Better Skin in One Minute with Celebrity Dermatologist, Dr. Debra Jaliman

Airdate: 10/9/2012

Renowned dermatologist and author Dr. Debra Jaliman reveals the latest and greatest cosmetic produces and shares easy tips to improve your skin.

Paula Begoun: Hello. I'm Paula Begoun, the Cosmetics Cop, with my Paula's Choice Research Team, Bryan Barron and Desiree Stordahl.
Paula Begoun: Desiree – who made her first appearance as one of the co-authors of "Don't Go to the Cosmetics Counter Without Me" on a local Seattle talk show and was adorable, and brilliant.
00:00:38 And they asked her back.
Desiree Stordahl: Oh, thank you. I'm excited. I want to do it again.
Paula Begoun: And, you know, even though I said I was going to – I definitely have some rants, because everyone knows I always do rants because the cosmetics industry is always pissing me off, but I was going to carry on about Olay's new CC Cream which is supposed to their new version of a BB cream. And I could carry on and wax poetic about why BB creams and CC creams are another marketing ruse that will take your money much like the mineral makeup ruse took everybody's money and just gave them so nice powders and nothing really in particularly special or beautiful, or necessarily better for skin.
00:01:50 But rather than that I have so many questions for Dr. Jaliman, because what the show is today – what we're talking about – is better skin in one minute. What can you do that doesn't take a lot of time – literally not a lot of time. I mean, maybe a little less time than brushing your teeth, but definitely fast and maybe even less than minute, actually, when I think of some of the things we're going to talk about. And I'm curious what Dr. Jaliman has on her mind about that topic because her book, Dr. Jaliman, Debra Jaliman who is a New York dermatologist – we call her our celebrity dermatologist – her book, "Skin Rules," I mean, some of it she means that literally with rules that you should follow and rules, and that she rules, and that her information, her viewpoint, her attitude, and background makes her one of the more objective dermatologists out there in the world of dermatology.
00:02:53 And I am telling you, those listening to us, finding independent dermatologists any longer is becoming as rare as finding a typewriter. And it's really just one of those, I don't know, sad little commentaries on the number of derms that are working for – and not that it's bad to work for the cosmetics industry, but when you hold yourself out as independent, and, okay.
00:03:20 You get my drift. That isn't Dr. Jaliman. Dr. Jaliman is our favorite objective voice out there in the world of dermatology. Dr. Jaliman, are you there?
Dr. Debra Jaliman: I'm here. Hi Paula. How are you?
Paula Begoun: I'm good, Debra. How you doing?
Dr. Debra Jaliman: Great.
Paula Begoun: So, forgive me for calling you Debra. I never call doctors – Debra, I can't believe I just did that.
Dr. Debra Jaliman: Oh, it's okay. We know each other well.
Paula Begoun: No, you spent way too much money on college.
00:03:50 That alone deserves the title. So, Dr. Jaliman, did I tell you – did you know that I got a facelift in May? Did you know that?
Dr. Debra Jaliman: No.
Paula Begoun: I rearranged my face a little bit.
Dr. Debra Jaliman: And how was it?
Paula Begoun: It was hell. I look great. But it was hell! Oh, it was hell. I'm still sore. Not sore; I still feel it. I still feel the tightness around my jaw. And I'm still a little numb.
00:04:21 I was a little concerned I was never going to feel my ears again, but I did get feeling back in my ears. The scars are a little bumpy, but I got to tell you I'm just not so good about taking care – you'd think given what I do for a living. I mean, I know how to take care of scars. And I'm just really lazy about what I can't see.
Dr. Debra Jaliman: Well, you know, there's a great scar bandage that I talk about in "Skin Rules" that you should get. I love this. I'm actually wearing it on my face today, so I recommend you get some.
Paula Begoun: Why do you have a scar on your face?
Dr. Debra Jaliman: Well, I had a little mishap, so I'm just wearing it to heal an area.
00:05:06 But it works so incredibly well and…
Paula Begoun: Wait, so you have a wound of some kind on your face, like your cheek, your jaw, your…?
Dr. Debra Jaliman: I have it right in the middle of my right cheek. It's really…
Paula Begoun: Right in the middle of your…? Go on.
Dr. Debra Jaliman: Yes. It's a tale of woe I have. A cautionary tale for your listeners. Be very careful who you let near your face.
Paula Begoun: Who got near your face? Should I ask? Is this too personal?
Dr. Debra Jaliman: No, it's not personal at all. A very silly thing happened to me.
00:05:39 Usually I try to work on my own face, but this was like on the side of my right face, so I couldn't do it myself. And I let a plastic surgeon shave off a sebaceous hyperplasia which is such a simple, simple thing, you know, it's sebaceous hyperplasia, it's totally benign, skin colored. It was the most minor thing. It was the size of a period, you know, just a dot.
00:06:05 And his hand must have slipped because he gauged out a big chunk of my face. Really. A big hole.
Paula Begoun: Oh!
Bryan Barron: Oh!
Paula Begoun: Oh god!
Dr. Debra Jaliman: And this was a year ago. And this became such a production because we lasered it with every laser we have. And we lifted it. We healed it. I used all my techniques, you know, that I talk about in "Skin Rules." And so we got it to heal, and then we lifted it because it was a bit hole, and after a year it looked like a white scar.
00:06:36 So I had a white scar that was lifted to the surface. But I wasn't happy because I don't wear makeup, I'm known for flawless skin, and I had a white spot. And every patient would say to me, "What happened to your beautiful skin?"
Paula Begoun: Oh god!
Dr. Debra Jaliman: So, finally, finally I said to myself I can't keep this white spot there anymore, even though I could cover it with makeup but I didn't want to wear makeup every day. So, I finally had another plastic surgeon cut out the white scar, so now I have a line from the sutures, so I'm wearing…
Paula Begoun: So like a [bow] surgery. [Technical Difficulty] Dr. Jaliman, did I lose you? I think I have to call back in, guys.
Bryan Barron: No, we're here.
Desiree Stordahl: No, we can hear you.
Paula Begoun: Oh, did I lose Dr. Jaliman?
Desiree Stordahl: Yes. Dr. Jaliman, we're going to have you call in on another line, or try calling in. We've lost you, but we'll get right back in touch. I'm going to go ahead and take care of her via email. You guys carry on.
Paula Begoun: All right. Thank you, Desiree.
