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Aging Beautifully at 50: Ask the Dermatologist

Dermatologist Susan Evans, MD, answers questions about how to continue aging beautifully at 50 and older.

Question:
I have a very wrinkly neck! Help!
Answer:

Your first approach is to identify the underlying causes and potentially aggravating conditions, such as pre-existing sun damage or ongoing, excessive sun exposure. You should incorporate a sun block and tretinoin-containing compounds in your daily skin care regimen, along with an exfoliator and hydrating creams. If you have significantly relaxed skin on your neck you may want to consider being evaluated by a plastic surgeon to discuss options for a neck lift.

Question:
Can you tell me whether "environmental" facial damage can be repaired outside of doing laser treatments?
Answer:

Skin damage that is secondary to environmental changes -- such as from the sun or harsh weather conditions -- can be treated with topical tretinoin, alpha-hydroxy acid (AHA), or glycolic acid and hydrating compounds. Severe conditions will dehydrate your skin cells and rob your skin of essential nutritional elements. In order to combat theses unwanted changes, your skin care regimen should be designed to rejuvenate, rehydrate, and stimulate new healthy skin growth.

Question:
I recently noticed that I have a lot of whiteheads on my forehead and below my eyes. Where did they come from and how do I get rid of them?
Answer:

Whiteheads occur when your pores accumulate excess oil, or sebum, and fail to drain. Frequently, acne-forming bacteria will arise simultaneously due to pore blockage, and the alteration of the pH on the surface of your skin. In order to combat this, you will need to begin exfoliating your skin and reduce surface bacteria on your skin with compounds containing alpha-hydroxy acids (AHAs) or salicylic acid.

Question:
What is the latest scoop on treating sun damage to the legs?
Answer:

The best course of action is to start with prevention. Avoid direct exposure when the sunlight is the most intense. If your job requires that you spend time in direct sun, consider wearing clothes that provide UV protection. Avoid tanning beds. If you suspect sun damage on your legs, your first approach is to determine if there are any underlying changes consistent with precancerous lesions. If you suspect changes in the area, border, color, or diameter of a lesion (ABCDs), consult with your physician.

Question:
I have a big scar where my doctors did a deep grinding on my face to removing acne scars. Now I have dent in the side of my face. Help!
Answer:

Deep scar management can be very difficult to treat. Fresh scars or revisions may take up to one year to fully mature or fill in. When evaluating your scar, you and your physician should decide if a revision would actually improve your scar long-term. You may want to consider less aggressive alternatives such as topical skin lighteners (if color mismatch is your concern) or the use of filler substances, if a depression from the scar is your primary focus.

Question:
What can I use for dark circles under my eyes?
Answer:

The treatment for dark circles begins with prevention. Getting adequate rest will improve your circulation and lessen the appearance of dark circles. In addition, look for topical agents that contain natural brighteners such as bearberry, niacin, or licorice extract. Topical caffeine and green tea also help constrict leaky vessels, which helps minimize the appearance of dark circles.

Question:
Everyone always talks about aging better up into your 50s. But what about us boomers in our 60s and 70s? We are active and enjoying life. We want to look our best without a lot of effort. What are some basic skin care necessities and tips for preventing those wrinkles and lines that we like to call "facial expressions from experience."
Answer:

Many of the antiaging tips that work in your 50s can also be applied in your 60s and 70s. Sun protection is your best and first step. A significant percentage of premature aging can be attributed to sun damage. As we age, our skin cells need additional nutrition and hydration.
Look for products that will rehydrate your skin; compounds that contain hyaluronic acid and natural oils. Skin needs to be exfoliated, meaning the older, "dead" cells are removed. Then new cells need to be nourished with vitamin A, C, and E-enriched compounds.

Question:
What can be done about crepe-like skin after weight loss?
Answer:

Loose skin after weight loss can be a very challenging issue. Following major weight loss, your skin may have lost a significant amount of elasticity. In addition, certain weight loss procedures may lead to changes in the ability to absorb certain nutrients such as folate, vitamin B12, and iron, which may have a profound impact on the viability of your skin.

