before treatment


after 6 treatments


before treatment


after 6 treatments


before treatment


after 6 treatments


I love this excellent article, written by Licensed Esthetician Danae Markland, so I wanted to share it with you…


In their decades on the market, microbeads found their way into a wide variety of products, including toothpastes, and facial and body scrubs. Although gentle and effective mechanical exfoliants, the unintended consequence of their use has had a negative environmental impact.

Plastic microbeads do not biodegrade, and once they are washed down the drain, they go through our waste stream to end up in waterways. These small, spherical particles are the size of a grain of sand and cannot be filtered out of bodies of water.

Therefore, over years of use, microbeads have inundated waterways and are causing negative health issues for marine life and our aqueous ecosystems. Although we have become attached to these small particles in our products, have no fear, there are many effective alternatives.

Why Exfoliation is Necessary?

In a perfect world, our skin is a self-renewing organ. New cells are born at the basal layer and rise up through the epidermis, ultimately flattening and turning from keratinoctyes into corneocytes. Approximately every 28 days, these cornecytes go through a complex biochemical process called desquamation, which cleaves and sheds dead cells away from the stratum corneum, leaving a fresh and bright skin surface behind. Unfortun­ately, there are many roadblocks to this all-important process of desquamation. Even simple skin dehydration can impede normal cell turnover. Add stress, pollution, poor lifestyle choices (smoking, drinking), age, insufficient skin care habits and the result can be impacted, dull, rough and unhealthy-looking skin. The best way to overcome this is regular, gentle exfoliation. Healthy cell turnover can be achieved by either chemical or mechanical means. There are a variety of chemical exfoliation options that can be used in place of microbeads, while there are also numerous substances and techniques that can be used as microbead alternatives for mechanical exfoliation.

Mechanical Exfoliation

By definition, mechanical exfoliation is the process of physically scrubbing or removing any surface build-up of corneocytes, or dead skin cells. As more time goes by after the deadlines pass for the Microbead-free Waters Act (H.R. 1321)—which banned the manufacture of, formulation with and sale of products containing microbeads— there will certainly be many more options on the horizon. Below are some of the most common options.

Fruit pits, seeds and nut shells. When crushed, there are a number of stone fruit pits and nut shells that are good to use for body exfoliation. Although these particles can have jagged edges, they are good for ridding feet, elbows and thicker body skin of build up. They can be used in varying particle sizes in formulations, but even the fine particles from pits and shells can be too aggressive for delicate facial and décolleté skin. Some of the most commonly used sources for these particles are apricot pits and coconut or walnut shells. Other fruit seeds and fibers like those from raspberries, cranberries and blackberries can also be used, but are not as common in commercial products. Most of these can be ground into fine powders, making them less aggressive, yet are still best left for use on the body.

Beads and waxes. Hydrogenated beeswax and castor and jojoba waxes and oils can be used to create clear and odorless beads. They are gentle, yet some downsides are that they can darken with exposure to oxygen, making them not cosmetically elegant for some formulations. Additionally, they are large in size and can be difficult to use in some types of packaging.


Grain powders. Many beneficial grains can be ground into gentle exfoliative powders. Some of the most popular and effective are oats, rice and chickpeas. Oat flours and powders can be a good option for more sensitive skin due to the natural calming properties of Avena sativa (oat). Rice is an excellent choice, as the particles are gentle and effective for a wide range of skin types and conditions. Used for centuries in Asia for skin clearing, rice powders and flours contain a variety of vitamins and amino acids.

Salts and sugars. Even when milled to a small dimension, these particles are best for body use. Salts are well known for their high concentration of minerals that can be beneficial for dry skin conditions. Minerals such as magnesium, potassium, calcium and bromide are the most prevalent. The most common are Dead Sea, black Hawaiian sea, Himalayan and basic sea salt.

Sugars are also best for foot scrubs and body scrubs. Their natural humectant properties help to keep the skin moist after use. The natural sweet aroma can also be a draw for many looking for a more spa-type experience from their body scrub.

Because many of these materials have their own set of benefits, it is also a good option to look for products that contain a blend of several to maximize results.

Chemical Exfoliation


Although many incorrectly assume that the use of chemical exfoliants must be more aggressive than mechanical methods, this option can be an excellent way to keep skin healthy and radiant. This method covers a wide range of options. Deeper peels, such as 30%+ TCA solutions, are only used several times a year, while gentle, low-percentage Alpha hydroxy acids (AHAs) and enzymes can be used with the same regularity as microbeads.

AHAs. Lactic, glycolic, citric and malic acids, among others, are included in this category. These acids offer many ancillary benefits, including humectant qualities, inhibition of P. acnes bacteria, reduction of hyperker­atinization and an inhibition of the melanogenesis process. Some studies indicate AHA may have the ability to promote collagen deposition in addition to increasing desquamation.

