A perfect nose for Christmas in your lunch break

Everybody now seems to know that you can soften lines and wrinkles with ‘botox’ and fillers, and that cheeks can be nicely augmented with injectable ‘volumisers’. One procedure that most people are still unaware of however is non-surgical nose-shaping - and yet the results are amazing and the procedure is very quick and uncomplicated.

Non-surgical nose shaping is a relatively new variation of treatment with a hyaluronic acid filler. In our clinic we use a filler with added local anaesthetic, so that the procedure is virtually painless in most patients. 

Not everybody is suitable for this treatment, but if you are, then this is a great alternative for a surgical ‘nose job’ (rhinoplasty). We can treat for example bumps on the bridge of your nose and an uneven shape to the bridge of the nose (for example after trauma or surgery). Often the nose might even appear smaller compared to before treatment. I also frequently have patients coming to see me in clinic, complaining that they can’t wear glasses or sunglasses, as these tend to slide down, due to the flatter shape of their nose. Through means of non-surgical nose shaping we can now build up flat noses, giving them a beautiful, even profile and thus reducing the problem of ‘sliding glasses’. 

Looking Great in 2011

I am pleased to announce that on the 28. January I will be holding an exiting work-shop with two brilliant colleagues on how to look your best in 2011. This will take place in our Chelsea Bridge Clinic. Places are filling up quickly, so to book your place call: Tel. 020 7467 8500 

Are you feeling the seasonal itch?

Have you noticed over the past week or so that your skin seems drier? You’re not the only one. Dry skin is an extremely common complaint that affects up to 40% of us. Interestingly, the paler your skin, the drier it’s likely to be although science hasn’t yet discovered precisely why.

I’m sure you’ve already guessed that the changing weather might be causing your drier skin. But why does winter make our skin drier? Well, there’s something in the air. Outside, it’s getting colder, drier and windier while inside, central heating parches the atmosphere, meaning moisture evaporates faster from the skin surface. This ‘double whammy’ significantly lowers the water content of the skin’s horny layer. So what does that mean, exactly?

The skin is composed of three main compartments -  from the bottom up, the subcutis, or deep skin ‘cushion’ of fatty tissue, the dermis of firm connective, supportive tissue and the epidermis, the skin’s outer protective layer. Most surface signs of ageing such as wrinkles and loss of elasticity begin deep in the dermis. But it’s the epidermal top layer which regulates water homeostasis - the skin’s moisture quota. In most parts of the body, the epidermis is paper-thin and it is the most superficial sheet of the epidermis - the stratum corneum, or ‘horny layer’ that plays the most crucial role. 

Think of this horny layer as a microscopically tiny mortar/brick wall. The bricks are flat, horny dead skin cells and the mortar consists of lipids - ceramides, free fatty acids and cholesterol - which cement them together. This protective horny barrier has two key functions - to keep environmental hazards out and to keep water in. And it usually does both pretty well.

But certain internal and environmental conditions can reduce the lipid content between cells, so that water evaporates more easily from the skin surface. A genetic tendency to dry skin, hormonal influences, metabolic diseases (an underactive thyroid gland, say, or diabetes), impaired kidney function and, of course, age all compromise skin lipids. Medication such as Vitamin A acid tablets and drugs that lower cholesterol as well as certain blood pressure lowering drugs won’t help. Neither does an unbalanced diet, excessive weight loss or sadly, increasing age.

So if you are suffering from dry skin and ‘winter itch,’ here’s the strategy. Try to reduce contact with water and limit your use of soap and detergents. If you’re wrapping up against the chill, avoid scratchy fabrics such as wool and opt for soft thermal cottons and fleeces instead. And give that stressed, horny skin layer a helping hand.  A lipid-rich moisturizer will help to reinforce the skin’s protective barrier, minimize water loss and calm itching instantly. My top tip is to apply it when your skin’s still damp from the shower to trap even more moisture in the surface layers. Now that’s a soothing thought.

