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					Keep Your Skin Young and Healthy
July 16, 2008
3:00 pm - 4:00 pm

Michelle Copeland, D.M.D, M.D., a world-renowned plastic surgeon, biochemist, and
best-selling author will answer questions in this online moderated discussion on how
women can keep their skin young and healthy. Current understanding of skin's
cellular structure is so advanced that it’s possible to turn back the clock on aging. Dr.
Copeland will provide insights on how to achieve healthy and young looking skin.
View Dr. Copeland's biography.

Submit your questions and comments before or during the discussion.

Good afternoon and welcome to today's discussion on keeping skin young and healthy with Dr.
Michelle Copeland. I would like to start by thanking Dr. Copeland for taking time out of her
busy schedule to answer your questions. You can read more about her by clicking on the link
to her biography at the top of this page. So, without further ado, let's get to the questions.
This promises to be a fun and informative session.

Nogales, Arizona:
Please tell me what is the least abrasive but effective way to exfoliate my skin. I am 56 yrs.
old and have an olive complexion. I have noticed a few little broken capillaries where I have
exfoliated before.

Michelle Copeland, D.M.D, M.D.:
Taking off dead skin cells makes the newly exposed tissue fuller and more brilliant. Your body
will shed this top layer naturally, but this regeneration process slows as we age. You’ll get a
greater glow if you slough off excess cells with an exfoliant that’s either physical, one with
particles that you rub in, then rinse off; or chemical, a product containing ingredients such as
glycolic or lactic acid that melt the glue holding wizened cells on the skin’s surface. I’ve seen
the damage from overzealous do-it-yourself peels. Improperly formulated, they can cause
burns and scars.

How often should you exfoliate? The answer depends on your skin type and the exfoliation
method you choose. Physical exfoliation, with a scrub, should take place once or twice a week,
three times a week at most. In terms of chemical exfoliation, mild cream or serum
formulations of up to 10% acid concentrations are safe to use twice a day, assuming your skin
can tolerate this. But stronger peels should be used at most once a week. Your skin should not
flake or peel after you exfoliate. If your skin is extra oily, use salicylic acid to stimulate cell

Long Island, NY:
How do you feel about fillers for cheeks that have become flat or sunken in?

Michelle Copeland, D.M.D, M.D.:
As we age, our faces begin to show the effects of gravity, sun exposure, and years of facial
muscle movement, such as smiling, chewing, and squinting. The underlying tissues that keep
our skin looking youthful and plumped up begin to break down, often leaving laugh lines,
smile lines and crow's feet. Skin treatments and fillers are short-term or longer-term
procedures that change the contours of the face and body through non-surgical or minimally
invasive procedures. Injected fillers can be used to improve the appearance of the skin's
texture and contour. Typically made from hyaluronic acid or fat, injectable fillers can help fill
out deep facial wrinkles, creases, and furrows, providing a smoother, more youthful-looking
appearance. Radiesse® and Sculptura® can be used to plump, fill, and contour the face.
Facial implants may also be used for cheeks that have become sunken in.

The Bahamas:
I'm 28 and have a problem with facial hair and skin discoloration, had a baby about 21 months
ago, I've inquired about laser hair removal, would you prescribe this method for patients? And
what product would recommend for skin discoloration?

Michelle Copeland, D.M.D, M.D.:
If you are tired of ingrown hairs and irritation from waxing and shaving, laser hair removal
offers freedom from unwanted body hair. Now popular with both men and women, it is best
suited for darker hair but new advances even allow reduction in gray or blonde hair.
Commonly performed on the face, upper lip, neck, chest, periareolar, underarms, back,
abdomen, bikini line, and legs, it cannot be used on the eyes.

There are a variety of FDA approved lasers, such as the Light Sheer® laser, for permanent
hair removal for all skin types. For skin discolorations, today there are a lot of options, some
of them botanical, all sold over the counter, usually labeled as lighteners or brighteners. We’ve
found that thyme; Licorice extract and mulberry all have anti-pigment capabilities. Despite the
fact that some of these are foods, you don’t want to rely on diet alone. It’s smart to select
topicals with a variety of additives so you get the maximum benefit.