Beta hydroxy acid (BHA). Salicylic acid (SA) is the only BHA currently used in skin care. It is a lipophilic keratolytic that has the ability to dissolve impactions in the follicles, reducing the occurrence of acne breakouts. Due to its anti-inflammatory benefits, SA is also a good choice for sensitive skin conditions, higher Fitzpatrick skin types I-VI and rosacea. It can be safely used in combined modality protocols.

Retinoids. All forms of vitamin A are included in this category, with retinoic acid, retinaldehyde and retinol being the most commonly used in professional treatment products. For use at home, retinol products used at night can have a dramatic effect in normalizing cell turnover and improving overall skin health. Because retinol is notoriously unstable in formulations, this beneficial ingredient is best used in a well-formulated nighttime treatment product, not a scrub. In general, retinoids help increase cellular turnover, smooth uneven skin texture, boost collagen production and improve skin discolor­ation.

Enzymes. Enzymes are catalyst proteins that start or accelerate an action. Fruit-derived enzymes such as papain from papaya and bromelain from pineapple are used most often in skin care. Enzymes are able to digest the keratin filled corneocyte, revealing the healthy cells below while living cells are left unaffected. These are also typically gentle at low percentages. You can find enzymes in many topical products and home-use treatments.

We Won’t Miss Microbeads

Our environment will thank us for getting rid of microbeads. Whether using alternative mechanical exfoliation materials or opting to use gentle chemical options—or even a combination of both—there are strategies to have skin turning over at a healthy rate and appear glowing, smooth and healthy.


Danae Markland, L.E., CMLT, has been a licensed esthetician for 14 years. She currently serves as vice president of business development for PCA SKIN and is an advanced educator.


The American Academy of Dermatology recently published a list of 10 general skin care tips from dermatol­ogists that can benefit just about everyone.

  1. Apply sunscreen every day. A quality sunscreen is an important element to any skin care routine. Applying it before going outside can slow down skin aging and help to prevent skin cancer. Broad-spectrum sunscreens of SPF 30 or higher and waterproof are best.
  2. Don’t smoke. Smoking speeds up how quickly the skin ages. Additionally, research shows that smoking worsens some skin diseases, such as psoriasis and hidradenitis suppurativa, according to the AAD.
  3. Check your skin for skin cancer. Because estheticians get an up-close view of their clients’ skin on a regular basis, they often spot potential skin cancer before their clients. Knowing the signs of skin cancer and advising at-home skin self-exams can help clients find skin cancer early when it’s highly treatable. If you notice a spot that differs from the others, or one that changes, itches or bleeds, an appointment to see a dermatologist may be in order.
  4. Avoid tanning beds. The AAD recommends using self-tanner in lieu of tanning indoors or outside. A self-tanner can give you the look of tanned skin without the risk of skin cancer.
  5. Use skin care products that match your skin’s needs.  Using products formulated for specific needs will help it look and feel its best.
  6. Resist the urge to scrub your skin clean. Scrubbing too vigorously can irritate the skin, which can worsen any skin condition, including acne.
  7. Wash your face when waking, before bed and after sweating. These are the three most important times to wash your face, according to the AAD. It’s important to remove the dirt and bacteria that settle on the face while sleeping, and it’s equally as important to wash before bedtime to remove makeup and grime, such as sweat, smog, smoke or dirt, which may have landed on your skin during the day.
  8. Gently wash your face. It may seem like a simple step, but this is an important tool in keeping the skin looking its best. First, wet the skin with lukewarm water. Then apply a mild cleanser in a circular motion with your fingertips. Finish by completely rinsing off the cleanser and gently patting the face dry with a clean towel.
  9. Stress less. Some skin diseases often appear for the first time when someone feels really stressed. Stress can also cause flare-ups of many skin conditions, including acne, eczema, psoriasis and rosacea, according to the AAD.
  10. See a dermatol­ogist. For a medical diagnosis or treatment outside the scope of an esthetician’s practice, it’s always best to see a dermatol­ogist.


Have you ever broken out in red rashy pimples within a few days or weeks after using a new product and thought it was acne?  Many who start using topical cosmeceutical or prescription products can have this experience and use acne products in an attempt to dry the breakouts only to discover that it makes their skin worse. This is because those “pimples” are not acne. What is happening is actually a compromised or disrupted skin barrier issue because the new product is too strong for your skin at the time.

The solution in this situation is counterintuitive because instead of using an acne spot treatment, you will need a barrier cream to help your skin recover. Once the skin returns to normal, within a few days, you can reintroduce the product again slowly over the course of a few weeks until it can be used again regularly without a reaction.

