antioxidant such as SkinCeuticals CE ferulic acid and also a great moisturiser such as Obagi’s hydrate. Also, very important to wear a good, high factor spf daily to prevent all of the benefits being undone and rendering your treatment ineffective.

If you’re still not sold on Fraxel laser, or don’t have the spare cash at the moment, there are cheaper and less daunting options available. These options include chemical peels such as the Obagi Radiance blue peel. These cost less than laser, have less down time and can work really well for Sun spots. I am personally a fan of both but do not recommend having them in conjunction with each other, especially not in the same sitting as they both target the superficial epidermis and can really aggravate your skin. If you have fractional laser, I would recommend waiting one month before having a chemical peel just to ensure the skin barrier has appropriately healed.

I hope you found this blog post educational and informative for those of you wishing to know more about Fraxel, to those of you who haven’t heard about it before.

If you do decide to go ahead with a course of treatment, it might be a great idea to do your own before and after photos to document your own progress as it’s a relatively long term treatment so can be difficult to remember where you started. Stay tuned for more posts about laser treatments.

Dr Golban

Hello sunshine!

With the sun making its appearance and the continued lock down situation, we’re feeling more restless than ever, particularly in London where the cities parks morph into a sea of people.

For those of us who love to bask in the sun all day long to those who prefer being indoors or in the shade, it is important to wear sunscreen! As the saying goes: nothing looks better in your 50’s than good skin care in your 20’s.

This point really drives home with me as I spent a couple of years living in the Caribbean in my 20’s and did not diligently use sunscreen. This is something I regret and since working in skin care clinics for the past 3 years, this has become number one in my beauty staple. I have seen first hand the damage the sun can do and how many people seek treatments that aim to undo the damage done in our youth.

Great sunscreen contains protection against both UVA and UVB and if you want to be really cautious, some brands also protect against the blue light from computer screens and phones, an important consideration for our generation. UVA are the rays which cause premature aging as they permeate the deeper layers of the skin and cause wrinkles known as photoageing. UVB rays play a part in sunburn and deadly skin cancer known as melanoma.

Here are my top 3 suggestions for sunscreen ranging in price but not compromising on quality.

1. Altruist spf50: this brand is developed by a dermatologist who believes that price should not be a barrier to sun protection. I love using this cream for my body and even purchase has proceeds which go to a charity for black albinos. Win win situation!
2. Heliocare 360 comes in a cream and a gel format. This is a personal favourite as it has the added bonus of protecting against infrared rays present in screens which can also cause collagen breakdown and subsequent wrinkle formation. I use this cream primarily on my face and it goes on well under make up, doesn’t leave residue and is a true well rounder.
3. Murad city skin: this is most expensive spf that I’m mentioning, but goes on like an absolute dream and has a slightly peachy tone which can correct skin damage from previous exposure. As this is in the higher price point, I would say that you only splurge on this cream if you don’t feel guilty about using it. I have found that pricier products can cause us to use the product more stringently as we want the product to last. However, cost shouldn’t really act as barrier to stop us from protecting our skin.

I hope you find these tips useful and if you have noticed sun damage, fear not I have upcoming blog about options available to help relieve this. Stay tuned.

Which suncream do you use? Any recommendations?

Dr Golban

Stress and our skin

As I’m sure we’ve all experienced varying amounts of stress during the pandemic over the past few months in addition to our usual stressors, it’s important to consider the impact it’s having on our skin and try to limit its effects.

Stress makes our body produce the hormone Cortisol which is pro-inflammatory and can make inflammatory skin conditions like acne much worse.

By adopting mindfulness into our daily lives, we can minimise stress and in turn improve our skin quality.

This premise entails becoming fully aware of our responses to certain situations so we can connect with the present and draw our attention to what we may be feeling and curb these thoughts before they overwhelm us and get beyond our control.

There are several ways to practice mindfulness by being alert in the present world. Here are some ideas you can try at home.

1. Meditation; I use the Calm App and I find it really useful as you can practice mindfulness for as little as 10 minutes, do it practically anywhere and achieve a multitude of beneficial effects such as reducing stress to even quitting smoking, both of which can wreak havoc for our skin. This can leave us feeling refreshed from the inside out, ready to face the world


2. Yoga; this is my personal favourite as I find it a great way to unwind and also to realign the body. I use a combination of YouTube videos to practice Yoga such as Boho Beautiful and Yoga with Adriene.


3. Breathing exercises: this can be done as an adjunct to yoga and regulating our breathing can have profound beneficial effects on our wellbeing.


4. Running: I recently took up running using the couch to 5k app on the NHS website. Honestly, I loathed running before I started and now I am able to run 5k which I never dreamt I could do! I can now see how people find it cathartic as it’s a great stress reliever.


5. Finding the root cause of stress and coming up with solutions e.g. if work is stressful, find ways to delegate tasks.

By incorporating these practices in to our daily lives, we can reduce stress and it’s impact on our skin as well as ensure we live longer healthier lives and look great whilst doing so!

Have you tried any of these methods? What works for you?

Dr Golban