What To Know About Moles

Beauty marks can give a person character. But as striking as they can be, they also needed to be understood for what they are: moles. And moles can be dangerous. Obviously this doesn’t apply to every speck that calls your body home, but it’s important to be alert about their appearance and if that changes. To advise, we called New York-based dermatologist Neal Schultz. You won’t be able to diagnose a mole on your own, but you can know when it’s time to get it checked out by a professional.

Know What You’re Dealing With
Semantics are important. “All birthmarks are moles, but not all moles are birthmarks,” Dr. Schultz says, referring to the fact that many moles can appear a good long time after we’re born.

But more importantly, not all moles are the same in terms of risk. “People are always concerned with raised moles, but very rarely are raised moles bad,” Dr. Schultz says. “It’s usually the flat moles that get into trouble. Raised moles are intradermal moles, or compound moles, and they have a much lower rate of malignant degeneration. Flat moles are where most of the cases of melanoma come from.”

Symmetry Can Be Good And Bad
“All normal moles have what’s called an axis of symmetry,” Dr. Schultz explains, meaning that if you could fold it in half over some point, one half would be the mirror image of the other half. “Any mole that does not have an axis of symmetry, you should show your doctor.”

But there’s a caveat: “There’s one other peculiar sign that’s really useful—if you draw a line down the middle of your body, from your chin down through your groin, and you have two moles that are mirror of each other, meaning roughly the same distance from that middle line and approximately the same level up and down, there is a good chance they are precancerous,” Dr. Schultz continues. “It’s one of the few times in medicine where symmetry is bad.”

Be On The Lookout For Change
“I tell people moles can change because they get hit, beaten up, and inflamed. But if in two weeks they don’t return to their normal appearance, then show up to somebody. Nothing terrible is going to happen in two or three weeks.”

Check In Once A Year—And Thoroughly
“Your skin is the only organ in your body that you get complete control on whether or not you get cancer,” Dr. Schultz explains. “I don’t mean by avoiding the sun—I mean by getting it checked regularly.” Make sure you’re seeing a dermatologist at least once a year—and dress down for it. “Go without your nail polish because you can get melanomas under the nail that we’ll look for. Don’t go with tight-braided hair because we want to look through your scalp, too,” Dr. Schultz adds. Basically, you can get a mole anywhere, so be prepared to check everywhere.

When you don’t have an appointment imminently approaching, you can still be vigilant. “If you have any type of procedures done on your hair—a cut, straightening, trimming, whatever—there is somebody looking through your scalp. Know to ask before you go to your hair professional, ‘Hey, if you see anything up there, let me know so I can show it to my doctor.'”

Photo by Jen Steele.

When to forgo the facial and see a dermatologist instead.

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Everyone Has Combination Skin

The drugstore is great for many things—impulse buys, emergency face-wipe restocks, really big bottles of moisturizer…But as with any relationship, it’s important to acknowledge holes in communication. That’s how you grow and mature and become more productive. So now seems as good a time as any to acknowledge that drugstore product descriptions have a major communication problem. 

Namely, the term “combination skin.” What does that even mean? Oh, so you’re dry in some areas and oily in others, and sometimes it changes? Welcome to having a face. At this point in our collective lives, I suggest we come to terms that this nebulous “combination skin” nonsense means nothing.

And I’m not alone.

“I never use the term ‘combination skin,'” said dermatologist/psychologist Dr. Amy Wechsler. “I think people get confused by it. There are people who have acne and dry, sensitive skin, and they are like, ‘I must be oily because of the acne, but I’m dry so it’s combo.’ Or ‘Normal skin is almost always more oily in the middle of the face and less oily on the sides, so is that combo?’ That all sounds normal to me.”

Sounds normal to me, too. But even then, I feel like we’re overthinking it. “For most people there are more oily or sebaceous glands on the nose and central face,” Dr. David Colbert of the New York Dermatology Group said, echoing Dr. Wechsler’s remarks. “So this area is naturally more oily. Many of my clients say they have combination skin, and in a sense, they are right.” Maybe we all have combination skin. But if everyone has it, then does anybody really have it?

