Birth control for beauty?

I wish someone had told me about this when I was younger, so I'm going to write about it now in case you're suffering through the same problem I had when I was in my early twenties.

I'd always had mild acne when I was a teenager. Nothing serious, just the usual hormonal stuff, little pimples here and there. It was bad enough to merit a trip to the dermatologist, though, but not enough for a prescription-strength medication. Instead, she gave me a thirty-day supply of topical antibiotic (tetracycline, if I remember correctly) and a recommendation that I use Purpose facial soap as a cleanser and Clear By Design with 2% Benzoyl Peroxide as a treatment. She thought that the harsher Clearasil and Oxy products with their 5-10% solutions would be too harsh.

Sure enough, the treatment plan worked. I would go to bed with a face dotted with the Clear By Design lotion, and the next morning, voila! Pimples be gone! It was a miracle cream, although I didn't appreciate it as much at the time. All I knew was that it kept the zits at bay and left my skin relatively smooth and clear.

For whatever reason, though, my poor skin suddenly went into overdrive not too long before I moved to Japan to teach English when I was 22. Instead of the occasional little pimple, I suddenly had what a doctor later told me was acne vulgaris. Yeah, it's as nasty as it sounds. Big, inflamed acne cysts appeared on my face and would not go away for weeks. Once they did finally disappear, they left behind dark brown spots that would stubbornly stay put for at least 18 months, if not more, before finally disappearing altogether. Of course, they made sure to leave behind a much more lasting legacy: a nice little pockmark. Thanks a lot.

I'm still not sure to this day what caused all of it. The stress of moving to a different country, adapting to a different diet, the different environment and climate? Who knows? Most of my fellow Western teachers suffered through some form of skin problems throughout their tenure in Japan, so likely it was a combination of all three, which probably put our hormones out of whack. Whatever the cause, I was mortified.

To be sure, the problem wasn't as serious as I make it out to be here. I would get only 1-2 at a time, once a month or so, unlike others who suffer from this condition who have a face (and often neck) full of the cysts. Still, it was enough to make me self-conscious and desperate to find a cure. Thankfully, I was well-paid in Japan, so I could afford to try all kinds of treatments. When I visited Singapore, I even contemplated an appointment at their Skin Care Institute, but the brevity of my stay precluded that.

Finally, during my visit home after my first year, I nabbed a prescription for Retin-A. It worked beautifully, and although it left a very slight red flush on my face the first few months, the acne mercifully disappeared.

Of course, a year later, when I prepared to go home permanently, I had a two-month-long backpacking trip throughout Southeast Asia on my itinerary before the final journey back home. That meant lots of potential for incidental sun exposure, even though I'm very vigilant about my SPF. As I had been sufficiently warned by my doctor that Retin-A made my skin very sun-sensitive, I decided to forego it altogether during my trip. Thankfully, my skin cooperated and didn't act up once.

When I finally returned to the US, though, I went on birth control pills almost immediately, and lo and behold, a miracle happened: for the first time in years, my skin cleared up and never, ever gave me trouble again.

Now, I know this may sound like total BS, given all the information we know about acne and its triggers, but up until that point no one had ever pointed out to me that really severe acne could be cause by hormonal imbalances. For whatever reason, my own hormonal levels were sufficiently disturbed to give my skin all that trouble all those years. Once I got on the BCP, I never once had any problems, and my skin looked better than it had ever been.

I wish someone had told me this sooner, as I would have saved myself tons of money and heartache by going on the pill right away. If you're suffering from severe acne, the kind that can potentially disfigure your face with pockmarks and/or hyperpigmentation, you might want to talk to your doctor about this option. It's arguably safer than Accutane, and if you're sexually active (but monogamous), you could pretty much kill two birds with one stone. Plus, BCP also has the virtue of regulating your periods, so if you also suffer from heavy, painful menstrual periods, this could be a beneficial triple whammy.

Bear in mind that BCP has tons of side effects, including increased risk of blood clotting, stroke, hypertension, among a host of other symptoms. I have chronic hypertension, but that has nothing to do with my being on the pill. Rather, my family has a very strong genetic tendency towards the disease, so I'm closely monitored by my doctor and am on both the pill and blood pressure medication. You must talk to your doctor about all the risks involved and whether or not your health profile allows you to be on the pill.

