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Why Your Skincare Routine Isn't Working (And What Actually Matters) By Dr. Salyards, Refine Dermatology | Knoxville, Tennessee Have you ever looked at your bathroom counter full of skincare products and wondered why your skin still isn't giving you the results you expected? It's one of the most common conversations I have with patients. Many people assume that if their skin isn't improving, they simply need more products, more steps, or the latest trend they've seen online. But in reality, healthy skin isn't about doing more—it's about using the right products consistently. As a board-certified dermatologist and founder of Refine Dermatology in Knoxville, Tennessee, my approach to skincare has always been centered around evidence-based medicine and personalized care. Every patient's skin is different, but there are a few fundamental principles that apply to almost everyone. Understanding the basics can help you build a skincare routine that actually works! Why Quality Matters More Than Quantity One of the biggest misconceptions in skincare is that expensive routines with dozens of products automatically produce better results. The truth is that an effective skincare routine doesn't need to be complicated. What matters most is using products that are formulated to create meaningful changes within the skin. This is one reason why I often recommend medical-grade skincare products. Unlike many over-the-counter products, medical-grade skincare is designed to penetrate the skin more effectively and deliver active ingredients at concentrations that have been studied and shown to make a difference. These products often utilize higher-quality ingredients, more sophisticated delivery systems, and formulations supported by clinical research. That doesn't mean every product on a drugstore shelf is ineffective. However, when patients tell me they've been using skincare consistently but haven't seen the improvements they expected, one of the first things we evaluate is whether they're using products that can truly impact the health and function of their skin. Over time, the right products don't just improve the appearance of your skin, they help create healthier, stronger skin from within. Why Vitamin C Matters If I could recommend one category of product for nearly everyone to use in the morning, it would be an antioxidant serum, particularly one containing vitamin C. Every day, our skin is exposed to factors that contribute to aging and skin damage. Ultraviolet light, pollution, environmental toxins, and even our body's normal metabolic processes generate unstable molecules called free radicals. These free radicals damage collagen and accelerate many of the visible signs of aging. This is where vitamin C becomes so valuable. Vitamin C acts as an antioxidant, helping to neutralize free radicals before they can cause significant damage to the skin. In other words, it helps protect your skin throughout the day while also supporting long-term skin health. But the benefits don't stop there. Vitamin C can also: Brighten uneven skin tone Reduce the appearance of pigmentation Support collagen production Improve overall skin radiance Enhance your skin's natural defense systems One of the reasons I love antioxidant therapy is that it's both preventative and corrective. You're protecting your skin from future damage while simultaneously improving its current appearance. Think of vitamin C as an investment in your skin's future. The Gold Standard for Anti-Aging: Retinoids While antioxidants are the cornerstone of a morning routine, retinoids remain the gold standard treatment for nighttime skincare. Retinoids are vitamin A derivatives that have been extensively studied for decades. In dermatology, they remain one of the most effective ingredients available for improving the health and appearance of the skin. Retinoids work by increasing cellular turnover and stimulating collagen production. This process helps address many of the most common skin concerns we see, including:  Fine lines and wrinkles Acne Hyperpigmentation Uneven skin texture Sun damage Loss of skin firmness If a patient asks me to choose just one product category that truly changes the skin over time, retinoids are almost always my answer. Of course, not all retinoids are created equal, and not every patient will tolerate the same strength or formulation. That's why selecting the right retinoid—and introducing it properly—is so important. When used correctly, retinoids can create remarkable improvements in skin health and appearance over time. The key word here is time. Retinoids are not overnight solutions. They require consistency and patience, but the long-term results are often worth the investment. When Should You Start Using These Products? One of the questions I hear most often is: "Am I too young—or too old—to start using products like vitamin C and retinoids?" The answer is usually neither. For antioxidants like vitamin C, I often recommend starting in your 20s. This is when prevention becomes especially important. Protecting your skin from oxidative damage early on can help preserve collagen and minimize future signs of aging. Retinoids can also be introduced in your 20s, particularly for patients dealing with acne. However, many people choose to start retinoids during this decade simply to support long-term skin health and aging prevention. That said, there is no "perfect" age to