Professional Micro Needling and Q&A with Dr. Theresa Pacheco

The search is over! I’ve been looking for a doctor I can trust for about a year to help with my pigmentation and get my skin back to where it was just a few years ago. Having a baby made it worse, I swear my skin aged 5 years from the melasma and hormone stuff that go along with pregnancy. Anyway, I’m almost 7 months post-delivery so I figured now is a good time to explore what my options are as far as a safe (I’m still nursing!) treatment to get my skin back on track.

My facialist Tjaden Lotito couldn’t say enough great things about Dr. Theresa Pacheco. She’s an M.D., professor of Dermatology, and researcher on all things related to aging and damaged skin at the University of Colorado Anchutz campus. She knows the skin and non-surgical treatments as well or better than anyone else you’ll find. I liked her right away, she’s down-to-earth and a wealth of knowledge who isn’t there to sell you on anything (they don’t offer packages and I didn’t see any product lines anywhere), just to educate you on what your options are and offer the least invase way to achieve what you’re looking for. If you’re looking for fluff, frills, and a water with cucumber in your glass sort of experience- this isn’t it as you can see by their website, they’re all about the medical side of skin. It’s exactly what I was hoping for.

Dr. Pacheco

Dr. Pacheco

I walked in to see Dr. Pacheco already knowing what I wanted: Fraxel. The ultimate in laser treatments. I’d researched it, I knew all about it, and wouldn’t accept anything else. Fire the thing up and start zapping, I’m ready to go! After a quick look at my skin she said she could do a laser treatment and loves what lasers do for the skin, but I also had other options. One being a combo laser treatment with levulinic acid that would basically give me new skin but has quite a bit of downtime. The other was medical micro needling (aka Derma Rolling!) Now you know I love me some derma rolling and have one at home that I use. The medical treatment isn’t the same as what you do at home though because her instrument has longer needles to create deeper channels in the skin which forces even more repair and better results. Basically, I go in and have a numbing cream put on my skin for about 20 minutes then she rolls the hell out of my skin poking a zillion little holes in it (yes, there is some bleeding) which tells my body to go and make new skin to heal that damage. By the time I leave, my skin will just be a bit red and swollen like a sunburn, and then over the next few weeks and even months I will see an improvement in overall skin quality especially pigment and even fine lines. I can keep up with the results by using great skincare with my at-home roller a few times a week. After seeing some before and after pictures that were pretty impressive, that’s what I ended up choosing. I’m so exited because the cost of this treatment is so much less than I expected to spend and we’re just doing one for now to see how it goes. It’s so important to see someone whose paycheck isn’t dependent upon selling you a service. If you’re in Colorado, this is where I recommend you go, otherwise check out similar doctors and clinics in your area.

A micro needle aka derma roller.

A micro needle aka derma roller.

She was also nice enough to answer a few questions I sent her way about treating different skin issues. Check out what she has to say, and click HERE to see her services and to make an appointment.

Q. What treatments do you recommend for pigmentation issues?

A. Medical therapy – Vitamin C but only if a proper concentration. Vitamin A’s but only formulated appropriately. Also, a light device/laser  depending on Fitzpatrick Skin Type and whether the pigment is epidermal or dermal to decide if certain light devices or lasers would work. Old fashioned chemical peels also work, but again they need to be properly formatted with the correct ph and free acid (this is my chemistry brain talking).

Sidenote: Right after I saw her I went and bought SkinCeuticals C E Ferulic, a proven C serum that all doctors I’ve talked to rave about. Don’t skimp on C serums, many are just a waste of money.

C E Ferulic

Q. What are your favorite ingredients that make the biggest difference in the skin?

A. Vitamin A but only when it’s formulated appropriately.Vitamin C but only if formulated with another antioxidant and a proper concentration. There are many other products that have benefit but it really depends on what difference you want to make in regards to skin health.

Sidenote: I’m using Vivant Exfol-A serum at night. An excellent vitamin A formulation that’s really concentrated and doesn’t make my skin red or flakey like Retin A does. I also use it with my derma roller so it has even better penetration.


