It is now accepted that much of the progressive deterioration of facial skin that occurs with ageing is caused by the cumulative effect of years of exposure to damaging UV light. Sun-protection is not something to be adopted for just a few weeks in the summer but should be considered all year round. Significant amounts of harmful UV rays pass through clouds; this means wearing sunscreen even on cloudy winter days in the UK.

Sunlight exposes you to two kinds of UV light. These are known as UVA and UVB.
The effect of UVB rays is quickly noticeable – they cause redness and sunburn. However the effect of UVA rays is much less apparent but these are the rays largely responsible for skin cancer and photo damage such as wrinkling and pigmentation. Hence just because you don’t sunbathe or get tanned doesn’t mean that you do not need to wear sunscreen.

Many day creams, moisturisers and make-up now contain a Sun Protection Factor (SPF) usually SPF 15-20 but I believe that the recommendations for daily, year round SPF will undoubtedly increase. One of the problems with wearing higher SPF creams is that many people find them unacceptably thick and white; hence I am always looking for a high SPF sunscreen that is cosmetically acceptable in use. In this regard I am very impressed with the Glō Therapeutics Oil Free SPF40+.

Glō Therapeutics Oil Free SPF40+ provides broad spectrum sun protection with added hydrators and anti-oxidants. It is a non-greasy, lightweight sunscreen that can be used as a standalone or mixed with tinted moisturiser/foundation. Unlike many other SPF 40-50 sunscreens it does not feel thick or clogging. Although it contains zinc oxide, an important component of a good SPF, it does not leave excess white residue on the skin; instead it leaves the skin with a gentle healthy glow.

For a sunscreen with SPF40+ I believe it amongst the best available.

Dr Peter Forrester
The Cosmetic Doctors Company
Esher, Surrey

Truly effective anti-ageing skincare
doesn’t need to be expensive.

As I have said in my earlier blogs, scientific research indicates that the essential components of an anti-ageing facial regime are a Vitamin C serum, a retinoid and a hydroxy acid.

To these three add a sunscreen, moisturiser & cleanser and you will not need anything else.

I have evaluated numerous products and my favourite combination is

1. Medik8 CE-Tetra (Vitamin C Serum)
   
2. Glō Therapeutics Renew Serum (Retinol, Glycolic & Salicylic Acids)
   
3. Cetaphil Gentle Cleanser
   
4. SkinMedica TNS Ultimate Daily Moisturizer with SPF 20

These are all quality products with high concentrations of active ingredients.  The SkinMedica TNS Ultimate Daily Moisturizer with SPF 20 is a superb year-round moisturiser with sunscreen but during sun exposure this should be supplemented with SkinMedica Environmental Defense Sunscreen SPF 30+ or 50+.

Don’t let glossy, air-brushed promotions fool you into filling your bathroom cabinet with expensive miracle creams; these four products are all you will need.

Dr Peter Forrester
Cosmetic Doctor
Esher & Cobham, Surrey and Teddington, Richmond upon Thames

The aim of Cosmetic Medicine is to produce a younger and healthier appearance without the need for surgery or procedures that have significant recovery periods. With this in mind, in the late 1980’s lasers began to be used for facial skin resurfacing, burning off ageing and photo-damaged skin allowing healthy new skin to grow.  By the 1990’s this form of ablative treatment was falling out of favour because of long healing times and the potential for complications. The next development was the arrival of fractional laser treatments that instead of removing the whole top layer of skin, treated a ‘fraction’ of skin in a grid-like pattern leaving the undamaged skin in between the grid to promote a more rapid recovery.

eMatrix is a new radio-frequency (RF) skin rejuvenating system that instead of laser utilises a fractional grid of RF pulses to penetrate the skin. It delivers energy just beneath the surface to stimulate new collagen production whilst leaving the skin’s surface relatively intact. Unlike laser, this response is not confined to microscopic columns but spreads out beneath the skin causing increased collagen stimulation with less surface damage and hence less down-time.  eMatrix is designed to fill the gap between non-aggressive therapies that have minimal benefits and more aggressive therapies that have excessive recovery times.

eMatrix rejuvenates sun damaged and ageing skin by gently resurfacing whilst stimulating the production of collagen and elastin. It is designed to smooth mild to moderate wrinkles as well as improve skin tone, elasticity, texture and pigmentation. It can be used over the whole face as well as the neck, décolletage and backs of hands. It is particularly useful for tightening and reducing lines on the lower eyelids and under eye area where Botox and other treatments do not work so well. eMatrix provides a significant advance in the treatment of post-acne scarring; a problem that has previously presented a difficult challenge.