00:07:38 So, you know, it's interesting that she's talking about that. So what we have to get to Dr. Jaliman right away, I want to FedEx out our BHA9 to her, Bryan.
Bryan Barron: Yeah.
Paula Begoun: Because I have taken care of some of – so for those listening who haven't been to PaulasChoice.com lately, we have a new product that we developed that is a very unique product. In fact, there isn't anything else like it out on the market, anywhere in the world.
00:08:09 It's a BHA9 salicylic acid based product with a high level concentration of salicylic acid. Completely safe. Almost nobody – the reviews on our website are even beyond what we thought it could do. But for sebaceous hyperplasia it is actually incredibly effective. But, even more so than that, what we found, especially for me personally, but definitely in the reviews we're getting an in our panel tests is that in terms of skin healing, and getting skin to heal faster it seems to do an incredible job of remodeling collagen and reducing inflammation, because part of the problem with wound healing is the inflammatory process, because the inflammatory process is what generates wound healing. But then that also is what causes problems and redness and thickness.
Bryan Barron: Yes.
00:09:00 Sometimes in some people with the inflammatory process it can come on too strong. And in other people it's more carefully calibrated. That's why some people seem to recover from various wounds or lesions, much faster and better than others. And there is maybe a trace of the scar, just a hint of the scar, and then for others just the slightest blemish can leave a mark that just seems to last forever.
Paula Begoun: And the BHA9, so we have 2% and 1% concentrations of BHA, which I think work incredibly well. And whenever – the reviews of how they work and what the research says is impressive.
00:09:42 But this BHA9 we created, particularly for special situations like a bad blemish, sebaceous hyperplasia which is this skin condition where you have a raised white area that kind of looks like a small little crater with a little hole in it. It can be like a little raised white bump, soft kind of texture, sometimes hard. It's a very unique-looking pore disorder. It's actually a disorder of the pore. And our BHA9 helps. And I also think it can help healing. So, we've got to FedEx that out to Dr. Jaliman.
Desiree Stordahl: And we have Dr. Jaliman back on the line.
Paula Begoun: So, we've just been talking about you, Dr. Jaliman! Dr. Jaliman, who we just got back, so everybody knows, is a New York dermatologist. She is author of the book "Skin Rules." And she rules.
00:10:37 And she was telling us about this mishap she had. And, you know, it is a cautionary tale. Things do happen. There are negative side effects or negative outcomes, not often; you're one of the rare situations I'm sure for this plastic surgeon or for any dermatologist for removing a sebaceous hyperplasia to go wrong. But, it happens. And, Dr. Jaliman, what we were saying is we're going to send you one of our new products, our BHA9.
00:11:09 I'd like you to experiment with it on your wound healing and see if it helps with your wound healing. We also have a scar gel coming out that competes with Mederma. We think is better than Mederma because we're using the active ingredient that Mederma is getting at their onion extract. We're using the actual active ingredient in the onion extract which is quercetin.
00:11:32 So, we want to get you a whole bunch of stuff and you can tell us what you think of it.
Dr. Debra Jaliman: Oh, that's great. Well, I'm sure yours will be better.
Paula Begoun: Well, you'll have to tell us. But tell me, so how is it looking now that you've gone through all of this?
Dr. Debra Jaliman: Much, much better. I'm wearing a scar bandage, getting a lot of sympathy. And then, of course, I can always laser over the suture line.
00:12:02 So, there's a big trick in dermatology – if you laser over a suture line at week 6 it ablates it, and it really makes it look a lot better. So, that's what we're waiting for, week 6.
Paula Begoun: So, you just got this incision, this repair thing for this little white space on your cheek. And what scar bandage do you have on it? What are you using?
Dr. Debra Jaliman: I like, my favorite is Mepiform, which, you know... – It's Mepiform.
00:12:46 And it's very thin and it comes in a sheet. And you can just cut off a little piece and it's pretty much skin-colored so it blends into your skin. And I find it to be the most effective. I've tested most of the scar bandages. I really like that one the best.
Paula Begoun: So, now what is this trick you said about healing or improving the appearance of an incision?
00:13:11 Do you do that with any incision, like even like a…?
Dr. Debra Jaliman: Yes.
Paula Begoun: Like, could I go? It's been longer than six weeks? So, for the incisions from my facelift, could I have gotten those lasered at week 6?
Dr. Debra Jaliman: Yes. But you could still have them lasered.
00:13:28 But if, yeah, but for example what we do, I work a lot with plastic surgeons and at week 6 I will take facelift scars and I laser them because a lot of people like to wear their hair up and they don't want any sign of the facelift scar. So, when we do that we can oftentimes make the scars disappear.
Paula Begoun: What laser are you using? And how come I'm not in New York? What laser are you using?
Dr. Debra Jaliman: I keep telling you, you have to come for a visit!
Paula Begoun: What laser are you using?
Dr. Debra Jaliman: Maybe I'll entice you with a complimentary laser treatment.
Paula Begoun: Oh, I'm there! Wait, guys, I'm getting off the phone. Doesn't Alaska have a non-stop?
00:14:10 Dr. Jaliman, what laser are you using for that?
Dr. Debra Jaliman: For the scars I use, a Genesis laser usually. I mean, it depends. But either I use a Genesis laser or a MedLite laser. And what they do is they do two things. One is the Genesis laser takes all the red out of the scar. So, usually at six weeks there is some redness, there's some increased blood supply to the scar. It takes out the red, but it also thins it out a little, so it makes it softer. And helps the collagen production, so that's one.
00:14:46 The MedLite also thins out the scar and sometimes in some people you have some pigment to the scar. You notice how some people hyper-pigment near their scar?
Paula Begoun: Right. Right.
Dr. Debra Jaliman: So, if I find there is hyper-pigmentation then I will use a MedLite laser. So, sometimes some people have a combination of both red and brown, so sometimes we alternate between the two. But, very quickly you can blend a scar back into the skin.
Paula Begoun: Do you do it at the same time or different appointments?
Dr. Debra Jaliman: Different appointments.
Paula Begoun: So, god, I have so many questions for you. Forgive me jumping.
Dr. Debra Jaliman: No, that's okay.
Paula Begoun: And I'm sorry a dermatologist had to go through healing something on the corner – really, I just feel your pain and I'm sorry you had to go through that.