Q. What about treatments for acne?

A. Medical therapy , alpha hydroxyl acids, Vitamin A, and anti-inflammatory agents. Light device/laser, but there is no laser/light device approved for acne treatment and covered by insurance. FDA device approval is very different than FDA pharmaceutical approval. The ‘heat dispersion’ from the devices control active acne lesions (red pustules, cysts, but not black heads and white heads). The no!no!™ skin device was the 1st device on the market that used ‘heat’ to control active acne lesions. Old fashioned chemical peels work, but again they need to be properly formatted with the correct ph and free acid (this is my chemistry brain talking again!)

Sidenote: I reviewed the no!no! years ago when it first came out and I love it for hair removal, I didn’t know I could be using it on my face?! Glycolic acid is awesome and Glytone tells you exactly how much Glycolic (aka Alpha Hydroxyl Acid) you’re getting in each product. I’m using their cleanser and moisturizer.


I’m hoping to schedule a treatment for next week where I’ll take pictures (maybe a video?) of the treatment and post it along with some before and after pics as the weeks progress. If you have any questions about micro needling or any other skin treatment, leave them in the comment section and I’ll get them answered for you!

Because It’s Worth It… Where to Spend a Little More Money

If you haven’t watched the adorable Marcel The Shell video that’s such a huge hit on YouTube – you have to check it out below (and click HERE to see it if you get this post delivered via email). The the couple who produces it has already written a book and is in talks to develop a series staring their lovable one-eyed shell after just 2 videos. I watch it religiously. It just makes me smile.

My favorite line is at the end when he says he smiles because it’s worth it. Which caused a mental domino about what’s really ‘worth it’ in terms of popping the lock off the wallet and spending a little more for an investment in your skin looking great. I’m not someone who thinks you have to spend a ton to look great – I recommend drugstore finds as often as department store ones – but there are a few exceptions that are so great that I’ll spend the extra cash because I know they’re worth it.

Chantecaille Future Skin Foundation:

I’m scraping the bottom of my jar of Chantecaille Future Skin that I got almost 2 years ago. I heard so much about their foundations that I purchased the jar at a counter not knowing it was $72 and then tried to play it off when she told me my total like it wasn’t twice as much as I’d ever spent on foundation. I quickly discovered that after I tried every type of foundation that passed my desk, I’d happily return to Future Skin. Its coverage is fantastic, staying power terrific, and the look of it is so natural – which might be because it’s made of 60% water and seaweed. The higher price tag could be attributed to its treatment benefits like reducing sebum and calming redness with chamomile and green tea – but who knows. All I know is that I’m mentally preparing for another $72 purchase very soon, but at least this time I know it’s worth it.

Liz Earle Cleanser:

Cleanse & Polish, the cleanser that I’ve referred to as ‘near perfect,’ is so worth an order from the UK based Liz Earle (or from Fred Segal Santa Monica- their only stateside location I know of.) It’s not a pricey buy at $25 for a 3.3oz pump (and around $7 to ship), it’s the ordering that makes it a little more of a challenge than grabbing a bottle at a store like we’re all so used to doing. I’m so addicted to this thick, creamy, lightly Eucalyptus scented gentle cleanser which removes all makeup so effortlessly, that when I try out a new cleanser to review it’s what I measure them all against. It’s a gold standard for a cleanser and one that’s so popular they have an automatic refill service and also a 3 pack available to make getting this perfect cleanser as easy as possible.

SkinCeuticals Serums:

SkinCeuticals is renowned for their high-potency, crazy effective serums designed to correct, fade, protect, and calm – whatever your skin happens to need. Their C E Ferulic is probably their best known do-it-all serum with vitamins C and E and Ferulic acid to protect the skin against environmental damage and skin aging. They use the purest, best forms of vitamins (like L-Ascorbic for their C) for maximum benefits and create combinations with other vitamins and acids for the very best skin absorption. Serums compliment any skincare routine and are so beneficial using only a few drops a day making them worth their $100- $150 cost.

Estée Lauder Eye Creams:

Eyes show age. It’s that simple. Getting that thin skin moisturized and protected is important, as is finding an eye cream that has some beneficial ingredients and proven science. So many eye creams are a complete waste – basically just plain moisturizers in a smaller jar without any true benefits. I trust and love Lauder’s eye creams – they have something for every skin type and concern, but their Re-Nutriv eye creams are their supreme offerings. With too much science in them to explain (or understand, really) I just know that when I use a Lauder eye cream, I can see the difference. I can waste money $35 at a time with something that isn’t working, or just fork out the $100 (ish) to see a difference and keep the Botox away a little bit longer.