Regardless of your answer to that question, there are steps to take to correct any wavering state in which you might find your face. Dr. Wechsler continues: “Sometimes people create their own dryness. If you’re over-scrubbing your skin, you could be making it dry. American women in general tend to over-cleanse. I like to tell people to listen to their own skin rather than listening to what a product says or listening to someone they met in a store telling them what to do for their skin.”

Products flagged for “combination skin” might be pure marketing, so look for things that tout balance instead. Dr. Colbert recommends his Balance Purifying Cleanser to gently clean without the oil-stripping effects of soap. Both doctors said a routine with fewer products (albeit the right products) might be the very simple solution to happier skin. “If your skin is reacting differently, the ingredients in your products may have changed, or something bigger might be changing with your skin,” Dr. Wechsler said. “But in general, I think if you find something that works for your skin, you should never have to change it.”

—Emily Ferber

Photo via ITG.

So now you know your skin’s not combination, but do you know its pH balance?

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Aesthetician Vs. Dermatologist: Who To Go To When

I don’t know anyone who would pass up a facial. There’s the spa-luxury aspect for sure, but then you hear the fairytale stories—that once you find the right aesthetician, finicky skin is solved, and it’s nothing but clear-complexion sailing from here on out. But what happens when your trip to the facialist fails to leave your skin glowing for any sizable length of time? Although opting for peels, scrubs, and light therapy isn’t necessarily bad, they might not be what your skin really needs. Before you splurge on another treatment, consider the possibility your latest skin woe might in fact be a job for the dermatologist. To help you determine which expert’s opinion to seek when, here are a few points explained to make the most of your visit.

To get it out of the way: What’s the primary difference between a dermatologist and an aesthetician?
To state the obvious: A dermatologist is a doctor and an aesthetician is not.

“A dermatologist is a medical doctor who has completed pre-medical studies in undergrad, four years of medical school, a one-year internship most commonly in internal medicine, three years of dermatology residency, and has passed national examinations for licensure and board certification,” explains Dr. Hadley King, dermatologist at NYC’s Skinney Medspa.

But aestheticians study, too, explains Joanna Vargas, celebrity skincare aesthetician and founder of the eponymous spa and skincare brand. The best of the bunch are schooled in various skin conditions, as well as on how to treat common problems with non-invasive procedures and non-prescription products. However, she notes, an aesthetician’s ability is primarily relative to their amount of experience in the industry. “Someone who has been doing facials for 10 years is going to have better skills in, say, extraction than someone fresh out of school,” she says.

So what skin problems can be addressed and solved from a trip to an aesthetician?
Acne, mild breakouts, sensitivity, dry patches, and aging concerns, says Vargas. Ultimately, it depends on your aesthetician’s expertise and your exact needs, but call your aesthetician if you’re looking for: microdermabrasion, extractions, pore cleansing, acid peels, exfoliating treatments, waxing, superficial skin peels, and various light, laser, ultrasound and radiofrequency procedures.

And what requires a dermatologist’s eye?
Anything more than just basic skincare concerns. This includes skin cancer checks, checking moles or other skin growths, hair loss, severe acne, eczema, psoriasis, rashes, hives, etc., explains Dr. King. And if you’re looking for some serious cosmetic treatments, many dermatologists these days are trained in cosmetic dermatology and can even perform fillers, injections, and laser treatments.

Is there a quick rule of thumb for deciding to see the dermatologist versus getting a facial?
Although both an aesthetician and a dermatologist can offer advice for proper daily skin care, some skin issues require advanced medical treatment—think anything that might require a biopsy, surgical removal, an aggressive treatment, or an invasive procedure. However, there are other non-medical times when a dermatologist is also needed. Dr. King suggests visiting a doctor for even the most straightforward procedures like facials or peels if you think you might be at a higher risk for adverse side effects. She suggests those with darker skin or a history of scarring be cautious and seek out a dermatologist for these specific treatments. Better safe than sorry.

