Transformative Skincare:
Healing Stories of Women of Color

Hello everyone and welcome back to the Skin Report. Today we’re going to discuss four case studies of women of color who are actually my patients, and actually, one of them is Shaheera, and the problems of their skin that they presented with, and those include acne, acne scarring, hyperpigmentation, and just simple sun damage, aging of the skin, and how we address them with medical aesthetic treatments and skincare that is specific for their skin tone.

So let’s go ahead and start. Hi Shaheera.

Hi.

So Shaheera, you have all the case studies that we’re going to talk about. Of course, these are patients of mine and yourself, who have all given me permission to share their photos and their journeys on our episode today.

So let’s start with Sapna, who is, she’s in her 20s. Sapna came in, you said, with some acne, overproduction of acne, and was it hyperpigmentation from it as well?

Sapna is a young woman in her 20s. She is a master’s student and she’s been suffering with acne for a while now. When I saw her, her acne had kind of subsided. Now she’s in her early 20s, but she had some deep scars from acne and her skin just looked dull. And she said that she still breaks out periodically, but for the most part, what was bothering her about her skin was that it just wasn’t bright. It looked dull, uneven, and she just really wanted to address acne scars.

I think it’s really helpful for people to know what people are doing, and also so they know that they don’t really have to settle for a skin texture or a skin circumstance that’s maybe causing frustration.

She was using what I would consider very popular brands at Sephora. From her skincare regimen, I could tell that she was over-exfoliating and she was running into a cycle of over-exfoliating and drying her skin and then over-producing oil, which was then making her breakout more, of course, increased acne scarring. But whatever she was doing was not leaving her skin in a state of feeling smooth.

And balanced.

Or balanced. Yes, the scars bothered her. I did a medical aesthetic treatment that I think is a little on the higher … I feel like it’s one of our stronger treatments, but for the depth of scars she had, it was the way to go.

If your doctor knows what they’re doing, they’ve had experience with your skin tone, it’s better to jump into the more, I would say, aggressive solutions because you’re not really just getting anywhere with lighter things. Sometimes people think that if they do a lighter type of microneedling, if they just do more of it, will they get the same results as just jumping into something a little more aggressive? The answer is no. You really just need to do that right treatment for yourself.

So for her, we decided to do microneedling with radio frequency using a device called Potenza. Potenza is the only microneedling with radio frequency device in the market for skin of color, and I just want to make that really clear because there are a lot of really good microneedling with radio frequency devices and those companies have big marketing budgets, so they’re advertised heavily. But for skin of color, you have to use a microneedling radio frequency device that works in a monopolar mode. And I know that may sound really foreign right now, but if you are considering that you’re talking to your physician about it, please ask him that question because it is a very important question to ask.

And we’ll drop that also in the description, too, what that means.

Yes.

So if you were to just describe that to me, because I literally don’t know what that means.

Yes. So that means that all the heat exchange that’s happening in a microneedling procedure, because of the radio frequency, which we need, has to happen in the dermis, in the deep layer of the skin. And your epidermis, your superficial layer should not be impacted by this heat. It should not receive any heat, and that can only happen in this monopolar mode.

With Sapna, we took her through this series of four microneedling with radio frequency treatments. Now, they’re aggressive, so she was making so much new skin to erase those acne scars, yes, very fast, and she’s young. She was breaking out a little bit in between. So to address that, I had her do a facial every two weeks in our office so that it could just take off all that dead skin that was coming to the surface while she was going through these procedures and made sure that her skincare routine was supported with a good glycolic gel exfoliant from my line, a good cleanser, a calming soothing botanical green tea serum, but not over drying her as well.

So there’s a balance, and that’s why I think that whenever you’re getting a medical aesthetic treatment, please, please, please ask about what skincare should I be using, because if it wasn’t working for you before, it’s definitely not going to help you during your aesthetic treatments also.

So her treatment lasted from start to finish and then maintenance [inaudible 00:05:20]-

Right, right. So let’s say her treatment’s one session every month, four times four months, and then we saw her three months later, she looked beautiful and her skin architecture had just changed. She was not breaking out as much. Her skin was smoother, her hyperpigmentation had cleared, and she felt that she wasn’t always experiencing this cycle of dry skin after washing her face, oily skin two, three hours later and blotting her skin and it was in a balanced state.

Again, Sapna’s in her 20s. Don’t shy to explore medical aesthetic treatments in your 20s if you have acne scarring. That’s probably one of my largest group of patients I work with, and you do great. You don’t have to live with your acne scars into your 40s because you’re worried that you might not get good results because you’re younger. It’s actually the opposite. You have a better ability to remodel your skin when you’re younger.

Because your skin is renewing itself at a faster pace and it normally-

Exactly.

So Sapna is in her 20s, she’s done her radio frequency microneedling, she’s on the acne system, she’s doing facials to kind of naturally help her skin renewal, understand how to renew at a proper rate and exfoliate and so on.

I think we should go into Rajna. Is Raja in her 40s, I believe?