If you do find that you're a great candidate for it, by all means, go for it! It may actually improve your skin, and who doesn't want that? Remember, too, that Ortho-Tricyclen, the contraceptive that's been heavily marketed the last few years as being the pill that also clears up your skin, isn't your only option. Just about any birth control pill -- by virtue of the fact that they regulate your menstrual cycle with hormones -- can perform the same miracles. It's up to you and your doctor to find out which one is right for you. For example, I tried going on Ortho-Tricyclen twice, and both times my skin broke out like crazy. Plus, I actually had my period twice in one month. I ended up going to the same pill I had when I first came back from Japan, another Ortho product called Ortho-Novum. Now I'm on the generic version, which costs $5.00 a month. Way cheaper than Retin-A, and I daresay more effective.

Like I said, it's entirely up to you and your doctor as to whether or not you're a good candidate for birth control pills. You should definitely talk to him/her before making this decision and find out all the pros and cons. If you were already thinking of going on the pill anyway for another reason -- to alleviate the inconvenience and suffering brought on my especially heavy periods, as a contraceptive, etc. -- and are also having to deal with pesky breakouts, then it just might be the answer you've been looking for.



Note: Photo taken by Stacy Lynn Baum and reproduced here under the Creative Commons License.

Obagi Update Part III

So I came back to the United States, went to the Open House at the local medical spa, got tons more information and encouragement from the Obagi rep (Nota Bene: Do not take what a sales representative says about his/her product as gospel. Ever. Do your own research, or proceed at your own peril.)

Anyhoo, so I thought, what the heck, I'll try it. I paid a lot of money for it, might as well check it out. Plus, I had a more stable schedule and could devote the time necessary to do the whole procedure, both A.M. and P.M. Also, my work schedule is limited to 1 day a week, and while my freelancing requires me some out-of-the-house time for interviews, those are fairly minimal, so I could schedule those at more convenient times when my face wasn't so sensitive. Easy peasy, right?

Whatever.

I did the P.M. routine the night after I returned home from the Open House, a Thursday. It took about fifteen minutes to do the whole routine:

• Foaming Gel cleanser for Normal/Oily Skin
• Toner
• 1/2 gm of Clear
• 1/2 gm of Blender mixed with 1/2 gm Age Defying Cream (the .1% Tretinoin)
• Triseryl Eye serum
  

I waited about 5 minutes between the Clear step and the Blender/Tretinoin step. Also, my Belo derm had prescribed 1 gm of Clear and Blender, but I cut it in half not only to save on the product (did I mention that this was super-expensive) but also because the sales rep and the aesthetician at the local medi-spa had suggested to use it sparingly. If this kit is gonna last me 4-6 months (as the sales rep said it should), I'll have to be conservative with dispensing the stuff.

The next morning, I went through the A.M. routine:

• Foaming Gel Cleanser
• 1/2 gm Clear
  
• 1/2 gm Exfoderm
• Triseryl Eye serum
• Healthy Skin Protection SPF 35

Again, I cut the original prescribed "dose" of 1 gram for both the Clear and Exfoderm in half, dispensing only half a gram for each. Also, I was pretty liberal with the sunblock, slathering it on my face. I only got a small tube of it, but sunblock is something you should never ever ever skimp on, especially when your skincare regimen involves products that will increase your skin's sun sensitivity.

I did the treatment through Saturday evening, faithfully following each step and making sure that I had plenty of sunblock each day.

As early as Friday afternoon, I noticed that my skin had become noticeably drier, and the familiar redness had returned. I knew that I was going to be at work on Monday, but I figured I could just apply makeup to cover up the ruddiness if it hadn't dissipated yet. By Saturday, however, the flaking and peeling had increased considerably, and the redness had only intensified. The flaking was concentrated on my chin and around my mouth, but the redness was all over my face.

By Sunday morning, the flaking had migrated to the lower part of my cheeks. In the meantime, I had done more research on the Internet, searching out message boards on skincare and finding posters who shared their own experiences with Obagi. One had written that he (? she?) had experienced severe flaking and drying in cycles -- every six weeks, I think -- the whole time they were on Obagi. Most of the posters had similar experiences to mine -- some not as severe -- but just about everyone said that they had to endure the intense exfoliation for weeks during the initial phase.

