On The Record With ... Dr. Julia Marshall

The search for ways to look younger, longer is a constant battle for many men and women in the U.S.

Dr. Julia Marshall, a cosmetic dermatologist in Lake Forest, has worked in her field for 22 years and has seen the development of anti-aging products and treatments like Botox and liposuction.

In many cases, simpler steps can be taken to improve the look of one’s skin, she said. A simple creme can take years off a face, and staying out of the sun does wonders, she said.

Marshall went on the record with Lake County Journal reporter Stephanie N. Lehman to talk about the best ways to keep skin looking healthy, what products are in, and which products to stay away from.

Lehman: How did you get into dermatology?
Marshall: When I got through medical school, I was looking at various possible specialities to go into,
and at that point in my life, I also had a lot of eczema, a lot of rashes as a kid. I had spent a fair amount of time going to dermatologists for hand eczema, dermatitis and various different things that I had [where] dermatology was involved. So, I looked at that ... because I liked the idea of a speciality that the patient and the doctor would know if you're getting results. So often in medicine, you have to just trust the doctor when he says, "Well, your blood pressure is looking better." Well, I hope it is, but yet you don't know, because you don't feel different necessarily ...
In dermatology, a patient comes in and show you their spots and then you help their spots to get better or their rashes to get better or their hair to grow in more or their acne to get resolved or their wrinkles to soften – everybody knows. And I like that accountability.

Lehman: Do people understand what dermatology is all about?
Marshall: They don't, not initially. It depends how many problems they've had themselves or personal experiences. Actually, dermatology is a specialist in three areas: the hair, the skin and the nails. But people tend to think of them as someone who just takes care of their acne or someone who takes care of their psoriasis. They don't realize that the skin is the largest organ on the body and that it obviously has way more diagnoses on the skin than any other area of medicine because it's such a big organ.

Lehman: How has dermatology progressed in the last 22 years?
Marshall: In '87, I finished my dermatology residency ... Cosmetic dermatology was just starting at that point ... Things like liposuction, where you actually remove fat from under the skin, that was actually developed by dermatologists, not by plastic surgeons, which is sort of a misunderstanding people have. And the whole idea of learning how to use products like Botox, which is a substance that relaxes muscles in the face and works on wrinkles primarily in the upper third of the face, that's something that was just released in 1988, so it's right after I finished my residency training ... so it's been out for a while, but not as long as other treatments for acne, for instance, and other skin conditions that have existed for many years.

So, I’ve seen – in the 22 years I’ve been practicing – a big development of many options and treatments for anti-aging, primarily, I think, to make the skin look better, longer, make people look younger, longer. The only option used to be look old or get a face lift and hope that would buy you some time. Now there are many more intermediate steps that are available and options that one can build upon another, so that you can start out by maybe just going to the doctor and getting some creme. I would recommend Retin-A, that will help to stimulate some collagen, and then they say, Oh, that looks good, maybe I want to try bleaching some of these brown spots, or maybe I want to have a little bit of laser treatment for my brown spots or my wrinkles or my retinols.

As time has unfolded, more modalities have become available and they've become easier. They used to be you'd actually be out for a couple of weeks. Today, many of the procedures I do in my office are truly done within half an hour to an hour in the office and people can go right back to work. So, we've gotten more skilled at making more natural results with less down time and less complications, even in the time I've been doing it. And that's been very fun.

Lehman: What are some of the best ways to keep skin healthy?
Marshall: Probably the No. 1 way to make the skin better is [to remember] the sun is not your friend. I tell people they really need to think in terms of wearing sunscreen on a daily basis and reapplying it every two to three hours when you're outside in the sun. Just by protecting yourself from intense sun, you'll preserve the skin and make the skin look better, longer, because you won't break down as much collagen ... you won't make blood vessels show as much, and that by itself is helpful.

Lehman: What are some common misconceptions people have about skin care?
Marshall: One of the most common misconceptions is that they may have experienced some products in the past and had a bad result and then they pretty much assume they can't use that product. "Oh, that dries me out too much, I could never use it." And it's more they haven't been told how to use it in a way that is consistent with their skin type. I think it's really important ... that somebody look at their skin and say, "You know, I can see you might have had a problem with that in your forehead and your cheeks, but this is how I would tailor my approach to use it so you would be able to tolerate this ..."

