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Nonsurgical Cosmetic Work: Ask the Dermatologist

Dermatologist Doris Day answers your questions about nonsurgical cosmetic procedures.

Question:
What nonsurgical treatments are effective on fine lines just above the upper lip?
Answer:

The skin is also relatively thin in this area so some wrinkling is an inevitable part of aging but this can be addressed by using skin care products with ingredients such as retinols, antioxidants, and peptides. If you want to help hold off these wrinkles for as long as possible, start with protection – use a moisturizer with effective protection (broad spectrum SPF 15) and avoid smoking if possible. Then make the most of your skin by using ingredients and products designed to firm your skin. Look for ingredients such as retinol and topical vitamin C among other antioxidants. Also be sure to not smoke, don’t drink through a straw, and always wear sunscreen.

Question:
I am an African-American lady. What do you recommend for evening skin tone on the face and on the body?
Answer:

Be sure to use a sunscreen. No matter what your skin tone, a wide-scale global consensus exists among experts that daily, year-round, broad spectrum photo-protection of at least SPF 15 is a key part of a sun-safe strategy to decrease cumulative lifetime exposure to solar UV. Also, niacinamide has been proven to be effective at improving skin tone, as have ingredients such as retinoids, mulberry root extract, and sepi-white. It is also important to keep your skin hydrated to avoid dry skin and irritation from dry skin. Proper exfoliation on the face and the body is important, too.

Question:
Are there any nonsurgical methods for fading age spots on the face?
Answer:

Start by using sun protection every day all year round and reapplying every two hours if you are outdoors. This will allow your skin to repair itself as much as possible. I would also start with an over-the-counter regimen of moisturizers, retinoids, and antioxidants. Products that contain hydroquinone have been known to brighten the skin. Niacinamide is also effective for reducing age spots. Other ingredients such as glutathione, sepi-white, n-acetyl glucosamine, licorice root extract, mulberry root extract, and azeleic acid can also be helpful.

Question:
Botox is expensive and to redo every four or so months adds up to big bucks. Is there any that lasts for a year or more? Any news on injections for turkey necks?
Answer:

There are no treatments similar to Botox that last longer. Botox does work very well in the right candidate to smooth neck bands, but not for excess skin. There are new radiofrequency, and less invasive liposuction-like devices that are coming in the next year or so that may work well for "turkey necks" but nothing beyond liposuction and plastic surgery for now.

Question:
Is there any product in a jar that will significantly tighten up the sagging and loose skin under the chin and jaw, including jowls, to where it will be visually noticeable? Also, is Thermage effective for this problem?
Answer:

Loss of firmness is a common concern in aging skin. Skin experts have long known that the loss of skin's firmness is a naturally occurring part of the aging process fueled in part by changes in the deeper layers of skin caused by decreases in functional hyaluronic acid (skin's natural "plumper") and accumulated damage to collagen and elastin, the elastic fibrous protein in skin's connective tissue. Combined, these changes lead to the loss of skin's firmness and an aged appearance. Products that contain ingredients such as niacinimide, caffeine, glycerine, and hyaluronic acid can be effective in firming skin. With the proper skin care, you will see observed the benefits.

Thermage can be highly effective in the right candidate. This is a procedure done by your dermatologist that uses radiofrequency energy for tissue tightening and can be used both on the face and other areas of the body.

Question:
I have moles on my face and I would love to have them removed, will they leave scars? And what about a birthmark on my forehead, can that be remove or faded?
Answer:

Any time an incision is made in the skin there is a risk of scarring. Some people are more prone to keloids (overgrown collagen after wounds in the skin that lead to raised firm scars which can be itchy and unsightly). I rarely recommend lasers for removal of moles since this removes the pigment but makes them more difficult to follow for change, which is important in evaluation of skin cancer.

Question:
Is Botox safe to use for frown lines and wrinkles? Do you know of any product that will remove the laughing lines?
Answer:

Botox is very safe for frown lines and wrinkles but must be done by trained aesthetic physicians such as dermatologists or plastic surgeons. Lasers are also effective in these areas, especially when combined with Botox.

Question:
Are certain skin types (ethnicity) more likely to scar or have bad reactions to treatments like peels and laser?
Answer:

Some people are more prone to poor wound healing or keloids, which are raised, firm scars that can often be itchy and may even be disfiguring. Keloids are more common in African-Americans but can occur in all skin types. If you are prone to keloids, you should let your doctor know and think very carefully before having any body piercings or elective surgery.

Question:
Is there anything I can do to prevent uneven tones in places like between my thighs?
Answer:

Weight gain can be an issue there since the rubbing of thighs leads to friction, irritation and that can cause uneven pigmentation. Wearing loose, cotton pants can be helpful in avoiding the irritation, absorbing moisture and minimizing friction. Powders such as Zeasorb powder can also be helpful in keeping the skin dry in this area.