start. I've helped patients in their 30s, 40s, 50s, and beyond incorporate these ingredients into their skincare routines with excellent results. The most important factor isn't your age—it's choosing products that align with your skin type, concerns, and goals. Skincare should never be one-size-fits-all. How We Choose the Products We Carry at Refine Dermatology At Refine Dermatology, we're very intentional about the products we recommend and carry in our office. We don't believe in offering dozens of brands simply for the sake of variety. Instead, we focus on products that are supported by clinical evidence and that consistently deliver results for our patients. One of our primary skincare lines is SkinBetter Science. I appreciate this line because its formulations are supported by strong clinical data and tend to be very well tolerated, even by patients with sensitive skin. We also carry Colorescience, which has become one of my favorite sunscreen brands. Sunscreen is truly non-negotiable when it comes to skin health and anti-aging. Colorescience products are mineral-based and include ingredients such as iron oxides, which provide additional protection against visible light and blue light exposure. In addition, we developed our own skincare line, Refine Skin, to provide patients with products that are simple, effective, and more affordable. We wanted to create options that allow patients to achieve excellent results without feeling overwhelmed by cost or complexity. For patients looking for more advanced treatment options, we also offer Plated Skin Science. These products utilize exosome technology, which supports skin repair and collagen production at a deeper level. I often recommend these products for patients who want to maximize their results or who are combining skincare with in-office procedures. At the end of the day, our philosophy is simple: we don't carry everything. We carry what works. Building a Simple, Effective Skincare Routine One of the most reassuring things I tell patients is that a good skincare routine doesn't have to be complicated. In fact, the most effective routines are often surprisingly simple. A foundational morning routine typically includes: A gentle cleanser A vitamin C or antioxidant serum A moisturizer A broad-spectrum sunscreen In the evening, your routine might look like: A gentle cleanser A retinoid or targeted treatment A moisturizer That's it. From there, additional products can be incorporated based on your individual concerns, whether that's pigmentation, acne, rosacea, sensitivity, or aging. But before adding more products, it's important to establish a strong foundation. Better Products, Used Consistently If there's one takeaway I hope patients remember, it's this: You don't necessarily need more skincare products. You need better products—and you need to use them consistently. Healthy, beautiful skin doesn't come from chasing every trend or trying every new product that appears on social media. It comes from understanding what your skin needs, choosing evidence-based products, and committing to a routine that supports your long-term goals. At Refine Dermatology, we help patients build personalized, physician-led skincare routines every day. Whether you're just getting started or looking to refine your current regimen, our goal is to help you find a routine that actually works for your skin. Because when it comes to skincare, the right approach can make all the difference.

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By Dr. Jill Salyards, Owner & Founder of Refine Dermatology in Knoxville, Tennessee Skin cancer is the most common cancer in the United States, affecting millions of people each year. While that statistic can sound alarming, there is encouraging news: when detected early, skin cancer is one of the most treatable cancers. Early diagnosis and appropriate treatment play a critical role in protecting not only your skin but your overall health. At Refine Dermatology in Knoxville, Tennessee, we believe patient education is a powerful tool. Understanding what skin cancer looks like, the different types, and the treatment options available can help you feel more informed and empowered about your skin health. Why Skin Cancer Awareness Matters Your skin is your body’s largest organ, and it’s exposed to environmental factors—especially ultraviolet (UV) radiation—every single day. Over time, sun exposure can damage skin cells, leading to abnormal growth and, eventually, skin cancer. Routine skin checks, both at home and with a board-certified dermatologist, are essential for catching skin cancer early. Many skin cancers begin subtly, often appearing as small changes that are easy to overlook. Basal Cell Carcinoma: The Most Common Skin Cancer What Is Basal Cell Carcinoma? Basal cell carcinoma (BCC) is the most common type of skin cancer. It arises from the basal cells in the lower layer of the epidermis and typically develops in sun-exposed areas such as the face, neck, ears, and scalp. Although basal cell carcinoma rarely spreads to other parts of the body, it can continue to grow locally. If left untreated, it can cause significant tissue damage and, in some cases, affect nearby structures. What Does Basal Cell Carcinoma Look Like? Basal cell carcinoma can appear in several ways, including: ● A pearly or shiny bump ● A pink or flesh-colored patch that slowly enlarges ● A sore that doesn’t heal or repeatedly scabs over ● A small