Dr. Debra Jaliman: Well, it makes you more empathetic to your patients.
00:15:40 The patients really appreciate it when I show them my spot and they come in with the scar. And then I go, look what I did for me, and then they're very happy because they feel like there's hope for their scars. So, we use it to good advance with scars.
Paula Begoun: Yes, actually, it is something to see it up close and personal. So, the two things I wanted to talk to you about before we get into your best one-minute skin rules – there have been some ads in magazines and stories in fashion magazines because they just love anything that's new, and if it's a gadget it's even better news.
00:16:18 So, there are two things that we asked you about, and there is a new laser –I don't know if it is new; it doesn't sound like it's new – called Cellulase that is making claims around being good for cellulite.
Dr. Debra Jaliman: Yes.
Paula Begoun: To me it seems to be a pretty typical 1440 Nd YAG Laser. There are a million of those out on the market. What is this about? Is it different?
Dr. Debra Jaliman: It is different. Because it actually – this one is different because you make an incision in the skin and it punctures your skin so you will have incision sites. So, you're breaking the skin and it actually breaks down the fibers that hold the cellulite.
00:17:05 So, you know, when you think of cellulite I always think of it like a mattress with those buttons. And you have it pulling down. So, you have these fibers pulling down on your skin and that's what makes the dimpling. So, you have these collagen fibers that are pulling down on the skin itself, and on the fat, and if you could break those fibers then you would make your skin look better. So, it does a few things. It dissolves some of your fat. It breaks the fibers. And it also thickens the skin. So, it does three things, this laser.
00:17:41 So, for some people it has actually worked. But, you know, the problem is that the study they did only had ten people. That's not a lot of people as you know.
Paula Begoun: No, that's not a lot of people.
Dr. Debra Jaliman: That's not a lot of people.
Paula Begoun: And you don't know what weight they are. You don't know the amount of – the before and after just shows a dimple, it doesn't show the whole frigging thigh.
Dr. Debra Jaliman: Right. It doesn't show the whole body.
00:18:03 And also, you know, the FDA approved it after one year of follow up; that's also not a long follow up for a procedure. Because let's say you spend all this money – it's very, very expensive. It's like a $5,000 procedure, minimum.
Paula Begoun: Wow.
Dr. Debra Jaliman: So, that's another thing. It's quite expensive.
Paula Begoun: It's a $5,000 procedure?!
Dr. Debra Jaliman: Mm-hmm. Yeah, minimum. I mean, I've seen, because I went online to read reviews of it and to look at what people spend. Some people spend $7,500. Some people spend $10,000. Very expensive procedure. So, the question is…
Paula Begoun: Is that because you have to get into the skin with the [candela], that you have got to…?
Dr. Debra Jaliman: Yeah, right. And you have to numb it, and you have to do each individual spot. And you don't start to see results for three months. So, the question is what did people say, because I've read reviews on it because people are now starting to have it.
00:18:58 Some people said they had modest results. Some people said they were happy. And some people said they were very unhappy and it was a waste of money. So, my impression about this is, having not seen it in person, I can't say I've observed a procedure, nor have I had any patients who've had it. I would say wait on this procedure because it's too new. I think this is one of those procedures where it's going to be perfected, and maybe it is a good technology, but maybe you don't want to be the first person having this technology and this procedure.
00:19:32 Because I think it's still being perfected, because there were some people that didn't get any results. And do you really want to spend that money and not get that result? And it may be based on the operator and maybe who is the person performing this. Maybe it's a tricky procedure.
Paula Begoun: Like Botox works, but until they have got the technique down solid you've got faces doing strange things…
Dr. Debra Jaliman: Right.
Paula Begoun: …and eyebrows popping up all over the place.
Dr. Debra Jaliman: Exactly. So, yeah.
Paula Begoun: The other thing we asked you to take peek at and tell us what you think is this thing called a Derma Pen that we've been seeing.
00:20:17 It got a big article in, I think it's Allure Magazine, talking about the newest in office procedure that promises to soften facial wrinkles, minimize pores, fade scars, oh my gosh.
Dr. Debra Jaliman: It does everything, right?
Paula Begoun: Right, does everything. And all you need is 11 little needles like, I don't know, like acupuncture or something thrown into [crosstalk]. You're younger and pore-less.
Dr. Debra Jaliman: Well, this is the thing about these needles. You're breaking your skin with these needles, so you do run certain risks with breaking the skin. I think given all the other technologies there are for doing all these things, like lasers, like Microdermabrasion, there are so many other technologies that are tried and true.
00:21:10 The interesting thing about this Derma Pen is I went onto the company's website. I read every single thing they have about it. I know all about micro-needling, because micro-needling has been around for a long time. This is just a better form of micro-needling because it is spring loaded, so it pumps into your skin more accurately than if you hand roll the skin with needles.
00:21:36 But interestingly enough I could not find one before and after picture of anything. They say it affects scars, it affects pigment, it affects wrinkles – that's very nice. I wanted to see one before and after of a scar, a wrinkle, or pigment where it changed it. I couldn't find any. So, I found that interesting. Why not? If it's so effective on all these things why can't they show a before and after?
Paula Begoun: What do we know about micro-needling?
Dr. Debra Jaliman: Well, micro-needling, the concept is that you're damaging the skin very superficially and you're forming more collagen.
00:22:15 But there are many other ways to form more collagen other than puncturing it. You know, my concern about puncturing the skin is, you know, you puncture the skin with a needle, you can get an infection. You can get into other problems. So, it wouldn't be my first choice.
Paula Begoun: Isn't that the thing about lasering, things like, you know, Fraxel and – actually any of the multi forms of lasers, Ulthera and ultrasound, radio waves, whatever it is. Isn't it about going deeper than these needles can go and sweeping a bigger area?
Dr. Debra Jaliman: Yes. Absolutely. So, what I'm saying is given that we have…
Paula Begoun: Because who wants superficial collagen? I mean? Isn't the whole idea…
Dr. Debra Jaliman: Exactly. I mean, given that we have so much better technology, I would say why go for this when you can go for so much better technology. And what they're saying is it will penetrate your product better. But, you know what?
00:23:17 You could use a Clarisonic. You could use a Sonic technology. You could use a MicroDermAbrader and then put your product on. And you will still penetrate your products because you're going to get off all that dead skin anyway. I don't know that you need micro-needling to penetrate your anti-aging products. I don't think that's necessary.