Yeah, so Rajna is in her 40s. She’s South Asian descent and she’s generally had pretty healthy skin all her life, just the usual, a few spots here and there from a little breakout here and there, but she didn’t have any acne scarring, just a few dark spots and those spots got a little more prominent and there were more of them with time. I don’t think she had a lot of fine lines.

And when she came, she just said in her own words, “Hey, I just want to look great for my age. I want my skin to look healthy, smooth.” And I think for women who are of South Asian descent or who have darker skin tones, usually in their 40s, they don’t have a lot of fine lines. They don’t have a lot of laxity, and it’s usually just hyperpigmentation and uneven skin tone that is developed from just sun exposure over time.

So with her, we took something which is a little less aggressive, but great for rejuvenation of skin, PicoSure Laser. PicoSure laser is the safest and I would say the deepest and most effective laser for skin of color. And she is actually on the same skin care routine that I follow, which includes a retinol, it includes a vitamin C. It’s in my signature system, and her skin in a series of four sessions, within just a few sessions got really clear and bright. It had a great texture to it. And again, the skincare was supporting that, but she’s a great example of what does skin of color usually encounter in their 40s and what should they be doing to her anti-aging.

With Rajna, that’s a good example of someone who is … She did what she kind of needed to do to kind of boost her skin renewal and also be on a really, really nice, healthy and easy maintenance everyday program.

Yeah, a makeup-free existence, because she has two young children. She’s the CEO of her company. She doesn’t have time to learn how to put makeup on and put it on, so her thing was, “Hey, I just want to look great with minimal effort,” and she does. She looks elegant, great, and she literally doesn’t have to put effort into it.

Yeah, she’s beautiful. For Rajna, I do want to know what is her maintenance program when it comes to medical aesthetics?

Number one, I can’t harp on skincare more because remember, if you don’t feed your skin renewal cycle with the right ingredients on a daily basis, you are honestly just losing all the progress you’re making with your treatments, right? So you have to do that.

For women in their 40s, women who have a darker skin tone, every six months, come in and get a collagen induction treatment, PicoSure Laser, microneedling, excellent choices for continuing to make your skin behave younger, make new collagen at a rapid rate. Your skincare, your retinol, your vitamin C are supporting that increased collagen building rate, so your skin will just look better and better after the treatments, actually, even better than when you first finished your set of treatments.

For lighter skin tones, same concept, but lighter skin tones are prone to more collagen breakdown, even if they’re using sunblock because their melanin, they just don’t have enough melanin to protect it, so make it a little more frequent. Come in three to four times a year to get a collagen induction treatment. Again, these don’t have downtime, so it’s easy to do. And of course, the same skincare principles, retinol, vitamin C, sunblock.

And when you say younger skin, I hope we can be very clear. It’s not like younger skin is better skin, it’s just that it is renewing-

Younger skin-

We have the technology for your skin and the skincare technology as well to renew your skin so it’s remaining healthier.

Yeah, exactly, exactly. When I refer to making your skin behave younger, I mean making it have all the efficient, rapid processes to correct errors. And errors include damage from environment from the sun, so that’s what I mean by making your skin behave younger. Increased error rate, error reduction rate.

Okay. Ashley is our next case study slash wonderful, beautiful patient of yours. I am very curious about Ashley’s case because Sapna, she’s a South Asian woman, Rajna as well. Ashley is a … She’s mixed race. What was her experience with other either aesthetic doctors or just her approach to her skin tone?

Yeah, so I’m so happy that Ashley was so candid about sharing her journey because she is half Caucasian, half African-American, and she’s someone who knows a lot about skin and skincare. So she had gone to a few physicians and it seemed like they always wanted to treat her skin like they would treat a Caucasian woman’s skin. And she had a lot of post-inflammatory hyperpigmentation from acne, and she was still breaking out on her face, her back and her shoulders.

Oh wow.

And she was very smart about asking, “Well, have you treated my skin tone?” They’re like, “Well, it doesn’t matter. It’s the same thing. It’s a treatment that corrects post-inflammatory hyperpigmentation.” And she was offered some laser treatments that were actually not indicated for her skin tone and would’ve worsened things.

We corrected all of this and she had beautiful results using microneedling with plasma-rich platelets, because that’s an excellent way to correct post-inflammatory hyperpigmentation. And we did this on her face and her back.

What’s the difference between microneedling with PRP versus microneedling with radio frequency?

So microneedling with radio frequency does a better job at deep scar reduction at tightening the skin. Microneedling with PRP does a better job at fine line reduction, maybe fine acne scar reduction, but very nice job on post-inflammatory hyperpigmentation. So I tend to reserve that for that, and it does really well.

And in Ashley’s case, she also was supporting all these treatments with the proper skincare. And what was surprising to her was that even though she was going through all this collagen induction, making a lot of new skin very rapidly because of the microneedling, she was not breaking out because now she was actually … She’s in her 30s, so she’s not going to break out as much as Sapna in her 20s would. So for her, she actually had a really nice balanced skincare regimen, was not breaking out and experiencing all the benefits of that hyperpigmentation reduction.

