This reader's question is a common one we get in the clinics.  Roaccutane had been withdrawn by its makers in the US because of public disquiet about its undesirable side effects.  The good news there are healthy and natural alternative acne treatments!

Reader's question

I have moderate active acne and I wondered what acne treatments you would recommend instead of Roaccutane?

Peter's answer:

Roaccutane is a type of isotretinoin which is a treatment for severe acne. It is associated with a few undesirable side effects and I would strongly advise exhausting the alternatives before considering this treatment.

You must have an expert skin analysis prior to deciding on a course of  treatments for acne.

If your skin is too alkaline you should adopt a home care regime that brings the pH to 5.5 or lower. A slightly acid skin allows the skin’s natural flora to flourish which will suppress the acne bacteria and the severity of the acne will decline.

Chemical peels that incorporate salicylic (such as jesnner ) can be very effective at controlling and reducing acne. They are quick to perform and depending on their strength  are not too uncomfortable. They also require very little downtime and have  little impact on your day to day activities.

Unfortunately acne is still not completely understood and there is not a single treatment that will be effective on all types of acne. Because of this you may have to try several types of treatment before you find one that works for you. It is however better to do this before you consider isotretinoin (e.g. Roaccutane). Most acne will respond to a low pH skincare regime and salicylic based chemical peels so I would always try these options first.

Here's another of Peter's expert answers, this time about a type of 'at home' chemical peel  we do not endorse at SkinGenesis.

Question:

I am two weeks into my Obagi treatment. It was recommended that I also have three sessions of laser treatment but should the Obagi be enough as an acne scar treatment . My acne scars are described as moderate?

Peter's answer:

If the acne scars are slightly pigmented then the laser was probably recommended to reduce the pigmentation.

The Obagi treatment has pigment suppressants in the formulation however these are designed to reduce the likelihood of any hyper pigmentation consequential of the treatment and may not be sufficient to remove any extant hyper-pigmentation. 

The Obagi treatment incorporates Retin A and AHA acids and results in significant peeling during a 6 week treatment cycle that can be repeated several times after a recovery interval.

The treatment not only removes dead skin cells but also stimulates the production of new collagen. After the cycle the dermis and epidermis will have been significantly replaced with new skin cells and less of the previous scarring will be apparent.

Your physician may also have recommended the laser to further stimulate the dermis. I would strongly recommend that you ask your physician for a follow up visit and ask him to explain more fully the purpose of the laser treatments and if you still have doubts I suggest you review their necessity after the first treatment cycle. At this stage you will be able to make a better assessment of your progress and decide whether you require additional treatments to achieve your expectations.

Regular readers will know that Peter answers readers' questions for a Cosmetic Surgery magazine.  Here is a recent one about adult acne.

Question:

I am 35 and have started to see the signs of ageing with tired skin, open pores and lines and wrinkles, but I’m still being plagued by breakouts every month which I’ve had since a teenager.  What  adult acne treatment plan would you suggest ? Is there one procedure that will deal with these very different problems?

Peter's answer:

The first thing you should do is have a skin analysis and checked for sun damage, pH levels and moisture content. 

Once the condition of your skin is determined it will be possible to chose which treatments will be necessary to achieve the skin you desire.

If your skin is too alkaline you are likely to notice an improvement just by adjusting your skin care regime to more acidic (pH 5.5 or lower) products.  This improvement would be aided further by having a course of salicylic skin peels which will help clear the acne and at the same time rejuvenate the skin.

There are a few other treatments such as microdermabrasion which may help with acne breakouts as well as rejuvenate the skin. These treatments are relatively non invasive and require very little recovery or down time, but the most appropriate treatment can only be ascertained after the skin analysis.

Both ageing skin and acne can respond significantly to changes in lifestyle and I would recommend seeing a nutritionist who specialises in skin conditions. A good diet and the correct skin care will enable you to reduce the number of treatments you require as well as get the maximum benefit from them.

The latest in Peter's series of 'Skin Treatment Expert Answers' deals with methods of tattoo removal for darker skin types.

I have ethnic skin, so I understand that laser tattoo removal would not be suitable for me. Is there a method of tattoo removal that would work for me?

 Because laser tattoo removal is the most successful treatment for the removal of tattoos I would strongly recommend that you have your skin and your tattoo assessed before you look for alternative treatments. If you have a dark skin (Fitzpatrick scale V and VI) there is a high chance that laser skin treatments will cause burns to the skin which could lead to hyper- or hypo-pigmentation, or other scarring.

However on lighter skins (up to Fitzpatrick scale IV) it might still be possible to have laser tattoo removal but a lot will depend on the type of lasers required to remove the colours in the tattoo and their interaction with the melanin in the skin. The Q switched Nd:YAG laser can treat black tattoos on darker types of skin however there will still be risks of adverse side effects and you should ensure these are fully explained to you during the consultation.

If your skin and tattoo are unsuitable for laser removal then it is worth exploring some of the new chemical systems becoming available. These require a chemical being tattooed over the existing tattoo and the chemical will bind with the original tattoo ink and cause it to be rejected by the body. As with lasers, several treatments will be necessary.

