Face Care Maintenance Program: The skin is a tough, flexible, waterproof covering that helps protect your body parts from heat, sun, cold, and micro organisms. The transition from perfect baby skin as a child to older, wrinkled, blotchy skin of the elderly is a progressive process.

REVERSING THE EFFECTS OF AGING AND ACCUMULATED SUN DAMAGE IS AN EXCITING PURSUIT AT OUR CENTRE. To obtain smooth facial skin with an even color, texture, and tone you must have an ongoing good skin care regimen.

1. CLEANSING
Cetaphil bar or equivalent should be used with a gentle Buf Puf morning and night.  The gentle Buf Puf is to be used with plenty of lather to create the proper cleansing and exfoliating for your facial skin.  (Buf Puf’s extra gentle is pink, gentle is peach and, regular is blue or white).  I recommend you start slowly and then work up to be fairly assertive with this approach.

2. AHA’S (ALPHAHYDROXY ACID’S) – GLYCOLIC ACID
There are many AHA’s on the market. The more stable predictable products are Reversa starting with 8% - 10% and Neostrata 8% - 10% working up to 15%.  (15% is available through our clinic for special requirements.)  The AHA’s should be used after your skin is squeaky clean preferably after a morning shower or bathing but it can be used at night as well or even both times a day once your skin becomes desensitized to the AHA. To be successful there should be some tingling sensation lasting 2-3 minutes and then the stinging will disappear.  Once your skin becomes accustom to AHA the tingling may not be noticeable.  It is better to start with the weaker percentages such as 8% and then use this for 4-6 weeks gradually working up to the next strength.  This will be a maintenance program for the rest of your life unless a better product comes on the market.  Moisturizers and sunscreens can be used after the Glycolic acid has been on your skin for at least 5 minutes.

3. TAZORAC (NEW CREAM BASE) RETINOID FOR IMPROVING AGING AND SUN DAMAGE
Applying Tazorac:

• Tazorac – a retinoid-like vitamin A acid with a cream base improves fine wrinkling, pigmentation, elastosis of the skin, and pore size all caused by the aging process and accumulated sun damage.
• Pinch out a “pea size” amount of Tazorac onto your finger.  This amount is to be used to apply to the whole face.  More is not better and may increase your chance of irritating your skin.  Dab Tazorac onto the forehead and cheeks and then spread it thinly to all areas of the face being careful to avoid the corners of the mouth and eyes.
• Apply Tazorac according to the specifications that Dr. Remington has determined to be suitable for your skin type.  If you apply it more than this you increase your chance for irritation.  If irritation occurs, just back off a couple of days and then continue.  This is a normal initial response to the adaptation your face goes through.
• If you have very thin cheeks with fine vessels throughout your cheeks avoid using Tazorac in this zone.
• For most patients I would still recommend Kinerase or equivalent around your eyelids, crow’s feet area and not use Tazorac in those areas.

What can you expect?

• If you have not used a retinoid in the past your face will undergo a few weeks of acclimatizing to Tazorac.  You may experience some peeling and redness.  This is a desired effect of the retinoid at work.  You can help this by applying a moisturizer that Dr. Remington suggests directly after bathing or showering when your skin is still moist.
• If you have used a retinoid in the past Tazorac will allow you to reach a new level of rejuvenation.
• You may begin to see results as early as 2 weeks with Tazorac.  However, typical results of reversing and preventing photodamage occur slowly and are maintained for a lifetime.

4. KINERASE (CREAM AND LOTION N6-FURFURYLADENINE 0.1%)
Extensive experience in our clinic using Kinerase we find it most useful for the crow’s feet and fine lines around the eyelids.  Kinerase should be used sparingly once or twice daily.  Kinerase is also used for some scars to help mold and blend the collagen and elastic tissue of the scar zone.

5. KINETIN (MADE BY ALMAY)
This is an excellent product that is close to Kinerase in its concentration and has quite a spectrum of options.  If Dr. Remington feels this is appropriate for you he will discuss it with you.

6. GLYQUIN (4% HYDROQUINONE AND 10% ALPHAHYDROXY IN A MOISTURIZING BASE)
This product is very helpful for those that have pigment changes of their face with a blotchy brown pattern. It is not to be confused with Neostrata HQ and similar products as the Hydroquinone variant of Glyquin does not have the usual preservative and irritating base that is associated with Hydroquinone products for many years.  If you are candidate for this product we would be happy to discuss this with you.

7. MOISTURIZERS
Moisturel lotion or cream is ideal.  Dormer liquid moisturizer is also excellent.  Moisture-Surge by Clinique is a very good product that will not block your pores and can be used in almost any patient who cannot tolerate other moisturizers.  There are other products available that may be better for your skin type and stage of your maturing process of the skin.  All of the moisturizers can be used over top of the above cosmaceuticals and before your sunscreens.  Do not apply moisturizers over any of the cosmaceuticals listed above for at least 5 minutes after the applications.

8. SUN SMART
The accumulated effect of sunlight is impressive.  The sunlight that you had on July first when you were 14 years of age is still present when you are 45.  Being sun smart means being very careful in the summer months and in our climate from 10 am to 3 pm being extra cautious around water, sand, and snow.  If you are traveling to hotter climates it is important to be aware of the Ultraviolet index – UV index.  This is often published over the radio and in the newspapers.

9. SUNSCREENS
Sunscreens have become quite confusing but are a very important part of your maintenance program.  Ombrelle 30 lotion is ideal for many patients but some will require a more waterproof product particularly if you are exposed to water, snow or intense sunlight.  The Neutrogena line is now available – Neutrogena Healthy Defense Oil-Free Spray SPF 30, Neutrogena Healthy Defense Oil-Free lotion SPF 45, Neutrogena Healthy Defense Oil-Free Stick SPF 30 for lips.