Paula Begoun: What are you going to do, micro-needle every night?
00:23:39 I mean…
Dr. Debra Jaliman: That's what I'm saying. I mean, that's ridiculous.
Paula Begoun: Exactly. And of course at Paula's Choice we feel strongly about exfoliation and our strong recommendation is always about salicylic acid or glycolic or lactic acid for exfoliation. And then you get the dead skin cells off and the ingredients get in real nice without damaging anything. I don't get it.
Dr. Debra Jaliman: Right. Exactly.
Paula Begoun: But, then again, there is so much I don't get. Okay, so, your favorite one-minute skincare rules.
Dr. Debra Jaliman: I guess would be exfoliation! Because in one of my rules, of course, is go for the glow. And the only way you're going for that glow is exfoliating. No matter what skin you have you can always make it look better by having great exfoliation.
00:24:33 The nicest skin just doesn't look good if it has dead skin sitting on the surface. So, it's the most interesting thing to me when we give somebody a great exfoliant, whether you do it with Sonic exfoliation, you do it, as you said, with glycolic acid, lactic acid, salicylic acid. Whether you do it with a pad, with a scrub. Whether you do it mechanically. There's no question – you're going to have nicer looking skin and it's quick, it's easy, and everybody can find an exfoliant that agrees with their skin.
Paula Begoun: You know, it's funny you say that.
00:25:05 But one of the things I tell people all the time, now we're not very fond of scrubs because we have strong feelings about doing anything that tears into the barrier.
Dr. Debra Jaliman: Right.
Paula Begoun: Anything that cuts. We're not fond of scrubs, and if you do use a Clarisonic we always say use the soft head. Get the sensitive head…
Dr. Debra Jaliman: Yes, the gentle. The delicate. I like the delicate as well.
Paula Begoun: But literally, with a well-formulated AHA or BHA, you know, the analogy I always use is it's like getting a pedicure. Who would go into the manicurist doing your feet and you would say, yeah, leave that big, built up, ugly dead skin cells on my heel and don't brush it off. Because you remove the dead skin cells.
00:25:51 Now, what would be better is if you did it every day so you didn't get that big accumulation. But that's exactly what's happening on the surface of skin. You get off the dead accumulated skin cells – oh my gosh – you wake up the next morning – in fact, somebody once said to me, because we have a lot of BHAs and AHAs. We have about ten of them in the line. And somebody once said to me, "I think you make those because you're addicting women." Because once they use it they have to keep using it because it isn't a cure. I just helps cell turnover and you need help everyday once you're over a certain age, and especially if you have sun damage or acne.
00:26:30 She said, "I think you're addicting women."
Dr. Debra Jaliman: Well, that's very funny, but you still have to brush your teeth every day, so are they addicting people with toothpaste. That's ridiculous.
Paula Begoun: I should have said that. By the way – that's actually a great analogy – I love your mattress analogy for cellulite. That is the perfect analogy. I love it. Okay, so exfoliation is number one. You've got to use a good exfoliant. 100 percent agree with you. What's another one?
Dr. Debra Jaliman: I guess another quick tip is, I mean, I'm such a big believer in retinols. I think that is a quick, easy way to really give your skin a boost. Because if you do it, it certainly takes you a minute. Now, you're not going to see the result immediately; it's going to take weeks to a month. [Technical difficulty] has a great result on your skin.
Desiree Stordahl: Dr. Jaliman, let me help her out one second. Carry on with you and Bryan for a little bit.
Paula Begoun: I'll carry on! So, actually, I have a one minute tip.
00:27:39 So, some of it is a lot of – Bryan, a lot of what we talk about is often what not to do as opposed to what to do. And I think that one of the biggest differences a woman can see when she starts doing it almost from day one is when she changes from using a drying or irritating bar soap – well, actually, that's redundant. All bar soaps and all bar cleansers can be drying and irritating. And at the very least the ingredients that keep a bar cleanser or a bar soap in its bar form just leaves a film behind on the skin.
00:28:18 You stop using bar soap, and just change it to a gentle water soluble cleanser, and a good water soluble cleanser – you got to check out the ones we rate high on Beautypedia.com, but unbelievable difference in skin almost from day one.
Bryan Barron: It's interesting you brought that up, because when I was staying at my parent's house last month when I was in town I ran out of my body wash. I didn't bring enough with me. And their guest bathroom shower had bar soap. And I figured, okay, you know, I know it's not great but I have to use something. And I washed with it a couple of times and my skin felt tight, it felt itchy, and all day it felt like I had some sort of residue on there.
00:29:09 And I eventually, just I went out and bought some body wash, but the next shower I actually washed with my shampoo. It was like, you know, I'm not using that soap again.
Paula Begoun: Right. Actually, that's really true. It is one of those things that once you get used to not – once you really feel the difference. But, you know what it is? A lot of people who try to switch to a water soluble cleanser, and then they say they miss their soap is because they haven't purchased a good water soluble cleanser, a good gentle cleanser. Like if you buy one, the ones at the drug store for the body often have mineral oils and plant oils in them.
00:29:48 And that just feels greasy and leaves its own layer behind on the skin, not to mention makes the shower slippery. You're going to slip and kill yourself. So, getting a really good gentle water soluble cleanser, and then, of course, one that is good for the face, then you don't miss the soap because you're clean without… – That super clean feeling, you can get that anyway without feeling the tight and dry after feel that you get from soap.
00:30:18 It's a huge difference. And it is such a fast, easy, simple difference. And then the other…
Desiree Stordahl: I've got Dr. Jaliman back on the line, Paula.
Paula Begoun: Dr. Jaliman, welcome back.
Dr. Debra Jaliman: Thank you.
Paula Begoun: I don't know why we keep losing you. You're our favorite guest. You're the last guest we would want to lose.
00:30:36 But it gives me the opportunity to reintroduce Dr. Jaliman. Dr. Jaliman is author of "Skin Rules." She is a New York dermatologist and Assistant Professor of Dermatology at Mt. Sinai School of Medicine and a member of the American Society of Dermatologic Surgery. So, what dermatologic surgery do you do? I take it, like most surgery? Do you do most surgeries?
Dr. Debra Jaliman: I do a lot of malignant melanomas.
