General Skincare Guidelines:

Before you begin use of your BuffRx products, it is important that you understand basic skincare. There are many “old wives tales” that have been handed down about skincare that simply aren’t true; so I want to dispel the fiction and help you understand your way to beautiful skin. **Lesson: The stratum corneum (SC) is the dead layer that forms on the top of the skin as skin cells mature and die as they reach the surface of the skin. The stratum corneum acts as a barrier to invaders and environmental insults; but the stratum corneum also helps trap moisture in the skin and prevents moisture loss.

First let’s review a little skin anatomy and physiology lesson. Your skin is very active with many many functions. The base of the epidermis consists of basal cells. These cells are the primordial cells that continually produce the epidermis by replicating and creating new keratinocytes that form the living epidermis. These keratinocytes are 10-18 layers in cell thickness and from formation until they die, move like a conveyor belt up through the epidermis. As the keratinocytes move up through the epidermis as new keratinocytes are formed from the basal layer, they eventually die and become the stratum corneum. The stratum corneum protects us from the environment and helps retain moisture within the epidermis. This layer is commonly removed by microdermabrasion, superficial peels, mechanical exfoliation (i.e. the clarisonic), etc. in order to make the skin more luminous and soft. But, there are trade-offs. We will talk about this later on.

Skincare Pearls:

Protect, Protect, Protect

Everyday. Even if it is cloudy wear a moisturizer with SPF 15-30. Titanium or Zinc should be in the sunscreen you use. You should reapply sunscreen every 2 hours when you are at the beach or in intense sun for longer than 2 hours. Remember that 80% of sun damage occurs during daily activity (driving to work, going to the mailbox, etc. and not when you think you are in the sun i.e. beach, golfing, etc.)

Hydrate your skin before product application.

This is the Golden Rule of skincare!!!!!! All of your skincare products, BuffRx or otherwise, should be applied to damp skin. This is because moisturizers do not add moisture to your skin, they “lock it in” or trap moisture in your skin. There are several classes of ingredients used in moisturizers to do this i.e. humectants and emollients. Humectants actually attract water to their structure and absorb water from the environment. Emollients trap the water beneath them, not allowing the water to escape from the skin. Common humectants are glycolic acid, malic and salicylic acid, lactic acid, glycerin, panthenol, propylene glycol and many others. As you may have noticed, many humectants mentioned are acids. You probably think of acids in terms of peeling your skin, and they do. But, at low concentrations, these acids function as humectants and are very mild exfoliators. As you increase the strength of acids, they have more of a mechanical “peeling/exfoliating effect. This leads to a reduction and/or removal of the stratum corneum. Therefore, it is very important to apply these products to damp skin, especially as the concentration of the acid increases. Otherwise, you are removing the SC, exposing the epidermis to the environment, leading to unwanted dryness and irritation. You cannot get very far in a rejuvenating skincare regimen if you do not keep your skin hydrated by applying your products to damp skin!! You will continue to have dehydrated, parched skin that stings and burns. Applying products to damp skin immediately after cleanser on warm skin allows better product penetration of your products and creates that much needed moisture. Then top it off with a moisturizer to trap the moisture. Now you have that dewy look you have always wanted. And you haven’t even started your rejuvenating products yet!! This small step in skincare can take you from irritating, flaky skin to glowing, dewy skin within 24-48 hours. As far as moisturizers go, your skincare provider will give you a list of over the counter moisturizers that you can use, or she will talk with you about her 2 BuffRx moisturizers available.

Use Retinoic Acid

People tend to either love or hate Retinoic Acid. Usually in 95% of the cases, I find that the patient has been misinformed about Retinoic Acid and its use. It is actually a very rare occurrence to find someone who can’t tolerate Retinoic Acid. First let us talk about Retinoic Acid and how Retinoic Acid works. Retinoic acid is derived from Vitamin A, a fat soluble vitamin. It is an acid but not a mechanical acid that peels off the top layer of skin like the humectants we just talked about. Retinoic Acid is actually a hormone that binds to receptors on your skin cells (keratinocytes and basal cells) and tells them to speed up cell turnover, but at the same time, prevents cells from making genetic mistakes with replication. So instead of a lawn mower which peels off the top layer of grass, Retinoic Acid is more like a fertilizer that makes your lawn look healthy and green. But, you need both the lawn mower and the fertilizer to have a great looking lawn, right? Studies have shown that combined use of glycolic acid in the mornings and Retinoic Acid at night leads to a better looking skin than what occurs with Retinoic Acid alone.Retinoic Acid also thickens your epidermis by increasing the number of layers of keratinocytes you have within the epidermis. It is a common false belief by patients that Retinoic Acid “thins” your skin. Actually, the opposite is true. This “old wives tale” is commonly spread by skincare providers who don’t understand the physiology of Retinoic Acid or skin. Because patients lose the dead layer of skin (the stratum corneum) with use of Retinoic Acid, it makes their skin more sensitive and vulnerable to the environment. The untrained person assumes that sensitivity occurs because your skin is thinner! This is not true. But, because the SC is diminished, it is imperative to wear sunscreen and moisturize the skin when using Retinoic Acid. So, yes, there are tradeoffs with Retinoic Acid use, just as there are tradeoffs with everything in life. Retinoic Acid will improve wrinkles, texture, color, and pore size in skin, but it will make your skin more sensitive. So, apply to damp skin, moisturize, and always wear sunscreen. The tradeoff to not using Retinoic Acid (trechinoin) is that your skin will never reach its full potential. Retinoic Acid is the only ingredient chemically proven to change the structure of your skin by increasing collagen and thickening your epidermal layer. No other chemical has been proven to do this!

