Skin Care

Keeping your skin healthy

Your skin is the largest organ of the body and protects us from the environment. So, it is extremely important that we care for our skin and its barrier functions. Just like we need regular maintenance of our inside organs to stay healthy, our skin also needs care and attention.

One of the biggest factors to external skin aging is sun damage which leads to fine lines and wrinkles and age spots. Luckily, some of this can be prevented and even reversed with a thoughtful and consistent skincare regimen. The key word is consistent. It can take up to 6 weeks to see any results as your skin cells turn over, but please be patient and stay consistent.

Visit my linktree shop under “Skincare” for some of my over-the-counter recommendations.

New to Skincare?

Preventative Measures To Take

I recommend starting with the following, basic routine. You can build upon this regimen and tailor it to your needs or even add medical grade skin-care to your routine, and other rejuvenating procedures that I provide in my office.

Morning Steps

Cleanse

I recommend using a gentle cleanser that will not dehydrate your skin. Cleansing in the morning will help wash off any sweat or product from the night before so that your skin is fresh, prepped and ready for the rest of your regimen.

Antioxidant

There are two popular and effective antioxidants that I recommend. You only need to use one, but it will not hurt to use two if you do not have skin sensitivity. If you want to have more radiant skin, using an antioxidant is a must.

Vitamin C: I personally love Vitamin C with the active ingredient, L-ascorbic acid (8-20% concentration). Functions include boosting collagen by helping with the cross-linking process and helps even out pigmentation by interfering with melanin production.

Niacinamide (at least 5%): This is a very stable and well-tolerated active ingredient that is easily combined with other products such as moisturizers while remaining effective. Functions include acting as an anti-inflammatory, boosting collagen, evening out pigmentation and strengthening the skin barrier.

Moisturize

This is an integral part of maintaining healthy skin. Functions include hydration, reinforcing the skin barrier, improving skin texture by plumping the fine lines and wrinkles.

Sunblock

Wear sunblock with an SPF of at least 30 everyday, rain or shine Functions include blocking UVA/UVB rays which lead to aging, burns or skin cancers. Whether chemical, mineral, or both, choose a sunscreen that you like so that you will wear everyday.

Nighttime Steps

Cleanse

Use the same gentle cleanser to remove makeup, oil, sweat and buildup from the day.

Retinoid

This is a topical Vitamin A derivative that can come in many forms. The ones that are the easiest to remember and know are: tretinoin and retinol. Either way, retinoids are the queen of anti-aging skincare and have been studied extensively. Retinoids help mitigate the effects of aging by thickening the skin (specifically, the epidermis), evening out skin tone by increasing skin cellular turnover, and promoting collagen production for a skin stronger foundation.

Tretinoin (aka retinoic acid) is a prescription medication and comes in multiple concentrations. It can cause some redness and irritation, so it is important to start slowly with this product until your skin is used to it. (Please talk to your doctor if you are pregnant or breastfeeding).

Retinol is the inactive form and can be found over-the-counter. It is not as potent as tretinoin but still has the same benefits when used consistently over time. It can also be a better option for patients who have very sensitive skin but still want a retinoid as part of their skincare routine.

Moisturize

At night, it is easier to use a thicker moisturizer or cream to really help hydrate the skin while you rest.

I recommend starting this basic and preventative routine as soon as possible. For my facial surgery patients, this will help preserve your results over time. However, it is normal to get aging spots over time, sometimes despite our best efforts with sun protection, and everyone will develop fine lines and wrinkles from our underlying facial muscle movement.

Sometimes, we need a complete transformation and overhaul of our skin. This is when we recommend our medical-grade skin-care that is tailored to you and your skin and guided by me. This usually includes two prescription topical medications: tretinoin and hydroquinone in addition to the basic routine and chemical exfoliation. This system will help turn back time on your skin!

It is important to pay attention to how your skin reacts to different products. Not every product and formulation is made for everyone. Some people may develop irritation with a certain brand where others do not. During this skincare journey, you will get to know and understand your skin. If you are pregnant and/or breastfeeding, some of these recommendations may not be for you. Please talk to your doctor if you have any questions about this.

What Fitzpatrick Skin Type are you?

The Fitzpatrick Skin Type scale is used by plastic surgeons, dermatologists, and other providers to classify skin type. It is based on how your skin responds to sun exposure and helps us assess sun sensitivity, risk for skin cancer, and appropriate treatment options for specific skin concerns. People with darker skin tones have more melanin, which protects them from UV radiation and can delay the signs of aging. However, even people who do not sunburn can still develop skin cancer.

Monthly

Type 1: I have pale, white skin. I always burn and never tan.
Type 2: I have fair skin. I burn easily and tan minimally.
Type 3: I have darker white skin. I burn initially then tan gradually.
Type 4: I have olive or light brown skin. I tan easily and burn minimally.
Type 5: I have brown skin. I rarely burn, and I tan darkly easily.
Type 6: I have dark brown or black skin. I never burn and always tan darkly.