A side effect of using corrective products with high concentrations of active ingredients, vitamin A derivatives like retinol or tretinoin (Retin-A), and AHAs, is called retinoid dermatitis, retinoid irritation, retinoid reaction, or AHA reaction. This “dermatitis” can usually be characterized by redness, scaling, dryness, or itching; however rash-like pustules or swollen red “underground pimples” are also very common.

Corrective cosmeceutical and prescription products induce changes in the epidermis that lead to increased and altered cell turnover.  This means that the top protective layer of the epidermis is being shed faster than new cells are forming in the lower layers. This causes the skin barrier function to become “disrupted” and the compromised barrier can no longer adequately protect the cells underneath so the skin REACTS. The level of irritation reaction correlates with the potency of the applied product but there is a solution.

  • Recognize – a sudden appearance of pustular pimples. Immediately STOP using the product
  • Recover – apply barrier cream (or 1% hydrocortisone cream if you have redness / itching) 2-3x day for 2-3 days until skin returns to normal. Recommended are BiON Restorative BalmAquaphor, SkinMedica TNS Ceramide Treatment Cream.  Organic shea butter or coconut oil also work well.
  • Reintroduce – start using the product again gradually.  Apply every other day for first two weeks and then daily. Experiment with smaller doses. You can cut strength by mixing with a plain moisturizer. Find your ideal dose. Maybe you can only use the product 2-3x week on an ongoing basis.

Adjusting the timing, dose, form, and strength of topical product can influence the reaction.  However in some cases, even with repeated efforts at reintroducing the product, it may simply be too strong for your skin.  But you will never know how a product will work for you until you try…




Before Treatment 11/24/2015


After 6 Treatments 7/7/2016


Before Treatment 11/24/2015


After 6 Treatments 7/7/2016

This just in from Skin Inc. Magazine:

How diet affects the skin—particularly whether it causes acne—has long been a conversation topic that professionals swing back and forth about. Here is a round up of foods that can aggravate common skin conditions.

Sugar and High Glycemic Foods

Acne. Foods with high glycemic index—meaning high in refined carbohydrates such as white rice, white bread and white potatoes—can cause blood glucose levels to fluctuate. According to Ramsey Markus, associate professor of dermatology at Baylor, “As a result of the high blood sugar levels there is a cascade of hormones released that eventually stimulate the oil gland, leading to worsening of acne.”

Glycation and premature aging. In a Good Housekeeping interview with Nigma Talib, London-based naturopathic doctor, skin care professional and author of Younger Skin Starts in the Gut (Ulysses Press, 2016), Talib says not only can excess sugar in the diet wreak havoc on overall health, it can also lead to glycation.

Annette Tobia, founder of Dynamis Skin Science, explains exactly what glycation is in an article published in Skin Inc.last year: The glycation process involves protein cross-­linking, and this causes skin damage and aging. The process compromises the production of collagen, elastin and other proteins in the skin, all of which are essential to skin health and vitality.

Dairy Products

Acne. Dairy intake may upset acne by increasing oil production, inflammation and abnormal hormonal activity.

Swollen eyelids, dark circles and under eye bags. Talib says as clients get older, they lose enzymes that help properly digest lactose, which can lead to inflammation.


Although wine in moderation carries several health benefits, it can also mess with skin due to it’s high levels of sugar, pesticides and sulphites, as well as the fact that it is dehydrating, according to Talib.

Signs of aging. Talib says heavy wine drinkers may cause pronounced lines between eyebrows, droopy eyelids, wrinkles underneath eyes, dehydrated skin, enlarged pores, redness and deep nasolabial folds.


Gluten has been a hot term for a while now, and while not everyone actually has celiac disease, people may benefit from lowering the amount of gluten in their diet. Talib says gluten can cause blemishes on the forehead, bloated face, redness and darkened skin patches on the chin.







Birth control pills, IUDs, implants and shots are widely used today and prescribed often as a means to control acne. Most forms of birth control can have the potential to cause acne and weight gain in those susceptible. Typically birth control is divided up as estrogen or progestin dominant and have varying degrees of androgenic (testosterone like) effects. Generally, those with the potential for higher androgenic symptoms should be avoided for people prone to acne because they promote breakouts.

