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Anti-Aging Lifestyle Tips: Ask the Dermatologist

Dermatologist Susan Evans, MD, answers questions about anti-aging skin care routines and more.

Question:
My dermatologist has recommended laser resurfacing. However, it is not covered by my insurance and I cannot afford it on my own. Can you recommend any other procedure that might help my face and neck?
Answer:

One option to consider is a chemical peel. Dermatologists that are familiar with chemical peels use a combination of salicylic acid, AHA, and TCA to remove the top layer of the skin and encourage new skin growth. Chemical peels can be very effective and are less costly than most laser treatments.

Question:
I don't eat meat that often, but my skin smells terrible. What can I do?
Answer:

Most body odor is caused by an accumulation of bacteria on the surface of the skin. In general, this problem can usually be improved with the use of natural cleansers while bathing.

There are also certain medical conditions -- diabetes, liver disease, and infections, for instance -- that may contribute to body odor. A balanced diet is critical to your well-being. Imbalances in your nutritional intake may lead to an accumulation of unfriendly bacteria within your digestive system.

Question:
I have bad bags under my eyes. I've tried many products to help. Nothing works. Should I just give up? What nonsurgical and surgical procedures are available?
Answer:

You will need to find out the cause of your under-eye bags. You would discuss them with a surgeon if the bags are due to excess skin or excess fatty deposits. Each of these conditions may require surgical removal to achieve the best result.

If you suffer from a “flattened” mid-face (negative vector), your concerns may be addressed with nonsurgical fillers to help achieve better balance in your face.

Question:
Lately I've noticed a lot of loose skin around my knees and in the front of my legs. What can be done? I walk all the time and I'm on my feet constantly at work.
Answer:

Loose skin around the knees may be part of the natural aging process. Extreme weight loss may lead to excess skin. These issues may be addressed by a plastic surgeon. Excess sun exposure is the No. 1 cause of premature aging and wrinkling of the skin.

If you suffer from chronic swelling around your knees, compression garments and support hose may be beneficial.

Question:
I've recently been to a dermatologist for advice on a new skin care regimen. Because of the cost, I am unable to afford the laser treatment that was recommended. Instead, I plan to carry out the at-home treatment, which may take longer to provide visible results. From a medical standpoint, is it really worth it?
Answer:

For most non-medical skin issues, at-home treatments offer a viable and cost-effective alternative. Your first step is to determine and educate yourself about your skin type (dry, oily, or combination). Also, familiarize yourself with the ingredients of the products in your at-home regimen. Once you gather that information, compare your own self-care practices with your physicians’ recommendations. This will provide you with your initial direction.

Question:
What is the best thing to do for the folds in my arms? My wrinkles are so deep in the folds, and my arms have a crinkly appearance. I use lotions and creams on my arms. My face is smooth compared to my arms and hands. What is the best thing to do for my arms and hands?
Answer:

The deep wrinkles you are experiencing are most likely from sun damage. Your initial approach should be to wear sunscreen at all times. If you live in a very sunny climate, consider wearing UV protective clothing.

In addition, you should continue to moisturize your skin with a noncomedogenic (non pore-clogging) moisturizer. Your moisturizer should also contain hyaluronic acid, which will help plump the skin cells. Sun damage dehydrates the skin. So it is important to drink plenty of water to rehydrate all of your cells.

Question:
What is the cure for dry skin?
Answer:

Dry skin can be attributed to a variety of skin disorders, such as eczema, rosacea, or psoriasis. Medical problems, such as thyroid disease, kidney disease, liver disease, and certain connective tissue diseases, may also contribute to dry skin. Your first approach is to exclude any potential medical causes with your physician.

If your dry skin is not related to an underlying medical cause, then your skin regimen needs to include moisturizers that contain health-rebuilding compounds, such as vitamin A, C, E, peptides, or hyaluronic acid.

Question:
I’m using an anti-aging cream that contains retinyl palmitate. Would this improve my acne and acne scars? What else should I use?
Answer:

Scientific studies have shown that retinyl palmitate and most retinoid-derived compounds work by increasing cell turnover and increasing collagen deposition. Healthy cell turnover and collagen deposition leads to a fuller dermis (less thinning). Another benefit of using retinyl palmitate is its ability to help remodel the skin’s surface, which may make your acne scars appear less prominent.