indentation with raised edges Treatment Options for Basal Cell Carcinoma Treatment depends on the size, depth, and location of the cancer. Common treatment options include: ● Surgical Excision: The cancer is removed along with a margin of healthy skin to ensure complete removal. ● Mohs Surgery: Mohs is a specialized, tissue-sparing technique often used for high-risk areas such as the nose, eyelids, ears, and lips. The cancer is removed layer by layer and examined under a microscope in real time, preserving as much healthy skin as possible. ● ED&C (Electrodesiccation and Curettage): For certain superficial basal cell carcinomas, the lesion is carefully scraped and cauterized. ● Topical Medications: In select cases, topical treatments such as imiquimod may be appropriate. Squamous Cell Carcinoma What Is Squamous Cell Carcinoma? Squamous cell carcinoma (SCC) is the second most common type of skin cancer. It develops from squamous cells, which make up the outer layer of the skin. While many squamous cell carcinomas are treatable, SCC carries a higher risk of spreading than basal cell carcinoma, especially when tumors are larger or located in high-risk areas. What Does Squamous Cell Carcinoma Look Like? Squamous cell carcinoma may appear as: ● Scaly or rough patches ● Crusted or wart-like bumps ● Tender or painful lesions ● Areas that bleed easily or don’t heal High-risk locations include the ears, lips, scalp, and hands. Treatment Options for Squamous Cell Carcinoma Treatment varies based on the tumor’s characteristics: ● Surgical Excision: Often the first-line treatment, especially for well-defined tumors. ● Mohs Surgery: Recommended for high-risk tumors, recurrent lesions, or cancers in cosmetically sensitive areas. ● ED&C or Topical Therapies: May be appropriate for early or superficial squamous cell carcinomas. ● Radiation Therapy or Systemic Treatment: In more advanced cases, treatment may involve radiation or collaboration with oncology specialists. Melanoma: The Most Serious Type of Skin Cancer What Is Melanoma? Melanoma is the most serious form of skin cancer because it can spread quickly to other parts of the body. It develops from melanocytes, the cells responsible for pigment in the skin. Early detection is absolutely critical for melanoma, as treatment outcomes are significantly better when caught early. What Does Melanoma Look Like? Melanoma often appears as a new or changing mole. Dermatologists commonly use the ABCDE rule to identify warning signs: ● A – Asymmetry: One half doesn’t match the other ● B – Border: Irregular, scalloped, or poorly defined edges ● C – Color: Multiple colors or uneven pigmentation ● D – Diameter: Larger than a pencil eraser (though smaller melanomas exist) ● E – Evolving: Changes in size, shape, or color Any mole or spot that looks different from others or changes over time should be evaluated. Treatment Options for Melanoma Treatment depends largely on the stage at diagnosis: ● Surgical Excision: Early-stage melanomas are treated with surgical removal, often with a wider margin of healthy skin. ● Sentinel Lymph Node Biopsy: For deeper melanomas, this procedure helps determine whether the cancer has begun to spread. ● Advanced Treatments: More advanced melanomas may require immunotherapy, targeted therapy, or radiation, typically in collaboration with oncology specialists. Actinic Keratosis: Precancerous Skin Lesions What is Actinic Keratosis? Actinic keratosis (AKs) are rough, scaly spots caused by cumulative sun damage. While they are not cancer, they are considered precancerous because they can progress into squamous cell carcinoma if left untreated. AKs commonly develop on the face, scalp, forearms, and hands. Treatment Options for Actinic Keratosis Managing actinic keratosis early is an important step in skin cancer prevention. Treatment options include: ● Cryotherapy: Freezing the lesions with liquid nitrogen. ● Topical Medications: Such as fluorouracil, which targets abnormal cells over a treatment period. ● Photodynamic Therapy (PDT): A light-based treatment designed to selectively destroy precancerous cells. The Importance of Early Detection and Regular Skin Exams While skin cancer is common, the good news is that early detection saves lives. Regular full-body skin exams allow dermatologists to identify suspicious lesions before they become more serious. You should schedule a professional skin exam if you notice: ● A new or changing spot ● A lesion that doesn’t heal ● A mole that looks different from others ● Any growth that bleeds, scabs, or feels tender Expert Skin Cancer Care in Knoxville, Tennessee At Refine Dermatology, our goal is to provide expert, compassionate care at every step—from screening and diagnosis to treatment and follow-up. As a board-certified dermatologist, I’m here to guide you through the process so you feel informed, supported, and confident in your care. If you have concerns about a spot on your skin or are due for a routine skin check, we encourage you to schedule an appointment. Your skin health today plays a vital role in your long-term well-being. Early detection makes all the difference!

I’m Dr. Salyards of Refine Dermatology in Knoxville. Thinking about a chemical peel? Here’s what to expect before, during, and after treatment.

As one of the most popular treatments at Refine Dermatology in Knoxville, I want to walk through what neurotoxins are, how they work, and the treatment areas that make the biggest impact.