Peter gets a wide variety of questions about skin, and from time to time these get written up in Cosmetic Surgery and Aesthetics Magazine where he sits on their panel of experts.

Here's a recent one, about a fairly rare (in the UK) form of uneven pigmentation.

My daughter has a large Mongolian spot on one side of her cheek that people often mistake for a bruise. Is there any treatment (laser or otherwise) that could get rid of this greenish blue colouration/ pigmentation?

Mongolian spots are a form of dermal melanocytosis and usually disappear completely by about 5 years of age. In about 4% of cases they will persist although the colour will fade partially. As Mongolian spots are completely harmless and normally always fade on their own accord there is no medical treatment available.

The condition is very prevalent in Japan and as a consequence aesthetic laser therapies have been developed there to remove the pigmentation. Although the therapy is most effective when the child is young and the skin is thin I recommend waiting until puberty to avoid unnecessary treatment as virtually all cases will have resolved themselves by that stage. I do not know whether or not this therapy is available in Britain but your GP should be able to advise.

I can understand that your daughter might feel very self conscious about the spot and may be reluctant to wait for it to fade. If this is the case I would recommend using camouflage make-up or mineral make-up (e.g. Youngblood Mineral Cosmetics - ed.) . Mineral make-up is kind to the skin, has excellent coverage and is easy to apply. It also has the advantage from your daughter’s point of view that it is very fashionable.

These days it's not often that a new magazine comes on the market.

Advertising revenues are down and many people now first go to the internet for their news and information, especially when researching skin rejuvenation treatments.  Image Cheshire is a new magazine that bucks this trend, and their first issue features SkinGenesis!

For some time now Peter has been a regular contributor to a national magazine called Cosmetic Surgery and Aesthetics Magazine in his capacity as a Laser/ IPL treatment expert.  He writes expert answers to readers' questions and we often reproduce these in the skin treatment blog on our website (tag 'Skin Treatment Expert Answers').
 
Cosmetic Surgery and Aesthetics Magazine has been a success and the publishers have now launched the regional spin-off called "Image Cheshire".

This has coincided happily with the opening of the new clinic in Mollington, Chester, and we were of course delighted when they said they would like to announce this in the news section and also run a feature on SkinGenesis in the main body of the magazine.  

The feature makes the point that recent resarch backs up the SkinGenesis philosophy that the quality of a person's skin - texture and tone - says as much about their age as visible wrinkles (or lack of them) do - hence why we specialise in skin rejuvenation.   

We have always maintained that anyone considering botox or fillers, or even surgery, should always do as much as they can to improve their skin texture and tone before deciding whether they need anything more invasive (and expensive!).  

Often they find that the skin rejuvenation treatments, like SkinGym,  give them what they want - just for people to comment "Wow, you look well" knowing they really mean you look great for your age! - and they are very grateful to have found such an easy and natural solution to the whole anti ageing question.

I hope you like the Image Cheshire article.

Peter sometimes gets asked for expert comment and here's the latest example, done as a Q & A, for a student who is writing an article on the effects of smoking on the skin, and how skin rejuvenation can help:

Q: What effect does smoking and other lifestyle habits have on the skin?

A: Smoking will have quite a serious effect on skin, especially female skin which is thinner than male skin and consequently more prone to the visible effects of smoking and environmental damage.

Smoking has several effects on the skin. The first and most damaging is the carbon monoxide in the blood. Carbon monoxide is damaging to most organisms and skin cells are no exception. The carbon monoxide will also constrict the capillaries that feed nutrients to the skin so that it is less able to sustain cell renewal. 

Finally cigarette smoke contains lots of rather nasty chemicals (used to effect taste and to keep them burning) which have a rather pernicious effect on skin cells. There are some other nasty side effects of smoking on the skin but there are no good side effects.

There is no doubt that cigarette smoke is especially destructive to female skin. Smoking ranks with UV exposure as the most damaging thing you can do to your skin and the visible effects of both are normally very noticeable from the mid thirties onwards.
 
 
Q: Do you think women are unaware of the damage they are doing to their looks? 

A: Most women start smoking young, perhaps as young as their teens and their skin is sufficiently robust at an early age to cope with damage from smoking. Unfortunately this means most have formed a life long addiction before their looks deteriorate and they appreciate the association between their smoking habit and skin condition. By the time they notice their thin skin is lined and needs wrinkle treatment, their addiction is too powerful for most of them to give up smoking even when they are aware of the damage it is causing.
 
 
Q: How could a skin assessment show the evidence of damage caused my smoking? 

A: Most smoking damage is easily visible. In chronic cases the skin will sag having lost most of its elasticity and the skin will have sufficient lines and wrinkle to give it a crepey appearance. The first signs are wrinkles where there is muscle movement for instance around the eyes and mouth; this develops further to pronounced lines on the upper lip (smokers lines) and hollow cheeks. Eventually the wrinkles spread over the whole face as the production of collagen and elastin fails to keep pace with the damage caused by smoking. 
 
