Ask Dr. Graf - Your Inner and Outer Beauty Expert

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Ask Dr. Graf

Why must I clean my face morning and night? Sometimes I am so tired at night that I forget to take off my make-up.

Facial cleansing is the first single most important step in skin care and it must be performed twice daily—upon arising and before bedtime. By bedtime we have accumulated a mixture of broken- down skin care products, cialis buy nurse sunscreen and make-up, cialis sales mixed with sebum and environmental exposures, such as airborne particles, accumulated over the day. The removal of the metabolic by-products of all these elements makes cleansing an essential step, providing the optimum conditions for skin to perform its important renewal function overnight. In the morning, the metabolic waste products from the renewal process must also be cleansed from the skin.

TIP: If you’re too tired for routine bedtime cleansing, keep a pack of pre-moistened makeup removal wipes or pads on your night table so you can easily reach over and wipe your face clean right before you go to sleep.

What is the best cleanser for my skin type?

There are many excellent facial cleansers for each skin type. Your skin can also change with the seasons—a normal to dry complexion may feel tighter and drier in the winter, or produce more oil in the T-zone during the summer. In each case, you want to adjust your skin care plan accordingly. You’ll find that using the right cleanser to meet your needs will make your entire skin care regimen more effective.

DRY SKIN: Dry skin as well as very dry skin may do best with a soap-free, non-foaming or milky cleanser formulated to either rinse off or tissue off.

NORMAL AND COMBINATION SKIN: Go for a gentle foaming cleanser that is pH balanced. These cleansers may contain gentle exfoliants, such as lactic acid and gluconolactone, both of which are excellent skin-smoothing additions to cleansers.

OILY AND ACNE-PRONE SKIN: The same type of cleanser with gentle foaming action recommended for normal and combination skin also works well for both oily and acne prone complexions. Another option for acne-prone skin is a cleanser which contains salicylic acid, an exfoliating ingredient that helps to unclog pores, helping to prevent breakouts.

SENSITIVE SKIN: If you experience redness, itching, stinging or burning in response to certain products, you are likely to have sensitive skin. Sensitive skin can occur in individuals with skin conditions such as rosacea, acne and contact sensitivity, as well as people who simply experience stinging and burning. It is best to choose products specifically created and labeled for sensitive skin. Also, products which are labeled as “anti-redness” should be well tolerated. If you have sensitive skin, but it sometimes becomes dry or oily or breaks out, choose a cleanser formulated for sensitive skin that also addresses the specific need such as acne, oiliness, dryness, etc. Look for words such as “nonirritating,” “soothing” and “anti-irritating” on the packaging.

Why is using a pH-balanced cleanser important?

Our skin protects us from the outside world, where we are constantly exposed to environmental insults from sun, pollution, airborne particles, allergens, bacteria, viruses, fungi and parasites. In order to provide maximum protection during the day, our outer skin layer should be at a slightly acidic pH of 5.4. A pH-balanced cleanser helps to maintain this level of acidity. This allows our skin’s probiotic microflora to function maximally to protect our skin.

There are so many skin care products out there that I get confused about when and how I should apply them. Can you simplify it?

I always ask my patients what they are currently using. If they tell me that they don’t have a routine, I start them with a very simple regimen of cleansing in the morning, followed with application of moisturizer with a broad spectrum sunscreen (the SPF should be at least 30; during the winter when UVB rays are weakest, you can get by with SPF 15). At night I have them cleanse and use a retinol moisturizer for stepping up skin’s renewal process. If they are able to take these simple steps and perform them regularly, chances are that they will be quite happy to expand their regimen and personalize it more for their particular cosmetic needs.

What is exfoliation?

Exfoliation is a natural process that is normally performed by enzymes naturally found in the skin. These enzymes trigger dead cells on the surface of the skin to flake off, revealing fresher, smoother skin. Unfortunately, as we age our skin loses the hydration needed to activate these exfoliating enzymes. That explains why a five-year-old child doesn’t require exfoliators and moisturizers for a healthy glow, but someone in their 30’s does.

Do I need to exfoliate? Is there a correct way?

Once you are in your teens, chances are you require some form of exfoliation, especially if you are experiencing clogged pores and breakouts. As we get older, there is less moisture within our outer skin layers and our natural exfoliating enzymes are unable to perform their desquamating function because they lack the level of hydration needed to activate this function. The result is an accumulation of dead skin cells on the outer surface of our skin. This build-up prevents the skin from reflecting light, which results in a dull, dry, gray, ashen look.