00:31:05 That seems to be very big in New York City. We find the smallest melanomas, but unfortunately you end up with a big scar with a melanoma because you have to take a big piece, even if you have an early melanoma. So, I do a lot of [technical difficulty] cell carcinomas. [Crosstalk] carcinomas, removing them.
Bryan Barron: Dr. Jaliman. Have you noticed in your practice are you seeing younger and younger women presenting with melanoma? Or is it primarily?
Dr. Debra Jaliman: Yes.
Bryan Baron: You are?
Dr. Debra Jaliman: Younger and younger.
00:31:35 As a matter of fact this week we had a patient who was 24 who had a melanoma on her leg.
Paula Begoun: Oh my!
Dr. Debra Jaliman: Yeah, you know, the youngest I've had is 17 years old with a malignant melanoma. So, it's pretty upsetting.
Bryan Barron: Oh my gosh.
Paula Begoun: So, just to be clear to anybody, so Dr. Jaliman and Bryan, just to be clear to everyone who is listening, when we talk about melanoma we're talking about the most severe form of skin cancer you can get, a very deadly form of skin cancer, particularly if you don't catch it soon enough.
00:32:05 And what Bryan is asking Dr. Jaliman, because we have just seen a new study that showed that the risk of skin cancer, I mean, there are definitely other studies, but this one – I wish I could quote it exactly. But this one was pretty definitive that there is an incredible increased risk, even with just minimal use of tanning beds, for all kinds of cancer but particularly melanoma. So, that's why – and younger and younger because of the increased – that's who tends to use tanning beds. That's what I think Bryan is asking, is do you find that to be…
Dr. Debra Jaliman: Yes. As a matter of fact when I take a history many of these young women have used tanning beds, so it's very unfortunate. Either they're people who have just had a lot of sun exposure, whether they are on a boat, or they've been in the Caribbean a lot, or they're in tanning salons.
00:33:04 So, they've just had extreme sun exposure.
Paula Begoun: Are you shocked by that? Of course you're shocked by that. But, I mean, the whole thing about tanning beds and this whole business wrapped around such a pernicious lie about tanning beds being healthy and providing vitamin D and all that insanity. I mean, how do you – what do you tell your patients when they come in and what do you say to them?
Dr. Debra Jaliman: Well, you know, it's so interesting because I just gave a lecture and people were fighting with me again over this vitamin D.
00:33:45 Because you know how many people on television are always talking about how important it is to go in the sun every day without sunscreen to get vitamin D. And it's just a terrible lie because, for example, in New York, and they say, "Oh, go for an hour in the sun." If you went for an hour in the sun, [technical difficulty].
Desiree Stordahl: Dr. Jaliman, we're losing you again. We're going to get you back on the line on a different phone.
Paula Begoun: We definitely need to get a different phone for Dr. Jaliman.
Bryan Barron: My goodness.
Paula Begoun: So let me speak to what Dr. Jaliman is saying because the insanity about going out in the sun to get vitamin D reminds me of when they used to sell cigarettes saying that – and doctors would go on television and say it calms you down, it's soothing, it's relaxing. It's trading one problem for another. Whether – now you get vitamin D from the sun, it's absolutely true; but it is also absolutely true that you get skin cancer, not to mention wrinkles, and a lot of other things you're going to be unhappy about down the road.
Bryan Barron: Right.
00:34:58 And another thing that's not pointed out is that depending on where you live in the world, but let's use the United States as an example, the amount – based on the latitude and how strong the sun is, for example somebody on a sunny day in Boston might need to be outside, unprotected, for over an hour to get their body to make enough vitamin D. but that same person in Florida or Hawaii may only need to be out for ten minutes.
00:35:26 So, there's no – the arbitrary advice and I've seen it on TV, too, where doctors will say, "Oh, tend minutes of unprotected sun exposure on your arms or your legs is all you need." Not so. It's just a guessing game that's very dependent on where you live. And the longer you stay in the sun…
Paula Begoun: And actually there are no studies showing how long, given every which way the sun is in the sky, and every which way the body may or may not be exposed, because where is the research showing that if it's on your arms, and hands, or face, or on your thighs, legs, and body. Where is the research showing that you're actually – that's the amount of time you need to be in the sun?
00:36:10 There's no evidence about that.
Bryan Barron: Right. It's an arbitrary piece of bad advice.
Paula Begoun: It's so, gosh, I just – you know what's sad about it is when people grab onto an idea that it's almost like no matter what evidence you present them, once they believe something they can't take in information to the contrary. And it sounds natural and it sounds wonderful, and now they've got the reasoning back to – because I ran into somebody, wherever I was, it was a sunny climate and I'm like the only one in the shade. And I'll never forget it – this woman said to me, "Well, now it's okay to be in the sun because if I don't get vitamin D I'll get cancer…or bone loss."
00:36:58 I can't quite remember what she said. And I'm thinking, oh my god, I mean, I'm sure that's what Dr. Jaliman was talking about is people are arguing going, "What, are you telling me not to get Vitamin D and now I'll be sick and bone loss and cancer?" And what the truth is – yes – you absolutely need vitamin D, but we can get vitamin D without also getting cancer and other aging factors that the sun gives us by vitamin D supplements or dairy products.
Bryan Barron: I take a vitamin D-3 supplement every day. To our listeners, check with your doctor on that as far as the dosage that's right for you, or ask your doctor to have your vitamin D levels checked.
00:37:46 It's a simple blood test. And most of us are deficient, even if we do get a decent amount of sun exposure. And honestly a supplement can be the best way to go. And it's so easy.
Desiree Stordahl: And we have Dr. Jaliman on the line once again. This time I think we're good to go.
Paula Begoun: I don't want to lose Dr. Jaliman again. But it gives me a very good reason to reintroduce this wonderful New York City dermatologist and author of the book, "Skin Rules." Really well-written. Some of these dermatologist books out there either are so dumbed-down or so overdone that you can't get through it.
00:38:25 Dr. Jaliman's book is easy to get through, very well done, very concise without drowning you in stuff. You can get to the good stuff right away. Actually, because we're carrying on way too long, Desiree, can we have Dr. Jaliman take a couple of calls?
Desiree Stordahl: Yeah! So our first caller is Nancy in Florida. Hi Nancy, are you there?
Nancy: Hi. My question is I have some red itchy spots on my face, not many, but some are just splotches, they'll just come and go. And then the other redness, they almost look like inflamed capillaries. And they'll be really dark and then they'll lighten up and sometimes they come back.
