Read Your Face: The 4 Signs of Aging continued...
What a doctor can do: If you have only a few superficial spots, ask about a light chemical peel or microdermabrasion, which will take off the top layer of skin, says Joshua Wieder, M.D., an associate clinical professor of dermatology at the University of California, Los Angeles. If you need a more potent plan, look into a series of Intense Pulsed Light (IPL) treatments. The improvement is gradual, Dr. Wieder says, but freckles and other dark spots eventually lighten dramatically or disappear altogether.
Redness and Sensitivity
Skin gets thinner and more delicate over time, and blood vessels weaken and enlarge, so many women develop this type of discoloration as they age. Age-related redness can be heightened if you also have reactive skin (meaning you flush easily), visible "broken," or dilated, capillaries, or rosacea.
What you can do at home: While active products are usually very helpful, they're a mistake for women who have sensitive skin. If a cleanser or moisturizer tingles or burns, trade it for a gentler product that doesn't irritate your skin. Try Purpose Gentle Cleansing Wash ($6, drugstores) and Cetaphil Moisturizing Lotion ($10, drugstores). If you're already using anything with retinoids, AHAs, or BHAs, scale back to a more gentle cream with antioxidants like green tea, soy, or idebenone. Try Prevage Anti-Aging Treatment ($150, department stores). Tip: Even if you don't have rosacea, dermatologists say, you may benefit from using products designed to treat that condition. Try B. Kamins Chemist Booster Blue Rosacea Treatment ($70, bkamins.com). And in general, handle your skin with care: no scrubbing, picking, or unnecessary roughness, especially in the superdelicate undereye area.
What a doctor can do: Prescription medications that usually help include MetroGel (generic name: metronidazole), a topical, and Oracea (generic: doxycycline), which comes in pill form. In addition, an M.D. can use certain lasers to zap blood vessels and thereby help alleviate redness. One example: A pulsed-dye laser, like Vbeam or V Star, will reduce unwanted rosiness without leaving bruises and can target specific blood vessels. You should see a noticeable difference after two to four treatments, but laser therapy is pointless if you don't add sunscreen to your daily routine, says Dr. Wieder.
Your Simple Daily To-Dos
Although skin care is individual, there are easy steps everyone can follow to get her complexion in great shape. The starting point: You can and should use an "active" treatment, but you need to pick one your skin will tolerate. Otherwise, your face will just end up looking red and irritated. (The one group that should not use an active treatment: women with a tendency for redness.) So pay attention to your skin's reactions and adjust your routine accordingly. "With any active [especially Retin-A], you'll experience a break-in period involving some irritation. But stick with it, being careful to use only a pea-size amount. Start with two or three applications a week and work up to using it every night," Dr. Hirsch advises. "Over six to eight weeks, your skin will adjust and the redness and flaking will disappear."
Every morning: Use a gentle cleanser if your skin feels dirty. Otherwise, just put on your moisturizer, then sunscreen.
Every night: Remove your makeup with a gentle cleanser (to get skin really clean, massage it for more than a minute, then rinse). Pat dry. Apply your active treatment (a gentle antioxidant cream if you have sensitive skin, or a retinoid or AHA/BHA if your skin is more tolerant). Finish with a basic (nonactive) moisturizer to hydrate skin and counteract any dryness or peeling brought on by the treatment.