Posts filed under Skin Care

Cutera Excel V: A New Approach to Treating Vascular Skin Conditions

Millions of Americans are affected by such vascular skin conditions as rosacea, spider veins and telangiectasia, which can cause unsightly broken blood vessels, discoloration and lesions to appear on the face and legs. People affected by these skin conditions often report feeling embarrassed or self‐conscious, which can deter them from attending social events or even going out in public. While much progress has been made to identify the causes of these conditions, treatment options have been largely limited to procedures that incur adverse side effects, such as surgery, electrosurgery and sclerotherapy. Now, there's a new approach to treating vascular skin conditions that puts patients’ safety and comfort first. Excel V uses a high-powered green laser that is absorbed by abnormal blood vessels in the skin. The laser heats and eliminates the abnormal vessels, ultimately restoring normal skin tone and color. Excel V can be customized to each patient’s skin condition, enabling precise and effective treatment of everything from superficial blemishes to deep scars. The system leverages innovative cooling technologies to ensure patient comfort, and there are no long‐term side effects or downtime.

Common Conditions Treated with Excel V

  • Rosacea: Rosacea is a common disorder that mainly affects skin on the face. While it is typically characterized by harmless cosmetic symptoms, such as facial redness, some patients also complain of heating or discomfort when they flush. Rosacea triggers can include strenuous exercise, extreme temperatures, alcohol and spicy foods.
  • Telangiectasia: Telangiectasias are tiny broken blood vessels that are permanently fixed in the dilated state. While they usually do not present medical problems, they do create cosmetic concerns as they take on the appearance of fine red lines coursing through the surface of facial skin.
  • Leg Veins: Leg veins are dilated vessels that range from large veins to small telangiectasias. Non‐laser treatment of leg veins typically involves sclerotherapy, a procedure in which a liquid is injected into the damaged vessels to harden and destroy the vessel wall. Excel V can treat leg veins up to 4mm in diameter.
  • Port Wine Stain: A port wine stain is a type of red or purple birthmark made of dilated blood capillaries. They often appear on the face and do not fade unless they are treated. Non‐laser treatment of port wine stains includes radiation, freezing and surgery, often resulting in pain and scarring.
  • Cherry Angioma: Cherry angiomas are small red bumps that appear spontaneously on the skin. They typically appear in middle age and will proliferate. Non‐laser treatment of cherry angiomas includes cryosurgery and electrosurgery.

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Posted on September 26, 2012 and filed under Skin Care.

Restore and Protect Your Skin with Vitamin C

Photo by Robynlou Kavanagh/Creative Commons attribution license Vitamin C may not be as effective in fighting colds as once thought, but this vital nutrient can do wonders for the skin.

Vitamin C, also known as ascorbic acid, is a powerful nutrient and antioxidant necessary for the growth and repair of tissues throughout the body. It helps the body produce collagen — an important protein used to make skin, bones, cartilage, tendons, ligaments and blood vessels — and it helps heal wounds, form scar tissue, and repair and maintain teeth and bones.

Collagen Booster

Collagen, a fibrous protein found in skin and connective tissue that aids the growth of cells and gives skin its strength and firmness, naturally decreases with age, leading to loose, weak and dry skin.

Vitamin C stimulates the production of new collagen, thus helping the skin maintain its elasticity and flexibility.

In fact, an American Journal of Clinical Nutrition study of 4,025 women ages 40 to 74 found that those with high vitamin C intakes experienced a lower likelihood of wrinkles, fine lines and dry skin.

Protective Antioxidant

Vitamin C is also a highly effective antioxidant that protects cells from free radical damage.

Free radicals, unstable molecules that damage the structure of healthy cells, contribute to the aging process and the development of such health conditions as cancer, heart disease, Alzheimer’s disease and arthritis. Although the body creates some free radicals during normal metabolic processes, most are caused by such environmental factors as pollution, radiation, sun exposure, cigarette smoke and herbicide.

Here’s how it works: When a molecule — the building block of every cell in our bodies — splits in such a way that leaves it with one unpaired electron, it becomes unstable and tries to recapture the electron by stealing it from another molecule. That attacked molecule then becomes an unstable free radical itself, setting off a chain reaction.