Know the difference between dryness and irritation

Many patients come to my office and say that they can’t tolerate Retin A or glycolic acid and/or other acids. They go on to say that they always peel when they use the product and/or it irritates their skin. They had never been told that your skin is going to peel and the peeling is normal. Or, they had never been instructed on Rule #1 and #2 above. And, after instituting Rule #1-4, 95% of these patients use Retinoic Acid with no problems.


If you have virgin skin that has never been exfoliated, you have a thick stratum corneum. So, when you begin use of your products, the skin will begin to peel as you exfoliate away the stratum corneum. This is normal and is expected to happen. This is not dryness, irritation or sensitivity when this happens. You can use exfoliating scrubs, exfoliating gloves, or exfoliating devices to help shed the peeling skin away. But, do not stop your products! If you stop your products, the stratum corneum will build up again, and when you try to use the product in 3-4 days, you will peel again!! This cycle will never END!! Let the process take place. This peeling is needed to get that polished look that you want. The peeling process is almost unavoidable when you begin a skincare routine that will produce dramatic results. It is possible to use very weak mechanical acids or very low strength Retinoic Acid or its derivative (retinoldehyde and retrivol) without producing visible peeling, but the improvement in your skin will be less dramatic as well. Normally the peeling process will end after 7-10 days of daily use and will not occur again unless you discontinue use of Retinoic Acid for extended periods of time (5-7 days) or your skin becomes dehydrated from change in climates or moisturizing incorrectly.

There are ways to speed up the 7-10 day peeling process:

MEASURES TO SPEED UP THE HEALING PROCESS

  1. Make sure you are adding products to damp skin
  2. Make sure you are moisturizing
  3. Exfoliate with a mechanical scrub device or have microdermabrasion administered
  4. Do an Elmer’s Glue peel on your face to peel off the dead skin. Apply a thin coat, let dry for 15 minutes, and then peel off quickly.
  5. Dermaplane, i.e. shave your face. (You won’t grow a beard!!)

True sensitivity to Retinoic Acid or other mechanical acids (i.e. glycolic) occur when not only are you peeling, but your skin burns, itches, feels hot, and sometimes turns very pink or red. It is normal for skincare to sting for 4-5 seconds upon application, but continued burning, itchy, and/or redness means you may be sensitive or allergic to the product; but, it may also mean that you are not applying your products to damp skin and moisturizing, leading to very dehydrated skin; or it simply may mean you started too many rejuvenating products at once, leading to severe skin dehydration.

SIGNS OF DEHYDRATED SKIN

  • Burning
  • Stinging
  • Redness
  • Tightness
  • **Acne (If your skin is too dry, your body will sense this and produce a lot more testosterone to lubricate the skin. This action leads to a buildup of oil in your pores and ultimately acne.)

If you experience irritation as described above, there are many steps you can take to correct it without even calling your doctor or skincare provider.

STEPS TO TAKE IF YOUR SKIN IS IRRITATED

  1. Discontinue everything and use moisturizers only on damp skin for 5 days.
  2. Resume the retinoic acid product every other night for 5 days, then move up to every night. (As always, hydrate and moisturize)
  3. If all is well, begin your morning rejuvenating product.

Now the problem with most women after they stabilize on their products, and their skin is looking tons better, is they want MORE improvement!

Sometimes this can be done by increasing the strength of their existing products; by adding a home peel sporadically to the routine, by dermaplaning or by seeing the aesthetician for regular facials with microdermabrasion and peels in the office. Others may have to jump to getting a medical peel by the doctor or a deeper laser treatment to see more improvement. There are a host of peels and laser treatments available to achieve more improvement. We will not discuss these treatments here.

So, in a nutshell, to rejuvenate your skin with skincare products, you need to learn to hydrate, moisturize, and protect your skin with sunscreen! If you do not hydrate and moisturize effectively, you will irritate your skin and not be able to advance in your skincare routine. Knowing what irritation is and how to correct it, saves you so much time and frustration and allows you to efficiently move up to more aggressive skincare and produce better results.