Another major misconception is, "Oh, the horse is out of the barn – it's not worth the bother. I think I've wrecked my skin too much, I really can't do much to it." I've never met a person I couldn't improve their skin at some level. They might not get it as good as if they'd never done some things they did before, but I can always make a difference where they're excited and they can see results.

Lehman: What kind of traps do people fall into when they're buying skin care products?
Marshall: A lot of times they think that going to the dermatologist is the last resort. They may have tried so many products from the beauty shop ... they could have saved themselves a lot of aggravation because they're trying so many different types of products and I think if they were kind of directed by a doc or somebody who's very comfortable working with the products – and I certainly recommend over-the-counter products all the time – that they could have avoided a lot of complications they had ... That's really common with acne. People try every kind of topical acne [product] out there when in fact, one prescription could have fixed it.

Lehman: What products right now are really taking off?
Marshall: Some of the anti-oxidant products are really getting popular. Things like the vitamin-C containing topical agents. It's a nice product to use especially for somebody out in the sun, because it helps with the anti-aging ... you get a lot of damage on the skin from free radicals that occur because the sun hits the oxygen in the air, and then that causes damage to the skin, so if you put anti-oxidant on your skin, then you can help prevent some of that damage ...

Another product that is getting huge reviews in my office is that product for making the eyelashes grow  Latisse. That’s really been a fun product. I’ve had patients come into my office who don’t even really wear makeup, and they say to me, "I really want to have this Latisse," and I’ll say, "OK, sure, where did you hear about it?" And they’ll say, "Well, I’ve been putting eyedrops in my husband for his glaucoma, and it’s the same drug" – which is true, because that was originally developed to treat glaucoma –  "and he’s got the longest eyelashes I’ve ever seen – I want the product." And so, I’ll give it to them for that reason, because it really makes the eyelashes grow.

But more importantly, it actually makes the eyebrows grow. And as women age, at least a third to as many as a half of women lose much of their eyebrows as they age, they lose the lateral third of their eyebrow – it's just an age-related phenomenon. And if you look at a lot of older women, then they draw on their eyebrows, and it looks kind of fake. The problem is that the eyebrow is such an important frame to the top half of our face, kind of what the lips are to the lower half of our face. If someone has no eyebrows, they look really weird ... So, the Latisse actually grows eyebrows better than it grows eyelashes. So, it's really exciting ... I would say those are the two biggest products.

Lehman: What about some products that people should stay away from?
Marshall: There are a couple of different companies, they have a benzel peroxide – I love benzel peroxide, it's great for acne – but they have some of these cleansers that have scrubs in them. I don't like all those granule-containing [products], the ones that have all those beads in them. There's actually one ... it's one of the big companies, and it looks like a scrubber in it. The scrubber is attached to the outside of the bottle, and then once you buy it, you add the scrubber to the cleanser, and I've seen several people come in my office where their faces have actually been scrubbed raw. So, I'm really not a fan of over-scrubbing. Probably the thing I like the most for cleaning the skin is a brush called the Clarisonic. That has really been fun and popular, and I only use the most sensitive brush ... It really helps the skin look smooth.

Lehman: Should people change their routines in the summer months?
Marshall: Yeah, they actually should. Usually what I tell people to do in the summer months is – especially for the younger people that have a lot of oil on their skin, but even for people that are middle aged or older – if they've got oiler areas, those areas can usually tolerate more mild toners in the summer time than they can in the winter time. Or, they can actually tolerate cleansing more. Instead of once a day washing with soap, for instance, then I would tell them twice a day in certain areas where they're really oily, like their cheeks, across their forehead and down their nose and chin. So, usually increase cleansing, but not many more than twice a day, because that would be too much.

Marshall lowdown

Who she is: A board certified dermatologist who subspecializes in cosmetic dermatology
Family: Husband, Jerry, four kids and a dog
Favorite cleansing product: Obagi's gentle cleanser line
Favorite dermatology website: www.aad.org
Her practice: Julia M Marshall, MD, 800 N. Westmoreland Road, Suite 100B, in Lake Forest