I had to make a decision and realized that, no matter what the result, there was no way that I could go through even one more week of what was going on on my face, much less 6-8 (as the brochure said). So on Sunday morning, I stopped cold turkey and started washing my face with Cetaphil cleanser. I followed that up with the Obagi sunblock, really slathering it on like there's no tomorrow. On Sunday evening, I did the same, only skipping the sunblock and letting my skin breathe and recover. I went to bed praying that I would wake up on Monday morning -- the one day I would actually have to be at work -- with my face calmer and the irritation eased.

No such luck. It looked like I was going to have to go to work with my face not just beet-red, but with the entire bottom half of it -- my nose, upper lip, chin, and cheeks up to my cheekbones -- flaking in sheets.

I tried applying makeup, but it only made the flaking more obvious. I realized I would have to go to work with my face in such a state, or call in sick. Since I only go to the office once a week, it seemed a ridiculous move to skip work, so I desperately tried to arrange my short bob so that it would cover as much of my face as I could get away with, and marched off to work.

As it turned out, very few people asked me about my face, but their politeness only increased my self-consciousness. I mean, you know what they're thinking, right? What the hell happened to your face, girl? I was able to get through the day only because I forced myself to rarely look in the mirror. The two times I did, I was horrified by how much worse it had gotten. At one point, I had to peel off a five-inch sheet of flaking skin off my right cheek. Fortunately, my hair had covered it up nicely.

Monday night was more of the same, but at least I was at home. My skin continued to flake and peel, shedding in layers on my clothes, sheets, on my husband's dark scrubs. It was disgusting, to say the least, and I vowed to stay indoors the rest of the week until my skin healed.

It took several days, but it finally calmed down and returned to normal. In the meantime, I had to be extremely careful with sun exposure, making sure that I applied sunblock even though I was indoors (we have a lot of windows). Nearly a week after I stopped using the Obagi products, my skin was finally back to normal.

My theory is that, if I had switched to a lower-dose Tretinoin (i.e., .05% instead of .1%), my skin might have tolerated it better. But the sales rep and aesthetician weren't kidding when they said that I would need to "push through" the initial phase, because the side effects can be dramatic, not to mention traumatic. My skin, however, isn't so bad that it needed such powerful ammunition, and my lifestyle just cannot accommodate such a high-maintenance regimen, particularly given the side effects and their duration.

I'm back to doing my normal wash-moisturize-sunblock routine, although I continue to use Cetaphil and will do so for another week or so, until I can be sure that the inflammation has really died down. Also, I had Dermasweep done yesterday, which I'll write about another time. That requires a mild skincare routine a day or two after treatment as well.

If you do decide that Obagi is for you, my advice is to proceed with caution, and make sure your dermatologist is aware of every medication you're currently on. Ask lots of questions, and make sure you schedule a follow-up a week or two after you begin so that he/she can evaluate its progress on your skin condition. And don't forget to use tons of sunscreen while you're on this regimen. As you can see, it exfoliates your skin like mad, and that means that the very sensitive new skin that's created will be very vulnerable to any sun exposure. Especially if you're a person of color, you're going to want to head off any hyper- or hypopigmentation by being vigilant with the sunblock.

It's a very expensive regimen (about $400 or so for the entire full-sized kit, which supposedly will last 4-6 months). You'll also need to get a Tretinoin prescription (such as Retin-A or Renova), and will likely need to refill your sunblock tube several times. Because of its high price tag, complicated steps and significant side effects, make sure that this is the right regimen for you before you commit to it. The good news is that, according to the aesthetician, Obagi will give you a refund if you decide to return it. But make sure that you confirm that information with your own dermatologist so that you can make a well-informed decision.

I've heard lots of great things about Obagi, and I'm sure that it's helped plenty of people with various skin conditions develop the smooth skin they've always wanted. But it's definitely not for everyone, and if your skin problems are relatively minor, you might want to seek other options before opting for this one. If you think that it could benefit you, however, I highly recommend talking to your doctor at length about it, and then doing your own research. It could save you lots of money and, more importantly, lots of frustration.