The eMatrix device allows for customisation of the depth of ablation and degree of resurfacing depending on your skin type and condition. Dr Forrester will choose the appropriate treatment program for you. Anaesthetic cream will be applied to the treatment area 30-45mins beforehand to ensure that the procedure is comfortable. During treatment most patients will experience nothing more than a warm pricking sensation and the eMatrix treatment itself usually takes less than 30mins.

Initially the treated area will look like moderate sunburn. Over the next few days the redness will subside and by 5-7 days will have completely healed. One of the big advantages of eMatrix over some other treatments is that immediately afterwards it may be covered with tinted creams. With sunscreen and camouflage applied most people will return to work and social activities immediately. After the initial redness fades your skin will look refreshed and firmer however the main benefits of eMatrix will develop gradually over the next 6-8 weeks as new collagen is produced.

The number of treatments required depends on your initial skin condition and the problem being addressed but is typically 1-3 treatment sessions at 4-6 week intervals.
Since RF treatment triggers collagen production and tissue remodelling of the dermal matrix improvements may continue for up to a year from the last session resulting in a gradual and long-lasting enhancement.

Dr Peter Forrester
Cosmetic Doctor
Esher & Cobham, Surrey and Teddington, Richmond upon Thames

Why I recommend Cetaphil Cleanser to all my clients.

We have been programmed to believe that the more a facial cleanser foams the more luxurious it is and the better it cleanses. On the contrary, luxury foaming or lathering cleansers are likely to contain detrimental detergents and fragrances that can cause dry skin and irritation.

Skin naturally produces lipids that are secreted onto the surface; these are very useful in keeping our skin protected, antibacterial, moisturized, waterproof and flexible.  Cleansers that contain even low concentrations of detergents not only clean off any dirt or grease but also aggressively strip these essential lipids off the skin leaving it exposed and vulnerable.

Your cleanser should be the most important product in your skincare range. Choosing the right facial cleanser will promote healthy skin and allow your skin to maintain its own natural lipid balance and moisture level, in turn reducing the need for excessive moisturization.

It is not necessary to buy expensive cleansers. Cetaphil Gentle Skin Cleanser has no frills – it is not foaming or lathering and is not perfumed. It is not meant to make you think that you’ve just had a spa day. It does what it says on the bottle. You can either use it as a wash or neat to cleanse away makeup. As soon as it comes into contact with water it creates a perfect PH balance on the skin which helps to hold on to natural moisture. It will clean dirt and grease as well as any expensive product but will leave the skin’s natural surface lipids to carry on doing their essential jobs.

As a brand Cetaphil is one of the largest selling cleansing ranges in the United States and a favourite with many Hollywood celebrities being often mentioned in magazines without any aggressive marketing. It has an ability to deeply cleanse the skin, removing debris and dead skin from the surface as well as heavy makeup. It is even strong enough to remove waterproof mascara without causing any irritation to the skin in or around the eyes.

It is one of the most clinically backed product ranges with well over 1000 clinical trials supporting its claims.

Cetaphil is available from some High St chemists and from on-line retailers with prices varying from  around £7-8 for 250mls.

Dr Peter Forrester
Cosmetic Doctor
Esher & Cobham, Surrey and Teddington, Richmond upon Thames

For significant improvements in the signs of facial ageing and UV damage I have put together a 16 week intensive programme of facial rejuvenation combining skin enhancing techniques with active cosmeceutical products, all of which have results proven by scientific research. The key is the careful selection and combination of techniques to produce maximum results with minimum downtime.

Clients will benefit from 3 Dermaroller treatments combined with light peels and a combination of carefully selected skin products. Vitamin C and Retinol will stimulate new collagen, elastin and healthy DNA. The alpha-hydroxy acids will gently exfoliate the skin and accelerate cell renewal. They will also increase hyaluronic acid resulting in improved moisturisation. These will be tailored to your age and individual skin type. The Dermaroller works by producing controlled micro-surgical punctures of the skin surface. These microscopic columns close over rapidly but stimulate the skin to regenerate itself naturally and safely.

At the end of 16 weeks you should see improved skin tone and texture and a reduction in fine wrinkles, roughness and pigmentation. The regeneration triggered by this process will continue over the following months providing a gradual and long lasting enhancement.

The 16 week programme is offered at a 30% reduction on the combined price of the individual elements. The price includes initial consultation, 3 Dermaroller & light peel treatments, skin cleanser, sunscreen, after-dermaroller cream, Vitamin C Serum, Retinol Serum and Alpha-hydroxy acid cream.