At the end of the day, which pro you see can also boil down to sheer personal preference. “Some people are really medical and like to have a doctor’s advice and a prescription,” says Vargas. “Most of the people who come to me are the opposite—they are seeking less invasive, more organic ways of treating their skin.”

Do dermatologists and aestheticians ever work together?
“Yes, it’s a great relationship when one—the derm—oversees skin health on a global basis and the aesthetician helps to carry out the plan outlined by the derm,” says Dr. Elizabeth Tanzi, co-director of laser surgery at the Washington Institute of Dermatologic Laser Surgery in Washington, D.C. She suggests asking your dermatologist about specific ingredients that would be helpful for your particular skin type, then refer to your aesthetician to help find them in products.

How much time does each appointment take?
This will ultimately depend on your personal circumstances. When visiting a dermatologist’s office, expect to see the doctor anywhere from 10 to 30 minutes per visit—longer if a procedure is required. If you’re not suffering from any specific problems, you only need to see your dermatologist once a year for a skin check. Otherwise, your frequency and length of visits will correlate with the issue at hand.

As far as your time with your aesthetician, this can also vary, but the standard facial time is an hour. Plan to see your aesthetician once a month for mild skincare problems. Call them mandatory facials.

Bottom line:
If you’re just having a bit of a flare up, are concerned about recurring pimples, need new product recommendations or just want to relax to the sweet soundtrack of a babbling brook, hit the spa. If you’re having some serious battles with your skin, think meds might be the solution, or want a more invasive procedure done, book an appointment with your derm. And for the best treatment around, see both.

—Caitlin Miller

Caitlin Miller is a beauty writer who cherishes her vast collection of cleansing oils above all else, including Netflix. She listens to Bob Dylan daily, eats nachos weekly, and would never travel without running sneakers and eyeliner.

Photo by ITG.

Time to get acquainted with your face map.

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A Primer On Lasers In Skincare

For the uninitiated, the concept of the 10-minute laser facial can seem daunting—sort of like that one-way trip to Mars too many people applied for. First of all, try free-associating the word ‘laser.’ Sci-fi might be the first word you come up with—or maybe something about newfangled weaponry. Laser hair removal might be in there somewhere if you happen to have experienced that, but skin resurfacing probably wasn’t among the first dozen reference points. After all, lasers are a big topic. But seeing as this is a beauty site, today we’ll tackle lasers as they relate to skincare—which can cover everything from a 10 second zap to take care of slight skin discoloration to the latest in nonsurgical facelifts.

The easiest way to understand what’s treatable is to understand what technologies are at your disposal. But before delving too deep, there are a few important clarifications. Mainly: Not everything in this article is technically a laser. “People lump everything under that umbrella—but that’s just one specific wavelength of light,” Dr. Patricia Wexler (of recent Top Shelf fame) clarifies. As the technology has evolved, there are now many tools to transfer energy through the skin, and in effect, injure it so that it heals stronger and more youthful looking. We’ll start with lasers though, since it’s the name of the game:

Lasers
A definition: Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Within that, there are ablative lasers and non-ablative lasers. Both can treat color issues in the skin and stimulate collagen regrowth in the skin. The former has a greater capability of targeting the surface of the skin, all the way down to the sub-dermis, whereas non-ablative lasers can target the dermis without addressing the epidermis. “Albating means you’re actually punching holes in the skin,” Dr. Neal Schultz explains. “With non-ablative, you’re just transferring the energy through it.” These days, non-ablative treatments tend to be more popular—they’re considered less invasive, and there’s significantly less downtime after the procedure. However, effects of an ablative laser tend to be longer lasting, depending on the area of the face targeted (lip lines and other problem ares caused by excessive movement are going to come back no matter what you zap them with). The downside is the downtime—lasers like a CO2 or Erbium are going to leave the skin “black and blue for a few weeks,” Dr. Schultz said. “But they’ll get rid of the spot or the line the first time, every time.” An Erbium can also treat benign moles and warts.