Beginning BuffRx

Now we are going to start you on BuffRx Skincare. This is a combined prescription/herbal skincare line developed to effect radical change in your skin. Please abide by the general skincare guidelines when embarking on BuffRx use. Remember, you will probably flake and peel the first 7-10 days you are on this product line. This is normal. If you don’t peel, this is okay too. You either have been using exfoliating products already and your stratum corneum is gone already, or the products aren’t strong enough, or rarely some people just have very slowly responsive skin that turns over so slowly that the peeling isn’t visibly noticeable. Good luck with your routine below:

Commonly Asked Questions:

  • Do I need an expensive moisturizer? No. There are many great moisturizers at Walgreens. With most expensive moisturizers at the cosmetic counter, you are paying for the packaging and heavy marketing they use to get you there to buy the product.
  • I sometimes breakout when I use Retin A or glycolic acids. Is this common? Yes, normally you are not hydrating properly but sometimes the products are too strong.
  • If I didn’t peel, will I still get results? Normally, yes. Sometimes you need to be on a stronger product. Use for 6 weeks and see what happens.
  • Can I use bleach (hydroquinone) all the time or is it dangerous? Hydroquinone has never been shown to be harmful to humans. Studies on mice that are fed hydroquinone orally with massive dosages develop tumors. Humans only use hydroquinone topically at very low strengths, and doses are miniscule compared to the mega doses used for the studies on mice. (Hydroquinone is organic, for your information.) But just because something is organic doesn’t make it safe! Arsenic and cyanide are both organic too! Some people say that if you use hydroquinone all the time, it loses its effectiveness. This hasn’t been proven. What I think happens, and this is only “MY’ opinion, is that when your use hydroquinone regularly, you reach a plateau where no more pigment is going to be removed. Obviously this happens since I haven’t seen anyone turn into an albino with chronic use of HQ! But, when people discontinue HQ for a period of time, the pigment starts to reoccur. Then, when you resume you HQ, you notice a quick improvement in your skin as the hydroquinone begins to work on the accumulated pigment. So it would appear to the untrained eye, that using HQ regularly leads to tolerance to hydroquinone. Regardless, your do not have to use hydroquinone, but there are no other products that remove pigment anywhere near as effectively as hydroquinone.
  • Are over the counter retinoic acid products as good as prescription ones? No. They are very weak compared to prescription Retinoic Acid. You may notice some improvement if you have virgin skin. But if your skin has been prescription strength products you will notice nothing with these products.
  • How does Retinoic Acid improve pigment compared to hydroquinone? Melanin is produced in the epidermis and is retained in the stratum corneum as the epidermal cell (keratinocyte) dies and becomes part of the stratum corneum. Retinoic Acid stimulates removal of the stratum corneum therefore, reducing pigmentation. Hydroquinone inhibits melanin formation within the keratinocyte. When used in combination, Retinoic Acid and hydroquinone have a powerful effect on pigment reduction.
  • I use hydroquinone and Retinoic Acid and still have melasma. Melasma is a condition normally created from excessive estrogen but any hormonal imbalance can cause melasma. Your hormones should be evaluated, if you develop melasma and it didn’t occur secondary to pregnancy or birth control pills. Other common causes of melasma include:
    • Progesterone deficiency or excess
    • Hypo or Hyperthyroidism
    • Insulin Resistance i.e. diabetes or Polycystic Ovarian Disease and others
    • Testosterone excess or deficiency
  • Hormones are all about ratios. So although your hormones may be within normal limits on a blood test, their relative values to each other may be excessive or deficient. You should see a hormone specialist, preferably an OB-GYN or endocrinologist with special training and use of bioidentical hormones. Is estriol safe? Estriol is the safe estrogen used in Europe to protect a female after breast cancer. It may also inhibit/reduce melasma. Do not take estriol in the U.S. if you have a history of breast cancer, unless you speak to your doctor first.
  • I have sensitive skin, so which BuffRx rejuvenating products are exfoliating and potentially cause dryness? All of the BuffRx rejuvenating products can cause dryness, as all have some exfoliating effect. The key is to hydrate and moisturize as described above. Depending on the other skin findings, which BuffRx product is right for you will be determined by your BuffRx Skincare provider.

Your Personal Routine:

With your personal routine, please keep in mind that your customized routine is a guideline and/or a final goal, possibly. You may find it too mild or too harsh and have to intensify or build up to it, depending on how you react. If your routine feels as though it isn’t strong enough because you aren’t peeling, then you are okay. Wait until your next appointment and your regimen can be intensified. If you are impatient, call and speak to our aestheticians and they can direct you. For example, they may ask you to add an in-home peel weekly. If your skin feels too dry or irritated, make all the changes discussed in the general skincare section. Good luck!