Milwaukee, WI 53215:
Will you talk about the role of nutrition, as in fresh fruits and vegetables?

Michelle Copeland, D.M.D, M.D.:
You are what you eat as the saying goes and in general. Skin is an outward reflection of the
internal situation and what’s good for the heart is good for the skin. Following the guidelines of
heart healthy eating – green leafy vegetables, fresh fruit, lean meat-benefits your external
appearance. Water is also a key component to beautiful healthy skin. You’ll erase dry, flaky
patches on your cheeks by downing gallons of water. Berries, grapefruit, grapes, and oranges
all contain antioxidants, vitamin C, and phytochemicals that may reduce the incidence of
chronic disease. Snacking on fruit is the way to go—it is good for you and good for your skin.
Green Leafy Vegetables such as Broccoli, Brussels sprouts and spinach are rich in fiber,
Vitamin A, calcium and antioxidants.

Redlands, California:
The skin on the soles of my feet have become dry, scaly and cracked. I apply creams and
lotions; use pumice stones and other tools, but my feet stay rough and stained. Why is this?
What can I do to correct this problem?

Michelle Copeland, D.M.D, M.D.:
Anything that sits around your tub or shower such as pumice stone, is going to breed bacteria.
However you can get away with a pumice stone. To disinfect between uses, boil the tool in hot
water or douse it with alcohol. If you message your feet with a rich alpha Hydroxy acid cream
once a day, not only will you moisturize your heels and toes, but the lotion will gently exfoliate
you skin. This reduces any hard, thick patches and prevents the formation of new ones.

Flander, IL:
I recently quit my office job and now I'm working construction. I've got a hard hat and it's hot
as Hades, so what can I do to prevent skin cancer that doesn't involve wearing a cloak? --
Peter G.

Michelle Copeland, D.M.D, M.D.:
Make sure that you use a sunblock that contains Zinc Oxide. I prefer blocks to the screen
version because their zinc and titanium mineral base induces less chafing than chemical
formulas. A block’s ingredients don’t break down in the sun, which is the major complaint
about most chemical UV guards. Plus Zinc is a powerful antioxidant that helps in the wound-
healing process. If it’s in your sun protection, not only will you be guarded from the rays but
also any UV-inflammation will be treated at the same time. Today we should expect sunblocks
and sunscreens to contain other ingredients, like antioxidants, that repair and protect
simultaneously. Zinc Oxide provides a physical barrier to protect your skin from the harmful
UVA and UVB rays. Also, if you are exposed to the sun all day you should be using SPF 40.
Remember to apply sunblock half an hour prior to sun exposure to allow the sunblock to be
absorbed by the skin.

Washington, D.C.:
What does the SPF number mean and is there a formula involving the number that tells you
how often you need to reapply it?

Michelle Copeland, D.M.D, M.D.:
SPF stands for Sun Protection Factor is a measure of how long a person can stay in the sun
before burning. An SPF of 30 means thirty times longer than if you went outside with nothing
on. It’s important to keep in mind that all skins are different. A woman with an Irish heritage
and an extremely pale complexion might last only a minute or two before her bare skin turns
pink, so an SPF of 30 would give her 30 minutes before she needed to reapply, assuming she
wasn’t jumping in her pool or perspiring. Her Latina friend on the other hand, could perhaps
go two hours or more before her unguarded skin became tender. The same SPF30 Lotion
would extend that time even more. SPF measures only a product’s ability to block UVB
(burning) rays. A cream’s power to shield skin from UVA (aging) rays is not currently indicated
on a package’s label. It doesn’t matter what your nationality is. If you don’t want wrinkles,
you need to guard yourself from UVA light.

I want to keep my facial skin moisturized but all moisturizers make my skin break-out. What
can I use on my face?

Michelle Copeland, D.M.D, M.D.:
Moisturizers fall into two main categories: humectant and lubricant. Hyaluronic acid is one
commonly used humectant and is also naturally present in skin tissue. You might find that this
will help moisturize without clogging because they work by drawing water from the air and
skin surface into the epidermal cells, keeping them bouncy and moist.(see Dr Michelle
Copeland Night Serum rich in hyaluronic and ferulic acid).
While lubricants can protect the skin they can also block pores. Avoid moisturizers that are
predominantly lanolin, mineral oil, or silicone.