Obagi Update Part II

So I went home after I got my Obagi Nu-Derm kit from the Belo dermatologist and was psyched about trying out the whole routine. The only hesitation I had was that, as I was traveling (my mom's house is a three-hour-bus ride-one-hour-ferry-ride-and-two-hour-jeep-ride-over-dirt roads away from Makati, the financial district of Manila where the clinic was located. Also, as her beach house had been having water problems of late and the quality of the water had been questioned, I wasn't that it was the right time to even begin such a complicated system.

Oh what the hell.

So when I finally got to the house that night, I carefully laid out the bottles and tubes on the edges of my mom's wee sink and went to work. First, the cleanser. Then toner. Then acne astringent. Then the Clear. Then the blender mixed with the Age-Defying Cream. Then, the finale: the eye-cream.

The blender/Age-Defying Cream combo was a mess. It took forever to absorb, and I wondered if perhaps I was putting on too much. It left a decidedly white sheen on my face that took me awhile to absorb. The dermatologist had told me that a gram was about a dab from the tip of my pinky finger to the first joint, but it seemed like an awful lot. Also, when I checked the ingredients of the Acne Astringent, I found that the active ingredient is Clindamyacin, a prescription-only antibiotic that can either cause colitis or induce complications in patients already with the disease.

Uhhhhh. I did tell the doctor that I had colitis. It's listed in the form that I filled out when I first came to the clinic, and I mentioned it again when I actually had the consultation. In fact, the doctor even laughed and said that it wouldn't really influence her recommendations for me.

I was super-irritated that the doctor was so irresponsible that she prescribed a medication (and yes, despite the fact that it's a skincare program, this particular product is a medication because of the presence of an prescription-grade antibiotic) with an ingredient known to be contraindicated with a disease I had told her I had. I stopped using the astringent after that first night.

The next morning, I skipped the A.M. routine because I knew that we would be traveling quite a bit around the island. My skin was already sensitive from the evening routine, and I was concerned about the possible sun exposure. Instead, I slapped on a thick layer of the Healthy Skin SPF 35 sunblock and went on my way.

I did the P.M. routine again that night, omitting the astringent. Again, the blender/Age-Defying cream combo was awfully thick and took awhile to absorb.

By the next morning (3rd day), I noticed that my skin had taken a ruddy hue and was partially peeling around my chin. I wasn't too worried, but as the day wore on, my facial skin only got redder, and the peeling had worsened. I decided that, with the traveling and all my outdoor activities, it probably wasn't the best time for me to really do the Obagi program justice. I stopped it altogether after that morning and resolved to restart it once I returned to the U.S.

The redness took only a day or so to fade, while the peeling calmed down after a couple of days. My skin was back to normal within 2 days.

Part III will conclude the Obagi update. I'll tell you more about what happened once I started doing the whole routine (AM and PM) on a regular basis, and more importantly, why I stopped it.

Obagi Update Part I

I started the Obagi Nu-Derm line last Thursday (October 25th) evening, right after coming home from the local medi-spa's Open House. I'd spoken to the Obagi representative there -- tall, blond, leggy...you get the picture -- and was dazzled by her confidence in the product and in its ability to give me the perfect skin I've long desired.

(Yeah, I know, she's the damn salesperson. She's supposed to be confident in the product and in its ability to work miracles. What can I say? I said I was dazzled.)

Anyhoo. So I started using the products as outlined in the instruction sheet provided for me by the dermatologist I consulted with at Belo Medical Clinic in Manila. The kit included:

• 1 full-sized bottle of the Foaming Gel cleanser for Normal/Oily Skin
• 1 full-sized bottle of Toner
• 2 full-sized tubes of Clear, a 4% hydroquinone cream
  
• 1 full-sized tube of Exfoderm for Normal/Dry Skin, an exfoliant
• 1 full-sized tube of Blender, also a hydroquinone cream and intended to be mixed with Tretinoin
• 1 small tube of Healthy Skin Protection SPF 35 sunblock (active ingredients: Titanium Dioxide and Zinc Oxide)
• 1 small tube of Physical UV Block SPF 32 (active ingredient: 18% [!] zinc oxide)
• 1 pot Belo house brand Age Defying Cream with .1% Tretinoin
• 1 small bottle Belo house brand Acne Astringent with the antibiotic Clindamyacin
• 1 glass bottle MD Therapy Triseryl "intensive eye zone serum" (not a Belo brand)

Yes, this was going to be a complicated system.