00:39:11 But I do have like a redness on my forehead and under my eye I have that redness. And it just started, like, it started maybe five months ago. I have no clue why – I didn't change anything. And I'm using, I have a lot of Paula's products and I just got that BHA9 – I just got it. I didn't know, will that calm the redness or will that be too strong for my face?
Paula Begoun: Whoa, whoa, wait, wait. First of all, now I'm worried about you. So, Nancy, did you start using my products and then this problem started or have you been using my products for…
Nancy: No, I've been using your products for awhile but I was using the 2% salicylic acid, the liquid. And that was fine. It was actually working on my skin. So, I don't know why all this started.
00:40:04 I really haven't done anything different. So, then I just stopped….
Paula Begoun: So, the BHA9 isn't for what you're describing. The BHA9 is for other issues like sebaceous hyperplasia, some stubborn blemishes, certain spot wrinkles, brown spots, but it isn't for what you're describing. Dr. Jaliman, any clue what Nancy is referring to?
Dr. Debra Jaliman: Well, let me ask you a few questions. First of all, you have broken blood vessels, so they must stay, they don't come and go, right? They're always there.
Nancy: Well, it's just so strange, and I haven't been to a dermatologist. I probably should go. Sometimes they'll be more pronounced but then they'll lighten up. But, still, especially under my eye they're still under there.
Dr. Debra Jaliman: So, that of course can be lasered. I mean, that's so simple. And now the lasers are so good that you can have a laser, sometimes it takes one treatment. It can take up to three treatments, and you usually do them four weeks apart.
00:41:10 And then it's permanent. Once you do it they rarely come back. So, that's probably worthwhile to get rid of the blood vessels.
Paula Begoun: Does it matter what laser, or just whatever laser the dermatologist uses?
Dr. Debra Jaliman: Well, usually it's a YAG laser, and it's usually like a 1060 YAG laser. We happen to use the Cool Glide laser – it's a very good laser. But if it's a 1060 YAG they're usually very good.
00:41:36 And they don't break the skin, so you could actually have the laser and put a little makeup over it after so it's not like you have to go into hiding or anything. It doesn't make you look worse. It just may intensify the blood vessel a tiny bit for that day. And then it will just fade away over the next four weeks. So, that's something I would have done. For the other red patches, did you change your hair products or any other products maybe, not the face products?
Nancy: No.
Dr. Debra Jaliman: Because you said it's on your forehead.
Nancy: Well, and on each side of my mouth. It just comes and goes.
Dr. Debra Jaliman: You have to look at other things you're doing. If it's not your face products you changed people always have to think of their mouthwash, their toothpaste, other things that you do sometimes.
00:42:24 It's sucking candies. So, you really have to be a detective. And I make my patients write every single thing down that they're doing, because sometimes we get the clues there. Because it may not be face products but it may be other products you're using that can be dripping on the corners of your mouth.
Bryan Barron: Or laundry detergent.
Dr. Debra Jaliman: Yeah, it could be laundry detergent. It could be the fabric softener. One of my least favorite products is those, Bounce sheets. I find many people are allergic to them, the fabric softeners. So, it could be a lot of other things that you could be having sensitivity to.
Paula Begoun: Dr. Jaliman, people can be allergic to fabric softener?
Dr. Debra Jaliman: Yeah, that's a very common allergy, Bounce. Like we prefer that people use like the baby products because the baby products are much less allergic than like those Bounce sheets.
Paula Begoun: No kidding. How do you like that?
Dr. Debra Jaliman: Yeah, very common allergy.
Paula Begoun: So, Nancy I'm strongly going to suggest because it is – what you described is really odd.
00:43:23 A little bit sounds like perioral dermatitis. A little bit sounds like Rosacea. A little bit sounds like – like crazy. So, Nancy, you got to…
Dr. Debra Jaliman: It could be allergies. So, you're going to have go see either a dermatologist, maybe even an allergist for you.
Nancy: Oh, okay.
Paula Begoun: You definitely need to get yourself – and do not use my BHA9 on those areas. It's not for that.
Nancy: Now, can I use it on my chin where I have blackheads?
Paula Begoun: Oh yeah. Go to town!
Nancy: I get them on my chin.
Paula Begoun: Yeah, go to town. That you can do.
00:44:00 But just know that there is really – you need someone to look at it because the patching you're describing – Dr. Jaliman, doesn't it sound a little bit like a cross between, I don't know…
Dr. Debra Jaliman: Well, it definitely sounds like she has Rosacea because of the broken blood vessels, and definitely could be perioral dermatitis. But because it comes and goes also could be some form of allergy coming from something she's doing, you know, maybe not from your products but from something else she's eating.
Paula Begoun: Well, hopefully not my products.
00:44:33 But if it's my products we are taking them bake immediately, Nancy.
Nancy: No, I've been using them for awhile.
Dr. Debra Jaliman: No, I don't think it's products because she's been using them, so I don't think it's that. It's usually something new. Oh, one other question I have for you – do you use anything with cinnamon, like cinnamon toothpaste and mouthwash, gum?
Nancy: No, I just put cinnamon in my smoothies.
Dr. Debra Jaliman: In your food?
Nancy: In my smoothies.
Dr. Debra Jaliman: Because, you know, some people get them from a cinnamon reaction.
00:45:04 So, you may want to stop the cinnamon for…
Nancy: Really?
Dr. Debra Jaliman: Yeah, I thought of cinnamon. So, maybe stop the cinnamon for awhile and see if that clears up.
Paula Begoun: You mean like sucking on Red Hots? Is that what you're talking about?
Dr. Debra Jaliman: Yes. So she does use cinnamon. I've seen that with a cinnamon reaction.
Paula Begoun: Really?
Dr. Debra Jaliman: And she does use cinnamon. So, why don't you stop the cinnamon and see if that helps you.
Nancy: Oh, okay.
Paula Begoun: Cinnamon is so healthy. I hate when healthy foods…
Nancy: I know; it's so healthy for you.
Bryan Barron: I love it.
Dr. Debra Jaliman: It is, it's very healthy. But some people react to it. It stabilizes your blood sugar.
Paula Begoun: It's actually kind of shocking.