Our office building burned down a few years ago and the new place is all space age with
windows everywhere. I'm in the sun all day despite the ironic fact that I'm still in a cubicle. Do
I need to wear sunscreen inside during work?

Michelle Copeland, D.M.D, M.D.:
Sun exposure is one of the major causes of wrinkles. Solar radiation radically alters your cells
and DNA and triggers the release of free radicals, which weaken your skin’s collagen and
elastin. There’s no excuse for not rubbing an SPF-rich lotion onto exposed skin daily.

Friendswood, Tx:
I have rosacea. It is mainly on my right cheek but some on my left. It just cropped up in the
last 5 years. I like to work in the yard but cannot stay out too long or I get this burning
sensation and bright reddness. The time of the day or evening does not matter.The reddness
lasts for a couple of days. My left cheek has the illusion of being dimpled now from the
scarring. (I call scarring). Would laser therapy help me and will it have a lasting effect? Is
there anything prescription or over the counter that helps? I just put an ice pack on it.
Michelle Copeland, D.M.D, M.D.:
People with rosacea have sensitive skin, in addition to a problem with inflammation. Those
with psoriasis, eczema, or flaky, scaly tissue have to tread lightly as well. Exfoliating could
convince the cells to function in a more rhythmic, therapeutic way but sometimes that
stimulation turns skin blotchy and red. Laser and other light-based treatments have
transformed cosmetic surgery. Now there are targeted, effective solutions for every skin
concern. With proper guidance, a person can resolve almost anything that's plaguing your face
or body. Nonablative lasers or fractional resurfacing lasers can help. These wavelengths
stimulate collagen production, building up a skin depression from underneath.

Old Tappan, NY:
My question is: as a medial doctor, dermatologist, surgeon, why would you want me to use
your products since they contain parabens? I believe these chemicals are deleterious to one's

Michelle Copeland, D.M.D, M.D.:
Parabens are a group of chemicals widely used as preservatives in the cosmetic and
pharmaceutical industries. These compounds are used primarily for their bacteriocidal and
fungicidal properties. They can be found in shampoos, commercial moisturizers, shaving gels,
cleansing gels, personal lubricants, topical/parenteral pharmaceuticals, spray tanning solution
and toothpaste.

Recently controversy around the use of parabens has arisen because of concerns about their
implication with breast cancer. The American Cancer Society recently reviewed the available
data and concluded "it is biologically implausible that parabens could increase the risk of any
estrogen-mediated endpoint, including effects on the male reproductive tract or breast cancer"
and that "that worst-case daily exposure to parabens would present substantially less risk
relative to exposure to naturally occurring endocrine active chemicals (EACs) in the diet such
as the phytoestrogen daidzein." In addition, the American Cancer Society has concluded that
there is no good scientific evidence to support a claim that use of cosmetics such as
antiperspirants increase an individual's risk of developing breast cancer. Some parabens are
found naturally in plant sources such as methylparaben from the fruit of the blueberry shrub
where it acts as an antimicrobial agent.

New Jersey:
I had a mole removed in November on my chest. It was basil cell makeup. It has a raised long
scar -- can this be fixed by a plastic surgeon to be less noticeable and flat? thanks.

Michelle Copeland, D.M.D, M.D.:
Often topical creams to reduce the thickness and pigmentation of scars can be used to
improve the appearance of scars without surgical intervention. Nonablative lasers can also be
effective to diminish the appearance of scars. Some scars, however, will also require surgical
revision to achieve the optimum result.

dallas, tx:
Can you talk about antioxidant serums? Do they work and what should you look for when
trying to buy one?

