Dermatologist’s Treatment Method for Obagi Nu Derm Products

My recent post on Obagi Nu Derm Products has generated some excellent questions from readers and I realize that people want more specific information on exactly how I, as a dermatologist, help my patients get the results they want.

The Obagi Nu Derm Treatment System can be transformational for uneven pigment, acne scarring and sun damaged skin, BUT………..it can also be a an expensive disaster that’s impossible to tolerate and ultimately a waste of time and money. The trick to success is how you use the products.

First a confession, for years I resisted the Obagi Nu Derm System because frankly it’s main product ingredients are prescription 4% hydroquinone, tretinoin and an ingredient that’s a cousin of glycolic acid.  I could build a system like it for my patients that was a lot less expensive using other products.  I have to admit though, the results were never as good.  There’s something synergistic about these products and they’re a great example of the importance of product compatibility and interplay -  Dr. Obagi did a good job with his Obagi Nu Derm System.

That said, I don’t exactly follow the official Obagi instructions when I use the Nu Derm System on my patients because only the toughest skin can handle it without misery.  Helen, one of my web readers had this to say about her experience with the products

I purchased Obagi NuDerm from my dermatologist. What a mess. Red, raw, blistery skin.  My Dr. doesn’t know your secret for using Obagi without the side effects.

It’s not an uncommon story with these products because the instructions tell you to ‘solder on’ through the snowballing irritation, that your skin will eventually adjust.  Well, not necessarily.  Would you expect that you could put lemon juice on freshly peeled skin that’s ‘open’ and more porous and expect your skin to tolerate it and eventually heal.  It won’t, you’ll just get what we call an irritant dermatitis that finally demands attention.

My solution to make Obagi Nu Derm highly effective AND a good experience

First,

I gently coax the skin to give in. We start using the products as instructed in the Obagi brochure and at the first sign of irritancy (aka redness, itching, skin sensitivity) we slow down on the 2 products that irritate which are the Exfoderm/Exfoderm Forte and the tretinoin.  That means skipping them for a day or 2 then starting back.  Also, if there are parts of the skin that are more sensitive (around the mouth for example), we slow down there but continue on the rest of the face.  By using this method of slowly coaxing the skin to give in I’m also able to use the products on the neck and chest.  These are much more sensitive areas and often the products are used there only twice a week, but it still helps.  Remember though, these are prescription products and any change in how you use them requires supervision from your treating MD.

Second,

When I treat with Obagi Nu Derm we stop almost all other products and just use the Obagi Nu Derm Products. This is because of product synergy.  The Obagi Nu Derm Products seem to enhance penetration of each other into the skin.  The toner seems to sooth irritation too.  Other products may either irritate or inhibit absorption so we pretty much stop everything else except on the days that we skip the irritating products.  On those days we use the non-irritating products (Cleanser #1, Toner #2, Clear #3, Sunscreen #6 and Blender #5) with additional soothing products such as Replenix CF Cream or Green Tea Antioxidant Skin Therapy – Replenix Power of Three Cream and a bland moisturizer like one of our Daily Moisturizing Face Creams. These additional products go before the sunscreen or Blender, in place of the Exfoderm or tretinoin, and they help the skin calm down faster.

Third,

We don’t do peels or other additionally irritating procedures during the Nu Derm Therapy.  The skin is so much more porous and peel predictability becomes too dicey; it always depends on being able to predict how fast the peeling agent will get into the skin and you can’t when a person is almost totally exfoliated and on the brink of an irritant dermatitis like with Nu Derm Treatment.  Another reader, Valerie asked about this.

I’ve been encouraged to do the Obagi peel at 6 weeks (into my Obagi Nu Derm Treatment), but I have yet to decide if I will, and if it would be 15% or 20%. I’m wondering if you use the Obagi peel in your office, or if there is another peel you recommend.

In my opinion, the risk of a peel isn’t worth it and remember the lemon juice on open skin analogy, it applies here big time.  Irritation can cause discoloration that may take a long time to resolve, and it’s unnecessary to getting great results. Building more irritation from a peel will also make the products harder to use. In my office we instead do gentle/hydrating facials during the Obagi Treatment.  If we need to exfoliate some of the skin peeling then we use gentle microdermabrasion because it does not function based on skin porosity, it’s a simple sanding of the loose outer layer of skin.    We go easy though and experience is necessary to know just how much microdermabrasion is ok and how much is too much for a person’s individual skin type and state of exfoliation during the Obagi Treatment.

Fourth,

I only treat with Obagi Nu Derm as a finite 3 to 4 month therapy course. I don’t like long term hydroquinone usage, I don’t think the skin thrives with this ingredient and in Europe they don’t even allow it at all.  I have a rare patient where we have to continue using it because their pigment is unbelievably stubborn, but for most everyone else, we stop it after the Nu Derm therapy is over.