Can Botox make you happier?

I just read a very interesting study* performed at the highly reputable School of Psychology at Cardiff University. In this paper the investigators wondered whether injections with botulinum toxin (botulinum toxin is the active ingredient in ‘Botox’) might be useful in cases of depression.

It has long been believed in psychological circles that the actual act of frowning itself can make us feel unhappier. This is believed to happen via facial feedback mechanisms. What this basically means is that if you frown, your brain ‘thinks’ you must be unhappy and provides the corresponding feeling to your facial expression. Cosmetic botulinum toxin treatment on the other hand temporarily reduces the activity of the facial muscles we need to frown. So the question is, if we are no longer able to frown, would that lead to a less negative emotional state? In other words, can we ‘trick’ our brain (by not allowing our frown muscles to do their job) into ‘thinking’ that we must be happy?

Lewis and Bowler put this theory to the test and compared the mood of people who had received cosmetic botulinum toxin treatment with people who had received other cosmetic treatments. Amazingly they found that cosmetic botolinum toxin treatment does indeed correlate with a significantly less negative mood.

Does this mean that people with depression should now receive botolinum toxin injections instead of counseling, psychotherapy and anti-depressants? A good friend of mine, Dr Malin, a lovely Norwegian psychologist practicing in London, comments “It has to be remembered that this study does not indicate that Botox can successfully treat depression and that it can as such replace other treatments for depression. I would therefore highly encourage anybody going through a depressed stage to seek appropriate psychological help."  I couldn’t agree more. However, this is a very interesting study and I am looking forward to further studies in this area.

*J Cosmet Dermatol. 2009 Mar;8(1):24-6 

The day our skin sins finally give us away

When we holistically access a cosmetic patient in clinic, dermatologists look at three key problem areas – a) lines and wrinkles; b) loss of volume and contour; and c) skin surface and texture problems. While early cosmetic treatments were all about ‘chasing’ lines and wrinkles, over the past couple of years there has been plenty of hype about re-contouring and volumising the face. There’s no doubt that plumper cheeks and a firmer jawline give a more youthful profile. Yet a good daily skincare regime can work wonders for your skin surface and texture, while improving elasticity, irregular pigmentation, fine lines and wrinkles.

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There’s no doubt that the right skincare can also delay the need for minimal invasive procedures and even surgery. But here’s the problem. There’s a jungle of extremely appealing skincare products on beauty shelves and counters out there - even practitioners find it hard to judge which ones come with serious scientific back-up. Marketing bumf can be so misleading….

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In clinic, patients are always asking me what skincare regime I recommend as a dermatologist. That’s why I have developed EudeloBoutique.com. Here I give expert tips and advice on how to look after your specific skin type and offer a hand-picked choice of must-have products I believe will work. It’s my hope that this new website will change the way people look after their skin and help them to stop wasting cash on so-called luxury products that frankly don’t deliver.

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As a dermatologist, I can't stress strongly enough how crucial skincare is. In our 20s, mother nature helps us to hide most of our 'skincare sins'. But from our 30s onwards, our skin is much less forgiving and it becomes more and more obvious how well it’s been looked after over the years and whether or not we’ve used regular sun protection. So don’t think skincare doesn’t make a difference. It’s no quick fix - we’re talking months to years, rather than days or weeks. But it’s worth it in the long term. So my advice is to choose your skincare wisely - and stick to it.  

Summer and skin – a love / hate relationship

We so deserve the gorgeous weather we’ve been having recently - even the odd shower doesn’t seem too bad now. But sitting in a London park recently for my lunch break, I couldn’t help but notice all those pale skins turning red in the sun. Surprising?  We’re in the UK - not Spain or Italy - after all.  Sorry to rain on your parade, but the average skin ‘suntype’ in the UK is simply not made to deal with the sun’s harmful rays, even on home turf. Yet we’re always so relieved when our summer finally starts, many of us forget to take precautions and bask in the direct sun at high noon without sunscreen - gradually turning into lobsters. Maybe most people assume that since we’re here and not somewhere in the Med, the sun can’t be that bad, can it?

