Questions + Answers
Beryl Reker specializes in anti-aging, age-prevention, and acne treatments. A national educator nearly 20 years of experience, Beryl has visited medical aesthetic clinics across the nation, and draws on her diverse experience to enhance Dr. Imola's practice. According to Beryl, the key to a successful skincare is education and accountability, and she provided patients with personal care, delivering the optimal results they desire.
How do I know if I need Retin A, and What does it do?
"Retin A 0.05% and 0.1% Cream are both FDA indicated for anti-aging, while 0.025% Tretinoin is indicated for acne. However, the higher strengths will work well for both acne and anti-aging. If I have a patient who has sensitive skin, I will start them on 0.025% Tretinoin and gradually increase the strength depending on their tolerability. The trick is to not over-treat. A small pea size is adequate to get the job done and application is important. You should dot that small pea size around the perimeter of the face, and then work toward the center. This way, you don’t get the bulk of the medication in the region that moves the most – the mouth area. If nightly application is too aggressive (you are continually irritated), apply it Mon-Wed-Fri followed by your moisturizer." - Beryl Reker, PMA
Can I Reverse the signs of aging from tanning with Retin-A?
"Lucky for you, oily skin does help ward off those pesky lines and wrinkles! I always tell my patients that 70% of their improvement and maintenance is what you do on a daily basis. Retin A .05 and .1 are FDA approved for anti-aging. Retin A thickens and strengthens the dermal layer, restructuring it. When you are in your 20’s, it takes 28 days for your skin cells to turn over, yet by the time you are 50 it takes 45 days, so the skin looks duller as the cells are not plump, round, and reflecting light as you get older. Retin A will help your skin regain that luminosity while also making it stronger. Chemical Peels are fabulous for keeping it that way and most of my patients come in every 4-6 weeks for those treatments. The new Enerpeels by Glytone work exceptionally well. This type of peel is dependent on the condition being treated. The bulk of the peel penetrates to the lower levels of the skin where it is needed, with less pooling at the surface. Therefore, most patients have little to no outward side effects." - Beryl Reker, PMA
I am 41 and I have oily skin with acne, What can I do?
"Most patients who experience acne and oily skin believe that it is related to cleansing the skin. In reality, if you over cleanse the skin, it strips the barrier of the natural oils that protect your skin. It also signals the skin to produce more oil, so it’s a catch-22. At 41, your acne is more than likely related to hormonal changes. I would recommend seeing a skincare specialist who can help identify what is going on with your skin and help formulate a plan to balance out your oil production while treating the acne. The key is to get it under control. In our office, the skin is evaluated with the Visia Complexion Analysis, which identifies bacterial count; this helps determine what course of action to take. The skin is cleansed, then extractions are carefully done, followed by an appropriate chemical peel to treat the acne, as well as aging. Finally, a hydrator, SPF, and a breathable Oxygenetix Foundation are applied. Typically, when a patient leaves the clinic, they comment that they look better after treatment than when they arrived." - Beryl Reker, PMA
How can I even out skin tone, acne redness, and white patches?
"You need to be using a good regimen along with the Ziana. Are you spot treating with the Ziana, or using it full face? If spot treating, you are more likely to end up with lighter spots in those treated areas. Ziana is meant to be used full-face, and will improve the overall appearance of your skin's tone, etc. A peel regimen will improve not only the appearance of your skin, but start the anti-aging process, making your skin stronger. Although you could have a deeper peel for a quick fix, a series of lighter peels has been proven to improve the overall appearance and health of the skin. A very nice program we do in our office is the DermaCeutic Peel, which comes with its own home care system." - Beryl Reker, PMA
Does Fractional Laser work on scars, pores, and dark circles?
"When patients come in for fractional laser treatment, I always talk to them about expectations…. In other words, 'what is it that bothers you and what would you like to see as an end result' or 'the benefit of lasering your full face is….'" That way you and I will be approaching your treatment in a holistic manner. Scar therapy is tricky and may take several treatments to reduce the appearance. They will not necessarily be 'gone.' Numbing cream can distort the skin, so pictures should have been taken ahead of time so the scars can be easily delineated. Yes, the fractional laser can refine large pores and make them less noticeable, but the laser, by itself, will not keep your skin refined. You will need to use a medical program designed to make a long-term physiological change in your tissue. Dark circles, depending on whether they are from vascularity or pigment, may need a different approach. If vascular, you need an ongoing home treatment that will help your body absorb the leaking blood molecules rather than them sitting under the fragile eye skin looking red-blue. The laser may help reduce pigment under the eyes, but you will likely also need to use a hydroquinone prescription to assist the process. In my office we typically treat the full face, concentrating on the areas of concern – scars, wrinkles, fine lines, pores etc. This decreases the chance of pigmentary differences between the treated and non-treated areas." - Beryl Reker, PMA
Does laser treatment for hair growth result in dark spots and scars?
