If the old adage “beauty is pain” still rings true, then pain management has become the collective forte of women all around the world. Since our earliest indoctrinations into the rites of womanhood, we’ve been required to endure some form of physical pain for the betterment our appearance. Waxing, lasers, and even Botox come with the price of discomfort.
Currently, there’s an array of popular invasive skin procedures in your dermatologist’s office that might also test your threshold for pain. While the goal is clear, smooth skin, some of the treatments require you to endure some degree of pain, downtime, and humility (since you’ll likely resemble a peeled tomato for a week or more). In the past year, dermatologists and skin experts have spoken out against invasive procedures, stating that, in the long run, they can cause more harm than good. Dermatologist Dr. Dennis Gross is one authority who attests to this theory. The famously emboldened Gross has no problem expressing his opinion on harsh skin procedures—or anything else, for that matter. “When it comes to skin, you never create ‘downtime’ or a recovery time to serve a higher purpose,” Gross says. “My background is in skin cancer research, so I have a unique understanding of how healthy skin cells function. You should never harm your skin in order to make it better. Your skin is an organ—you would never harm your heart or lungs in order to approve them. The same goes for skin.”
New York-based Gross is renowned not only for his practice—and blunt demeanor—but also for his skincare line (his coveted at-home Alpha Beta Peel is sold every three minutes). It’s a consistent favorite with A-listers including Zoë Kravitz and Linda Evangelista, as well as the aestheticians like Shani Darden and Joanna Czech. We decided to take advantage of the doctor’s candid directness and conduct a thorough Q&A about all of the hot topics in skincare: collagen promotion, product efficacy, lasers, peels, and more.
Let’s speak further about invasive treatments that can do more harm than good. What invasive treatments in your opinion are outdated or potentially harmful?
My number one pet peeve is lasers that damage the skin. In my experience, I have never seen a patient that has been enthused or satisfied with the results from an invasive laser that causes damage. Lasers that generate free radicals are counterproductive, especially in light of new technologies that are outstanding and do not have a recovery time. These new lasers literally work on the internal skin layers, completely bypassing the top layer, creating no injury whatsoever. To me, the future is now what’s called “non-invasive laser surgery.” High concentration, single acid peels are outdated and have been proven to cause damage to the skin. In general, technology has improved greatly when it comes to in-office procedures. You can truly obtain the same results with a non-invasive treatment. Plus, you don’t have to hide in your home for weeks after you receive the procedure.
What are the best ways to stimulate collagen for the face?
First, I want to bust a myth I hear constantly in my practice: drinking collagen does not improve your skin. The only way to create more collagen in the skin is to stimulate your skin’s own production of collagen in the fibroblast cell. This can only be done via topical products.
Commit to a daily skincare routine that incorporates active ingredients like vitamin C, retinol, and LED. Your skin cells have receptors for each of these ingredients and they all work slightly different to stimulate your skin’s own production of collagen—the fibers that give skin its firmness and prevent fine lines and wrinkles. The goal is to have a skincare regimen that maximizes your own production of collagen though a combination of multiple ingredients. Remember, there is no one magic bullet ingredient.
Combine at-home skincare with professional treatments. While at-home treatments are a key part in stimulating collagen production, professional treatments can really give you an unparalleled boost. As I mentioned, Ultherapy is the king when it comes to collagen production, but peels and other lasers can also help stimulate collagen.
Wear a sunscreen. I always recommend a physical SPF of at least 30. The sun destroys collagen and is the number-one cause of early aging. No matter how great the rest of your skincare routine is, you are really doing yourself a disservice if you don’t wear SPF.
What methods that claim to be useful for cell turnover are nonsense, in your opinion?
One-step peels are not as effective as two-step peels for cellular turnover. One-step peels are actually just strong exfoliators—all peels must have two steps to be a true peel. For decades, dermatologists have used two-step peels—you would never see a dermatologist using a one-step peel at their practice. One-step peels for at-home use are typically formulated with both the acid and neutralizer together in the same bottle—so while the packaging might say it is 10% glycolic acid, when the neutralizer is added into the same packaging, the concentration of this acid ends up being much less. It is a smoke and mirrors effect that misleads consumers.
Is retinol something to be used all year, or seasonally?
You can use it all year, as long as it doesn’t cause irritation, which can be common among a lot of the different retinol offerings. Retinol is one of the gold standard ingredients to correct and prevent early signs of aging. You are going to see the best results if you use it daily all year long. However, it is important to note that not all retinols are created equal. Retinols that are formulated with ferulic acid actually reduce irritation and sun sensitivity. This unique formulation combination allows users to wear it morning or night. Regardless of when you apply your retinol or what season it is, you should always wear a sunscreen.