Antioxidants — essential nutrients that include vitamins C, D and E, beta-carotene and selenium — protect the skin from damage by stabilizing those free radicals. But if antioxidants are unavailable to stop these attacks or if too many free radicals are produced, cell damage can occur, leading to a multitude of chronic diseases and prematurely aged skin.

Vitamin C not only neutralizes free radicals, but also regenerates other antioxidants, such as vitamin E. In fact, a 2006 study by the Linus Pauling Institute in Oregon found that vitamin C concentrations restored depleted vitamin E levels in cigarette smokers.

And in 2009, researchers at the University of Leicester in England and the Institute of Molecular and Cellular Biology in Portugal found that ascorbic acid 2-phosphate, a derivative of vitamin C, can both heal wounds and reverse DNA damage caused by free radicals.

Sources of Vitamin C

The human body is unable to make vitamin C on its own, and because it is water-soluble, the body can’t store it. So, once the body absorbs what it needs, excess amounts are discharged through the urine. That means you need a continuous supply of vitamin C in your diet. The best sources are raw or lightly cooked fruits and vegetables.

 Fruits high in vitamin C:
  • acerola cherries
  • black currants
  • cantaloupe
  • citrus fruits, such as orange and grapefruit
  • guavas
  • kiwis
  • mangos
  • papayas
  • pineapples
  • strawberries, raspberries, blueberries, cranberries
  • tomatoes
  • watermelon
 Vegetables high in vitamin C:
  • ­bell peppers, yellow, red and green
  • broccoli
  • brussel sprouts
  • cabbage
  • cauliflower
  • leafy greens, including kale, mustard greens, turnip greens, chard, spinach and watercress
  • potatoes, sweet and white
  • winter squash


Posted on July 26, 2012 and filed under Skin Care.

Are Nutrient Deficiencies and Food Allergies Harming Your Skin?

What you’re eating — or, in some cases, not eating — could be harming your skin. In fact, your skin can be a road map to a number of food allergies and nutritional deficiencies you may not even know you have. Food allergies and nutritional deficiencies can cause excess inflammation in the body, which in turn can cause such skin conditions as eczema, acne, rosacea and premature aging. In many cases, nutrient testing and simple dietary changes can help you combat these conditions. And when they can’t, there are numerous treatment options available to help improve your skin.

Premature Aging

Premature aging can be an obvious sign of nutritional deficiencies. Free radicals, unstable molecules that damage the structure of healthy cells, are a major cause of premature aging. While normal biological processes do cause some free radical damage to the skin, most results from such environmental aggressors as pollutants and sun exposure.

Antioxidants — vital nutrients that include vitamin C (found in citrus fruits and green leafy vegetables), vitamin D (found in sunlight and such foods as milk, eggs, cheese, salmon and tuna), and vitamin E (found in nuts, seeds, whole grains, green leafy vegetables and vegetable oils) — protect the skin from these free radicals. If your body is deficient in one these, your skin can age prematurely. A nutrient test can determine what you are lacking and what your body needs to fight free radical damage.


Eczema (atopic dermatitis) is an itchy inflammation of the skin that often appears on the arms or behind the knees. While the exact cause is unknown, researchers believe it may result from a combination of inherited sensitive skin and a malfunction in the body’s immune system. Food allergies — typically dairy products and gluten — can make eczema worse.

Eczema can be treated with topical medications, such as hydrocortisone, pimecrolimus (Elidel) and sulfacetamide, and with creams and cleansers containing oatmeal preparations. Although these creams treat the symptoms, they don’t treat the underlying cause. A food allergy test can identify potential triggers.


Acne, an inflammatory skin condition characterized by clogged pores, blackheads and pimples, is the most common skin condition in the United States, affecting about 40 million to 50 million Americans, according to the American Academy of Dermatology. But it doesn’t just affect teenagers. Adults in their 30s, 40s and 50s can develop it, too.

Acne is caused by an overproduction of oil by enlarged oil glands in the skin, a blockage of the hair follicle that releases oil and the growth of bacteria in the hair follicle. Some studies suggest that processed foods and refined sugars can exacerbate acne. But hormonal imbalances, food allergies — typically to dairy products — and nutrient deficiencies also can trigger acne outbreaks.