Michelle Copeland, D.M.D, M.D.:
Free radicals are molecules that assault and break down skin’s supporting framework and are
formed by oxidation. Pollution, UV light, stress- these are just a few of the entities that create
free radicals. The good news is you have antioxidants on your side. Antioxidants like vitamins
C and E and green tea, work to neutralize the damage caused by Free radicals. Everyday we
are bombarded with news on scientific and technological breakthroughs in the skin-care field.
This list of powerful anti-agers and serums continually swells, with new ones being developed
around the clock. The deluge of conflicting information can be extremely confusing.
Austin, TX:
I am of Indian descent. Am I at risk for skin cancer? Thanks in advance, Samir

Michelle Copeland, D.M.D, M.D.:
Melanin is in our skin for a reason: It helps shield the tissue from absorbing too much UV light.
Even highly pigmented skin can be damaged by ultraviolet light. Though a person’s
complexion may not appear wrinkled, a deeper complexion can still end up with pigment
variation, usually mottled, cause by sun exposure. Skin cancer should be the concern of every
person no matter what skin tone or type. Make sure that you are rubbing an SPF rich lotion
onto your skin before you go out in the sun.

My mother is in her early 90s and recently developed rosacea. She's never out in the sun,
doesn't drink alcohol, eat spicy foods, or exercise much. Do you have any idea what might
have triggered it?

Michelle Copeland, D.M.D, M.D.:
People with rosacea have sensitive skin, in addition to a problem with inflammation. It is most
common in women between the ages of thirty and sixty plus and those with fair complexions.
Rosacea causes redness and pimples on your nose, cheeks, chin, and forehead. The redness
may come and go. People sometimes call rosacea "adult acne" because it can cause outbreaks
that look like acne. It can also cause burning and soreness in the eyes and eyelids.
Unfortunately experts are not sure what causes rosacea.

Rosacea often flares up when something causes the blood vessels in the face to expand, which
causes redness. Things that trigger flare-ups are exercise, sun and wind exposure, hot
weather, stress, spicy foods, alcohol, and hot baths. Swings in temperature from hot to cold or
cold to hot can also cause a flare-up of rosacea. Exfoliating could cause the cells to function in
a more rhythmic, therapeutic way but sometimes that stimulation turns skin blotchy and red.

When I see someone with rosacea I try to get them to follow a basic skin care regimen of
cleansing, toning, gentle exfoliation, moisturizing and using sun protection. This can help
reduce inflammation. Other treatments could include lasers and other light-based treatments.

Erie, NY:
I've got a bottle of sunscreen that I bought five years ago. I'm not out in the sun much, so
there's still a lot left. How long is it good for? Thanks, Suzi

Michelle Copeland, D.M.D, M.D.:
Products that contain SPF are required to have an expiration date. Check your bottle for this
date which usually ranges from 1-3 years from the manufactured date. This assures that the
SPF is working effectively and protecting you from harmful UV rays. Since you don't use very
much you might find it more cost effective to get smaller containers and discard the out of
date sunblocks.

How can the dark circles under my eyes be reduced? Although, they are worse when I don't
sleep well they don't go away even with enough sleep.

Michelle Copeland, D.M.D, M.D.:
Dark circles under the eyes are an extremely common issue and make you look older, tired,
stressed, sick, depressed and just plain bad. There are many contributing factors to the
development of these dark circles such as stress, lack of sleep, prolonged exposure to sunlight
and hyper-pigmentation to name a few but there are ways to treat. Using an eye formula can
help reduce puffiness, dark circles and lines. You could also use a pigment reducing cream.
The skin around the eyes is extremely delicate so be careful and use products that are allergy
tested and do not contain harmful dyes and perfumes that could irritate your eyes.
Middlebury, VT:
I am 60 years old and have many brown "age spots" on my skin, mostly on my arms, face and
neck from years in the sun while I was growing up in Florida. Is there anything I can apply
topically to improve my skin?

Michelle Copeland, D.M.D, M.D.:
Today, there are a lot of options, some of them botanical, all sold over the counter, usually
labeled as lighteners or brighteners. We’ve found that thyme; Licorice extract and mulberry all
have anti-pigment capabilities. Despite the fact that some of these are foods, you don’t want
to rely on diet alone. It’s smart to select topicals with a variety of additives so you get the
maximum benefit.

The Ham, Alabama:
I have very sensitive skin on my legs. I have to use 10% benzol peroxide as a shaving cream
when I shave…and sometimes I still get Folliculitis. Do you have any alternative suggestions?

Michelle Copeland, D.M.D, M.D.:
Benzoyl peroxide can be harsh and irritating. You might do better with something like daily
AHA skin smoothing lotion and a weekly microdermabrasion in the shower to help gently
exfoliate and reduce razor bumps and ingrown hairs. You might also try using a Pigment
reducing cream to minimize discoloration caused by folliculitis. Laser treatments to reduce hair
growth will also eliminate problems with folliculitis (in-grown hairs).