Both types of lasers can be used to treat discoloration or photo-aging (whether that’s brown from sun spots or red from broken capillaries) and skin texture. “When we talk texture, we mean rough, dull, tired-pored, tired-looking skin and even fine lines,” Schultz said. “All of these things create a skin surface that isn’t smooth. When you have junk accumulating on the surface, like dead cells and pore sludge, all of these things create irregularities where light hits and scatters instead of reflecting. The lasers that will remove that top layer of hanger-on cells tend to be non-ablative. You don’t need to drill holes to get rid of that stuff.” Afterward, there might be a little flaking on the skin for a few days, but no serious down time. “Plus, when you peel off some of those cells, you’ll also be getting rid of  some of the discoloration in the brown family,” Schultz continued.

Intense Pulsed Light (IPL)
While still reliant on specific wavelengths of light to target melanin or hemoglobin under the skin’s surface, IPL doesn’t have the same radiation associated with laser technology (all IPL is considered non-ablative, as well). It works by transferring short blasts of specific lights through the skin—different pigments are reached depending on the filter you use. As such, IPL can treat rosacea, hyperpigmentation, and some laxity related issues in the skin. All told, IPL tends to be less expensive, but it often takes several rounds of treatment to get the desired results. It may seem like an altogether more gentle procedure, but Dr. Wexler warns “since this is still a pigment sensitive area, people with darker skin have more trouble with this technique.” IPL, along with a low-intensity YAG laser are used in Skin Laundry’s facial.

Ultrasound & Radiofrequency
“Anything that heats that skin and fat in a controlled fashion to a certain temperature will make it shrink,” said Schultz of heated therapies, which also prompts cells to rebuild by damaging the collagen. If you’ve ever heard people talking about Thermage, this is what they’re referring to. “Think of it as overcooking your steak. It shrivels up, but the heat doesn’t char the outside of the steak. We’re just shrinking the fibers around the fat which will reduce the puffiness around your face.”

As for that illusive (or not illusive anymore) nonsurgical facelift—”Ultrasound is amazing,” said Wexler about the technology she admits she’s the most excited about. “You’re delivering a different energy to the layer of the muscle and the layer of the deep dermis.” Those are the same two levels targeted during a traditional facelift—but you’d be cutting the muscle and tightening the skin. Instead, by heating the tissue at a specific temperature over the course of an hour and a half or so, it tightens and lifts. The most impactful results are seen several months down the line, once the collagen as regrown.

Now for an important reminder: Like with any procedure, there are always potential risks. But all doctors consulted for this story said with an experienced technician, there’s very little to worry about in terms of laser treatments. “They’re invasive, but without collateral damage,” Dr. Schultz says about lasers and their popularity among patients. “If you want to take advantage of the laser, you also have to take the limitation of the laser—which is that you need a different laser for every single problem.” You can do too much, however, and end up with an oddly shaped face, eventual discoloration, and thin-looking skin.

“Any time a patient has a risk of cold sores, we put them on Valtrex before the procedure and keep them on it afterward, but you can always get an infection whenever you have a procedure,” Dr. Wexler said. “Cold sores in particular because you keep the virus in your body and it comes out during heat and stress.” You also want to stop using hydroquinone products and self-tanners the week before and keep off of them for at least a week after.

The best way to figure out which laser suits your needs is to talk to a doctor. “Brands and types of lasers shouldn’t really come into it at first,” Dr. Schultz says about consulting your dermatologist, confirming that there is no such thing as the best laser: “One size never fits all. First talk about what the problem is and what the desired result is. And if you’re in good hands, your doctor will know where to take it from there.”

Illustration Lauren Tamaki.