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames

With the current enthusiasm for things natural, organic or botanical we should perhaps consider whether these attributes necessarily go hand in hand with a product being safe. The expression natural goodness is loved by advertisers and is used to promote everything from breakfast cereals to hair shampoo. These two words are so frequently used together that we have become conditioned to believe that if something is natural then it must also be good for you.

In recommending a mineral make up, a beauty writer in a highly reputable national newspaper recently wrote  Its USP is a 100% rare minerals, active soil complex . . . the thinking goes that if you consider how mineral rich soil can turn a fertile seed into a nutritious juicy plum . . . well imagine what that can do for your skin. I have no experience of this product and it could well be a good product for skin. However, my concern is that being natural doesn’t always equate to being good and importantly to being safe. For example, stable manure may be very natural and organic; it may be very good for the soil and for growing juicy plums but it certainly doesn’t follow that you should apply it to your face.

There are several instances where cosmetic medical products have been promoted on the basis of their natural origins but have subsequently been shown to have unacceptably high complication rates. In 2010 a new dermal filler was launched by a reputable international pharmaceutical company. It was manufactured from natural marine algae extracts – that means seaweed to you and me. The promotional materials went on to say that this seaweed  . . . has been perfected in the laboratory using a patented technology that gives you a pure and natural treatment that lasts . . . offers a number of benefits over traditional dermal fillers . . . you can be confident that this pure and natural treatment is safe to use.

Notice the implied association between pure, natural and safe. After being on the market for only a couple of months this dermal filler, derived from natural seaweed, was suddenly withdrawn from the market. The UK government body, the MHRA said “The manufacturer has received reports of adverse reactions to the filler including redness, bruising, pain, swelling and histologically confirmed granulomas. They have also received reports of nodules and indurations in the infra-orbital area.” In plain speak this means that an unacceptable number of people developed lumps and bumps following treatment, particularly in the area under the eye. It may have been pure and natural but it certainly wasn’t safe.

Between 1995 – 2000 around 5,000 women in the UK received Trilucent breast implants. At this time the safety of silicone implants was being questioned and Trilucent were widely promoted as being safe and natural because they were filled with soya-bean oil. The inference here was that natural things are safe; soya-bean oil is natural; therefore soya-bean oil is safe to put in your breasts.  Sadly for those 5,000 women and many more around the world, this was not the case. It became apparent that they had an unacceptably high rate of capsule formation and rupture. Implant rupture would result in spillage of the soya-bean oil into the surrounding breast, made all the more worrying by the realisation that the breakdown products of this oil were potentially cancer-inducing. This resulted in almost all of them having to be surgically removed.

In addition to my point that natural isn’t necessarily safe and good, there is another important message here. Namely, be wary about being an early-adopter when a product is released.  Be sceptical about the manufacturer’s promise that their new product is safe. Only the passage of time will prove whether this is true or not. I have written before about published reports of complications arising from Polyacrylamide Hydrogel dermal fillers that occurred anything up to 4 years from their first injection. I have recently heard about problems arising from Poly-l-lactic Acid fillers that have developed months and years after injection.

When it comes to fillers, I only use the hyaluronic filler, Restylane. This has been made by Q‑Med for the last 14 years and has a safety record that few, if any, other fillers can equal.

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames

Acknowledgement:
Grateful thanks to Barry Jones, Plastic & Cosmetic Surgeon for his input, especially regarding the Trilucent implants.

In Skin Deep 1 and Skin Deep 2 I covered ascorbic acid and the retinoids; this time I will consider the alpha-hydroxy acids.
They are the third cornerstone of the Cosmeceutical management of ageing and photo-damaged skin.

The alpha-hydroxy acids (AHAs) include glycolic, lactic and citric acids. They occur in nature and are often called fruit acids. In higher concentrations they are used as chemical peel treatments but it is their use in lower concentrations that I will look at today.

In lower concentrations they have been shown to exfoliate the outer layers of skin and accelerate cell renewal. In general I much prefer the regular use of AHA’s to produce gentle exfoliation rather than physical methods such as micro-dermabrasion or gritty facial scrubs. I remain concerned that although physical methods of exfoliation may initially produce a healthy glow over the long-term they could cause low-grade skin irritation and inflammation.

AHAs can also improve skin moisturisation. This has been demonstrated in scientific studies showing an increase in both hyaluronic acid and collagen in the dermis and epidermis.

Because of their ability to remove the top layer of dead skin cells, AHAs have been used to increase the penetration of other active skin products such as pigmentation treatments and retinoids. I have found that the combination of AHAs with Retinol to be a great treatment for ageing and photo-damaged skin. However, this combination approach needs to be used cautiously, preferably under practitioner supervision, as the AHAs may increase the likelihood of reactions to the Retinol.