Schedule Consultation

Improve the health of your skin

Get in-depth personal consultation where I will review your goals, anatomy, and medical history to formulate a skin care plan that is specific to you.

I am located in a beautiful and classic San Francisco neighborhood called Pacific Heights.

Directions: Apple | Google

Phone: 415-981-3911

Transformative Skincare

Many people experience changes in the color of their skin, particularly on the face. These changes can range from a slight increase in freckles to more pronounced dark blotches,with many variations in between. These may appear as darkened moles, an increase in spots, or uneven patches of discoloration.

In my practice, I have seen firsthand how these conditions can be effectively treated with a tailored program. In most cases, the results can be long-lasting, offering patients a chance for beautiful, even-toned skin once again.

What is skin discoloration & why does it occur?

Skin discoloration can result from various factors, many of which involve changes in melanin production. The most recognized cause is sun damage, either on its own or exacerbated by other factors. Prolonged or unprotected sun exposure stimulates melanin production, leading to dark spots, freckles, and uneven skin tone. In addition, hormonal changes, such as those during pregnancy (melasma), or from birth control pills or hormone therapy, can trigger excess melanin production, leading to pigmentation changes. Post-inflammatory hyperpigmentation also occurs when the skin darkens after injury or inflammation, such as from acne, burns, or cuts, as part of the healing process.

Age can also play a role, as the skin’s ability to regenerate slows down over time, resulting in age spots or liver spots due to accumulated sun damage. Some people are genetically predisposed to develop freckles or dark spots more easily, and these spots can darken further with sun exposure or other factors. Medications, particularly those for chemotherapy, birth control, or hormone therapies, can increase the risk of pigmentation changes, either by making the skin more sensitive to the sun or by directly influencing melanin production. Skin conditions such as melasma, vitiligo, and acne can also contribute to uneven pigmentation, either through overproduction or loss of melanin in specific areas.

Environmental factors, including pollution and toxins, can exacerbate skin discoloration by increasing oxidative stress and inflammation, further affecting melanin production. All these factors can intensify skin discoloration, particularly with mild sun exposure, leading to darker moles, blotchiness, and irregular skin pigmentation. Regardless of the cause, the result is an accumulation of melanin that manifests as darker spots, discoloration, and uneven skin tone.

What is the treatment for skin discoloration?

The good news is there are several very safe and predictable treatment options for skin discoloration, ranging from the simplest option – sun avoidance – to advanced techniques such as laser treatment. The best treatment option for you will depend on:

The degree of pigmentation to be corrected.
Coordination with your chemotherapy schedule.
Your personal lifestyle.
How complete and rapid a result you desire.

I highly recommend a treatment program that combines tretinoin with brightening agents, as it delivers exceptional results that are safe, predictable, and reversible. This approach allows for noticeable improvements in a short period, and the flexibility to adjust the treatment—whether you choose to pause, intensify, or continue the treatment, even with regular sun exposure. It is a versatile program that can even serve as a foundation for future treatments like peels or facial cosmetic surgery. In fact, we consider this a “no lose” situation for our patients.

This physician-supervised regimen includes powerful ingredients like tretinoin, glycolic acids, and hydroquinone, which work together to brighten the skin and target pigmentation. It is completely customizable to fit your unique needs. For patients who have tried tretinoin alone and experienced irritation, I reassure them that this combination provides a different experience with remarkable benefits. Not only is it effective for pigmentation concerns, but it also helps soften wrinkles and improve skin texture. When used as a preparatory step for cosmetic surgery, it can significantly enhance satisfaction, preserve the results, and provide a solid foundation for further rejuvenation.

What is tretinoin & how does tretinoin work?

The therapeutic benefits of topical tretinoin have been recognized for nearly 40 years. Derived from vitamin A, a fat-soluble vitamin, tretinoin belongs to the group of compounds called retinoids. Vitamin A is available in our diet as the vitamin itself or as precursors known as carotenes with Beta-carotene (found in carrots) being the most popular example. This vitamin has long been essential for maintaining healthy eyesight, especially in treating night blindness, and has been used for over 3,000 years. Beyond vision, vitamin A plays a critical role in maintaining epithelial surfaces, such as those in the skin, mucous membranes, and digestive system. In more recent years, retinoids have been shown to aid in tissue development, suppress tumor growth, and enhance immune function.

Tretinoin revolutionized the treatment of acne when it was introduced in the late 1960s, sparking a wave of non-surgical options for skin rejuvenation as its anti-aging properties became apparent as a side effect to acne treatment. In 1995, tretinoin was officially FDA-approved for reducing signs of sun damage, wrinkles, and other signs of aging, though it had been used off-label for those purposes long before.

Tretinoin, available in various strengths as creams or gels, gently exfoliates the epidermis while penetrating deeper into the dermis. In the epidermis, it disperses and reduces melanin to improve pigmentation, while also thickening and strengthening the skin. In the dermis, it stimulates collagen production, enhances blood vessel formation, and accelerates cell turnover, promoting skin repair and reducing pore blockages. This leads to improvements in the appearance of wrinkles, spots, and overall skin texture. While temporary side effects like mild peeling, redness, and increased sun sensitivity may occur, tretinoin can be safely used with sunscreen to protect the skin.

