You wouldn’t drive a Ferrari and not change the oil. So why do so many patients spend hundreds, even thousands of dollars on cosmetic procedures and fail to take care of their skin?
As a plastic surgeon, I routinely perform facelifts, laser rejuvenations, Botox & filler injections, and in-office peels and microdermabrasions, all for the purpose of keeping my patients looking younger. While there is no shortage of people happy to come see me for their “quick fixes” of improvement, many are simply unwilling to do the routine maintenance at home required to maintain their skin and youthful appearance. As I always counsel my patients, getting procedures done without doing routine skin maintenance with professional quality products, is like driving a Ferrari and never changing the oil!
All patients, including those who get routine treatments from a dermatologist or plastic surgeon and those who do not, should have a basic regimen of skincare. The skincare universe of products is enormous and often confusing. In general, skincare products are found in several vertical markets. These include mass market brands, such as you would find in Costco, Target, or CVS, spa brands that you may find in your local spa, QVC, or cruise ship, Upscale retail brands, such as those products you may find in Sephora, Nordstroms, or Neiman Marcus, and physician grade brands such as those products you will find sold through your doctors’ offices.
What is clear after many years of research and investigation into many of the skincare products on the market, the best value and certainly the best efficacy of skincare products are those sold through doctors’ offices. Let me explain why. If you take the cost, packaging, smell, texture and marketing out of the mix (which are variables irrelevant to your skin), you will find that there are only a dozen or so active ingredients common to all skincare products which have been scientifically and clinically shown to have impact on your skin. So what matters to your skin is which of the active ingredients are in a product, their concentration, and their pH or level of acidity.
Facial skin in healthy adults usually has a pH of about 4. Most acid products such as vitamin C (ascorbic acid), salicylic acid, Vitamin A (retinoic acid), glycolic acid and so on, are most efficacious as they reach a pH of about 3. Some products, such as growth factors, cytokines, moisturizers, and sun blocks, work at pH levels which are more neutral. In general, most physician-dispensed products have more ideal concentrations of active ingredients at a lower pH. While these more “bioavailable” products can create more initial reactivity in the skin, they also produce better results. Most of the brands from the “lesser vertical” markets tend to buffer their products and reduce concentrations so as to a) avoid returns due to reactivity b) reduce cost of goods and c) reduce the amount of education required to sell the products. Simply put, doctor brands are invariably better than the rest, and often less expensive than upscale retail brands.
Most dermatologists, plastic surgeons, and many other healthcare professionals dispense physician grade products. Most of these brands and products do not require a prescription. Good counsel from the doctors as to which products are appropriate for your needs (which change by age and season) is important so that you get on a correct regimen. Further, no one line or one set of products is always best for the same person as seasons change as you get older. Reevaluation at least twice a year is important.
Lastly, be careful of typically physician dispensed products sold on mainstream websites such as Amazon.com. Many of these products are often grey market, expired, or fraudulent. Virtually NONE of the physician grade lines permit the sale of products outside of the doctors’ office, and hence all of the physician grade products you find on web sites like Amazon.com, are obtained illicitly. Source your products from your doctor or your doctor’s e-commerce site to ensure consistent quality.