 
Q: What message would SkinGenesis send out to women smokers with regards to their skin?

A:  There are very few alternatives to giving up smoking. If a woman is serious about her skin then she must give up smoking however it would be wrong to say that smokers cannot help there skin. If a woman cannot quit the weed she should cut down as much as possible.

Cutting down is not just a question of smoking fewer cigarettes it involves smoking less of them. The last half of a cigarette is far more destructive than the first half to the extent that 5 completely smoked cigarettes will cause far more damage than 10 half smoked cigarettes. Smokers should also have a diet very rich in anti-oxidants to help mop up the free radicals associated with smoking that cause so much destruction.
 
 
Q: If damage has already been caused by smoking, is it reversible? 

A: This is the good news. If someone gives up smoking, adopts a very healthy lifestyle and embarks on a remedial skin care regime their skin will radically improve in a few months. Some skin clinics such as ours (SkinGenesis) have developed highly intensive skin rejuvenation programs (e.g.  SkinGym™) which combine nutrition, home care and intensive in-clinic treatments which are remarkably effective in undoing the effects of sun-damage and smoking.

Peter has been answereing a question in Cosmetic Surgery and Aesthetics Magazine about non-surgical facelift.  The reader asked:

"I keep reading about a non-surgical facelift. What is this? Is it a combination of treatments or just one specific treatments?"

And Peter answered:

"A non-surgical facelift is a term used to describe tightening of the skin tissue without any surgical intervention. There are quite a few varieties but the two most common techniques involve either heating the skin tissue using either infra-red or radio frequencies or muscle stimulation using micro-currents.

In the first instance skin tissue is heated to between 55^o to 60^o when significant shrinkage of collagen occurs producing an immediate skin tightening effect. The heat will also stimulate a healing response which increases the production of collagen for several months after the procedure and this thickens the skin further to enhance the tightening effect.

The heating is achieved by exposing the skin to radio or infra-red radiation that penetrates the dermal layer and is absorbed either directly by collagen or the surrounding moisture. The procedure is quick and relatively painless with little recovery time. The results can be good but will not be as pronounced or as enduring as a surgical facelift.

The term can also refer to toning the facial muscles by stimulation with micro-currents. Although some increase in collagen production is also achieved, the results can be subtle and this technique is best suited to people who are not looking for a dramatic change to their appearance."

Some of you will know that we share premises with cosmetic surgeons Castlefield Clinic in Manchester. They do great work and have pioneered minimally invasive techniques that do not require general anaesthetic.

You can imagine their patients love this, and they also appreciate the fact that the scars are minimal. Despite this, we have been working with them to develop methods of scar removal which will make any scar even less noticeable. This experience has helped Peter answer this woman's question, published in this month's Cosmetic Surgery & Aesthetics Magazine.

Readers question:

"I had a tummy tuck almost two years ago and still have a very dark scar. Is there anything I can have done to make the scar less noticeable? "

Peter's answer:

"The scar is likely to be a combination of hyper-pigmentation and increased vascularity as a consequence of the wound.  Normally such scars will fade over time.

Recently new creams have become available that will treat both the vascularity and the hyper-pigmentation and these are generally availablefrom any good skin clinic.  However even with using these creams progress can be slow and it may still take a couple of years to achieve the results you want.

If you require faster progress then you will need IPL or laser treatments which will reduce simultaneously both the pigmentation and the vascularity. These treatments can be enhanced when combined with a regenerative chemical peel. Peels will bring about increased skin cell renewal and give the skin a smoother surface.

The results of this treatment are usually very good and in most cases the scar will not be immediately noticeable to the casual observer after about six months of treatment. the final result will ultimately depend on your body and the skill of your plastic surgeon. It is possible even with exceptionally fine stitches close examination will reveal a faint outline of the original wound."

Writing in Cosmetic Surgery & Aesthetics Magazine this month, Peter has been asked about acne scar treatment, and acne treatment.

The reader's question:

"I am a 22-year-old male from Edinburgh suffering from post-acne scars and still getting occasional acne break outs. I have just got engaged and I am getting married in the spring."

And Peter's reply:

The most immediate issue is to get the acne breakouts under control and so stop the formation of new scars. This is best done by having a full skin analysis which among other issues will indicate the acidity of the skin. Acne thrives on alkaline skins and quite often it is very well controlled by making the skin less alkaline. Acidity of the skin can be regulated easily and successfully by using synthetic washes, moisturisers and other topical products that have an acidity of less than 5.5pH.  Depending on the secerity of the acne, further acne treatment may be a good idea.

Acne scar treatment should target the two visible aspects of the scar: hyper- pigmentation and atrophic scars. Pigmentation responds well to IPL treatments and atrophic scars respond well to peels and high vacuum microdermabrasion.

Fortunately not only can these skin treatments be used simultaneously but they have a synergy when used together which enhances the result. These treatments will also help control the acne.

Unfortunately time is not on your side if you want to be sure of a perfect skin in time for spring so I recommend that you start treatment as soon as possible at a skin clinic that not only has all the treatments available but also undertakes a full skin analysis.