If you suffer from acne, it’s important to get a nutrient test or food allergy test to identify possible triggers. Clearing your acne could be as simple as avoiding certain food groups or replenishing zinc stores.

For some, however, dietary changes may not be enough. Topical treatments, such as retinoid medications, benzoyl peroxide and salicylic acid, can be highly effective in combating acne. Laser light treatments, including blue light therapy, can help eradicate the bacteria in the skin to reduce outbreaks.

Chemical peels also can be used to treat acne. SkinMedica’s Illuminize, Vitalize and Rejuvenize peels use a unique blend of alpha and beta hydroxy acids to dramatically improve the tone and texture of your skin. These exfoliating peels have been clinically proven to help pigmentation problems, including sun damage and acne scarring, while stimulating collagen production in the cells beneath the skin’s surface.

  • The Illuminize Peel is a gentle, superficial peel for all skin types that uses a newer generation of alpha hydroxy acids (mandelic acid and malic acid) in conjunction with phytic acid, salicylic acid and resorcinol to rejuvenate skin with little irritation. This peel improves skin clarity, color and texture, increases skin radiance, and tightens the skin with little or no visible peeling.
  • The medium-strength Vitalize Peel uses salicylic acid, lactic acid and retinoic acid to address pigmentation problems, melasma, sun damage and post-inflammatory hyperpigmentation. It can be customized to treat each specific condition. Visible improvement can be seen after one treatment, with more significant results after a series of peels. The Vitalize Peel has little or no downtime and can be used on all skin types.
  • The Rejuvenize Peel, SkinMedica’s strongest, uses salicylic acid, lactic acid, resorcinol, panthenol and isoceteth-20 to exfoliate damaged layers, revealing fresher, healthier skin. This peel is particularly effective for treating sun damage, melasma, pigmentation changes and acne scarring. It is recommended after tolerance to the Vitalize Peel has been established, and requires little downtime.


Rosacea, an inflammatory, vascular condition often characterized by flushing of the face, affects about 14 million Americans between the ages of 30 and 60, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Although its exact cause is unknown, researchers have identified a number of common triggers for rosacea flare-ups. These include genetics (particularly in fair-skinned individuals of Irish, English or Scottish descent); environmental factors, such as sun exposure, wind, extreme temperatures (hot or cold), hot baths and saunas; harsh skin care products; stress and other emotional influences; and such medical conditions as menopause, high blood pressure, immune system problems and gastrointestinal imbalances. Rosacea flare-ups also can be triggered by a number of foods and beverages, including alcohol, hot or spicy foods and drinks, and foods that either contain high levels of histamine — a chemical produced by the immune system during an allergic reaction — or trigger the release of histamine.

If you suffer from rosacea, it is important to use a broad-spectrum sunscreen with an SPF of 30 or higher. Treatment options include intense pulsed light (IPL) photofacials, topical medications and oral antibiotics. But identifying gastrointestinal triggers and inflammation-causing food allergies can keep rosacea at bay for years.

Identifying Food Allergies and Nutritional Deficiencies

If you suffer from acne, eczema, rosacea or premature aging, it’s important to get a nutrient test or food allergy test to identify possible triggers.

Dr. Thalia Farschian, ND, a naturopathic doctor at Current Health in San Francisco, specializes in diagnosing and treating food allergies, nutrient deficiencies and hormonal imbalances. Her nutrient tests assess each patient’s supply of vitamins, minerals and antioxidants over a period of 3 to 6 months, so testing is consistent and not dependent on what you ate the day before.

The nutrient test includes testing for vitamins B12 and D, selenium and glutathione. The food allergy test looks for allergic responses to 95 foods, including gluten, dairy, eggs, nuts, corn and soy. For more information about these tests, visit Current Health or call (415) 732-7029.

Identifying Other Treatment Options

To find more about other treatment options for acne, rosacea, eczema and premature aging, including topical medications, oral antibiotics, IPL phototherapy, laser treatments and chemical peels, contact our office at (415) 927-7660 or email

[hr] Photo by Victoria Ushkanova/Creative Commons attribution license

Posted on June 30, 2012 and filed under Skin Care.

