A Better Way to Brighten

Move over, hydroquinone

Before delving into today’s topic, I’d like to address some feedback on my last post, the goal of which was to acknowledge that the SMAS facelift is currently having a moment, thanks to Kris Jenner and the handiwork of her talented surgeon, Dr. Steven Levine, who made her look years younger. (Allure actually ran a condensed version of my post, giving it even more of a pro-SMAS spin.)

Plastic surgeons have long debated facelift techniques, sparring over which approach—SMAS or deep plane—offers better, safer, longer-lasting results. These doctors tend to have strong preferences and their passion frequently permeates their quotes.

In my last post, I highlighted Dr. Elizabeth Chance’s educational analysis of Jenner’s facelift outcome, because much of what she said directly answered the questions that readers have been asking: What, specifically, did Jenner have done and, more importantly, why do certain techniques deliver different effects? It wasn’t my intent to disparage any procedure or offend any surgeon.

I do believe in transparency around procedures and their potential limitations. I see the six-figure price quotes that plastic surgeons are doling out (to you, dear readers) and I want you to be fully informed of all the risks, drawbacks, and disappointments you could possibly experience before you pay an eye-watering sum for surgery.

Clearly, there are multiple ways to achieve beautiful results in facelifting and, as I’ve said many times, here and elsewhere, no single technique has ever been proven superior. As always, my aim is to deliver balanced, unfiltered commentary.

The SMAS Facelift is Having a Moment

This next piece of news also stems from reader feedback. John E. Kulesza is the founder and chief formulating scientist of Young Pharmaceuticals, a company specializing in private-label and doctor-dispensed skin care. Twenty years ago, his firm invented Arbutase (enzyme activated arbutin), the pigment-inhibiting ingredient in the Coleman Compound, a popular brightening cream from Patrick Coleman, MD, a board-certified dermatologist in Metairie, LA. (Full disclosure: Dr. Coleman’s wife, skin-care consultant Melissa Coleman, a.k.a. @mrs.derm, kindly gifted me a jar.) You can find Arbutase, in varying strengths, in other MD skin-care lines, as well.

Kulesza reached out after reading my posts on topical estrogen (here, here, and here), offering kind words and a bit of education. In the nicest way possible, he suggested that I was using Arbutase inappropriately. As I shared in this post, I’d been trialing the Coleman Compound during Tri-Luma breaks, to help keep my melasma at bay. (Tri-Luma is a prescription-strength blend of 4% hydroquinone, .05% tretinoin, and .01% fluocinolone acetonide, a corticosteroid.)

“I'm not sure [Arbutase] is what you should be using when you take a break from Tri-Luma,” Kulesza wrote. “Arbutase is structurally related to hydroquinone [HQ]. We advise customers to apply the same precautions to Arbutase as they do HQ. Our suggestion is to use a potent retinoid and/or a non-phenolic brightening agent, like kojic acid, for the break period.”

Hydroquinone has long been considered the gold-standard treatment for hyperpigmentation, but it poses a rare risk of ochronosis, a darkening of the skin, when used for long periods of time, especially at high doses. For this reason, physicians recommend cycling on and off of the drug—using it routinely for a few months, then pausing for two to three months—to avoid long-term exposure.

Since Kulesza created Arbutase, I felt compelled to share his concerns—and to correct my erroneous usage advice—but, at the same time, I didn’t want to cause alarm or contradict the guidance that doctors are giving patients who use Arbutase.

Unsure how to proceed, I called Dr. Coleman and board-certified NYC dermatologist Ellen Gendler, MD, who’s also very familiar with Arbutase, to get their thoughts.