Question:
I am age 58. I had a complete facelift and eye surgery by a well-known surgeon. Ever since the recovery, the top of my scalp continually itches. I've developed sores, bumps, and even a few bald spots from scratching so much. I visited my dermatologist and she did a biopsy. She found no serious diseases but said it was urticaria ... hives. What can I do?
Answer:

Your first step will be to visit with your surgeon and discuss the details of your procedure. Certain face-lifting procedures may result in a transient sensory nerve injury, which can lead to hypersensitivity and/or pruritis (itching).

Question:
I have large brown patches on my forehead and cheeks, like liver spots. It's not skin cancer or liver damage. I have used Melquin HP cream for 6 months, with no visible change. What do you recommend?
Answer:

You may be suffering from melasma, a skin condition characterized by hyperpigmentation of the cheeks and forehead. Some melasma sufferers will exhibit refractory hyperpigmentation after topical regimens. You may want to consider further evaluation with a physician who is experienced in laser treatments for refractory melasma, specifically for your skin type.

Question:
I am well over the age of 60. I am balding like men do, on the crown of my head and in the back. I went to a dermatologist who prescribed hair lotions that were not effective. Can Rogaine work for older women? Is there another process available? This is very stressful to deal with every day.
Answer:

Premature balding in women can be attributed to several factors including stress, medication, and heredity. Your first step should be to exclude any medical causes such as hormonal imbalances, polycystic ovarian syndrome, adrenal disease, or thyroid disease. For hereditary hair loss, topical Rogaine is currently one of a few compounds that are FDA approved for regrowing hair.

Question:
What can I use for dark marks on my skin?
Answer:

Your first approach is to consult with your physician in order to exclude any underlying medical causes for the darkening. Next, work with a dermatologist that knows how to care for people with your skin type and color. Your dermatologist should implement a program that combines topical exfoliating treatments (to facilitate greater preparation) followed by skin-brightening agents and an effective sun block.

Question:
I am a 62-year-old female. I have a sagging jaw line and neck. Several years ago I bought a "Dermal Tone Facial Exercise Treatment" "machine." It claims to stimulate the muscles in the face and jaw line to tighten them. What can you tell me about this treatment?
Answer:

The majority of visible wrinkles that we observe are due to extrinsic aging. Extrinsic factors are associated with damage to the upper layers of the skin (epidermis or dermis) primarily from either sun damage or smoking. Extrinsic aging cannot be corrected with facial exercises. I encourage daily exercise for your overall health and well-being. However, "exercising" your facial muscles will not reverse skin damage or premature wrinkling due to extrinsic factors.

Question:
I have tried several fillers to erase my lip lines and have still not found a suitable one. Is there a procedure that works? A dermatologist I spoke with suggested laser treatment. Does it really work, as I have heard negative feedback about it?
Answer:

Lip lines are a difficult problem to treat. Even with current technology completely "erasing" lip lines may not be feasible. Deeper lines can be attributed to a hypertrophied orbicularis muscle or damage to the epidermis and dermis. If you choose a more aggressive approach such as laser surgery or deeper chemical peels, make sure you choose a physician that is familiar with your skin type and color. Before you implement your definitive treatment, consider starting with a small test area.

Question:
What are aging spots?
Answer:

Aging spots, or solar lentigos, primarily result from sun damage. Age spots have also been mislabeled as liver spots. (They do not have any correlation with liver disease.) The majority of age spots are benign (noncancerous). If you notice any changes in the border, color, or diameter of any lesions on your skin, you should be evaluated by your dermatologist.

Question:
Can diabetes lead to a rash? Is it common for diabetics to get rashes?
Answer:

Unfortunately, almost a third of all diabetics may be more prone to certain types of fungal infections (candidiasis) or oral thrush. Many diabetics are also at a greater risk for secondary bacterial infections such as folliculitis (infection of the hair follicles), carbuncles (deep soft tissue infections), and paronychia (infections around the nail bed).

Many of these infections may present initially as a rash. Therefore, any suspected rash (on a diabetic) should be evaluated by your physician.