You will be placed on a regimen that consists of a morning and evening routine. The am routine will normally include a rejuvenating product and a moisturizer with sunscreen. The evening routine will contain one rejuvenating product and a moisturizer. That will be your basic routine. Eye moisturizers and peels are optional products which may be added to your regimen. Depending on your skin type and skin issues, your routine will normally produce peeling for the first 5-10 days. Maintaining moisture in your skin is very important during this time. If you have sensitive skin, you should start your am routine only 1-2 weeks before you add your pm routine.

BuffRx Peels:

There are 2 BuffRx “at home” peels. Both peels are prescription products and should only be used under the direction of your dermatologist’s office.

  1. TCA Shine (10-127): These peels are designed to calm the skin and dry up oily acne prone skin. At the same time, the skin will glow with a slightly pink undertone after application. Normally you peel for 1-2 days very lightly, starting about 2 days after your peel. This product is great for acne and Rosacea patients and is used approximately every 7-10 days. Men also love this product as a “stand alone”, using once a week to keep their skin looking fresh and minimizing their pores.
  2. Skin Rehab: This peel is designed to eradicate pigment and to retexturize the skin rapidly. When applying it to the entire face, it should only be used every 2 weeks for no more than 3 days unless directed by your dermatologist. For spot treatment, it can be used on a spot until irritation occurs (usually 5-6 days). If you are on a BuffRx regimen, you will peel for 1-2 days starting day 2-4, and it will be a very fine peel. If you don’t use rejuvenating products, you will peel for more days and more extensively. Note that this product must be refrigerated. It has a gritty texture because of the concentrated ingredients.Please keep in mind that all BuffRx products are made fresh in the lab weekly. Because the actives are fresh, with higher concentration of actives normally found in other prescription products, they produce results very quickly. The trade-off is occasional irritation when starting the products.
  3. HydroGlo: Because Hydro contains vitamin C which is added minutes before it is purchased, you should use this product 2 X week the first 2 weeks, and then increase as tolerated. These products are very customized to treat multiple skin types and skin conditions. Your skincare provider will help you choose a routine that best fits your skin type.

Product Descriptions:

HydroGlo Pads is a novel hydrating serum to use under your moisturizer to maximize your glow and deliver high levels of vitamin C and other calming agents to the skin. Rosehip oil can be added for extra moisture. Apply HydroGlo moisturizer/sunscreen in am/pm.

Calming Pads These treatment pads are packed with ingredients to control acne, rosacea, and minimizing your pores. These pads are our biggest seller and we keep finding things they can treat. Apply calming pad moisturizer/ sunscreen in am/pm.

Calming Wash is an acne fighting yet calming wash. This product contains sulfate. Wash face and leave on 1-2 minutes before rinsing. This product will dry up acne and take the redness away without drying out your skin.

Lemon Cleanser was developed for dry skin as well as patients with rosacea who have extremely sensitive and dry skin. Wash with this product once or twice daily.

Polishing I/II This exfoliating product will exfoliate gently, wick away excess oil, lighten pigmentation, yet retain moisture when applied to damp skin.

Renewal Cream/Renewal Cream Plus is designed with the most potent concentration of tretinoin to effect radical change in the skin. Within 2-3 weeks your skin will be smoother and more even-toned. Combined with botanicals to calm the irritating effect of tretinoin, but also work synergistically to stimulate collagen and reduce pigmentation.

Gentle Renewal Cream is for those with sensitive skin, “retinoid” intolerant skin. Packed with anti-inflammatory and soothing ingredients with a concentrated retinoid formulation to exfoliate, rejuvenate and help acne or rosacea prone skin.

Gentle Renewal Plus for those with sensitive yet oily skin, i.e. Rosacea patients with oily skin. This product has the highest concentration of tretinoin (0-3%) for its exfoliating properties to reduce oiliness combined with botanicals and other anti-inflammatory agents to calm the skin to increase retinoid tolerability.

Skin Rehab The most powerful anti-aging pigment reducing peel known. The ingredients are so concentrated that it must be kept in the refrigerator to maintain stability. This product produces radical changes in pigmentation and texture within 2-3 days, and contains high concentration of HQ and tretinoin. It can be used as a peel every 2 weeks, as well as a spot treatment.

TCA Shine 10/12% The TCA peels are designed to reduce pore size, oiliness, and calm inflammation and dry up acne. It also gives the skin an amazing glow due to its special hydrating ingredients. Use this peel the night of a big event to showcase your beautiful skin, or use as an acne fighting peel. This peel can also even out pigmentation over time with weekly use.

Other Active Ingredients: All of the above products can be customized even further by our active ingredients that can be added to individual products. We won’t sell you a lot of products; we will supplement the ones you have. This increases compliance of the patient and reduces the price of the overall program. Get it right the first time!!

BrianBuffRx Guidelines