Exfoliation may be performed at home gently and gradually through a variety of different types of products, including daily cleansers, pads, gentle scrubs, foaming peels and at home kits. At-home microdermabrasion and chemical peel kits are stronger than daily use products, and should be used with caution since frequency of use will depend on skin type.

These may be done from once weekly to up to three times per week as tolerated.

Is there such a thing as over-exfoliating? How would I know?

Absolutely! Remember that the reason we exfoliate at home is to replace the natural process that our skin’s enzymes are no longer able to perform. If we exfoliate at home to the point of redness and/or irritation, then we have over-exfoliated. While a peel that is performed in the doctor’s office is stronger and will often result in redness, that is not a desirable result in at-home peel.

Can over-exfoliating be potentially harmful to my skin?

Aside from the potential for irritation, over-peeling and over-exfoliating your skin regularly over time result in producing higher levels of enzymes, which can break down our skin’s collagen, the protein that maintains skin’s resilience and elasticity. Less collagen can result in sagging and wrinkling. This is why exfoliation must be performed in a gentle manner.

If I use “hypoallergenic” products does that mean I won’t have an allergic reaction?

When a product is labeled as hypoallergenic, it means that it has been formulated without any known allergens, such as fragrance and/or coloring agents. But you may have a reaction to other ingredients—even if they are “natural.” According to the U.S. Food and Drug Administration (FDA), to date there are no federal standards or regulations governing the use of the term “hypoallergenic.” Allergic reactions to any product depend on the individual’s sensitivity. In a nutshell, there is no guarantee that any skin care or cosmetic product—whether or not it is labeled as “hypoallergenic”—will never trigger an allergic reaction. Keep in mind that “hypoallergenic” does not mean “non-allergenic.”

What are parabens, and why are they used in skin care products?

Every skin care product must undergo very stringent and vigorous testing methods in accordance with standards defined by both international guidelines as well as the U.S. Food and Drug Administration (FDA). In order to ensure a stable two-year shelf life of a product, preservatives must be included in the lowest concentration possible to prevent the growth of any pathogens which may have inadvertently been added to the product. The most common preservatives used in both drug and cosmetic formulations are parabens, which are esters of para-hydroxybenzoic acid. The most commonly used are methylparaben and propylparaben.

Aren’t parabens dangerous? Do they cause cancer?

In fact, parabens are used in very low concentrations and at these levels are deemed safe by the FDA. They have been used as preservatives for over 40 years in both foods and cosmetic and drug formulations, and have an excellent safety profile. There has never been a reported case of cancer linked to paraben use.

What if skin care products don’t contain parabens or preservatives?

The consequences of excluding parabens can be far worse. If we do not include parabens in formulations the resulting overgrowth of bacteria, fungi and parasites can be far more dangerous. If any of these pathogens are applied to the skin and we do not have the appropriate probiotics and microflora in our own skin needed to neutralize them, the possibility of developing severe skin infections is much greater.

Can we use any preservatives labeled as “natural?”

The use of natural preservatives in skin care is one of the most actively researched areas among scientists and cosmetic chemists. Unfortunately, none of the natural preservative systems to date are nearly as effective as parabens.

If I am concerned about breaking out, should I use only products which are labeled as “oil-free” and “non-comedogenic?”

There are many terms used in marketing skin care products. The most commonly used are “oil-free” and “non-comedogenic.” In fact, these terms are not regulatory and no federallyregulated test dictates their use. The terms “oil-free” and “non-comedogenic” date back to a time when mineral oil was industrial grade and extremely thick, impure and clogging. This has resulted in the demonization of mineral oil; you hear recommendations to avoid mineral oil again and again, even by dermatologists. Today, if mineral oil is used in cosmetic formulations, it is of a fine cosmetic grade that is completely different from the thicker mineral oil originally referred to in the terms “oil-free” and “mineral-free

Meet Dr. Graf

START LIVING, STOP AGING by Dr. Jeannette Graf Distinguished dermatologist, groundbreaking pioneer of the anti-aging power of peptides, sought-after expert on inner and outer beauty based on her revolutionary two-week pH-balancing diet, best-selling author of Stop Aging, Start Living, go-to media resource for cutting edge expertise on dermatology, cosmetic injectables, and skin science—Dr. Jeannette Graf does it all. A board certified, clinical and research dermatologist, Dr. Graf is also renowned for her innovative four-point body alkalinizing plan as a unique approach to beauty, vitality and health at any age. "Without science there is no skincare" - Dr. Jeannette Graf