Question:
What is the most effective antiwrinkle treatment for the eyes?
Answer:

Your best way to fight premature wrinkling is sun protection. Sun damage and smoking account for the majority of premature aging. In order to help combat wrinkling, use compounds that exfoliate dead skin cells (glycolic and AHAs), encourage new collagen deposition (tretinoin-based products), and provide nutrition for skin cells (vitamins C and E and peptides).

Question:
I'm going on 74 and my face shows it. Baking in the sun when I was younger has caused me to age prematurely. I fight dry skin, too. I do not wear a lot of makeup, and one side of my face has more lines on it than the other. What do you recommend?
Answer:

It's never too late to implement a good skin care regimen. Use a sunscreen with an SPF of at least 30. Begin a daily regimen that includes exfoliation, hydration, and nutrition with peptides and vitamins A, C, and E for your skin.

Question:
I am 58 years old. My eyelids have darkened with age. Is there some way that I can effectively lighten my eyelids?
Answer:

Yes. You can brighten your eyelids. First, make sure there is no underlying condition that may be causing the darkness. Your doctor or dermatologist can help you determine if you having an allergic irritation or drug reaction.

Treatment should consist of sunscreen, SPF 30 or above, to block the sun from rays that darken the skin. Also, bearberry extract and licorice extract are great brightening options that can be mixed with a moisturizer for the delicate skin on the upper eyelid.

Question:
What really works on wrinkles?
Answer:

Your first treatment is prevention. Avoid direct sunlight. The majority of premature aging is attributed to sun damage. Use a sun block, exfoliate, hydrate, and nourish your skin with compounds that contain vitamins A, C, and E.

Question:
I am 56 years old, and I have not had a monthly cycle for 6 years. I have large pores, whiteheads, blackheads, and adult acne. I have used ProActiv for many years. I now use prescription tretinoin + 0.025 CRE. I walk 6+ miles every day, so I sweat a great deal. I wash my face at least twice daily. But nothing seems to help. Do you have any suggestions?
Answer:

This sounds like a complex problem. Your current treatment regimen sounds appropriate. One issue that may be getting overlooked is your overall hormonal status. Changes in your hormones may contribute to adult acne. Your physician should evaluate your hormone levels and functioning.

Question:
My face is red all the time. What can I do?
Answer:

You may be suffering from any of a variety of conditions that can cause persistent redness, including an allergic response, contact dermatitis, immunologic diseases, or infection. Prior to trying to treat the redness, your first step is to consult with your physician to obtain an accurate diagnosis.

Question:
I'm an 81-year-old man with a severe scalp problem; scales that seem to be moving down to my face. My dermatologist tried using a procedure that was very cold. But the situation has gotten worse. This problem runs in my family, so it may be a genetic thing. Any advice you can offer will be very much appreciated.
Answer:

If you are suffering from a "severe" scalp problem, your differential diagnosis (at age 81) may include anything from infection, an immunologic disease, or cancer. You should have your condition evaluated by a physician.

Question:
Is it dangerous to color your hair if you have extremely dry scalp from scalp psoriasis?
Answer:

In general, there is no contraindication to the use of hair dyes with scalp psoriasis. Certain hair dyes may further aggravate your scalp psoriasis. Consider patch testing a small area prior to dying your whole head. Do not leave the dye in place for extended periods. Other options include natural herbal dyes such as henna dyes.

Question:
I'm 55 years old and I noticed that my skin is becoming more sensitive to skin care products. Can skin become sensitive when it wasn't before?
Answer:

Certain products may contain preservatives or fragrances that can cause hypersensitivity or an allergic reaction on your skin. Also, if you are using products that contain tretinoin, AHA, or salicylic acids your skin may become more sensitive when exposed to direct sunlight. Therefore, it is important to incorporate a sun block within your skin care regimen.

Thank you for joining us for WebMD Ask the Dermatologist. Be sure to come back on Dec. 15 at 1 p.m. ET when we will discuss skin care and beauty tips for your 40s: how to prevent wrinkles and blemishes and preserve your skin’s elasticity. Sign up if you'd like an email reminder the day before our next event.

WebMD Ask the Specialist Transcript

Reviewed by Susan Evans, MD on November 17, 2010

The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. 

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