Well, you might be surprised to hear that we have extremely worrying skin cancer rates in the UK. Our rate of melanoma - the most serious type of skin cancer - is above the EU average. Interestingly, skin cancer rates in affluent areas are much higher compared to those in more deprived areas, but overall cases are rising steeply, with almost a third of all cases affecting women under 50. According to the British Association of Dermatologists, the incidence of melanoma is increasing faster than any other common cancer - rates are doubling every 10-20 years and projections suggest they’ll continue to rise until 2024!

One reason must be that we still see a tan as so attractive, it’s worth the risk - as I observed in the park the other day. But the good news is that at least we’re starting to teach our kids about sun protection. I was delighted to receive a letter from my children’s head teacher last week, reminding parents to apply sun protection to their kid’s skin each morning and send them to school with sun hats. An excellent start.

So here’s a thought. If we adults protected our own skin as well as our kids’, we’d have a win-win situation. Serious sun protection includes not sitting in direct sun, especially around noon and always apply a good broad-spectrum sunscreen product of at least SPF30 regularly.  For everyone’s sake - save your skin.

Feet that look fab in flip-flops and legs worth showing off? I've found the perfect solutions

At last, it's time for bare legs and strappy sandals. Dreading exposing those pasty-pale legs and rough, dry heels? You're not alone. A long winter's neglect - not to mention central heating - can leave the skin on your feet dry, thickened and maybe even cracked. Plus, it's a fair bet that your legs haven't seen daylight in months. But whoa there, no knee-jerking - sunburn's not the way to give your legs a dress-friendly glow. I've found far more effective solutions to prepare you for the great summer reveal.

So, feet first. Let me introduce you to the perfect pedi - in a jar! Minor miracle 'NeoStrata Problem Dry Skin Cream' contains high strength (20%) alpha hydroxy acids, which will progressively soften and smoothen even very dry, tough skin on your heels. (In fact if it doesn't do the job, you may have a skin condition that needs medical attention - see me in clinic if you're worried).

Now for those legs. Flatter them with GloMinerals Body Glisten, a refreshing lotion with a wonderfully subtle shimmer that gives skin a smooth, even glow that also helps to make them look more slender and shapely - a best-kept celebrity secret.

Now flex those feet and liberate those limbs!

Why no-one should trust those ‘All skin types’ labels

Whenever I snoop around department stores or ‘mystery shop’ at beauty counters, the abuse of the phrase ‘for all skin types’ really annoys me. No matter how many times you read this on packages, to a dermatologist, it’s nonsense. And while I fully appreciate that the more people a product appeals to the better its profit margins, what I don’t understand is how it can attract loyal customers. Surely at least half of those who believed the ‘for all skin types’ promise won’t just end up disillusioned - they’ll share the bad news with their friends!

I can tell you that every single week I have patients sitting in my clinic with breakouts, simply because they’re using the wrong type of skincare product for their skin.  And this, by the way, is something they’ve often been advised to use by a supposedly experienced beauty consultant. While we’re talking about consultants, sadly I have to report too, that many have a shockingly poor knowledge about even the basics of skin biology and the science (if any!) behind the products they’re selling.  Apologies to anyone not falling into this category - and I would be truly delighted to be proved wrong next time I approach a beauty counter. But it does seem that too many of these super-groomed ‘know alls’ well……don’t, actually. 

But let’s not digress. What I really want to say is that skincare should always be adapted to individual skin types. In the majority of cases, one simply does not fit all. While dry skin needs a re-hydrating, lipid-rich cleanser, say, oily skin prone to breakouts would benefit from a foaming cleanser and should use only oil-free products. I feel strongly that many skin problems could be avoided if people received the right advice from companies less interested in making a quick buck and more dedicated to offering long-term, tailor-made solutions. So next time you are tempted to buy a product at the beauty counter, be wary about those ‘All skin types’ products.

