Peels To The People: Skin Decisions

The People's Skincare Newsletter, Vol. 13, No. 1 April 2020

Inside this issue:

Greetings Friends! It’s been many months since my last newsletter and I’m afraid procrastination got the best of me. Skincare seemed like the least of our worries. No excuses in these times of stress and disruption but there have certainly been difficulties for all of us. I did eventually realize that taking care of our skin is something that we can control so let’s focus on that, shall we?!

Epionce Holiday Sale

I have to say that Epionce has really been on target this challenging year, considering that many of their customers have lost their jobs and/or aren’t visiting their dermatologists, spas or estheticians to have treatments or buy products. So they’ve had an e-commerce focus which is convenient and time-saving. I know many of you have ordered products directly from and I’m delighted that you’re still sticking with this wonderful product line.

Now you have an opportunity to save 20% off select Renewal products between November 2 and December 31. Here are some of your favorites and their sale prices:

  • Intense Defense Serum: $115.00 (normally $144)
  • Renewal Facial Cream : $78.00 (normally $98)
  • Renewal Facial Lotion: $78.00 (normally $98)
  • Renewal Eye Cream: $59.00 (normally $74)
  • Intensive Nourishing Cream: $91.00 (normally $114)

Here’s the thing: I will be in Kentucky from November 10-November 21 so am unable to handle products during that time. You can order directly from and I’d appreciate if you used my code #20090528. If you order between Nov. 2-8 or after Nov. 22-December 31, I’ll be in St. George and am happy to attend to your requests, be it by mail, delivery or pick-up.

I want to focus on one of the most popular Renewal products, Intense Defense Serum, and now is a great time to stock up on it. If you have not tried IDS, now is the time!

Epionce Intense Defense Serum: A Complete Multivitamin for the Skin

"Intense Defense Serum is a highly advanced, clinically proven anti-aging serum formulated with therapeutic concentrations of essential vitamins that the skin cells can properly use. Combined with the proprietary Epionce delivery technology, IDS provides the correct amount of cell nutrition to targeted skin cells, reducing fine lines, wrinkles, rough skin texture and uneven skin tone—all without creating inflammation and barrier damage typically associated with high concentrations of select vitamins”.

"Many companies generalize what vitamins they contain—A+B+C+D+E. However there are various forms of each of these vitamins and the skin cell receptors accept and use those forms in different ways. For example, for vitamin C to work optimally in the skin, both forms of vitamin C (L-ascorbic and dehydroascorbic) are needed by the skin along with iron. Dehydroascorbic is challenging to formulate so companies started using only L-ascorbic while claiming the benefits of "vitamin C”. While L-ascorbic does provide some benefit, it doesn't provide the complete benefit the cells need. Unfortunately too much of a singular vitamin will create an inflammatory response as the cells try to get rid of the excess they can’t absorb.”

IDS is different because it uses botanical sources that provide all vitamins in their various forms such as L-ascorbic and dehydroascorbic acids along with iron so the skin cells receive optimal benefit. Furthermore the formula is stable and cosmetically elegant. Key ingredients include Niacinamide (vitamin B3), Achiote (vitamins A and E), Shiitake Mushroom extract (vitamins A, B, C and D), Melon Fruit extract (vitamins A, B and C synthesis), Raspberry Seed Oil (vitamin E), plus Hyaluronic Acid and many other botanical ingredients.

When and how to use IDS: After washing your face and neck apply a pump or two of IDS, then apply a Renewal moisturizer and sunscreen. If using IDS at night, follow the same routine without sunscreen.

According to independent clinical studies, Intense Defense Serum provided a 50% improvement in fine wrinkles at week 1, showed a 39.3% improvement in tactile roughness at week 4, and improved pore size by 25% by week 8. Do you have anything to lose?!

Skin Decision: Before & After

This is the name of a reality TV program on Netflix that I recommend if you have time to watch television. Normally (but this being non-normal times), I distain reality plastic surgery programs but this one really resonated with me. At first I thought the surgeon, Dr. Nazarian and her co-presenter Nurse Jamie, were about as superficial as this TV genre produces but after a couple of episodes I believe in their authenticity, skill-set and empathy with patients. Plus their results were excellent and met patient expectations.

Each episode presents the practitioners with two cases, each one involving a decision whether to approach the patient’s issues surgically or non-surgically or possibly both. The patients range from victims of trauma (domestic violence, bicycle accident for example) to aging (sun damage, alcoholism, smoking, chronic depression)… many of us can relate to whether in actuality or in familial situations.

The approach of Dr. N. and Nurse J. are not only practical but interactive; they do interview their patients thoroughly and discuss outcomes that are acceptable and anticipated. As usual, patients have their consultations but don’t fully realize the consequences of their procedures, healing times and so forth. You are altering your body after all but it sounds so seamless in a consultation. I applaud Dr. N. and Nurse J. for their honesty and patient support. Sometimes patients are non-compliant regarding post-op instructions so you sense the frustration of the practitioners. Naturally, this being reality plastic surgery TV, everyone is presented in the best possible light but in actuality the patient results seem very satisfactory, if not astounding. The focus of the practitioners is what will make the patient satisfied, physically and emotionally. I also enjoy the camaraderie and humor that Dr. N. and Nurse J. have for each other. They are working mothers juggling many children, parents, their own career ambitions and lifestyles (it’s Beverly Hills after all!).