I would say you are more famous for your products than your practice. Your at-home peels have a cult-like following. I, however, am still skeptical of anything that is chemical. How is this not overstimulating your face? It’s “safe for everyday use,” but isn’t doing it every day overstimulating your face?
Absolutely not. The Alpha Beta Daily Peels are specifically designed to be used daily without any irritation or recovery. These peels are essentially a micro-peel—it removes the dead, dull surface that accumulates every 24 hours. It is like a constant refresh and rejuvenation button for the skin. These peels have two steps: step one is formulated with a blend of acids at lower concentrations (instead of a single acid at a high concentration) and step two is the neutralizer which shuts off the acids after two minutes with built-in anti-aging and soothing ingredients. Having two steps is key to prevent irritation—the neutralizer essentially turns off the acids, so they are not sitting on your face for a prolonged period of time. Using these peels daily will never over-stimulate your skin. Your skin actually loves routine—by delivering AHA/BHAs to skin daily, you are consistently removing dead skin cells and debris buildup on the skin’s surface. This not only improves cellular turnover (which slows in your mid-twenties), but it also allows any other product you apply afterward to be absorbed directly into skin, improving the products’ efficacy.
If someone has hyperpigmentation or melasma, should they be doing the in-home peels at night to avoid any sensitivity or additional pigmentation?
To play it safe, yes, you can do it at night. However, our product development allows for it to be used morning or night. As I mentioned above, the neutralizer shuts off the acids in step one, eliminating sun sensitivity and irritation. However, regardless of when you use the peels, you must always wear a physical SPF of at least 30 every day, all year long. Sun exposure is hyperpigmentation and melasma’s number one enemy. For those with melasma, I would recommend taking sun protection even further by incorporating a vitamin C serum which protects against UVA/UVB free radicals and wearing a hat and/or large sunglasses. Even the smallest exposure to sun can darken melasma.
What is your plan for clients that have melasma or hyperpigmentation?
For the quickest and most effective treatment, I recommend combining a professional laser treatment with a diligent at-home skincare routine. At my practice, I use IPL (Intense Pulsed Light) technology to treat sunspots and melasma. It works by targeting hyperpigmented or otherwise damaged skin cells with the use of specific intense light wavelengths. However, it is important to note that IPL is not preventative. If you do not take care of your skin, it is remarkably easy for dark spots to reappear. This is where your at-home skincare regimen comes in. As I mentioned above, the key to really targeting existing melasma or other forms of hyperpigmentation is to attack it from multiple angles. You want to exfoliate and remove the dead pigmented cells from the skin’s surface, stop melanin transfer in the middle skin layers and prevent melanin production deep within the skin. Once the dark patches are faded, it is crucial to avoid the sun. Even the smallest exposure can make patches appear darker. Using a vitamin C serum with SPF is going to give you the best protection and prevent melasma from reappearing.
While skin types vary, is there any additional exfoliation one needs to incorporate into their weekly skin routine on top of this? How much or how little?
If your main concern is uneven texture and dullness, you can add an “exfoliation boost” to your skincare regimen. The Clinical Grade Resurfacing Liquid Peel is a step up from the Daily Peels—it incorporates bromalin, which is a naturally derived enzyme, for an added layer of collagen stimulation and radiance via cellular turnover. This product is for anyone whose skin is already acclimated to active ingredients and needs a boost. You can use it one to three times per week in place of your Alpha Beta Daily Peels. But stay away from physical exfoliants. They can be harsh and cause micro-tears in skin.
How do you feel about microdermabrasion?
Microdermabrasion is a form of professional physical exfoliant—I think that this treatment is too abrasive for skin. Think of physical exfoliation like sandpaper on wood. It doesn’t give you an even exfoliation. Chemical exfoliation leaves you with a smooth, even surface. If you are looking for glowing skin, opt for a chemical peel with a blend of multiple acids at various concentrations. A single-acid peel at a high concentration can actually damage skin and leave you red, flaky, and irritated.
How often do you recommend the LED light mask should be used?
The SpectraLite FaceWare Pro LED mask should be used once per day every day to see the best results. The device is hands-free, and the treatment is only three minutes, so it is really easy to incorporate into your routine.
What do you say to women who suffer from adult acne? What is a sensible regimen for them to incorporate?
First of all, acne at any age can be frustrating. But don’t despair: here are some tips for women who suffer from adult acne.
The acne you are seeing today actually started forming beneath the skin’s surface two weeks ago. If you have consistent acne, you can’t just use a spot treatment. You need to make sure your skincare regimen is preventative—that’s the best treatment for acne.