The most commonly prescribed in this category are:

  • Brevicon
  • Demulan
  • Femcon
  • Kelnor
  • Modicon
  • MonoNessa
  • Necon
  • Ortho Tricyclen
  • Ortho-Novum
  • Ovcon
  • Previferm
  • Sprintec
  • Tri-Nessa
  • Tri-Previferm
  • Tri-Sprintec
  • Zovia

It is best to avoid the following that are high in androgen activity and low in estrogen:

  • Alesse
  • Amethyst
  • Apri
  • Azurette
  • Caziant
  • Cryselle
  • Cyclessa
  • Depo-Provera
  • Desogen
  • Emoquette
  • Estrostep Fe
  • Implanon
  • Jolessa
  • Kariva
  • Lessina
  • Levora/Levonest
  • Linessa
  • Lo-Feminol
  • Lo-Ogestrel
  • Lo-Ovral
  • Loestrin
  • Lutera
  • Marvelon
  • Microgestin
  • Mircette
  • Mirena IUD
  • Nexplanon
  • Nordette
  • Norplant
  • NuvaRing
  • Ogestrel
  • Ortho Tricyclen Lo
  • Ovral
  • Paragard/Copper IUD*
  • Portia
  • Reclipsen
  • Seasonale/Seasonique
  • Skylar IUD
  • Sronyx
  • Triphasil/Trivora

Only you and your doctor can determine what form of birth control is right for you. The above is just a basic guideline that should be used to initiate a conversation between you and your physician. If you are considering using birth control, it is important to know that it can be associated with a high risk of blood clots, weight gain, nausea, mood changes, depression and breast tenderness. Serious side effects include strokes, digestive issues and embolism.

It is entirely possible to treat acne without using birth control. If you have no underlying health issues that require you to be on birth control and are considering using birth control only to control your acne, please consult with your doctor about selecting a form of birth control that is higher in estrogen and lower in androgen potency.

*Although the Paragard/Copper IUD does not contain any hormones, we have observed that it has aggravated acne with our clients.

– courtesy of Face Reality Acne Clinic, San Leandro CA

Stop the on-again, off-again relationship with your products

You ditched a product because….

1. It left your face red and irritated. Some ingredients, like retinol, inflame skin on purpose (to shed damaged outer cells or kick-start production of skin-plumping collagen), and it can take four to eight weeks to build up a tolerance, says Jeanette Graf, M.D., a dermatologist in NYC. Stop using it until skin returns to normal, then “reintegrate it into your routine, using only a pea-size drop every other night followed by a gentle moisturizer,” says Dr. Graf.

2. You didn’t see results. “On average, you won’t see a visible skin change for about four weeks,” says Amy Wechsler, M.D., an NYC dermatologist. If, after that, you still see zilch, schedule a quick trip to your dermatologist’s office (or see a trusted aesthetician) to be sure it’s right for you.

3. You didn’t like its smell or texture. Playing with the product in-store (via a communal tester or requesting a single-use sample) is your best bet. Other ways you can curate: Sephora.com’s Skin Care IQ (an online consultation that helps you zero in on new faves by calling out ingredients, types, textures, and fragrance-free options) and the OG product-reviewing website MakeupAlley.com

4. You found something newer and cooler. Indulge your impulse-purchase habit with samples. A monthly subscription service (like Birchbox or Glossybox) lets you test-drive products and spring for a full-size version of something you love. Also helpful: Sephora.com, which includes three free samples with your order.


If you just hate it, these retailers offer the best return policies- even for opened products. Just stash your receipts.

1. CVS and Walmart: full refund, no questions asked.

2. Sephora: full refund within 60 days; store credit up to 90 days.

3. Macy’s: full refund for unopened or barely used products.

4. Target: exchange on a case-by-case basis.

5. Nordstrom and Walgreens: refund or exchange on a case-by-case basis.

6. Ulta: full refund within 60 days; store credit thereafter.

This was originally published as “Playing the Skin-Care Field?” in the August 2015 issue of Cosmopolitan

This beautiful young lady had inflamed and non-inflamed acne that took several weeks longer than normal to finally clear.

Once acne breakouts are under control, it takes 3-6 months to help fade the marks with OTC products and light epidermal peels. She has been diligent about her home care routine and regular treatments.  Because she did not want down-time, she chose to continue having treatments at your best skin rather than go to a dermatologist and get laser.

It was worth the wait.   Now that her skin is smooth and breakout free, she spends a fraction of the time applying makeup!

Before treatment. March 17, 2014

Before treatment. March 17, 2014

After 14 treatments. October 10, 2014

After 14 treatments. October 10, 2014


After 22 treatments, July 10, 2015

IMG_4067 - Version 2

Before treatment. March 17, 2014

IMG_4677 - Version 2

After 14 treatments. October 10, 2014


After 22 treatments, July 10, 2015

This client had primary inflamed acne. A combination of salicylic acid + benzoyl peroxide was used to achieve this result within 6 months.  (Hydroquinone was added after 7 weeks)

Before Treatment

January 29 – Before Treatment


May 14 – After 5 treatments


June 6 – After 6 treatments