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Dr. Patricia Wexler, Dermatologist

“I was five when I told my mom I wanted to be a doctor. She never discouraged me—she never said, ‘Are you sure? Do you want to be a nurse?’ Nothing. She just went to my school and told all the teachers to give me the advanced science books in second grade.

CAREER
I went to New York University—I was pre-med but with an art minor. I’ve always had an interest in sculpture, particularly of the face. I love old faces, young faces, children’s faces, so that’s the focus of my collection. And that’s when I met my husband, too. He proposed on the third date…I had to break up with my boyfriend to say yes! [Laughs] We got married nine months later and have been married 42 years. That was during the Vietnam War, and we had difficult time getting into medical school together—we ended up in Brussels doing courses in French. They were quick to fail people and didn’t accept poor accents. So they would say, ‘Your knowledge isn’t bad, but your accent is terrible,’ and they’d fail you. But it was an experience, and it made us strong and close.

When we got back to this country, I did internal medicine and infectious diseases at first. But the body is all connected, and I’m not good with losing people, so I switched over to dermatology. Emotionally, I had to accept the fact that people might judge me for switching focuses, but I don’t really care about being judged. As long as my patients are happy, then I’m happy. I don’t care about the outside world. But I’m not just a cosmetic dermatologist. When every patient comes in, they get a cancer screening. If they come in for Botox, they are still going to get undressed and examined. Patients will say, ‘I’ve never had a skin exam,’ and they’ve been going to dermatologists for years.

If you’re going to work 10 hours a day, five days a week, you want to love what you do. Dermatologists tend to really love what they do. And I have to do what I’m good at—when you’re in a practice with five other doctors, you get to pick and choose what you work on. For me, it’s sculpting.. I’ve been doing full-body liposuction since 1986, and I do a French technique where patients are standing for the contouring. I play Carly Simon while I’m doing it—“You’re So Vain.” Such good music to do it to.

SKINCARE
My mother was very big on taking care of yourself. She always took me to the best hairdressers for the best hair cuts. When I got my first pimple, she took me to the head of the acne program at NYU—things like that. It definitely influenced how I continue to treat my skin. Get a routine and figure out which products you like. Nobody can use three retinols, three night creams, and two day creams. If you’re going to deviate from your core products, only do it one at a time. And I always tell people to exfoliate on a daily basis. This once-a-week thing is nonsense. But, I think you have to know your skin. You should never look red or irritated—you should look better after you scrub. I tell my patients to do it in the shower, because if you’re not doing it in the shower, it’s inconvenient, it’s messy, and you’re just not going to do it.

So every day, I exfoliate and shower with my Resurfacing Microbrasion System—it’s a tiny granule, and I file it with a very rich hydronic serum that has pigment. It also has mulberry, bearberry, and chamomile. Your skin will actually look more soft and less pink and afterward. Then I also wash my face with my Universal Anti-Aging Cleanser With Olive Oil—it takes off makeup, too. Never go to bed with makeup on. It could be 3am—even if it’s just three hours of sleep—I never go to bed with my makeup on. It’s got pollution and free radicals in it from the environment so you should be taking that off and using an antioxidant to combat those effects.

When I’m out of the shower, the first thing I put on my skin is Patricia Wexler Acnescription Overnight Acne Repair Lotion [ed note: currently unavailable]. I use a retinol three times a week—right now it’s the Natura Bissé Diamond Extreme. I think that it’s great, but you have to know how much your skin can tolerate. I have a lot of red in my face, so I’m careful. If you’re not so red, you can use it a little more, especially because a lot of the new formulas are non-irritating. I also love the Natura Bissé Diamond Ice-Lift. A day before a red carpet event, you put it all over your face, leave it on for 10 minutes to dry, and it peels off like cellophane. It looks like you had a facelift. I try to keep two jars around at all times. If you have puffy eyes or lip lines, it’s like a miracle.