Question:
I had liver spots as a child, and now it looks like they’re coming back. My skin appears blotchy and two-toned. How can I get rid of this?
Answer:

The term “liver spots” is somewhat of a misnomer. Liver spots are typically not related to any diseases of the liver. Most of these changes are due to age, sun damage, or solar lentigo.

Your first approach is to exclude any potential skin cancers. Once this is accomplished, a combination of glycolic peels and skin brightening agents will improve your skin.

Question:
How can I get rid of dark spots on my face? I was overexposed to the sun and my skin peeled, although not completely. I have tried everything but the dark spots do not fade.
Answer:

Once you have excluded medical causes, there are multiple options to regain your even skin tone. A combination of glycolic, AHA, and retinoid-based products, along with a traditional topical skin care regimen for skin brightening, will work.

Hydroquinone-based products work well. However, there are other alternatives, such as bearberry extract, kojic acid, licorice extract, and niacin. These compounds will work toward brightening your skin and correcting your skin tone.

The key is to work with a physician that is very familiar with your skin type and color, because incorrect use of these agents can lead to further hypo- or hyperpigmentation.

Question:
How much do fillers cost for eye puffiness? Does insurance cover it? If not, what other treatments do you recommend?
Answer:

The cost for eye fillers differ from region to region across the U.S. Typical fees may range from $250 to $700 per syringe. Your final decision for skin rejuvenation should not be based solely on costs. You may want to contact the physician in your area and ask about their fees and payment options.

Insurance does not typically cover cosmetic facial enhancement procedures. Other alternatives include simply getting enough rest, placing a cool compress on your eyes (with caffeine), and reducing the level of your stress.

Question:
I have a weird residue gathered in the part in my hair. It almost feels like build-up from my shampoo or conditioner. But I am always sure to rinse my hair out as best as possible. It’s most apparent after I shower. I’ve tried switching shampoos/conditioners and it didn’t help. What should I do?
Answer:

Residue on your scalp may be due to folliculitis, dandruff, or a fungal infection. All of these conditions may lead to a flaky scalp and an accumulation of residue. Consider washing your hair with an antifungal shampoo.

Question:
I have been to my dermatologist. But my adult acne is so aggressive and itchy and I’ve had no success with combinations of topical creams. I know my skin and I know I need to be on long-term oral antibiotics, along with topical treatment. That was how I took care of my acne when I was an adolescent. My dermatologist started my regimen that way and my acne and the constant itch cleared within days. Why can't I use an oral antibiotic again?
Answer:

Adult acne may be due to a hormonal imbalance. Your physician may be considering incorporating therapy in order to achieve an improved ratio of estrogen and testosterone in your body. Oral antibiotics can be effective in treating persistent acne. You also want to make sure that you are not using compounds that are adversely affecting the pH balance of your skin.

Question:
I have dark eyelids and a dark circle around my mouth. I need help getting rid of them! Natural remedies please. I really need your help.
Answer:

Natural alternatives, such as bearberry extract, kojic acid, licorice extract, and niacin work toward brightening your skin and correcting your skin tone. However, your first approach should be to avoid exposure to UV rays. You should wear a sunscreen containing titanium dioxide, with an SPF of at least 40 if you are prone to hyperpigmentation.

Question:
I think I have developed adult acne. I used an over-the-counter product. And now the pimples have flattened, reddened, and spread. I have an almost complete circle around my mouth. The bump started on my chin. What did I do wrong?
Answer:

Simple acne can sometimes be treated with over-the-counter products. In your case, it sounds more complicated and you may be experiencing another condition that resembles acne. I recommend going to your dermatologist and getting evaluated.

Question:
Nothing seems to be working on my face. I have used a plethora of acne remedies and medications. In the past two years I have become more and more frustrated. I recently made a dermatologist appointment. What types of medication should I ask my physician or dermatologist about, since benzoyl peroxide and salicylic acid aren’t working?
Answer:

Your dermatologist will examine your skin and make an assessment for which anti-acne plan works best for you. Retinoic acid may be added to your skin plan, or an antibiotic.