Chocolate’s good for your skin – we’ve proved it!

A moment on your lips - an outbreak of zits?  Chocolate has long been stigmatized as a skin enemy, causing spotty, oily skin. The role of diet in acne remains highly controversial -  numerous scientific studies have failed to demonstrate that chocolate aggravates acne, yet many sufferers claim there’s a clear link. Clearly, this is an area that needs even more research.  But in the meantime, here’s the good news for chocolate lovers. We have recently completed a controlled scientific study at the University of the Arts, Cosmetic Science that indicates chocolate may help protect skin from sun damage.

You might know that cocoa beans fresh from the tree are exceptionally rich in antioxidant flavanols. The problem is that conventional chocolate making methods greatly deplete antioxidantactivity in all types - milk, dark, organic or regular. The new Acticoa method however, preserves the fresh beans’ flavanols - and it was this type of chocolate that we clinically tested under highly controlled conditions. What we found was that eating small amounts daily for twelve weeks more than doubled skin’s natural protection against sunburn, while normal dark chocolate had no such benefits. Our findings have now been published in the Journal of Cosmetic Dermatology.

So my advice would be that if you love chocolate, make sure you choose a bar with the ‘Acticoa’ logo and the highest possible antioxidant content. But don’t give up your regular broad-spectrum SPF30-50 protection. Chocolate’s by no means the ultimate UV-defense - but every bite helps!

Honoured to be named one of UK's best cosmetic doctors

I've finally escaped Volcano chaos and arrived back in the UK to some fabulous news.  In their current issue, Tatler magazine has named me as one of Britain's best cosmetic doctors. It goes without saying, I'm thrilled to be honoured. Thank you Tatler!

A distressing spot of bother?

The other week I read in a major newspaper that we, as patients, are wasting billions of pounds on the NHS because we see our GPs with only ‘minor’ ailments. One of these ailments the article quoted was acne. As a dermatologist, I was shocked and outraged. Just because acne is so common - not only among teenagers but increasingly in women in their 30s and 40s, too - that doesn’t mean it should be accepted as inevitable. Acne is a distressing condition that can result in permanent scarring.  Can anyone give me another example of an often disfiguring disease affecting the face that would be tolerated without trying everything under the sun to resolve it?  Frankly, I can’t think of one. So why is it that in the UK, acne is often accepted with stoical patience by so many patients who believe they must endure it without complaining?  When I have mentioned their child’s truly dreadful outbreak, I’ve even heard a parent refer to it as ‘only acne.’

How tragically wrong that parent’s attitude was. In a study published in the British Journal of Dermatology, Professor Gupta, MD and professor in the Department of Psychiatry at the University of Western Ontario, Canada, found that even non-severe acne can cause profound emotional problems such as depression and even suicidal thoughts. Acne has also a significant impact on the patient’s quality of life. I would always strongly encourage anybody suffering with breakouts to see a dermatologist to get started on treatment – before scaring occurs! There are now highly effective treatments available, one of which can even switch acne off for good in the majority of patients. Above all, please never feel you’re a time-waster. The only possible waste is the time you’ve spent feeling distressed. 