Then I put on Nia 24 Eye Repair Complex all over my face because it strengthens the barrier of your skin, so if you’re dry, it keeps the moisture in. After that comes my Intensive 3-in-1 Day Cream or Intensive Night Reversal and Repair Cream. The day cream has sunscreen, the night cream doesn’t—but I like to use my night cream twice a day because it’s more reparative. It gives more oomph to your face.

But at the same time, I’m also very lazy. I haven’t done any lasers. My last filler was two years ago…and I haven’t done Botox in two years either. The things I am OCD about doing are habits that are just generally better for the skin. I’ve never smoked a cigarette in my life. If I’m somewhere sunny, I wear a t-shirt backwards, so it’s more like a boatneck, stand under a tree, use a parasol—I really try not to be in direct sunlight because I’m sensitive to it. And I need to stay hydrated all day long. I think being dehydrated is the worst thing for your skin so I have an 8 oz. glass of some liquid in every room that I work in, and if it’s not there, I get really testy.

MAKEUP
I don’t always wear makeup. In fact, there was a period this year where for about three months I didn’t wear makeup to the office. I just was in a phase—I wanted to look like Tilda Swinton or something. People said I looked so young and this and that. It was a conversation piece. Then I got tired of it.

During the day, I use ColoreScience Sunforgettable Face Primer. It makes your makeup go on really smooth and has SPF 35, which is fine for the winter. I use SPF 45 in the summer. After my primer, I use my new Giorgio Armani Luminous Silk Foundation in 5.75—It’s really nice. I use my fingers to apply it, not a brush or sponge. I know makeup artists do it with tools, but I don’t have the time or the patience for that. And afterward, this is the best blush—Giorgio Armani’s Cheek Fabric Sheer Blush in 306. After that, I go for my eyebrow pencil—the Vincent Longo Eyebrow Micro Pencil in Auburn one is the only one that goes with my red hair. I bought 40 at a time because you can use this pencil, and in a week to 10 days, it’s literally a micro pencil—but it’s the only one that doesn’t look like you’re penciling it on, which is good because my brows are totally blond. I dye them, and it only takes two minutes. Then I highlight under them with Anastasia Beverly Hills Brow Duality in Camille Sand.

Stila Eye Shadow in Kitten is the only eyeshadow I’ve worn for 20 years. I bought a ton of those, too, because I’m scared they’re going to discontinue the color. It adds a brightness to my eye. Smoky eyes aren’t my thing—I like a fresh look. I just started wearing eyeliner for the first time in my life this year. I feel like it makes my face pop. I like to do it in a straight line with Eyeliner Baby Doll by Yves Saint Laurent. It stays all day.

I like to put my lipgloss under my lipstick because it’s moisturizing but not too sticky that way. I just got the Chanel Lèvres Scintillantes Glossimer in 93 Pailettes. Then I’ll put Lipstick Queen Sheer Lipstick in Saint, which is a pinky-nude, on top. It’s really a pretty color but still neutral. I never do a bold lip. I think I’m bold enough. Even the eyeliner is pushing it for me.

HAIR
I’d never say I’m very playful with my makeup, but I’m very bold with my hair. I change the shape a lot. To me, hair is hair—it’ll grow back, and I can change it again.

I love Terax Crema Ultra Moisturizing Daily Conditioner and Kérastase Bain Miroir, which I don’t think they’re making now, but you can go on eBay and spend a fortune on whatever is left. I’ll use Serge Norman’s Meta Lush Volumizer at the roots because I have thin hair—it’s curly but the texture is still really fine. The Shu Uemura Fiber Lift is necessary in my life. I use it two or three times a week. And then when my hair gets very dry looking, Nevo by Pravana Hydra Pearls Drops of The Amazon is amazing. It’s an oil in a little capsule or a pump bottle, and you put so little on through the ends. Occasionally I’ll do Kérastase mask, but that would mean I have 10 extra minutes in my life.”

—as told to ITG

Dr. Patricia Wexler photographed by Tom Newton. For more of The Top Shelf, click here.

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