How does hydroquinone work as a brightening agent?

In the specialized cells of the dermis, called melanocytes, the amino acid tyrosine is converted into DOPA, which then combines with proteins to form melanin, the pigment responsible for skin color. This melanin is stored in granules called melanosomes and released into the basal cells of the epidermis, where its distribution and quantity determine skin tone and pigmentation.

Hydroquinone, a powerful skin-brightening agent, works by blocking the enzyme tyrosinase, preventing the formation of new melanin. Thus, hydroquinone prevents the formation of new melanin, which helps to lighten existing dark spots, hyperpigmentation, and uneven skin tone. The result is a more even complexion and reduced visibility of skin discoloration. When used alongside tretinoin, it enhances the effectiveness of hydroquinone, accelerating the skin-brightening process. Chemical exfoliants, such as glycolic acids, remove the outermost layers of dead skin, facilitating deeper penetration of these active ingredients and maximizing their impact.

The goal of my transformative skin program is to combine tretinoin, hydroquinone, and glycolic acid into a carefully tailored, physician-supervised treatment. This program not only targets pigmentation but also offers one of the safest and most predictable solutions for discoloration, while simultaneously rejuvenating the skin and allowing it to age gracefully.

During your consultation, you will meet with me to discuss and implement your skincare journey. I can help you start a preventative skincare routine or dive into the full skin transformation. I also offer several non-surgical solutions with almost no down-time including Botox, hyaluronic acid filler, chemical peels, and microneedling.

FAQs

Frequently Asked Questions

What is visible light & how do I protect myself from it?

Visible light is the part of the light spectrum that we can see, ranging from 400 to 700 nanometers. It comes from the sun, LED and fluorescent lights, and digital screens. While visible doesn’t cause sunburn, certain wavelengths—especially blue light—can contribute to skin aging and pigmentation, especially in people with darker skin tones or who are prone to hyperpigmentation and/or melasma.

To protect from blue light, look for tinted mineral sunscreens with iron oxides (often found in the tint itself). Iron oxides are especially helpful for visible light protection and reducing hyperpigmentation risk.

Can I use retinoids during warmer seasons or if I am exposed to the sun?

Yes. Direct sunlight onto unprotected skin will cause burns, and using a retinoid can increase the risk of skin irritation and burns. However, you can still use a retinoid as long as you are using a sunblock, wearing protective gear (i.e. hat, visor), and staying out of direct sunlight. I counsel my patients to be mindful during warmer seasons.

Is hydroquinone also known as bleach?

No, hydroquinone is not the same as household bleach. It is a skin lightening and brightening agent. Hydroquinone is sometimes referred to as a “bleaching agent”. However, I prefer to use the term, “brightening agent.” Hydroquinone is a safe, medically approved treatment for skin discoloration when used correctly.

What is a chemical exfoliant & how can I add this to my routine?

A chemical exfoliant is a skincare product that uses active ingredients to dissolve and remove dead skin cells from the surface of the skin. Unlike physical exfoliants, which scrub off dead skin through friction, chemical exfoliants work by breaking down the bonds between skin cells, allowing them to slough off more easily.

Common types of chemical exfoliants include alpha hydroxy acids (AHAs), such as glycolic acid and lactic acid, which work on the skin’s surface, and beta hydroxy acid (BHA), such as salicylic acid, which penetrates deeper into pores to clear out blockages. These exfoliants help improve skin texture, unclog pores, reduce hyperpigmentation, and promote a more radiant complexion.

However, overuse of chemical exfoliants can cause irritation and break down your skin barrier. When adding to your routine, I suggest using chemical exfoliants only at night, 2 – 3 times a week. If you are new to both retinoids and chemical exfoliants, you should alternate these two active ingredients. If you are doing medical-grade skin care with me, I may suggest a more aggressive regimen such as using a chemical exfoliant with a retinoid, even sometimes as part of your morning routine as it can provide deeper penetration of the other active products we are using.

Addressing Wrinkles & Fine Lines

My approach is honest and realistic—I focus on achieving natural, balances results

In addition to the approved uses of Botox to treat the fine lines and wrinkles of the forehead, glabella, and crow’s feet, I also used advanced Botox injection techniques to address other issues of the face and neck, specifically the area around the mouth, the lips, and neck.

My Approach

I am committed to the highest standards of patient care and plastic surgery. I believe in developing a strong relationship with my patients in order to best serve their needs and desires.

Furthemore, I am committed to the art and science of plastic surgery and believe that the best results come from a combination of technique, knowledge of patient anatomy, and artistry. My goal is to achieve excellence with a natural aesthetic and elegance while matching the patients’ desires to what is surgically possible so that they can radiate from the inside out. I look forward to meeting you.

Patient Testimonials