00:45:36 Some people can have literally anaphylactic shock to salmon, to shellfish. You can severe reactions to the healthiest... – I have a girlfriend who if she gets near pineapple it's like a death sentence. And it's pineapple! Pineapple!
Dr. Debra Jaliman: I know. I've seen people's lips swell up to pineapple. It's very reactive.
Paula Begoun: Nancy, get thee to a dermatologist. And if you were in New York I'd make you go to Dr. Jaliman. But wherever you are…
Nancy: Well, thank you for your help.
Dr. Debra Jaliman: Sure.
Paula Begoun: Okay, bye. Desiree, let's take the next caller.
Desiree Stordahl: Okay, we actually have a question from Karen on Facebook. And she wants to know what Dr. Jaliman would suggest for crepey but not really saggy skin on the next, eyelids, and backs of hands?
Dr. Debra Jaliman: Well, one thing that we do for crepey skin is I use a lot of Thermage because Thermage is skin tightening. So, that really helps when it tightens the skin.
00:46:35 And it's one of the few technologies that you can use on the neck safely. So, Thermage is radio frequency and it's mono-polar radio frequency because there are a lot of companies that make bi-polar radio frequency that doesn't really work as well. And it's an hour procedure, for example, to do the neck. There's no downtime. And it really tightens up the crepiness on the neck. So, it's one of the few procedures that work almost as well as surgery on the neck.
00:47:05 So, if your neck is crepey you can really tighten it up.
Paula Begoun: And Thermage isn't that expensive. So you said the mono-polar versus the bi-polar – kind of interesting they call it bi-polar; it sounds like a schizophrenic or something.
Dr. Debra Jaliman: Like a disease, right.
Paula Begoun: So, is there a brand? Do you ask that question if the dermatologist is using mono?
Dr. Debra Jaliman: Yes.
00:47:35 So, I would ask for Thermage CPT. And there is old-time Thermage that is a few years old, not as effective. I wouldn't have that either. I would only have the Thermage CPT because that is the newest technology Thermage and it's really the one that works the best.
Paula Begoun: Say those initials, the acronym again?
Dr. Debra Jaliman: So, it's Thermage C-P-T. CPT. That's the one that really works because it gives even heating of the skin and what it does is it stimulates the fiberglass which are the cells that make your collagen.
00:48:10 So, you get instant tightening and then you get more tightening over the next six months. It's very dramatic the change that you get.
Paula Begoun: So, you only need – do you have downtime with this?
Dr. Debra Jaliman: No. No downtime. One treatment. You look instantly younger and then you keep looking younger over the next six months. So, every week you wake up you look younger. It's pretty exciting.
00:48:34 And we do it for eyelids. We do it for necks, faces, hands. So, every area you asked about, it works.
Paula Begoun: Is it expensive?
Dr. Debra Jaliman: It is. It is expensive. Like in New York, I mean, I'm sure different parts of the country it varies, but like in New York a neck would be $3,500. So, it is an expensive procedure. But, it doesn't have to be repeated; it's a one-time procedure.
Paula Begoun: Oh, so it's the old Thermage that's so cheap.
Dr. Debra Jaliman: Yeah. Which didn't work. It was cheap and it didn't work.
Paula Begoun: When you're look at a Thermage treatment that's really inexpensive, you're looking at…
Dr. Debra Jaliman: Beware! Old technology.
Paula Begoun: Okay, got it. Desiree, do we have another Facebook question?
Desiree Stordahl: Not from Facebook ,but we have Jessica live on the line.
Paula Begoun: Hi Jessica.
00:49:25 What do you have for Dr. Jaliman?
Jessica: Well, I have really bad bumps on the back of my upper arms. And I've been using the BHA 10% of yours.
Paula Begoun: No, that's the BHA 2%. We don't sell 10%.
Jessica: The body lotion one. Or is it AHA.
Desiree Stordahl: 10% AHA.
Paula Begoun: That's okay. I worry you are using somebody else's with a really high concentration. So, you're using the 10% AHA glycolic acid on the bumps on the back of your arm.
Jessica: Exactly.
00:50:04 Because I'm 33 weeks pregnant so I don't want to use the salicylic acid on such a big area of my skin.
Paula Begoun: Oh, yeah.
Jessica: I mean, is that okay to use salicylic acid when you're pregnant? I've seen conflicting research.
Paula Begoun: Oh, that question I will leave to Dr. Jaliman.
Dr. Debra Jaliman: Oh, you're using salicylic acid?
Bryan Barron: No, she's been using glycolic.
Jessica: I don't want to.
Dr. Debra Jaliman: Oh, you're using glycolic.
Paula Begoun: Dr. Jaliman, we sell two body lotions, one with 10% glycolic acid and one with 2% salicylic acid. And then there's this issue about aspirin, acetyl salicylic acid…
Dr. Debra Jaliman: I know. Yeah.
Paula Begoun: …for pregnancy. And so she's asking is glycolic acid the same problem on skin as salicylic acid might be for a pregnant woman.
Dr. Debra Jaliman: So, glycolic acid is totally safe during pregnancy.
00:51:06 But I would not use salicylic acid. It's not approved for pregnancy. Yes, so you're fine.
Jessica: Ironically my face looks fantastic since I've gotten pregnant, but the back of my arms are kind of gross.
Paula Begoun: So, is the 10% working? Are you finding it's working?
Jessica: No. No I don't think so.
Paula Begoun: How long have you been using it for?
Jessica: A couple months. A couple of months I've been…I mean, I use it on my elbows and stuff, so I was just kind of moving it up.
Paula Begoun: So, glycolic acid, and forgive me for jumping in, Dr. Jaliman. Glycolic acid for the red bumps on the arm, which is keratosis pilaris, can work for some people. There's no question it can work for some people. And for other people they just don't get any benefit.
00:51:59 But you want to make sure in the shower you're not scrubbing the area and trying to get rid of it by scrubbing, because that will just re-inflame…
Jessica: No, I'm really careful.
Paula Begoun: Okay, so you're not doing that. And bar soaps, you're not using bar soaps on that area?
Jessica: Not at all.
Paula Begoun: Well, have the baby and then go back to 2% BHA!
Dr. Debra Jaliman: I have one thought. Why don't you try a Sonic cleansing system with it? So, continue the glycolic acid but if you could add a Sonic cleansing system I think it would help because it would vibrate out a lot of those bumps.
Jessica: Oh, okay.