"If you have a fair complexion and dark hair, you are a perfect candidate for hair removal as the laser’s target is color: the darker the hair and lighter the skin the better the results. That said, the clinician should always evaluate your ethnic background when consulting with you to determine if there is any potential to pigment, i.e. do you have American Indian in your background? If there is a potential for pigmentation, the settings should be adjusted for that potential, which means the treatment is still effective, but it may take a few more treatments. Safety come first, followed by efficacy. Ask questions about the laser as well. The laser we use in our clinic, Lumenis LightSheer Duet, is FDA certified to treat the darkest skin type, as well as tanned skin. If your clinician sees that there might be a potential for pigmentation, especially on the face, a prescription called Hydroquinone is dispensed in order to suppress excess melanin production. Infrequently, hyper-pigmentation or hypo-pigmentation can occur, but is usually transitory." - Beryl Reker, PMA
Will IPL or FotoFacial work for broken vessels on the face?
"IPL or FotoFacial works extremely well on redness or broken vessels over a period of time. The light breaks down the vessel and it may look resolved after treatment, but blood will partially fill those vessels up again, so staying on a regimen of 3 weeks between treatment, with 3-5 treatments total, will greatly diminish the appearance of redness. I always tell my patients that they will then need maintenance treatments a couple of times a year to maintain results. Apply SPF on a daily basis will help prevent further damage." - Beryl Reker, PMA
What is PDT, PhotoDynamic Therapy?
"PhotoDynamic Therapy is a combination of Blu-U and Levulan PDT, a two-part treatment, unique because it uses a light activated drug therapy to destroy pre-cancerous lesions called Actinic Keratosis (AK). How does it work? For AK, Levulan Kerastick Topical Solution is applied. The solution is then absorbed by the AK cells where it is converted to a chemical that makes the cells extremely sensitive to light. When the AK cells are exposed to the BLU-U Blue Light Illuminator, a reaction occurs which destroys the AK cells. We often combine lights; Intense Pulsed Light (IPL) and Blu-U which takes the treatment to the next level for photo rejuvenation. The purpose is to treat the tissue at different depths to increase efficacy. With Acne, the Levulan Kerastick Topical Solution is applied to the blemished regions. The solution is then absorbed into the follicle where it is converted to a chemical that makes the p-acne bacteria, the leading cause of acne, extremely sensitive to light. When the p-acne bacteria is exposed to the BLU-U Blue Light Illuminator, a reaction occurs that destroys it." - Beryl Reker, PMA
Can IPL burn your skin?
"Every laser can be dangerous; however, they are only as dangerous as the provider performing the treatment. Aesthetic lasers are designed to treat various skin types safely, from light to dark, depending on the technology, fragile skin to thick skin, 18 year old skin to 80 year old skin, so there are many settings, from conservative to aggressive. The provider must have an in-depth awareness, developed through proper training and experience, of what can be accomplished. It is far better to treat multiple times than to push the envelope and leave someone with scars for life. Do your research, and by all means ask for referrals, contacting your clinician to establish reasonable expectations. Are you a good candidate for the treatment? Is there pre-care and post care set up to prevent adverse effects? Don’t have a treatment from a facility simply because the treatment is 'cheap.' These are extremely sophisticated technologies require, education and experience to operate safely and effectively." - Beryl Reker, PMA
Should IPL/FotoFacial for pigmentation be done on the arms?
"Although IPL can be done successfully on the arms, the area can be tricky. The best way to approach treating pigmentation on the arms, shoulders is to (1) pretreat with a glycolic lotion, (2) have your clinician perform two to three chemical peels in the area to reduce excess pigment and break it up. Then a series of IPL can be done carefully, using a longer wavelength, and meticulously to finish up the process. This technique will result in an even, favorable result. Also, I’m not sure if you were intimating that there were scabs after the treatment, but this is not the desired end point. My suggestion is to use SPF to the excess, let that skin heal fully, at least 4 weeks, then have your doctor or his/her clinician treat as recommended above to even out the skin." - Beryl Reker, PMA