An area of contention in AHA use is the issue of sun sensitivity. It has been shown that glycolic acid may have a beneficial inhibitory effect of UV-induced skin growths. However, paradoxically it has also been shown that AHAs may increase the skin’s sensitivity to UV light. This is a fairly small effect and it has been estimated that it would only need the use of a SPF 2 to return the skin’s sensitivity to normal. Hence the recommended use of a daily SPF10-15 moisturiser would be more than sufficient to maintain the safe use of AHAs.

As I have said twice before, sadly there is no miracle, quick-fix solution. My four-part regime needs to be used daily over many months to see significant improvements.

The NeoStrata range of AHA products is excellent. My particular favourite is the Ultra Smoothing Cream (10AHA) that contains glycolic and citric acids.

Next time: Sunscreen

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames

Don’t forget that having Restylane or Botox is not like buying soap powder from the supermarket.  It’s not just about shopping around for the cheapest price. You are also paying for the time, opinion, advice, expertise and follow-up from a qualified professional.

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames

In my recent blog post Skin Deep 1 I said in my opinion there are four cornerstones to the Cosmeceutical management of ageing and photo damaged skin; these are ascorbic acid, retinoids, hydroxy acids and sun screen.

Last time we looked at Ascorbic Acid and this time we will consider the Retinoids which are perhaps the most potent and effective anti-ageing skin treatment currently available.

Retinoids are a group of compounds related to Vitamin A.  They include Retinol, Retinaldehyde, Retinyl esters as well as Tretinoin (Retin-A) and Adapalene (Differin), both of which are used as prescription treatments for skin conditions including acne.

Retinoids have been scientifically proven to have several beneficial effects on the skin. They restore damaged collagen and elastin, reduce roughness & fine lines and increase the turnover of skin cells & natural exfoliation. They will stimulate healthy DNA synthesis and help protect the skin from oxidative stresses and environmental damage. With regular use they should restore health to aged and photo-damaged skin as well as help protect the skin from further damage.

The issue with Retinoids is that used in effective concentrations they may cause skin irritation, redness, drying and flakiness.  The ability of facial skin to tolerate regular Retinoids will vary greatly from person to person. When most cosmetic manufacturers produce an anti-wrinkle product containing a Retinoid they will keep the concentration of Retinol very low so as to minimise irritation but sadly this will also minimise their effectiveness. My approach is to use a good quality Retinol or Retinaldehyde serum containing an effective concentration of active retinoid, but introduce it with a strict regime of slowly increasing frequency over many weeks. If there is any irritation during this time then we reduce the frequency for a few weeks and then try to increase again.  In this way we establish each individuals tolerance to Retinoids; some people can ultimately tolerate Retinoids every day whilst others perhaps only 2-3 times a week. Even with regular usage 2-3 times weekly there will be long term benefits.

Retinoid serums only need to be applied sparingly and are absorbed quickly into the skin.  They should be applied before bed after cleansing. Spread 3-5 drops of serum over the whole face, allow to dry for a few minutes and then apply your usual night cream/moisturiser.

As I have said before, sadly there is no miracle, quick-fix solution. My four-part regime needs to be used daily over many months to see significant improvements.

Next time: the alpha-hydroxy acids.

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames

Today’s Mail Online article: The Botox boom: Six women talk candidly about their quest for perfection contains the outrageous statement “. . . . . and even your local hairdresser could administer the injections if they’ve been on the right course.”

This is a common misconception and totally incorrect. Botox and the other botulinum anti-wrinkle injections such as Vistabel, Dysport, Azzalure, Xeomin & Bocouture are all licensed prescription-only medications.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health and amongst other things regulates the licensing and supply of medicines. Their regulations clearly state that Botox and similar injections can be:

1.      self administered
2.      administered by an appropriate practitioner
3.      administered by anyone acting in accordance with  the  directions of an appropriate practitioner

They go on to say that by “appropriate practitioner” they mean either a doctor, a dentist or, subject to certain limitations, a nurse or pharmacist independent prescriber.

This means that Botox can only be legally prescribed by a doctor, dentist or a nurse-prescriber.  We can be certain that they would not view your local hairdresser as an “appropriate practitioner” no matter how many courses they had done.  With regard to 3 above it is also highly likely that the regulatory bodies would take a very serious view of a doctor, dentist or nurse who directed a hairdresser to administer Botox.

Dr Peter Forrester
Cosmetic Doctor
Esher, Surrey & Teddington, Richmond upon Thames