Paula Begoun: So, Dr. Jaliman is talking about the Clarisonic, and I guess the Clarisonic has a body one?
Dr. Debra Jaliman: Yeah.
00:52:41 But you don't even have to buy the body one because it's expensive. You could buy the little Mia because you're only using it on your arms and it's going to be big enough to do your arms. And it's much less expensive. But I would still get the delicate brush. Or you can get the acne brush. You don't have to get a hard brush, because we don't want to irritate the area, we just want to vibrate out the bumps.
Paula Begoun: Jessica, will you do me a favor? If you follow up on Dr. Jaliman's recommendation, I'm going to have Desiree get your email, and she's going to share contact information with us, because I'd like you to get in touch with me personally.
00:53:17 I'd like to know if what Dr. Jaliman is recommending actually is successful for you. Now I'm really curious. So, if you would follow back with us, that would be wonderful. I'd really, really, really, really, really appreciate that. And I'll get you some free products to boot.
Jessica: Okay. I would love that.
Paula Begoun: Okay, so one more question, Desiree, before we're done.
Desiree Stordahl: Okay, we've got Shannon.
Paula Begoun: Hi Shannon.
Shannon: Hi. How are you?
Paula Begoun: I'm good, Shannon. What question do you have for Dr. Jaliman, the author of "Skin Rules?"
Shannon: Well, it's interesting that you all were talking about allergens and then claims that you read about regarding vitamin D because recently I've been reading about how we need to reduce our exposure to chemicals because of the risk for cancer, and I was reading how you need to wash your face with a blend of castor oil and olive oil because like dissolves like and the oil will help dissolve the oil on your face.
00:54:28 And then moisturize with olive oil. And all of these things are designed to help reduce the number of ingredients your skin is exposed to. I was curious to know what your professional opinion was on that. I've been doing that, of course, it doesn't help because I'm still breaking out. I know, it's terrible, but what they were saying in the article is that your skin is designed to heal itself. And I have not found [crosstalk].
Paula Begoun: No it's not. That's like saying if you break a bone your bone is designed to heal itself. If anything your body is designed to get old and break down.
00:55:08 That's what your body is designed to do. And we're fighting to keep that from happening.
Dr. Debra Jaliman: If your skin was designed to heal itself I'd be out of a job very quickly!
Paula Begoun: It's not because we're not eating healthy or we're exposed – I mean, skin problems happen and I would love to, forgive me Dr. Jaliman, I'm jumping in because this question could take, I mean, I've written books and page, and pages about this.
00:55:36 And the very simple answer is that I would no sooner tell you to go back to using a typewriter than I would tell you that a simple skincare routine works. The reason we use a computer and all that fancy technology is because what we know now about skincare, about computers, so outpaces anything – I mean, who would pick up a pen, or a pencil, or a typewriter when you can go online?
00:56:01 You would never do it. And skincare is the same thing. Skincare is rocket science. It would be a mistake for your skin and the health of your skin to not use what is available that are brilliantly, beautifully-formulated products. You can't protect your skin from the sun with olive oil or with – I mean, your skin is going to look like crap and you're going to run the risk of skin cancer and definitely get wrinkles.
Bryan Barron: Dr. Jaliman, because we do get this question a lot about people being concerned about chemicals in skincare and all of that.
00:56:38 And we know that for the most part the skin is a very effective barrier. It's actually designed to keep things out. And there's a mistaken notion that anything that you put on your skin ends up in the bloodstream, gets into the body, gets into all the organs, and then that's where problems start. What do you tell your patients that come to you with that concern?
Dr. Debra Jaliman: My only thing that I tell them is stay away from nanoparticles because those are the only particles that have been shown in some studies to get into the blood stream.
00:57:10 So, how do you know, people ask me, how do you know if it's a nanoparticle? So, for example, if it's a sunscreen, and if the sunscreen says it has zinc, and it comes out of the bottle clear, then you know it's a nanoparticle, because it has to be zinc that comes out white, and then you rub it in and it's clear. In Europe they have to write on the bottle that it's a nanoparticle.
00:57:34 So, nanoparticles could get into your bloodstream and that could be a problem, but other than nanoparticles I don't think you have to worry. And most products other than sunscreens don't really seem to have nanoparticles. So, that's my big concern is, you know, they started making zinc and titanium nanoparticles. So, I avoid that.
Paula Begoun: So, real quick, well, actually it's a bigger discussion, but I actually have to let you go Dr. Jaliman. But we'll talk about sunscreen and nanoparticles at another point.
00:58:05 But would you agree just really quick that not only would you be out of a job if that was true, women's skin would look terrible, that Shannon would have the skin problems she's experiencing following some of those recommendations, the natural…
Dr. Debra Jaliman: Oh, of course. And you certainly can't clean your skin with oil. I mean, especially if you're acne-prone, for example. I mean, I'm acne-prone. If I put oil all over my face my skin would be all blocked up with all kinds of problems. And you're certainly not exfoliating it with oil. So, a lot of people that write these simplistic articles don't know –
00:58:43 They're not dermatologists. They know nothing about skin. They know nothing about products. And as you know, Paula, they just write articles.
Paula Begoun: They just write articles. They're guessing and not helping. And, you know, there are beautiful products out there. We don't have to be so scared of skincare. We don't have to be so scared just in general. So, Dr. Jaliman, thank you. I have to say goodbye.
00:59:06 And we'll have you on again. You're our favorite dermatologist, our New York dermatologist, Dr. Jaliman, author of "Skin Rules." Thank you. And I'm Paula Begoun.
Dr. Debra Jaliman: Thank you.
Paula Begoun: Thank you, dear. I'm Paula Begoun, the Cosmetics – what am I? I am, I'm the Cosmetics Cop, with my Paula's Choice Research Team, Bryan Barron and Desiree Stordahl. Come visit us at PaulasChoice.com. So, we're here every other Tuesday keeping you beautifully informed.
00:59:35 On the 23rd we will have celebrity makeup tips with Kimberly Heintzman. On the 6th, what to wear – professional stylist tips for any occasion with Darcy Camden. And on the 20th, hair [technical difficulty] tips. But you've got to stay listening to us. You've got to come visit us at PaulasChoice.com. We'll take good care of you, I promise. Until next time, bye-bye.
585631-IIS3 v1.0.0.344 10/21/2014 4:47:39 PM
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