Do not over strip or over dry skin when treating acne. This can make breakouts worse. When selecting an acne treatment, look for products that use a combination of strong, fast-acting ingredients with soothing and hydrating ones. For example, salicylic acid is great to decongest pores, azeleic acid to regulate oil chemistry, farnesol which kills acne-causing bacteria (and is a great, non-irritating alternative to benzoyl peroxide) and soothing ingredients like green tea and aloe to sooth inflammation and redness. And don’t forget a moisturizer—specifically an oil-free moisturizer that won’t clog pores. Remember that drying or irritating the skin with acne products can increase redness and inflammation, which can further clog pores and increase acne.
For hormonal acne, monk pepper is our breakthrough discovery brand new ingredient in skincare—it stimulates the pre-cursor to testosterone, a lookalike compound with a weaker biological effect on sebum. It also blocks testosterone from binding with the androgen receptor in the first place to prevent sebum production.
Blue and red LED light are great to target acne. Blue light kills acne causing bacteria and helps regulate oil chemistry while red light reduces inflammation. Plus, LED light will never over dry skin.
Let’s talk body care. Before you were a dermatologist you treated skin cancer patients. You must be hyper aware of the necessity for sunscreen and proper skincare. Why are you a proponent of physical vs. chemical sunscreen?
Recently, the FDA released a study that showed six common chemical sunscreen ingredients absorb into the bloodstream and greatly exceed levels considered safe. The study was published in the Journal of the American Medical Association and showed that all six chemical sunscreen ingredients exceeded the safe level of 0.5ng/mL in the bloodstream after just one application. One ingredient—oxybenzone—showed an absorption rate 188 times the safe level after one application. They have stated more testing needs to be done to show the safety of chemical sunscreens. But why would you take the risk? Physical SPFs are already proven to be effective and safe.
What would be a sensible and intelligent regimen for keeping skin hydrated and in great shape, in terms of elasticity, long-term?
I am seeing skincare being related more and more with health rather than strictly beauty, which makes sense. As I mentioned, your skin is an organ—actually, your largest organ—so taking steps to keep it healthy is important. And it doesn’t stop at your face. Your neck and décolletage are also at high risk of early signs of aging as the skin on your neck is much thinner than the skin on your face. Address this by using the peels on your neck and chest area and be sure to apply SPF. In the past 10 years, I’ve seen a huge uptick in “tech neck” issues which are lines on the neck resulting from looking up and down on your phone. This repetitive action causes wrinkles. To combat this, incorporating a neck cream with retinol is ideal. And again, sunscreen is your number one line of defense against premature lines and wrinkles.
Are you a fan of daily dry brushing or is that too much over-stimulation of the skin?
As you know by now, I am not a fan of physical exfoliation. A chemical exfoliation is going to give you more even application and benefits—this goes for the body as well. In the upcoming months, we will be able to share some exciting news about a new product that will replace dry brushing.
Is there some in-office face treatment you deem as a “skin maintenance must” for your clients to get at least once a year?
Receive an Ultherapy treatment once per year. It will simulate collagen production to help with firmness and elasticity. However, this recommendation can vary from person to person, depending on what your skincare concerns are. If you are susceptible to hyperpigmentation (even after avoiding the sun and using SPF), I would recommend IPL at the end of summer to fade any dark spots that popped up. It is important to note, however, that most in-office procedures require a series of treatments. Very few treatments can be done only once per year and achieve the best results.
When applying a series of products in layers, how much time do you recommend leaving each product on before you put on the next one?
Ideally, you should allow products to fully absorb into skin before applying the next product. This allows for maximum absorption of all ingredients. There is not really an exact amount of time to wait between products. You should wait until your skin feels normal to the touch (i.e. not sticky, etc.). Most consumers actually use too much product, which makes the wait time between applications unnecessarily long. Read the individual instructions for how much of each product to apply and stick to that! Your skin cells can only absorb so much of an ingredient before they become saturated—any extra product just goes to waste. More is not better in this regard. Layering is always applied thinnest to thickest.
What do you think about products touting Epidermal Growth Factor? Is it hogwash or legitimate?
As a former skin cancer researcher, growth factors concern me—they can work in scary ways. In my opinion, I question whether EGF should be considered a drug with more safety testing before being released. We really don’t know what the long-term implications are for stimulating cells to reproduce. At what point is growth safe? Skin cancer, for example, is a state of unregulated growth. I am not comfortable with this active ingredient and I have never and will never use it in any of my products. It is my duty to always uphold the highest safety standards when it comes to my patients.