The routine I was provided was thus:

MORNING
Wash face with gel cleanser
Apply acne astringent with cotton pad
Apply 1 gm (about the size from the tip of your pinky finger to the 1st joint) of Clear, massage into skin
Apply 1 gm of Exforderm, massage into skin
Pat Triseryl gently around eyes
Apply Healthy Skin SPF 35

EVENING
Wash face with gel cleanser
Apply toner with cotton pad
Apply acne astringent with cotton pad
Apply 1 gm of Clear, massage into skin
Apply 1 gm mixed with 1/2 gm (pea-sized) of Age Defying Cream, massage into skin
Pat Triseryl gently around eyes

If you include waiting a minute or two (or more, depending on the product just applied) between each step to let the skin absorb each product, the whole regimen took at least 15 minutes each morning and evening. Believe it or not, I actually didn't mind, as I'm of the belief that if something works for you, it's worth the effort. In addition, I've always been such a beauty junkie that the whole process felt quite, well, European. Very pampering.

Tomorrow I'll post about my first round on the Obagi treatment, in Manila, about 3-4 weeks ago.

Spa Open House

As I mentioned last week, I attended the Open House at the biggest medical spa in town last Thursday night. A bunch of my co-workers had promised to go as well, but as usually happens, only 3 others showed up, including my supervisor, L. who is quite possibly as vain as I am. :-)

Anyhoo, very interesting evening. I expected at the most perhaps fifty attendees, given the conservative, North Face-wearing kind of crowd here in my little town. So imagine my surprise when I turned the corner at exactly 6 pm (when the invitation indicated that the party would begin) and was confronted with at least fifty women already sipping champagne, hovering over the free samples and lined up at the free massage station. By the end of the evening (two hours later), over 200 people had come through the entrance. I even saw quite a few women of color, another surprise considering the very whiteness of this town. The aesthetician had mentioned the day before during my consultation with her that at least 30% of the practice's patients are people of color, but as she's actually a staff member I'm less inclined to believe her and would prefer to see for myself.

Almost two dozen tables offered information on everything from reflexology, aromatherapy, Jane Iredale mineral cosmetics (with free makeover), Fraxel, Obagi, La Roche Posay, Dermasweep, Nia 24, Radiesse, and a host of other dermatological services and products. I spent most of my time at the Obagi and Fraxel tables, grilling the reps about their product, checking out the brochures, and swiping whatever samples I could get away with. I got enough information from the Obagi rep -- a perky, tall, thin blonde who was just nice enough to be not-very-annoying -- to feel comfortable about starting the kit I bought while in the Philippines a few weeks ago.

The Fraxel rep, on the other hand, was a smooth-talking guy in a suit and sporting a Mediterranean-like tan. He was thorough with my questions, but I hated that, in answer to my question about potential risks and/or problems, he sort of screwed up his face and said, "You know, I've never actually heard of any problems with these. You'll have the downtime, but otherwise, these are practically risk-free."

Uh, dude, you haven't been doing your research. Are you telling me that a high-powered laser burning off layers of your skin poses no risks at all? Later that evening, a cursory search through some forums on the Internet unearthed quite a few posters who weren't very happy with the treatment. Some were pleased, while others were adamant that the minimal results they ultimately got weren't worth the downtime and considerable expense. I also found one whose downtime lasted considerably longer than the "5-7 days" that the rep claimed.

Anyway, that pretty much clinched the deal for me. As appealing as the rep and the aesthetician and the brochures all make it sound, the risk-benefit analysis just didn't work out for me. The cost for me -- 4 partial treatments -- would have been about US$1440 (or US$1100 had I been willing to pay in full the night of the Open House), quite a big amount for a freelance writer with some credit card debt left to pay. I decided that a series of microdermabrasion and chemical peels (which I've had done before, in the Philippines, and am comfortable with) would be better for me and my wallet.