Don’t worry, I’m also rounding up a ‘not worth it list’ (hello mascara!!) so you can save your pennies on things that are all pretty much the same.

PCA Skin Clearskin

I love PCA Skin and their effective professional grade line of affordable skin treatments, so when reached out offering a voucher good on any product on their site in exchange for an honest review of what I chose, I had to get something I hadn’t tried from PCA. My skin is temperamental with breakouts that come and go, so I explored their moisturizers to see if they had something for my crazy skin. I ended up choosing Clearskin mostly because of its almost 200 glowing reviews from really happy customers who claim it changed their skin and now they’re totally loyal.

It’s not designed to be an acne treatment, though its antibacterial properties make it perfect for that sort of thing – it clarifies and heals using vitamins and natural acids in a base of aloe to improve the look of all types of skin. It has a texture that could be pump-dispensed so don’t let the jar fool you, it isn’t heavy. More of a gel-cream really. Dry skin might need to add moisture on top, other skins will find it hydrating enough.  I loved how soft my skin felt and how it alive and clear it looked after a few week’s use. It’s also great for redness, fading old acne scars, and balancing oil over time – which I’m excited to see happen over the next few months.

I would buy Clearskin – especially with the $32 price tag, well within reason for a good moisturizer and skin treatment rolled into one.

Check out PCA Clearskin at

Facial Cupping

Facial cupping. While it sounds like a frat house dare, it’s actually a cheap, easy, chemical-free way to fight skin sagging and puffiness. There isn’t anything terribly advanced or complicated about cupping either, just press the bulb at the top of the cup and place it along the bottom of the face creating a suction on the skin. Let go of the bulb to create suction and move the cup going upward sucking sections of the skin into the cup until you’ve done the whole face which takes only a minute or so. Cupping immediately increases circulation and also drains stagnant fluid from the face so it decreases puffiness, brings nutrition to the skin’s surface, and helps to keep sagging away by tightening up the contours of the face. Weird but it works.

My esthetician Tjaden at the Skin Studio here in Denver uses it on her clients for those very reasons, and to also help vitamins and other serums better penetrate into the skin. You can get a set of cups HERE, HERE, or a ton of other websites when you google ‘facial cupping.’ Just make sure they’re the smaller size and not the larger ones for the body.

if you want to see cupping in action (and a really sweet t-shirt with a big red fish on it) check out the vid below. If you received this via email, click HERE to watch the video.

Dr. Harold Lancer, 20 Years Younger, and Oprah

Dr. Harold Lancer is celebrating tonight. He’s the dermatologist to the stars who also happens to be Oprah’s go-to guy to keep her skin looking pristine (seriously, her skin is perfect.) He teamed up with Bob Greene on a program called 20 Years Younger, a 2 month life-changing kickstart for 20 lucky women who wanted to get their health back on track. Dr. Lancer turned back the clock on the women’s skin returning it to a much younger state using treatments like microdermabrasion, lasers, Botox, and of course his skincare line. The ladies looked a lot better, and Lady O raved about how radiant her skin looked since using Dr. Lancer’s regimen so she vouched for his line’s efficacy. Well, that was enough for me to pause my TiVo and obsess over which of his products I can’t live without for the past hour and a half.

His home site is under construction so HERE is where you’ll find his offerings on the 20 Years Younger site. I can’t figure out what would work best for my skin type since it isn’t laid out or explained in an organized way so I’m a little hesitant to pull the trigger.

If there is one product that looks to be universal, it’s Nourish, a day and nighttime treatment that’s supposed to restore the overall look of the skin and visibly reduce fine lines and wrinkles.


It’s also at Nordstrom so seeing a counter rep about what my skin needs might be a safer bet. Nordys opens at 10 right??

Dear Carissa- What Do You Use Everyday?

I would love to peek into your cabinets and see what you use every single day!

Salt Springs, FL

Well Meghan, here you go. A complete snapshot of what’s in my cabinets this very second. Maybe next time we’ll do makeup, today I only had the strength for skin care.
And although it might change 10 more times by the end of this year, this is my current daily (and nightly) skincare routine.