How to Keep Your Skin Healthy in Your 30s

Photo by Mizrak/Creative Commons non-derivative attribution license Your 30s is a special time. You’re wiser, more confident and more conscious of how your choices affect your health, yet young enough to make changes that will benefit you into your golden years. That’s why it’s an important time to focus on the health of your skin, the body’s largest organ and the one that’s most exposed to the outside world.

Even if you’ve taken good care of your skin, you’ll probably begin to notice some changes. As cell turnover slows down, your complexion dulls. Collagen, a fibrous protein that gives skin its strength and firmness, begins to break down. Fine lines and wrinkles start forming around your eyes and mouth. Sunspots and broken blood vessels may appear on your face. And even if you haven’t battled it before, hormone-driven acne may make unwanted appearances before or during your period.

Here are some tips for keeping your skin healthy and maintaining that youthful glow.

Hydrate. As we age, our skin begins to dry out, so it’s important to stay hydrated. The amount of water you need each day depends on a number of factors, including your health, your activity level and where you live. According to the Institute of Medicine, men generally need about 125 ounces or 3.7 liters of fluid each day and women need about 91 ounces or 2.7 liters. (By comparison, the oft-advised eight glasses per day yields about 64 ounces or 1.9 liters.) But it doesn’t all have to come from plain water — beverages and foods that contain water count, too.

Load up on antioxidants. Antioxidants — essential nutrients that include vitamins C, D and E, beta-carotene and selenium — protect the skin from free radicals, unstable molecules that damage healthy cells as a result of exposure to pollutants and radiation. For best protection, eat fruits and veggies high in antioxidant nutrients every day. Many moisturizers also include such antioxidants as vitamins C and E, green tea and selenium.

Use sunscreen daily. Unprotected sun exposure is a major cause of premature aging, and its cumulative effects worsen as we age. Wear a broadband (UVA and UVB protection) sunscreen with SPF 15 or higher. Some moisturizers and cosmetics already contain sunscreen. If yours doesn’t, apply a separate one.

Use a retinoid. Retinoid products, made with derivatives of vitamin A, unclog pores, boost collagen and speed cell turnover to fight wrinkles, uneven texture and acne. Just make sure to use sunscreen because retinoids can make your skin more susceptible to sun damage if worn during the day. If your skin is sensitive, use a gentle exfoliator instead. (Caveat: Pregnant or breastfeeding women should not use retinoids.) Ask your health care provider to prescribe one that’s right for your skin.

Exfoliate and peel. Chemical peels — particularly those with alpha and beta hydroxy acids, salicylic acid, glycolic acid, lactic acid, retinoic acid or resorcinol — encourage new cell turnover, revealing fresher, brighter skin. If you’re not a fan of peels, slough off dead skin cells and stimulate collagen production with a gentler microdermabrasion or try an at-home treatment with glycolic or lactic acid. Ask your health care provider which peels or products are right for you.

Posted on June 29, 2012 and filed under Skin Care.

Rejuvenate Tired, Sagging Eyes Without Surgery

Do you suffer from dark circles, deep tear troughs, or tired, sagging or crepey skin around the eyes? If so, don’t be alarmed. Signs of aging and fatigue are often most visible around the delicate eye area. But thanks to recent technological advances, we can rejuvenate those tired eyes in just one office visit, without surgery and with little downtime. Botox can eliminate those problematic periorbital wrinkles — the dynamic wrinkles, such as crow’s feet, that appear when you smile or move the skin and the static wrinkles caused by loss of elasticity that remain when your facial muscles are not contracted — and lift the medial and lateral brows to give the eye a more open appearance.

When light hits the face, it tends to settle in areas of concavity. Hyaluronic acid fillers, such as Restylane and Juvederm, can be injected into the troughs below the eyes to eliminate dark circles and other concave areas, decrease the appearance of crepey skin and create a more uniform contour around the eye.

We also offer a new eye cream with regenerative growth properties, peptides and caffeine that can help eliminate puffiness and reduce crepiness around the eye area. It's called Neocutis Lumiere.