You put her on the acne system for post-inflammatory hyperpigmentation for the brightening and balancing?

For brightening, and she was a little bit more of an oil producer. And also, our acne system has some really nice hyperpigmentation correction with balanced botanicals in it, so that’s why.

If we’re using the Fitzpatrick scale, were they’re treating her skin tone as like a skin type three?

Yeah, so she’s half African-American, so she was getting treated like a skin type two and three. Whenever we’re looking at how to treat someone with a mixed ethnic background, what kind of skin tone pathway we need to take, you should look at the darker skin tone parent’s heritage. So we need to treat her like a skin type four and five.

I see.

And that’s what we did.

What’s her maintenance program now after her treatments?

So again, she’s in her 30s. Her skin’s in great condition now. She doesn’t really have any fine lines. So for her, she just likes collagen induction once every six months with microneedling or PicoSure laser. I mean, you can really pick either one because her skin’s in great shape now, and of course, skincare.

For somebody who has issues from acne, post-inflammatory hyperpigmentation … I know you can’t promise a timeline of results … How long does it usually take for them to really start seeing new skin renewal?

I would say a good two months. I think the first thing you start experiencing is that your skin should feel smoother. And I think that after two months it really does look clearer and your friends are starting to notice. So yeah, two months is not a long time because you probably spent years experimenting and it took years forming these issues in your skin, so I would say start seeing results in about two months and final, final results in six months.

That’s a really good point. It takes so much longer to have developed, especially if you have darker skin, to really see the full impact of it being on the surface now, so it’ll take a bit of time. I was like, two months is not that long.

Yeah, no, it’s not.

They’re seeing a full expert.

Yes, that’s right. And like you said, it has to be patient. There’s no instant gratification in skin. You have a skin cycle to work with. There’s no way to change that fact. So yes, two months is relatively not a long time, and people feel that their skin is different.

So moving on, I don’t mean to make this all about me, but I am happy to be a case study, and thankfully, I didn’t have acne or issues with that type of skin renewal, probably because I’ve learned a lot from you just watching how you’ve treated your skin. I think simplicity is really important for me.

For me, I had that really, really heavy eczema on my eyes and not just there, I’d have patches around my eyes too, so my lids especially were just very thick. And what I did, and I think a lot of people do treat their eczema or dry skin in interesting ways. They may also over-exfoliate because they think that they’re fluffing off that dry skin. But for me, I really loved the hydration system for me, at least at that point in time. I had just moved to a drier climate. I had a lot of stress from that. And then also, my eyelids were so thick, I could not even keep my eyes … sometimes couldn’t keep them open. And if they were closed, I mean, it was quite painful.

But I wouldn’t say this is a serious issue. I think mine would be more dullness of the skin. So for people who don’t have serious concerns or maybe more advanced concerns, how do you approach that skincare for general dullness, improvement of complexion, especially dryness if they’re prone to sensitive, sensitive skin?

A lot of people of color will say, “Hi, Dr. Sethi, I just want to tell you I have very sensitive skin.” And first I thought that maybe this is just their perception because they think their skin is sensitive, because the data behind the prevalence of eczema in skin of color, it doesn’t suggest that they have more eczema, but the problem is that I think they’ve tried products and experimented so many times that the skin has become more sensitive, so I think that’s what they’re actually saying.

So in your case, yes, eczema is very undertreated in skin of color because it doesn’t look hot and pink like it does in Caucasian skin or lighter skin tones, which is what we see in our medical textbooks, so it’s usually underdiagnosed and undertreated. But again, this concept of building back the skin barrier, which is usually broken in dry skin, will naturally make your skin brighter, clearer, stronger, plumper.

I think you were a good example of not only did it fix my eczema without use of steroids, which is what most people will be on if they had eczema anywhere, but using proper skincare to just rebuild that skin barrier and actually see that evenness in the skin and lack of dullness.

For people who have dry skin overall, as we age, I’ve learned from you as well, is that our skin naturally just because it takes a little longer to renew, it does get dryer, especially in your 40s. But from the medical aesthetic side, what do you recommend for somebody who just wants a boost of hydration from a laser microneedling, dermal filler?

Hydration boosting honestly comes from doing actually good exfoliation, so you can take off all that dry dead skin on your skin so that your product can penetrate, and a product that has lipids in it, not coconut oil, not oils, but lipids that are clinically formulated to penetrate into your skin, not sit on top of your skin, attract all the dirt and debris on it, and then cause you to break out, and I think that’s always a really good start. And I would say that should first happen, and then you can get into medical aesthetic treatments.

This is amazing. Thank you also for just explaining everything so, so in depth. And also, I feel like they’re easy solutions. And even if it’s something that someone’s not ready to do yet, they at least have the kind of viable answers that they’re like, “I will seek this eventually.”

Thank you again for joining us today, and if you want to see the images we discussed in our case studies today, please go to our YouTube channel. And as always, please help us by subscribing, sharing, and liking our episode, and feel free to comment or ask any questions.