From left to right: Olive Oil, Suki Exfoliate Foaming Cleanser, Liz Earle Gentle Face Exfoliator, Liz Earle Skin Repair Light Moisturiser, Liz Earle Cleanse & Polish Hot Cloth Cleanser, Weleda Refining Toner, Obagi Elastiderm Eye Treatment, Obagi Exfoderm Forte, Osmotics Blue Copper 5 Firming Eye Repair, SkinCeuticals Serum 15, Obagi Healthy Skin SPF 35 Moisturizer, Latisse.

What I do-


Cleanse:        Weleda
Toner:             Weleda Toner
Treatment:    SkinCeuticals Serum 15
Moisturizer:    Obagi Healthy Skin SPF 35
Eye Cream:   Blue Copper


Pre Cleanse:  Olive Oil
Cleanse:         Liz Earle Hot Cloth
Exfoliate:         Either Suki or Liz Earle
Toner:              Weleda
Treatment:     Obagi Exfoderm Forte
Moisturizer:     Liz Earle Light Moisturiser

Sidebar; I do this every single night. Doesn’t matter if I get home at 4am, I always take time to wash my face.

Click to Enlarge

Break it down-

Liz Earle:

I know I’m not supposed to be super partial to any one line, but I have to get something off my chest: Liz Earle is one of the greatest lines on the planet. There I said it. Her Cleanse & Polish Hot Cloth Cleanser is one of the best cleansers around (so popular it comes in a 3 pack and a year-long subscription).

I’m also quite sure that the Skin Repair Light Moisturiser would turn any moisture-phobic into a devout super fan. Its pump dispenses a tiny amount that disappears right into the skin without a hint of after-feel.

I’m big on exfoliating, so I have two that I rotate out. Earle’s Gentle Face Exfoliator is the one I use when my skin is acting up because its soothing jojoba beads inside a creamy base sweep away dead skin without any harsh scrubbing.


I kept reading review after review from people raving about Exfoliate Foaming Cleanser so I decided to pick it up at Whole Foods. It’s a sweet smelling sugar-based exfoliant I use when I mean business. It foams up and buffs away every last impurity imaginable leaving behind totally soft skin.


I didn’t get a shot of it because it’s in my shower, but Weleda’s silky new Gentle Cleansing Milk is what I use every morning always following it with thier Refining Toner. I’ve always preferred a post-cleansing toner for an extra clean feel and this one is a simple base of Witch Hazel with Lemon Juice and botanicals that cleans up what you didn’t cleanse away without stripping or drying out the skin.


My skin really turned a corner a few months back when I started using Exfoderm Forte every night. It felt smoother, looked clearer, and my breakouts were much less frequent. It’s a glycolic-based exfoliant that chases dull surface skin away. I’ve been recommending it to just about anyone who is looking for an overall skin improvement that doesn’t leave the skin dry and flakey.

I could also see a difference around my eyes when I started using Elastiderm Eye Treatment , their much raved about eye cream. It’s what I slather on at night so I wake up with fresh looking eyes that aren’t crepey.

Healthy Skin Protection SPF 35 is my favorite physical SPF I’ve tried yet. It’s totally non-greasy and doesn’t leave a hint of white behind. It’s also a big tube for the price, mine will last about a year.


Under makeup during the day, I use Blue Copper 5 Firming Eye Repair so I can get some added firming benefits around my eyes. My makeup goes on smoothly over top because the formula is a perfectly weighted gel that soothes sleepy eyes into looking more awake.


I’m a big believer in using Vitamin C serums in the day to protect the skin from environmental damage and Serum 15 is the perfect kind to use. It’s L-Ascorbic, the best absorbed Vitamin C with a fantastic delivery system to ensure maximum penetration. Even if I’m heading to yoga knowing I’ll wash my face again later I apply it in the morning, the formula can’t be wiped or washed off for 72 hours once it’s in the skin.


No, I’m not wearing false lashes so please stop asking. And to answer the questions I always hear; yes, it itches a little sometimes when I apply it and yes, the skin along my lash line is slightly darker now but I don’t care. The benefits far outweigh the slight disadvantages.

Okay, I promise next time we’ll go over makeup.