Pigment - The good, the bad and the ugly

Still hankering after that golden glow? Sorry to tell you, but all tans are not created equal. Human skin has two main types of pigment - eumelanin and pheomelanin. Under the sun, fair skin generates more pheomelanin - a reddish, yellow-brown tone, while dark skin makes mainly eumelanin, a black-brown melanin - the best quality for natural UV-protection. Pheomelanin is less stable and breaks down when exposed to UVB rays, generating free radicals in the skin. So instead of protecting against the sun, pheomelanin actively contributes to UV-induced skin damage - the reason why fair, freckly skin types are at most risk of sun damage. Scientific studies have shown that not only sunburn is a sign of skin damage - in fair skins, tanning is too. For this vulnerable skin type, sun protection equals skin preservation. The best way to protect fair skin is to avoid the sun wherever possible - especially between 10am and 4pm on holiday. Back in the real world, this isn’t always possible, so a good sun protection cream is the next best thing especially for your face, hands and chest.
Remember ultraviolet A (UVA) rays are the most ageing in the sun’s spectrum and can penetrate clouds and glass. To keep your face and décolletage skin young, you need to apply sun protection every single day, all year around. I recommend a broad-spectrum (UVA/UVB) SPF20-50 sunscreen cream instead of a morning moisturiser. When you choose the right texture for your skin type to prevent breakouts and blocked pores, you can regard it as your No.1 anti-ageing skin-saver.

Self tanners - really harmless?

How safe is it to fake it?  Self tanners have traditionally been seen as an easy way of getting a sunkissed look without risking UV-damage. And although I agree that they’re much less harmful for your skin than baking on a beach or - heaven forbid - a sunbed, I do have my reservations. And that’s apart from the ‘burnt biscuit’ whiff….

Self-tanning formulas usually rely on DHA (dihydroxyacetone), a sugar-derived molecule that stains the horny layer of your skin brown due to a chemical process called the Maillard reaction. Self-tanners don’t induce real pigment formation then, but only stain the skin’s surface layer. Sounds harmless. But  the ‘Maillard’ reaction still generates a certain amount of free radicals and oxidative stress in your skin. And although that amount may not be high, I personally try to avoid products that generate free radical activity in my skin, in order to limit the risk of premature ageing. It is also important to remember that unlike a natural tan, the colour you get from a self-tanner provides hardly any sun protection at all. 

So my advice is, love and accept your skin’s natural colour. Noticed how more and more celebrities in glossy magazines are dumping the perma-tan in favour of their own, natural tone? Each skin colour has its unique beauty.  So isn’t it time we celebrated that? 

7 days to change the future for your skin

Want to make an investment that pays serious long-term dividends? Change one thing in your life each day for the next seven days, and it could dramatically change how well your skin will age. In time, you’ll look 10 years younger than your contemporaries who have kept up their old habits. Here’s what to do.

Day 1: Stop smoking. This is one of the single, most crucial moves to keep your skin looking young. Come on - it’s never too late!

Day 2: Start using broad-spectrum (UVA / UVB) sun protection. Instead of your regular moisturiser, switch to an SPF20-50 formula and use it every single morning, year-round - summer and winter. I use an SPF50 product whether or not I plan to spend time outside. Aiming high with sun protection is important, since studies have shown that we rarely use enough product to reach the SPF factor stated on the package! And sun beds? Don’t even go there…

Day 3: Get the antioxidant habit. Apply a good antioxidant serum to your face, neck, chest and hands every morning before you apply sun protection.

Day 4: Change your diet. Make sure you include lots of fresh fruit and vegetables, low-GI carbohydrates, lean, high-quality protein and unsaturated fats.

Day 5: Drink 2 litres of water daily. You can also include unsweetened white or green antioxidant teas in your quota.

Day 6: Start using a vitamin A ‘repair’ cream. Apply it to your face, chest, neck and hands each evening. Look for over-the-counter products containing retinol or retinaldehyde, or ask your dermatologist to prescribe a ‘gold-standard’ tretinoin cream. As vitamin A derivatives can be potentially irritating, they need to be adjusted to whatever your skin tolerates.

Day 7: Make sure you have enough sleep and reduce your stress levels! Sleep deprivation and stress raise your levels of cortisol - a hormone known to have negative effects on collagen metabolism. Did you know too, that increased cortisol levels due to chronic sleep loss can lead to insulin resistance, a risk factor for obesity and diabetes?

It only takes a week to change the future of your skin. Start now - and prepare to look fabulous for your age!