What is cellulite?
“Connective tissue bands beneath the skin, called fibrous septae, are arranged in a crisscross manner in normal skin. When they are oriented in a parallel manner from birth, they allow the fat to bulge up against the skin’s thinner surface, creating a rippling, lumpy look. Some septae also harden and contract as women age, which causes more bulging and dimpling by pulling the skin surface inward.” Dr. Theodore Diktaban*, NYC Plastic Surgeon
*Dr. Diktaban is not associated with the following product in any way.

Have you ever met an FOF who didn’t care about her cellulite? Neither have we.
We’ll try anything that promises to reduce the appearance of those icky bulges and dimples that manage to pop up in all the wrong places.

So it got our attention when we heard that a group of Australian scientists has formulated an easy, affordable way to conquer the cellulite curse. Their revolutionary cream, used twice a day, decreases the appearance of cellulite by an average of 38 percent within as little as four weeks, and 57 percent within eight weeks. This is based on a scientifically validated consumer study conducted by an independent lab in New York.

The product’s complex formulation contains a concentrated blend of caffeine, retinol, forskolin, vitamins A & K, aloe vera, and TPM® Dermal Delivery Technology. TPM, which is derived from natural vitamin E, is the secret weapon that enhances the absorption of key ingredients into the skin. That means more of the key ingredients in the product are delivered into the skin’s layers where they are needed most. The result for you? Noticeably smoother, firmer, and younger looking skin. And there is the added bonus that the cream can be used all over your body for a more toned appearance, not just on your legs or thighs!

BioElixia Body Shaper Cellulite Contour Crème ($49.50 for 5 fl oz) is now available in the United States. Lather up those legs today!

What did FOFs do before there were fancy-shmancy lotions and potions? They treated their wrinkles and imperfections with things they found from the earth–raw herbs, plant and animal oils.

Now, some FOFs are nixing modern anti-aging treatments and creams loaded with chemicals and other unidentifiable ingredients in favor of the all-natural remedies used by our FOForemothers. “Recently, my nutritionist encouraged me to get as far away from manufactured creams as possible,” says FOF Trish Perry. But, do these natural remedies actually work? We spoke to FOFs who swear they do and dermatologist Dr. Jessica Krant about what the current research says about these age-old beauty secrets.

Tell us: What natural home beauty treatments do you use?

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Doctor’s-office cosmetic procedures, such as laser treatments, micro-dermabrasion and peels, are generally considered a luxury. Perfectly realistic for the Real Housewives of Beverly Hills–less so for the average FOF on a budget.

But recently, a number of products that employ medical-grade technology have been approved for home use, from “skin-renewing” lasers to “body-smoothing” eletromagnetic pads. These items aren’t cheap (the Palovia Skin Renewing Laser is $500 and the Brazilian Skin Peel is $78) but when compared to their in-office counterparts, they’re a steal.

The question is–do they work?

We looked at 6 new at-home anti-aging products that employ medical-grade technology and asked Dr. Joshua Zeichner, Director of Cosmetic and Clinical Research Mount Sinai’s Department of Dermatology, whether their science made sense. Then we asked real FOFs who had tried the product to tell us what they thought. Check out the slideshow below to see them all.

Dermatologist Jessica Krant reveals the products that can save your skin–while saving you money.

Navigating the world of anti-aging creams is a harrowing process. They range in price from $15 at the drugstore to $400+ at department-stores, all promising smoother, tighter, more youthful skin. So which ones will actually work–without breaking the bank? We posed this question to Dr. Jessica Krant, a New York dermatologist with a passion for helping women make educated decisions about their skin. Unlike many dermatologists, Dr. Krant has no financial relationship with any beauty companies, so she’s a great source of honest info.