Ft. Walton Beach, FL:
Do some sunscreen ingredients and products really work better than others?

Michelle Copeland, D.M.D, M.D.:
Sunscreens disintegrate faster than sunblocks, so you have to reapply them more often. The
new chemical UV blockers (MExoryl et al.) aren’t supposed to dissolve as quickly as the older
chemical version, such as Avobenzone, the they’re not yet widely available.

Make sure that you use a sunblock that contains Zinc Oxide. I prefer blocks to the screen
version because zinc and titanium induces less chafing than chemical formulas. Sunblocks are
a physical block to UV rays and don’t break down in the sun, which is the major complaint
about most chemical UV guards. Plus Zinc is a powerful antioxidant that helps in the skin's
reparative process. Today clear zinc oxide preparations can provide both UVA and UVB
protection. It's the UVA that causes sun damage and the UVB that causes the sunburn so just
because you aren't getting burnt does not mean you are not getting sun damage. Make sure
your sunblock protects you from both types of UV rays

Fairfax, VA:
Can the aging effects of the sun really be reversed or once your skin is damaged is it

Michelle Copeland, D.M.D, M.D.:
Reversing sun damage is possible. Using products with antioxidants in them can help to
reduce sun damage. Also pigment reducing creams can help to even out skin tone and
diminish sun spots and brown spots. Remember to keep your skin moisturized and hydrated
and always put on sunblock. Sunblock should be used every day whether it is winter, spring,
summer, or fall.

Besides encouraging skin cancer formation, sun exposure is also one of the major causes of
wrinkles. Solar radiation radically alters your cells and DNA. And triggers the release of free
radicals, which weaken your skin’s collagen and elastin- the very same stuff that people spend
tens of thousands of dollars a year injecting back into their faces with varying degrees of
success. There’s no excuse for not rubbing an SPF-rich lotion onto exposed skin daily.
However, I don’t think you have to be pale-faced to be healthy. You can have some color in
your skin, but the key word is some.

Sunblocks with Zinc are the best. Zinc oxide acts as a physical barrier to the harmful effects of
UVA and UVB rays and also is an excellent anti-oxidant so it helps the skin repair itself. Also
make sure to use an SPF of 40 for the highest protection.

Fairfax, VA:
I have another question. Are there skin cleaning products that make your skin more
susceptible to (or alternatively better protect it from) aging and sun damage?

Michelle Copeland, D.M.D, M.D.:
Using a cleanser that is allergy tested and free from harmful dyes and perfumes is a great way
to begin protecting your skin from the signs of aging. Cakes of detergent soaps are harsh and
detergents are disruptive by nature. The act of saponification, turning cleansing ingredients
into bar form, results in a solid that is more drying to skin than its liquid counterparts. This is
the case with all solid cleansers – even ―beauty bars‖. The chemical reaction that stabilizes a
bar’s components also makes it alkaline, but the skin functions optimally in a slightly acidic
environment. After you cleanse, it is very important to use a toner. You need to balance the
skin and create the proper environment for your skin cells to regenerate so that your skin can
be as healthy as it can be.

New York, New York:
We all know about the injectables used for deep wrinkles and creases, but what about the fine
lines all the creams and potions don't seem to help?

Michelle Copeland, D.M.D, M.D.:
It may be you aren't using the right regimen or products. While no single magic ingredient can
do everything, there are topicals that can effectively reduce the appearance of fine lines and
wrinkles. Look for products that are clinically tested and that contain multiple youth builders
with ingredients listed near the top of the list. Avoid those that are loaded with dyes and
fragrances which can irritate your skin.

That concludes our time for live discussion today. Thank you to everyone who participated,
especially Dr. Copeland for her many thoughtful answers. You can learn more about Dr.
Copeland and her work at her Web site: To stay on top of
women’s health news and to find out about upcoming online chats and other events, sign up
for the Society’s biweekly e-newsletter. The transcript of today’s discussion will be archived on
this Web site. Thank you again for taking part in today’s event.


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