Plus, I like health promoting skin care regimens for long term skin beauty and health.  This include products with antioxidants and vitamins, along with tretinoin and/or professional strength glycolic acid products.  There is so much great science supporting the benefits of these products on skin beauty and health so we go straight back to them. We create a product combo that will maintain and build on the Obagi Nu Derm Results. I’m picky here and not every product with these ingredients really delivers what’s possible so I only recommend the products that I trust, they are the products on my web site.  Most often, I put my patients back on their antioxidant kits with tretinoin and/or glycolic acid.  My favorites:

Antioxidant Kit With Glycolic Acid For Normal Skin

Dermatologist recommended antioxidant and AHA skin care

Antioxidant Kit With Glycolic Acid For Dry Skin

Dermatologist Recommended Antioxidant and AHA Skin Care

Antioxidant Kit With Glycolic Acid For Oily Skin

Dermatologist Recommended Antioxidant and AHA Skin Care

Antioxidant Kit Without Glycolic Acid

Dermatologist Recommended Antioxidant Skin Care

Fifth,

Obagi Nu Derm Treatment is a great prep for other cosmetic dermatology procedures that give us that ‘icing on the cake’ zing of beautifully rejuvenated skin. We often start laser and/or intense pulsed light (called BBL in my office) treatments, or a series of chemical peels and/or microdermabrasion maintenance treatments once we are done with the Nu Derm system.  It’s why I love doing Nu Derm in the fall -  it gives us the winter and early spring to complete cosmetic procedures and laser/light treatment series.  By spring, wow!  We have new skin and a new look and it’s absolutely fun and amazing.

Finishing 3 to 4 months of Obagi Nu Derm has the skin perfectly ready to begin an IPL (BBL) series, or ProFractional Laser and/or MicroLaserPeel treatments, all with supportive aesthetician skin care treatments.  Any stubborn pigment or skin issues can be cleaned up this way.  We also look at skin volume and may use a little Juvederm filler to soften skin contour issues. I’m in the process of  updating the web pages for my cosmetic dermatology and aesthetician services and you can get an idea of some of what we do in my office by visiting the new pages.

To see the information on the cosmetic dermatology procedures and services that we do click here

To see my Aesthetician Services click here

We sell the Obagi Nu Derm Cleansers and Toner on Dr. Bailey Skin Care web site.  Click here for the Obagi Nu Derm Gentle Cleanser, Obagi Nu Derm Foaming Gel Cleanser, and the Obagi Nu Derm Toner.  obagi nu derm toner

If you still have more questions about how I use Obagi Nu Derm Products in my dermatology practice you might find your answers in a post that I wrote last year that outlines the specifics.  Remember, these are prescription products and my information is educational and informational only – it is not intended to override your doctor’s advice.  Please take it in to him/her and discuss whether it would be appropriate for you. To view the post click below:

Winter: Now Is The Time To Fix Your Unwanted Age Spots and Skin Pigmentation

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4 Responses to “Dermatologist’s Treatment Method for Obagi Nu Derm Products”

  1. Valerie October 9, 2011 at 6:23 pm #

    Hi Dr.Bailey,
    Thanks for letting us pick your brain with questions about Obagi Nu Derm. I had never heard of it prior to my basal cell evaluation appt. with my physician last month, and now I am learning so much.Thank you!
    I’m entering my 5th week soon, and until a few days ago I hadn’t considered using the bleacher/blender or Retinoic Acid on any parts of the eye area because I thought that skin too fragile-same thing with the neck. I’ve read your comment on coaxing the neck and chest, and I intend to start that. But what about under the eye brows, lids, and under the lower lid? In a previous post you wrote the Replenix eye repair was very beneficial, and I think you said that the bleacher and Retinoic Acid could be applied also.Would it be best to start slowly and work up to every day? Is it appriopriate to apply the Exfoloderm in these places?
    The Exfoloderm wasn’t offered at the time of my consult, and I think that is perhaps the reason a peel was recommended at 6 weeks. I do intend to call the office and request the exfoloderm with the plan to do a peel or Fraxel at 3 months.
    Thank you again for your time, interest,and expertise.
    Warmest Regards,
    Valerie

  2. Cynthia Bailey MD October 9, 2011 at 6:53 pm #

    Hello Valerie,
    The Exfoderm comes in the complete Obagi Nu Derm Kit, it is step #4. The tretinoin and other products would need to be used with your physician’s supervision if you are thinking of applying them near the eye. I never have my patients place them on the folded skin of the eye because they are irritating there. We do sometimes go pretty close to the eye, remembering that as products warm to the skin they melt and spread even further than where directly applied. I personally supervise this in my patients as I am responsible and the eye is delicate. Your physician needs to assume responsibility if you are thinking about deviating from the manufactures recommendations.
    Warm Regards,
    Cynthia Bailey MD

  3. Ariana Davidson October 14, 2011 at 8:04 pm #

    Dear Dr. Bailey,

    Instead of using the Obagi system for 4 months, can it be spread out like say, continuously for 1 month, then twice a week for 6 months or so? Is it possible to reap the benefits that way?

    Warm regards,
    AD

  4. Cynthia Bailey MD October 15, 2011 at 8:46 am #

    Hello Ariana,
    Possibly, but I don’t do it that way. There are many ways to get results, but with interrupted use a person may never get through that initial ‘break in’ period, and it’s nice to be through that. I’m on about week 3 and just done with the subtle flaky peeling that’s just a little noticeable and annoying. Plus, in my practice I don’t like to keep people on hydroquinone for long periods of time if I can help it.
    Warm Regards,
    Cynthia Bailey MD