Marisa Garshick, MD, FAAD is a board-certified dermatologist MDCS: Medical Dermatology & Cosmetic Surgery in New York city and an assistant clinical professor of dermatology at Cornell – New York Presbyterian Medical Center. She is up to speed on cosmetic procedures while also treating a wide range of medical derm procedures from treatments for acne, eczema, psoriasis, rosacea, to skin cancer and aging skin.
A member of the AAD, Dr. Garshick has numerous publications in scientific journals and book chapters, including a chapter on the treatment of acne, and has presented at national meetings. She specializes in neurotoxins, fillers, chemical peels, and lasers. Dr. Garshick is also involved in teaching the dermatology residents at Cornell, leading discussions reviewing the latest dermatology literature.
BITB talked to Dr. Garshick about her best skincare tools and techniques that she uses to keep her Manhattan patients looking ageless.
What are the most effective tools to turn back the clock and keep skin looking and feeling healthy and glowy?
It’s generally best to begin taking care of your skin before the lines have settled and the sun spots have come. I recommend to avoid waiting until the lines are fully formed to begin thinking about anti-aging and how to improve the appearance of your skin. Doing various treatments over time and the concept of prejuvenation allows us to keep people looking their best, while maintaining a very natural result. Often it is a combination of tools that gives the best results for healthy skin.
Laser resurfacing is a great way to improve skin texture, tone, the appearance of fine lines, wrinkles, brown spots and acne scars and is one of the best tools we have to rejuvenate the skin. Because it creates small micro injuries to the skin, it stimulates collagen. The depth and severity of the treatment can be adjusted based on what we’re targeting, so it’s truly a treatment for people of all ages. We also use microneedling which physically creates the micro wounds in the skin and as those heal, collagen is being developed which helps tighten the skin and improve skin texture and tone. Chemical peels are another way to help brighten the skin, improve scarring and skin tone and stimulate new collagen over time.
Neurotoxins, such as Botox, Dysport or Xeomin, are one of the best treatments we have for minimizing the appearance of expression lines. The best time to start doesn’t necessarily rely on a specific age, but rather when someone first starts to notice the lines at rest, or even before, as the lines at rest are due to how expressive someone is or how strong their muscle appears to be, not just age. Botox helps to relax this movement and by placing a small amount early on, so-called ‘baby botox’ can prevent lines from getting deeper. But don’t worry if you already see your lines – it’s not too late. The beauty of Botox is that the dosing can be customized to keep things individualized and natural, so the amount I recommend relates to how strong the muscle is.
I love fillers to help give back lift to the cheeks and jawline and help fill in areas where we lose volume over time such as the lips, tear troughs (under eye area) or folds that extend from the nose to mouth or the mouth to chin. As we age, our skin starts to sag which relates to a loss of collagen and bone. By helping to recreate the structural support with carefully placed filler injections, we can help to keep your skin feeling its best.
What skincare mistakes do your patients make most often and what advice do you give them?
Overdoing it. This can relate to quantity of products used both actual number of products and amount of individual product applied. People often think since exfoliating leads the skin to feel soft and smooth, it needs to be done every day. This can actually injure the skin barrier and ultimately be worse for the skin. I often recommend exfoliating only a few times per week and to avoid harsh scrubs. Instead try chemical exfoliants like First Aid Beauty Pads, Skinceuticals Glycolic 10 Renee Overnight, or polishing powders like Good Science Beauty. Similarly, particularly when patients are trying to correct something on their skin, they think by using a lot of a specific ingredient, it will go away faster but many skincare products are designed to be used to small amounts to minimize irritation. I often recommend starting out with new products one at a time and building up as tolerated. Find a routine that you’ll stick to, no matter how many steps are involved.
Expensive is not always better. I always encourage my patients to understand that there are places to splurge and places to save. Some of the best gentle cleansers can be found at a drug store including Dove Gentle Body Wash, which maintains moisture without stripping the skin of its natural oils, Cetaphil Wash. Similarly, many good moisturizers containing key ingredients such as ceramides and hyaluronic acid can be found in products like Cerave facial lotion, La Roche Posay Toleriane or Neutrogena Hydroboost gel, respectively. Sunscreen is an area that is very much based on personal preference and since the best sunscreen is the one that you’ll use. Some good options are Elta MD UV Clear, La Roche Posay Anthelios, Revision Intellishade or Avene. For some ingredients, however, sometimes it is worth spending a little more to know you will get the most benefit because it’s a good formulation or appropriate penetration. This is true for antioxidants such as Vitamin C found in Skinceuticals CE Ferulic and Drunk Elephant C-Firma as well as a glutathione and melatonin containing combination found in Good Science Beauty Brightening Cream, which through Good Silicon technology ensures proper delivery of the ingredients to their target.
Forgetting the neck, chest and hands. Many people are so focused on skincare for their face and forget about their hands, chest and neck. I emphasize the importance of applying your daily sunscreen to those areas as well to avoid letting your hands tell your age. In the age of tech neck, it can also be helpful to use neck tightening and firming creams, such as Revision Nectifirm or Good Science Beauty Firming Cream and procedures such as laser resurfacing, Botox or fillers to help improve the appearance.
Taking care of your lips can help keep them looking plump and hydrated. I always recommend Aquaphor or Vaseline. Bonus is using Aquaphor with SPF on the lips as we know the lips are also prone to sun damage over time.
As a dermatologist, what are your favorite desert island beauty products?
Sunscreen! If I only had one product, especially on a desert island, it would most definitely be sunscreen. We know sunscreen is one of the most important things you can do to help prevent signs of aging. Right now I rotate between the Elta MD UV Daily Tinted and the La Roche Posay Anthelios Mineral Tinted – the tinted is great because I don’t worry about applying makeup on top. Skinceuticals CE Ferulic, a tried and true vitamin C antioxidant which helps to prevent UV damage and improves the appearance of brown spots. Good Science Beauty Hydrating Face Cream is packed with hyaluronic acid and marine omega-3 to keep my skin feeling moisturized and healthy. A prescription retinoid such as tretinoin which has been shown in studies to both prevent and treat wrinkles. Dove Gentle Body Wash to keep my skin clean and refreshed, plus Aquaphor for my lips and hands