• Before you start recommending products, can you explain why there is so much confusion around this issue? How can so many different products, at such different prices, all claim to work?
  • It’s very hard to know what “really works.” To understand why, it’s helpful to understand what a “cosmeceutical” really is. Riding the gray area between cosmetics, which only claim to alter the appearance of skin, (think bronzer or eyeshadow), and pharmaceuticals, which alter the body’s biology (think Botox), cosmeceuticals try to have it both ways. Companies that make these products want the public to believe they actually do change skin scientifically, but they don’t want to spend hundreds of millions of dollars and many years going through FDA drug trials to prove it.
  • The result: most anti-aging creams, both in the drugstore and in the department store, avoid the FDA entirely, which means they can make lots of claims without the need to prove anything. They just have to pass muster with the Federal Trade Commission, which requires that they maintain a level of safety. (Even this is difficult to rely on, since most safety issues come up only after the product has been out on the market and caused enough trouble to get attention.)
• Wait, so are you saying that none of these products work?
  • It’s possible some anti-aging products really do work, but there is currently no independent group that is testing and validating these products’ claims. A company may advertise that it’s put a product through “clinical trials,” but that only means it has been tested on actual humans–as opposed to cells in a dish. Clinical research is vital, but when it’s presented by the company that’s selling the product, you need to take it with a grain of salt. Often, results are reported such as a reduction in the “appearance” of fine lines or dark spots. That does not mean that the lines and dark spots have been reduced, only that it looks better.
• What ingredients have been tested so that we KNOW they have benefits? Are there inexpensive products that contain these ingredients?
  • The most proven anti-aging ingredient on the market is the only one that has gone through the formal FDA-approval process. This is tretinoin, a vitamin-A derivative known as a retinoid. The most recognized brand name is Retin-A. Tretinoin is the gold standard for anti-wrinkle treatments. It’s also proven to reverse other signs of aging, as well as help to reduce the risk of skin cancer by keeping skin cells growing in a healthy, ordered way. Because it is irritating to skin if used improperly, hard to get because it requires a prescription, and expensive, we look for other anti-aging options.
• So are there other ingredients that have been shown to work?
  • Several ingredients on the market are known to have real results in basic science research–the science behind them looks good, even if they haven’t been formally tested by the FDA. These include over-the-counter retinoids (retinol, retinyl palmitate, and retinaldehyde), antioxidants such as soy, green tea, feverfew, licorice, mushrooms, vitamin C, coffeeberry, and other formulations proprietary to different companies. Finally, glycolic and salicylic acid and their relatives are also useful ingredients in many anti-aging formulations.
• What affordable products do you recommend to your 50+ patients and why?
  • For drugstore brands, I tend to stick with some of the most tried-and-true companies and products that I do believe have ingredients with real evidence behind them. For retinol products, most will work, but my favorites are Neutrogena’s Ageless Intensives Retinol SA line ($18.99-$20.99) , which contains various formulations for different skin types (from serum to night cream), and Roc’s Retinol Correxion line ($19.99-$22.99). For patients with age spots and general skin dullness, I recommend Aveeno Positively Radiant Triple Boosting Serum and the SPF 30 day moisturizer ($21), to take advantage of its antioxidant and spot-fading soy. For sensitive, rosacea-prone skin I recommend Aveeno’s Ultra-Calming cleanser and moisturizer($7.49, $16.79) which contains anti-inflammatory and antioxidant feverfew.

