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A Primer on "Graduating" to the Next Stronger Level
By Peter T. Pacik, M.D., F.A.C.S.

The active ingredient in an exfoliating product is glycolic compound. Some products contain additional ingredients such as Vitamins A, C, and E and these will be discussed in a future e-mail. In an effort to have enhanced exfoliating results, one normally "graduates" to the next higher level. Facial Cleanser I is generally used with Skin Rejuvenation Lotion I in the morning and Facial Cream I in the evening (see our newsletter "Should I Use Facial Cream, Facial Lotion or Skin Rejuvenation Lotion?). This is the most common starting point for someone new to the program, for someone with very sensitive skin, and for someone who has difficulty tolerating stronger products. After 3-4 months (or longer), Level II products can be introduced.

To ease into Level II products, you may try alternating using Level I products in the morning and Level II products in the evening for those using the products twice a day. You may also try alternating every other day or every 2-3 days with Level II products to help condition the skin to the stronger concentration of glycolic compound. Another helpful hint would be to use Level I products in sensitive areas and Level II products in less sensitive areas. Experiment to see what works best for you. The same approach can also be taken when graduating from Level II to Level III products such as the Skin Rejuvenation Lotion III or Facial Cream III. By slowly graduating to the next level, in most cases we can condition our skin to accept the next stronger concentration without undue irritation.

As you "graduate" to the stronger products, you may feel a tingling, stinging sensation and may notice some redness. This is usually temporary and disappears after a few minutes. If you are uncomfortable, you may have to space Level II products further apart or use Level I products for a longer period of time. When we do a resurfacing procedure in the office, the peel, dermabrasion or laser needs to be done with anesthesia because of the discomfort. The light "burn" or tingling that we feel is the product working as an exfoliant and is actually "mild" compared to what we do in the operating room.

Whenever using glycolic compound products for exfoliating the dead cells from your skin, it is very important to remember to use a moisturizer such as the Replenish Hydrating Cream followed by a sunscreen such as Total Daily Protector SPF 15. The Replenish Hydrating Cream is a super hydrating cream ideal for maintaining the natural moisture balance for all skin types. (See our newsletter "Part II Advanced Skin Care -- MD Forte Replenish Hydrating Cream".) The Total Daily Protector SPF 15 containing transparent zinc oxide provides superior protection against UVA/UVB exposure. (Our next e-mail will cover the importance of sunscreen and the role it plays in premature skin aging and prevention of skin damage by the sun's ultraviolet rays.)

For more information, please visit our Web site skincare-md.com and our plastic surgery website plasticsurgerypa.com. All of our previous educational e-mails , as well as The MD Forte 4-Step Daily Regimen, Obagi Nu-Derm System Daily Regimen, and Obagi-C Rx Recommended Daily System Application are found on our website www.skincare-md.com. If you have any additional questions or would like to speak to or would like to speak to Lisa Roberge, our esthetician, please feel free to call us during office hours Monday thru Thursday 9-4, Friday 9-3 EST at 1-877-415-0600 or (603) 669-0290. If there are any topics that you would like covered in these educational e-mails, suggestions or concerns you may have, please let us know. We encourage you to share your experiences both positive and negative with us. Your comments are important to us.

Peter T. Pacik, M.D., FACS
Medical Director

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