But I did enjoy one consolation: I won -- Yes, I won! I, who almost never wins anything! -- a gift bag with full-sized bottles of an Obagi cleanser and day eye gel. Woooooo hoo!!! They gave away quite a few door prizes, but most of the numbers they called belonged to people who had already left. Anyway, I also did a quick makeover at the Jane Iredale table and found what appeared to be the perfect shade of mineral foundation for my skin.

In between the table-hopping I visited the food table and ate more than enough hors d'oeuvres to make a very satisfying dinner. Skipped the wine and champagne, though, as I don't drink and drive. Besides, being surrounded by all these awesome beauty products and high-tech skincare equipment gave me enough of a high!

Erasing Ethnicity

I know I've written before about using a lightening/whitening cream, but I use it primarily to even out skin tone from years of sporadic acne and hyperpigmentation. I happen to really like being Mahogany, hence the name of this blog, despite the insatiable hunger among women in Asia to be super-white.

Please please please, for the love of all women of color, don't succumb to this. Or this. With regard to the latter, I saw an episode of some evening program when I was in Manila whereby this attractive young woman had bought an over-the-counter glutathione product (I think they were pills). The reporter said that it was the "2nd leading brand" in the country for glutathione products, so the woman was confident that they were safe. Not too long after she ingested them, however, her skin -- which had been otherwise been clear and fair, judging from the Before photos the report showed -- began to turn red and develop what looked to be severe acne and/or blisters. Her entire face erupted in these horrible red lesions, and it was obvious that she would never look quite the same way again.

It's just way too risky to be taking anything that's not only unnecessary, but unproven for long-term use. (Yes, I know that the doctor quoted in the above article said that glutathione is "relatively safe" and that "there have been no reports of adverse reactions even with long-term use," however, she then goes on to say that in her own practice, she "personally advises her patients to choose non-invasive options if the same results can be achieved." In addition, she is quoted in a previous paragraph that "not all doctors are convinced of the safety profile of [the intravenous administration of glutathione]," a popular method in Manila for quickly achieving the whitening results patients are looking for.

I would strongly suggest anyone considering the numerous skin lightening options on the market (whether its active ingredient is hydroquinone, glutathione, kojic acid, etc.) to talk to their dermatologist first. Ask about all the risks involved, and if they're not forthcoming about it, find another doctor. As the woman in the report mentioned above found out too late, your skin is just too delicate an organ to mess around with. Not to mention that you could end up making worse what you had originally set out to "fix."

And did I mention that Mahogany is Beautiful?

Revisiting Obagi and laser treatments

Well, maybe I have to rethink this whole Obagi thing after all.

I went to a local medical spa this afternoon and had a nice, long consultation with one of their aestheticians. We went over my skincare concerns (acne, hyperpigmentation, the usual suspects women of color have to deal with), and she strongly recommended the Obagi Nu-Derm line. She said that the Neutrogena Facial Foam Wash I've been using isn't strong enough to address my skin problems. She also said that, from my description of the package I bought at the Belo clinic in Manila (I forgot to bring it with me to my appointment), I should be able to make it last for at least 4 months, if not more.

Big sigh of relief. The last thing I want to do is fork over hundreds of dollars a month on just my skincare program. I mean, I'm awfully vain and am willing to spend good money to achieve healthy skin, but seriously, if I have to decide between my rent and my face, uh, I think even I would prefer to have a strong roof over my head.

Anyway, I'll give the Obagi a try and see how it goes. Also, tomorrow night the medi-spa is going to have an open house at their facility, with wine and hors d'oeuvres and representatives from various laser and cosmetics/cosmeceutical companies such as La Roche-Posay, Obagi and Jane Iredale (a mineral makeup line). A bunch of my friends and I will be attending, and I'll be getting more detailed information about the various treatments the spa offers. Also, they'll be doing drawings and giving away coupons, so I'm holding off on signing up for any treatments until then in case I win something!

I'll post more re: my tentative foray into Obagi later. Also, the aesthetician recommended a laser treatment called ScanLite that uses an IRIDEX laser system, to cut down on hyperpigmentation on my face. In addition, she suggested Fraxel (there it is again!) to target past acne scarring. Treatment costs aren't negligible (i.e., they're freakin' expensive), so I'll have to determine what's best for my skin and my wallet.