• In choosing anti-aging products, try to go for the most emollient (moisturizing) versions tolerable, such as heavier night creams. This allows the skin’s top layers to absorb creamy moisture which allows it to be plumped up, giving more of a translucent glow as well as swelling tiny lines and wrinkles full of moisture so they smooth out temporarily. In fact, this is how some of the most expensive anti-wrinkle creams do their best work.
• Is there a benefit to spending more to get a prescription anti-aging cream?
  • The benefit of using tretinoin by prescription is that it has the most research evidence behind it; it’s rigorously evaluated and proven in an unbiased way; and it not only reduces the “appearance” of fine lines (which plain moisturizers also do), but actually does reduce the fine lines. A tube of tretinoin, which is sold under various brand names as well as the generic, does cost a bit more than some drugstore creams, but less than some department store creams [editor’s note: a prescription for a 20-gram tube of tretinoin could cost anywhere from $40 for a generic to $75 for a name brand]. However, a little goes a long way, and it may be the best bang for the buck, if one knows how to use it properly to avoid issues.
• Do you recommend any expensive anti-aging topicals–department store brands? Are there any that you think have interesting science behind them?
  • Physician-dispensed anti-aging topicals and some of the more expensive department store brands claim to have higher concentrations of active ingredients, formulated in more expensive ways, to justify their higher prices. This may indeed be true, but since formulas are often proprietary, it is hard to know exactly how much more of the ingredient you’re getting. Some of the more reliable brands are SkinCeuticals, which has highly researched antioxidant serum formulations; Revaleskin, which is a line containing active coffeeberry extract that performs multiple anti-aging functions; Neocutis, a company whose product line is based largely on their proprietary PSP (purified skin protein) formula, which aids wound healing—a finding they extrapolate to claim anti-aging effects in intact skin; Obagi, a line which contains many well-tested products; and Neova, a line which contains many copper peptide and antioxidant products.
• What anti-aging products and services are, in your opinion, worth a “splurge?” In other words, they may be more costly, but they make a huge difference in the longterm? 
  • In my opinion, any of the products mentioned here are worth a try, remembering that it may take 6 months to be able to tell whether a product is making any difference. The most reliable anti-aging treatments are still tretionin–the prescription retinoid–and some of the more invasive procedures, including peels, Intense Pulsed Light photofacials, laser treatments, and the injectable neurotoxins (Botox, Dysport) and fillers (including Restylane, Juvederm, Radiesse, Sculptra, and others). All of these treatments have risks that are important to discuss in great detail with your dermatologist before starting, to have a clear understanding of the medical risks involved as well as costs and realistic expectations of change and length of benefits.

Author
	Dr. Jessica KrantDr. Jessica J. Krant is a dermatologist based out of New York and founder of Art of Dermatology, LLC. She is also the assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City.

A dermatologist to the stars reveals the non-invasive treatments that really work.

Meet Dr. Howard Sobel at the Beauty Bash, Oct. 1-2 in New York City.

“Most women in their 50s do not need a facelift.”

So says cosmetic dermatologist Howard Sobel, a New York MD who’s gained a cult following among women who want to look tighter and smoother, without going under the knife. One conversation with Sobel and it’s clear that this is a man who’s passionate about his job. If you’ve ever witnessed a football fan discussing his Fantasy team, you get a sense of what Dr. Sobel sounds like when he talks about laser treatments. Here, he discusses the latest non-invasive treatments that “really work.”