If you watch this show, please let me know your reaction and thoughts! I love your feedback.

Childhood Trauma & Reconstructive Surgery

This article is a deeper dive into reconstructive surgery and who is/isn’t a surgical candidate. It was published in the periodical MedEsthetics and the author is Inga Hansen. There’s an underlying sadness to it due to child abuse but the doctor who wrote the book Child Abuse, Body Shame and Addictive Plastic Surgery knows his topic well and is in the position to help other surgeons understand the red flags associated with certain patients.

"In the early 1990s, I saw three rhinoplasty ("nose job”) patients within a few months who had exemplary results and they were all distraught afterwards, says plastic surgeon Mark B. Constantian, MD. One man tried to cut his nose off with a razor and ended up in the ER. One woman became a recluse in her home. Another woman gave up her job as a university professor. After surgery they either hated themselves or me, yet they were all positive that if I would only operate again, they would be OK.

These stories are sadly familiar to many cosmetic surgeons. For Dr. Constantian, this was the beginning of a quest to understand the roots—and how to identify—mental health concerns such as body dysmorphic disorder. Earlier this year he published Child Abuse, Body Shame and Addictive Plastic Surgery, a book based on years of postoperative interviews and analysis of his own revision rhinoplasty patients.

"I always have patients bring in photographs of what they looked like before they had the first operation, he says. A lot of these people had completely normal noses—straight, no bumps, no crookedness, no nothing. I would say to them, what were you trying to accomplish with your first operation? And the response would be, "My mother said I was the ugliest baby she’d ever seen’ or "I had surgery so people would love me’. These aren’t surgical indications".

Dr. Constantian had an "a-ha” moment in 1998 when he read a study from Kaiser Parmanente on adverse childhood events (ACE). The study of 17,000 patients found that two-thirds had experienced at least one ACE. They were asked about emotional abuse, emotional neglect, physical abuse, physical neglect, sexual abuse, divorce, alcoholism or drug abuse in the family, violence against the mother, imprisonment and suicide. When he put the same questions to his patients, he found that about two-thirds of his reconstructive patients had at least one ACE. The revision rhinoplasty patients reported the highest number of ACEs; in this group 85% had experienced at least one ACE.

Dr. Constantian then surveyed those same patients for shame via the Experience of Shame Scale. "Children reframe their world because they have to make sense of what’s going on and often end up blaming themselves: "My parents got divorced and it was my fault. As they grow up, they continue to feel they’re not as good as other people. That they are defective somehow and they carry that shame”. He found that patients with high shame scores had higher trauma scores, much more difficult personalities and were twice as likely to be unhappy following surgery than those with low scores.

The good news is many people overcome difficult childhoods. The key for cosmetic surgeons is recognizing those who are seeking surgery to correct internal shame which will lead to unhappy outcomes no matter the result. "I have been almost uniformly unsuccessful in getting patients to therapy after surgery. The only leverage you have is preoperatively and you have to do that through personal contact”. Dr. Constantian notes that ACE and Shame Scale tests are not screening tools—they were all completed post-treatment by his patients and patients desperate for surgery can see through questions and will not answer honestly.

"I listen to how they describe themselves. Patients who have been through trauma use disaster language: "my nose is hideous’, "when the doctor took off the bandages, I looked like an animal’. These patients often don’t make eye contact. They’re not relaxed. They may interrupt you. That’s all shame. And I tell them, "You’re too angry to have surgery’ or "Your motivation is not medical; it’s tied up with other things in your life and I don’t want to add the stress of surgery to what you are experiencing’.

This is how the article ended. It’s certainly not a happy ending for those patients whose doctors reject them for their shame traits but possibly and hopefully, those people will seek help with therapy or self-help groups. On a personal note, I have encountered a number of people who would fall into Dr. Constantian’s group of the perpetually unhappy. Some of them preferred to stay in their victim mentality for whatever reason. Others sought help and thrived. And as the article notes, many people overcome difficult childhoods.

Odds and Ends

Didn’t mean to get so heavy on you but I thought the contrast between the upbeat program Skin Decisions and the sad reality of Dr. Constantian’s patients with mental issues was quite interesting. Is it just me or doesn’t it come down to personal choice as to how you want to live your life?

Speaking of living your life, I mentioned that I’ll be in Kentucky next month to take two more classes at Moonshine University in Louisville as part of my bourbon education pursuit. This time I’ll be learning about the differences between whiskeys of the world…Japanese, Irish, Scotch, etc. The second course is on oak and the barrel aging of spirits. I’m excited to learn more about these two topics and then share my knowledge with whomever is interested. In July, I became an Executive Bourbon Steward and since then I’ve partnered with the chef at Harmon’s Cooking School in Ivins, Utah. Since the school is closed by covid concerns, she and I have done monthly "lessons” in private homes, socially distancing of course. It’s been a lot of fun and the feedback is wonderful.

I’m hoping that Dr. Thornfeldt of Epionce will provide his advanced education workshops in 2021. They were all cancelled this year. They’re usually held in interesting places and it’s an opportunity to learn more about the science of skincare and to meet estheticians from across the country.

I sincerely hope that you are well and keeping your spirits up. I love hearing from you and what’s going on in your world. As always, your support through the years means so much to me.

Best wishes,