But for now, I'll do the due diligence I wrote about yesterday and engage in some heavy research. In the meantime, tomorrow's Open House should be fun -- hey, at least they'll have food and wine!

Belo Medical Clinic visit, Obagi and hydroquinone

I am far from having a flawless face. I've been faithfully applying sunscreen every day of my life since my early 20's, but for various genetic and hormonal reasons, I've had long, painful bouts of acne since that time as well. (And no, the two are not connected.) There was a period of a few years in the late '90s when my face was calm, but it was mostly because of the birth control pill I was taking at the time.

Anyway, I have some minor acne scarring on my face as well as a few small moles called seborrheic keratosis. Depending on the weather and time of day, my face can be oily or combination. Otherwise, my skin texture is fairly good, sometimes even quite smooth.

While I was in the Philippines a few weeks ago, I made an appointment at the Belo Medical Clinic near Makati Medical Center. The clinic has a national reputation, as it treats quite a few celebrities, so I at least knew that I wasn't going to some neighborhood doctor with questionable credentials and experience. It wasn't cheap, but it's much cheaper than what it would cost here: the office visit was about P450, or US$10. Not bad, eh?

I ended up doing a glycolic acid facial and microdermabrasion. The doctor also recommended that I try Fraxel, a type of laser treatment that targets microscopic areas of the skin (hence the term fractional laser, or Fraxel). I was wary at first, as it involved not only a topical anaesthetic to be applied an hour before the actual procedure, but also a sedative that the attendant said might compromise my thinking post-op. Uhm. No.

I ultimately chose to cancel the treatment and get my money back after my husband sent me some research indicating that it's not the magic bullet the dermatologist at the clinic claimed it was. Also, according to the good doc, ideally I should have had 4 separate treatments to remove the scars from my face, but not only did I not have the time (treatments are generally spaced 2 weeks apart, and I had only two weeks total in the country), I also didn't want to spend the money. (Each treatment was going to be about P17,000, or US$350, which is half of what it costs in the U.S. but still pretty spendy.)

I would advise anyone considering Fraxel to engage in due diligence and research the procedure carefully. It's not for everyone, and the risks can be difficult to reverse. It can definitely improve your appearance, but I'm an advocate of always knowing what you're getting into before forking over your hard-earned money.

The facial and microdermabrasion were wunnnnnerful, though. I had two sessions of each, spaced a week apart, and they left my skin positively glowing and clean. Not a blackhead or whitehead in sight. Yes, the facial was painful at times (extractions are never fun, and I had plenty of work for the aesthetician), but so worth the effort. If I lived in Manila I'd probably do it at least once a month. And they weren't that expensive, either: I think the two treatments together were about US$70, with no tip required. (It is a medical clinic, after all.) I was a little apprehensive about the microdermabrasion, as I wasn't sure if it was going to be painful or not, but it really was a bit like a wand with a sponge at the end gliding across my face. I slathered on tons of sunblock after each treatment, as I was heading out into an afternoon sun each time and didn't want my "new" face to start hyperpigmenting. The effects lasted for days, and I loved the feel of my skin. I highly recommend it to anyone looking for a facial deep cleansing.

Lastly, I also bought a way-too-expensive "trial" kit of Obagi skincare products that the doctor suggested I try. I don't even want to say how much it cost, but I don't think it's worth it. The kit had a cleanser, toner, retinol treatment, eye cream, sunscreen, lightening cream, and a few other things I can't remember. Most of it consisted of Obagi products while the rest were Belo brand. I know lots of women swear by the stuff, but I just can't imagine spending hundreds of dollars every month on it, when surely there are equally good products for a fraction of the cost? So I can't really review it here, as I never did give it a good trial. Again, a lot of women love the line, but I would caution anyone who is considering going on the regimen to do so only under the supervision of their dermatologist.

By the way, note that one of the products in the Obagi line has hydroquinone, a well-known skin lightener. For more information on this potent ingredient, here's an article from Brownskin.net, a Web site devoted to skin concerns of women of color, created by Dr. Susan C. Taylor, a Philadelphia-based dermatologist. She also wrote a new book called Brown Skin: Dr. Susan Taylor's Prescription for Flawless Skin, Hair and Nails, which I'll review in the coming weeks.