Be open-minded and realistic with your expectations. Sometimes it takes 3-4 different plans before you find the right one for you.

Question:
My skin is prone to lots of whiteheads and breakouts. Help!
Answer:

Adult acne and whiteheads are very common. It could be caused by anything, including a hormonal imbalance, makeup, a new moisturizer, or the sunscreen you’re using. Try backing off of any new additions to your skin program and trying oil free makeup and skin care.

Question:
I have been using an anti-aging cream for a few months now. It was helping. I saw definite improvements. But in the last few weeks it seems to be helping less. My skin feels irritated by the cream. Is it possible to use a product too much? Should I rotate products, or just keep using this one that was working so well?
Answer:

It is difficult to assess what is causing your skin irritation. Have you been out in the sun, without sunscreen? Some anti-aging products make your skin more susceptible to the sun. You may now require more sunscreen, or may have used another substance on your skin (like makeup) that doesn’t mix well with your anti-aging cream.

Typically we suggest that you stop using everything and reintroduce one at a time. You may have used too much. Try smaller amounts, and see if you can again get the improvements without the irritation. If it persists, go to your dermatologist for help.

Question:
I had my eyebrows waxed by a new technician a few months ago, and she shaped them too thin. I’ve been trying to grow them back and have them reshaped into a thicker shape. But the hair isn’t growing back like it used to when I was younger. Is this normal? What can I do to stop looking like I’m permanently surprised?
Answer:

Eyebrow hair growth, just like other hair, requires a healthy diet, rich in protein and nutrients. However, the amount of hair that grows in the eyebrows decreases with age. To make sure that aging is not the only explanation for the loss in eyebrow hair, visit your dermatologist. They can work you up and make sure that there are no other medical reasons.

Question:
What products are good for a woman who’s still getting breakouts but is also seeing the beginnings of wrinkles?
Answer:

The best products for women that are still breaking out and want to start anti-aging products are those that are labeled “oil free” and don’t contain wax. They typically help prevent acne and are sometimes labeled as “noncomedogenic.”

Question:
Besides surgery, is there anything you can do to reduce spider veins in the legs?
Answer:

There are some creams that contain caffeine that help decrease the size of the blood vessels. It may help diminish the appearance of your existing blood vessels. Preventing the formation of more spider veins is easy if you protect your skin from the sun with sunscreen and vitamin antioxidants A, C, and E, as well as having a healthy lifestyle.

Question:
I know I should be eating better, getting some exercise, sleeping more, etc. How much of a difference does that make for my skin?
Answer:

Exercising, drinking water, eating fresh fruit, vegetables, lean meats, and whole grains help your body fight free-radical damage that leads to fine lines and wrinkles. Not doing these things can contribute to the growth of dull, uneven skin that’s wrinkled and looks unhealthy. Your body and your skin deserve the best.

Question:
What is the single best thing I can do to keep my skin’s youthful appearance?
Answer:

The single most important step to keep your skin youthful is to avoid the sun. Use sunscreen with antioxidant vitamins and wear protective clothing and coverings.

Question:
Is there really any benefit to buying one product over another, or is it all just hype? What ingredients really are worth looking for in a product?
Answer:

The ingredients are the most important aspects of any moisturizer. Look for antioxidant vitamins A, C, and E. In addition, make sure you’re using a sunscreen and exfoliants, with an alpha-hydroxy acid (AHA). Some companies may not put enough of the ingredients in to make a difference. Stick to the companies that you trust.

Question:
I wear sunscreen and sunglasses and have even started using eye cream. But I’m still getting crow’s feet. Is the damage done? Is there anything else I can do to prevent or minimize them?
Answer:

Eyes are typically the first place that my patients complain of wrinkles. The muscles around the eyes contract frequently and secondarily wrinkle the skin covering it. Make sure that you’re not overlooking simple solutions to stop contracting your eye muscle, such as getting the proper prescription on your eyeglasses or contacts. Are you squinting? Are you smoking and frequently squinting as a result?