These treatments — coupled with Latisse, a prescription eyelash rejuvenation treatment to make your lashes grow longer, thicker and darker — can brighten and rejuvenate your eyes without surgery using the latest medical advancements.

Posted on May 30, 2012 and filed under Skin Care.

Welcome to My New Aesthetic Medicine and Skin Care Practice

As many of you know, I have a strong passion for the science of skin and anti-aging. My goal is to make people feel good about the way they look. So it's with great pleasure that I send this message about my new Marin County aesthetic medicine practice. For those of you who don't know me, I gained my training and experience at Harvard University, Columbia University’s College of Physicians and Surgeons, New York University, UC Berkeley and UC San Francisco. You can read more about my credentials on my website.

New Office

My new private practice is located at the Tamal Vista Medical Building, 21 Tamal Vista Blvd., Suite 103, in Corte Madera, Calif. The beautiful ground-floor office, shared with Tancredi D’Amore, MD, FACS, includes an entry lounge, three private treatment rooms and an operating suite.

New Website

Our new website is designed to provide you with everything you need to know about our practice. I will periodically publish articles on my blog about the latest skin care trends and procedures, the science behind our skin care products, and how to improve your appearance without spending a fortune.

About the Practice

My practice specializes in a wide range of skin care services including Botox, Dysport, Juvederm, Restylane, Perlane and Radiesse injections, medical-grade peels and pharmaceutical-grade skin care products. I use the latest advancements in laser technology to treat brown spots, visible redness, enlarged facial vessels, rosacea, lip lines, dark circles, eye bags, skin laxity and wrinkles. We also offer eyelash, eyebrow and neck rejuvenation, and injections to treat excessive perspiration and TMJ. I perform all injections and laser treatments myself.

Our talented staff strives to provide our patients with comprehensive services and personal, hassle-free experiences. Please contact us to ask questions or schedule an appointment. We are excited to serve you in our new office!

Sincerely, Skylar Ulrich, MD, MPH

Posted on April 25, 2012 and filed under Skin Care.

Understanding the New FDA Sunscreen Guidelines

Just when you thought you understood the SPF (sun protection factor) system, the labels are changing. To protect consumers from skin damage and false advertising, the U.S. Food and Drug Administration (FDA) created new regulations in June 2011 that require all sunscreens to be tested for protection against UVA and UVB radiation — the two types of sun exposure that cause sunburn, skin cancer and premature aging — and limit how manufacturers can label their products.

UVA + UVB = "Broad Spectrum"

Under the new rules, effective in June 2012, only sunscreens that protect against both UVA and UVB rays can be labeled “broad spectrum.” While UVB rays are primarily responsible for causing sunburn, both types cause skin cancer and premature aging. Products that protect against all types of sun-induced skin damage will be labeled “broad spectrum” and “SPF 15” or higher on the front of the product. Sunscreens that do not offer broad-spectrum protection or those with SPF values of 2 to 14 must contain a warning label stating that the product “has been shown only to help prevent sunburn, not skin cancer or early skin aging.”

Water Resistant vs. Waterproof / Sweatproof

Because no sunscreen is completely waterproof, the terms “waterproof,” “sweatproof” and “sunblock” are no longer allowed on labels. Products may be labeled “water resistant” only if they pass the FDA’s water-resistance test, which involves applying sunscreen to human subjects and submerging them in a whirlpool or tub of water for either two or four 20-minute periods. Any water-resistance claims must state how much time — 40 minutes or 80 minutes — a person can expect to get the declared SPF while swimming or sweating. The products also must provide directions for reapplying after sweating or swimming.

Children and Infants

Although there are no changes in the FDA guidelines specifically related to children and infants, it is important that parents of infants 6 months and younger limit sun exposure during peak hours, from 12 to 2 p.m., and use shade devices, such as hats and umbrellas. For specific product recommendations, talk to your health care provider. All other age groups will benefit from the use of a broad-spectrum sunscreen with an SPF 15 or higher in conjunction with other sun-protection measures.

For more information about the new guidelines, visit or

Posted on April 16, 2012 and filed under Skin Care.