• FOF: When it comes to their faces, many FOFs are particularly interested in non-invasive anti-aging treatments–creams, lasers, facials and so on. Which ones work the best?
  • Dr. Sobel: I know we’ve all heard this, but the very best anti-aging regimen starts with prevention. Stay out of the sun and use a sunscreen properly. That means putting a full teaspoon on your face every day and re-applying every 2-3 hours if you’re outside. SPF 30 is probably enough (there’s not a big difference in protection when it goes above 30).
• Is there a specific brand that you recommend in your own practice?
  • Well, we created our own line, DDF, which is now owned by P&G. It’s good, but there are a lot of good sunscreens on the market. Just make sure it blocks UVA and UVB rays.
• Okay, so what about the woman for whom the damage is done. Now what?
  • Right, so once you have that sun damage, you’re naturally going to lose elasticity in your skin. You get fine lines, wrinkles, and hyperpigmented areas where skin becomes irregular, rough and lumpy. There are amazing lasers for that.
• Let’s start with the least involved! Are there any creams that work?
  • There are some topicals that will get rid of the uneven pigmentation–somewhat. The key ingredient is hydroquinone. Some people are a little afraid of hydroquinone because there were studies connecting it to cancer in mice. But we know now that hydroquinone is very safe and there’s nothing wrong with using it. The trouble is, it doesn’t always work.
• Tell me about the lasers.
  • The one I like is the Fraxel Dual laser–1927 wavelength. It really removes the sun damage…brown spots, uneven skin, etc. It’s terrific. You’ll need one or two treatments, depending on how much sun damage you have, and there’s no downtime. You might get what looks like a little cat scratch right afterward–you can cover it with makeup.
• How much does that cost and how long does it last?
  • Not costly by laser treatment standards. It’s $1500 per treatment, and the results last as long as it takes for you to re-damage you skin through sun exposure. Also, it’s a laser that really works. There are a lot of lasers out there that promise to do everything–and do nothing.
• Does that also get rid of wrinkles and sagging?
  • Yes, you can set that same laser to a different wavelength, and it removes wrinkles and fine lines and tightens the skin. I think it’s most effective to get rid of the pigmentation first and then have the patient come back in two or three months to have the wrinkles done. Some doctors will put the laser up to half strength and do a little of each, but I find that doesn’t work as well.
  • Another great laser for skin tightening is the eMax. It actually goes below the skin and tightens the collagen fibers and stimulates the collagen. It gives the skin back its elasticity.
• What are other laser procedures really work?
  • The ulthera laser–it’s actually ultrasound, not a laser–tightens skin and stimulates the fibroblasts to make collagen.
  • And the C02 laser works well to get rid of fine lines and wrinkles. C02 lasers used to have several weeks of recovery time, but now we have C02 lasers called fractional C02s which have very little downtime–they’re excellent.
• You’re known for doing “facelifts” with injectibles. Can you tell me about that?
  • It used to be that if you had a little loose skin, and you wanted to look younger, plastic surgeons were very keen on doing facelifts–earlier than later. But now most people believe that volume creates a younger face. A surgical facelift causes the skin to get pulled, and if you don’t put volume back, you look like you got caught in a wind tunnel. So you don’t have loose skin anymore, but you don’t necessarily look better–you just look like someone who had surgery. Injectables like Juvederm, Radiesse, etc, create volume.
• I know that injectables can fill in wrinkles, but if you have sagging skin and jowls, do they really help?
  • Yes, they absolutely lift. For example, I’ll inject filler on top of your cheekbone, and that creates volume that actually lifts the skin on your cheek. It’s like re-draping a shirt on a hanger. I do a very popular procedure called “The Trifecta” which involves three types of injectables–Botox, Radiesse and hyaluronic acid. The results are comparable to a facelift. Wrinkles and lines are smoothed and sagging skin is actually lifted and tightened.
• What is the Botox for? That’s not really a filler, right?
  • Nothing works better to get rid of dynamic lines than Botox. Your crows feet, your worry lines, the wrinkles on your chin. No matter how much filler I use on those, they’ll keep coming back because you’ll keep creasing the skin. Botox actually stops the muscle from moving so the creasing stops. Unfortunately, you have to do it every 3 or 4 or 5 months, but, like I said, nothing works better.
• So who is a good candidate for “The Trifecta”–or any “injectables” lift?
  • That’s for someone who wants to look younger and fresher, but doesn’t want surgery. Patients literally can walk out and look ten years younger.
• What are the limitations of these non-surgical procedures? In other words, when do you refer a patient to a plastic surgeon?
  • Between the lasers and injectables there’s so much you can do. And I think the biggest mistake you can make is doing too much. But once you get into your 60s and the skin around the neck area starts to hang, you probably will need the knife to get rid of it. Filler won’t be enough. But just cutting, without filler, isn’t enough either. Because these days, the trend is to do a lift and then still add volume back in.
• What is the biggest mistake women over 50 make when it comes to their faces?
  • Of course, spending too much time in the sun. The other thing is, women come in and have cutting and pulling procedures a little earlier than they needed to. They wind up with their eyes up near their scalp. Too much surgery is much worse than no surgery at all. Start with the simplest procedures and work your way up.
• What non-invasive procedures on the horizon are you most excited about?
  • Injections and topicals that can actually turn on individual cells to increase collagen production and give us back our youth. Or that can inhibit the enzymes that stop collagen production. There are are topicals now with stem cells and dermal growth factors but they don’t work yet. They just don’t penetrate the skin. And this is something you have to be careful with, because any factor that encourages cell growth might encourage a cancerous cell to grow–like a melanoma. I don’t know when it will be ready, but that’s the future.

Author

Dr. Howard Sobel, MD Dermatologic SurgeonDr. Howard Sobel, MD, is a Board Certified Cosmetic Dermatologic Surgeon and the first editor-in-chief of the International Journal of Cosmetic Surgery and Aesthetic Dermatology. He is recognized by both New York Magazine and the Castle Connolly Guide on How To Find the Best Doctors in the New York, Metropolitan Area as one of New York’s premier cosmetic dermatologic surgeons for eleven consecutive years.