In addition to decreasing excessive muscle contraction, you should add vitamins A, C, and E to your eye moisturizer, and apply it twice a day. Good job with the sunglasses and sunscreen! Find a cute hat, too!

Question:
Does sunscreen with an SPF over 30 actually work? Or are the claims for anything over 30 just hype?
Answer:

SPF 30 is effective because it provides protection from both UVA and UVB rays. When SPF is greater than 30, it should mean that in addition to chemical sunscreens, the makers have included titanium dioxide and/or zinc oxide, which provide physical barriers, and are actual sunscreens. Irrespective of the SPF, you’ll need to reapply the sunscreen every 2 hours.

Question:
Can stressful events (divorce, death of a parent, etc.) actually age my skin? If so, how does that happen and is there anything I can do?
Answer:

Stress has effects on our skin, nails, and hair. Also, if you have an underlying skin condition, such as psoriasis, eczema, or acne, stress can make it worse. Furthermore, stressed facial expressions contribute to expression lines, like the 11 wrinkle between your eyebrows, and those around your eyes and mouth. Learning how to effectively manage stress helps keep your skin looking younger, and also you’ll feel better overall.

Question:
Are there toxins in the air/environment that will age my skin? If so, how are they fought?
Answer:

Ultraviolet radiation, as well as toxins from smoking and smog, all contribute to free-radical damage and aging in your skin. The best way to fight the aging process is to avoid the sun between 11 a.m. and 3 p.m., wear sunscreen, protective clothing, avoid secondhand smoke, or if you do, stop smoking.

Skin care should include antioxidant vitamins A, C, and E as well as moisturizers. Drinking eight glasses of water, fresh fruits and vegetables, lean meats, and whole grains also help keep your skin beautiful, inside and out.

Question:
Are there any age-advancing toxins in the chemicals that I use to clean my home? Anything I should do to protect my skin?
Answer:

Protecting your skin from cleaning chemicals in your home is an important and healthy step for your skin. Toxins can cause irritation and breaks in the skin that can lead to infection. For that reason, protect your skin with gloves when dealing with chemicals. If toxins accidentally come in contact with your skin, rinse off immediately.

Question:
Should I be applying moisturizer to my neck? Will that help to prevent neck lines as I age?
Answer:

Neck lines and sagging neck are common complaints. Most patients ignore their necks until they notice how aged their necks look. The neck skin is fragile and requires more moisture than the face. Just like you moisturize your face you should be moisturizing you neck. You’ll be glad that you did.

Question:
Are certain foods linked with healthy skin? I was told that oatmeal is good for the skin; is there truth to that statement?
Answer:

Healthy foods help your skin become healthy, also. Skin is made up of proteins. So lean proteins are necessary in your diet. Examples include lean chicken, fish, and tofu if you’re a vegetarian. Fresh fruits, like papaya and blueberries, and fresh vegetables and whole grains also contribute to healthy skin. Hydration also helps your skin fight off signs of age.

Question:
Are there natural ways to help firm up the skin on my face for a more youthful look?
Answer:

The most natural way to help your skin look younger and firmer is to incorporate the following anti-aging steps:
1. Exfoliate, gently and daily. (Exfoliating cleanser)
2. Use a moisturizer with sunscreen and antioxidant vitamins A, C, and E.
3. Moisturize at night with a second dose of vitamin A (retinol) and peptides.

Question:
What are the best ways to exfoliate to prevent breakouts? How often is it recommended?
Answer:

Exfoliation is one of the most important steps to prevent and treat acne. There are three types of exfoliation: manual (with beads or crystals), chemical (AHA, BHA), and enzymatic. Acne exfoliation is best done with salicylic acid and gentle beads.


Thank you for joining us for WebMD Ask the Dermatologist. Be sure to come back on Nov. 17 at 1 p.m. ET when we will discuss how to age beautifully and continue looking your best. Sign up if you'd like an email reminder the day before our next event.

WebMD Ask the Specialist Transcript

Reviewed by Louise Chang, MD on October 13, 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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