Question:
I am debating getting eMatrix RK for wrinkles and some scarring around my mouth area. Should I? How long does it last? If you do not recommend this, what else can I try?
Answer:

The eMatrix uses radiofrequency energy but also a technology that is fractional and "sublative," meaning that there is very little time needed for recovery and a broader range of skin types can have the treatment since it is gentler on the skin. I have been impressed with the improvement in acne scarring, however several treatments are needed and you should be evaluated because some scars will improve more than others. It is important to understand that most scars will be improved but not completely resolved unless they are very superficial.

Question:
I am 65 years old. I've suffered from facial scars for years. I’ve tried to hide them with makeup, plus used many so-called scar removal creams to no avail. Is there anything I can do for scars other than laser peels?
Answer:

The main ways to remove unsightly scars are to have them surgically removed and hope the new scars look better, or laser resurfacing to improve the texture or intense pulsed light or pulsed dye lasers to improve the pigmentation and redness. The newer fractional CO2 lasers have been used with excellent success on many scars and are a great advance over previous laser treatments.

Question:
Is there a laser procedure that raises eyebrows?
Answer:

Radiofrequency treatments such as Thermage and Aluma have been effective in raising eyebrows in the right candidates. I often use this in combination with a neurotoxin such as Botox or Dysport for the best effect.

Question:
I'm interested in your opinion of dermal fillers.
Answer:

There has been a virtual revolution in our ability to rejuvenate, sculpt, contour and enhance without surgery with the FDA approval of new soft tissue fillers. The newest product to gain FDA approval is Sculptra, which is more of a volumizer to help your body restore its own natural collagen and lasts 2-4 years. Other fillers such as Radiesse, Restylane, Juvederm, and Perlane are also excellent options. These are medical treatments that are safest and most effective when performed by trained aesthetic physicians, rather than in a spa or by a non-aesthetic physician.

Question:
I need a "quick fix" for a few sunspots and skin tightening. I have my daughter's wedding and can't afford expensive laser treatments prior to that time. A local skin care clinic does "photo facial" treatments. Will that give me the results I desire or will it make the situation worse before it gets better?
Answer:

Photofacial treatments use intense pulsed light to help even out skin tone and reduce redness. This can be very effective, but should be done by or under the close supervision of your dermatologist. Multiple treatments are usually necessary for best results. There can be some redness for a few hours to a day or so after the treatment.

Question:
What should you do or not do before you get a professional-strength chemical peel?
Answer:

You should speak with your physician and tell them about any product or drug allergies and make sure you let them know all the products, prescription or otherwise, that you are using on your skin. Also let them know if you are prone to cold sores on your face.

Question:
I am 33 years old with premature lines on my face. I have booked an appointment to have a fraxel resurfacing procedure done but I am concerned about some comments on the Net made about fraxel scarring women, causing skin cancer, causing hyperpigmentation, skin lesions, etc. Are any of these side effects possible, and if so what are the chances that it will happen to me? Do the settings of the laser make a difference?
Answer:

As with any laser/surgical treatment, it should only be done after consultation and by or under the direct supervision of a trained aesthetic physician such as a dermatologist or plastic surgeon. They will know if you are a good candidate for the procedure, explain to you what you can expect and how many treatments you will need, as well as decide on the best settings for your skin type and condition.

Question:
What I should do to get rid of eye puffiness? And if I’m looking for cosmetic surgery, do I need general anesthesia?
Answer:

Look for under-eye creams that contain ingredients such as niacinamide, peptides, and caffeine. Be careful to also manage your salt intake, get enough sleep, and try not to rub the area around your eyes. If you have allergies/sinusitis, be sure to keep them under control as much as possible since that can also contribute to the puffiness in this area. The under-eye area is also one place where stress shows very quickly, so managing your stressors is helpful as well. Avoid heavy eye creams that trap moisture into the skin and may cause puffiness. Make sure you use a full face product with anti-aging ingredients that deliver firmness and protect skin from UV damage, and ensure you add a targeted eye cream or serums for extra care.

Question:
I am 51 years old and am considering some facial treatments for my skin. Can you tell me the difference in microdermabrasion, peels, and all the other choices that are available? I don't know where to start. Wrinkles and fine lines are overtaking my face!
Answer:

The place to start is with proper skin care and this means sun protection every day all year round. After that I recommend using products that contain retinoids. You should also have your dermatologist evaluate your skin to better guide you as to whether or not microdermabrasion, chemical peels, or laser peels would be best for you. Microdermabrasion is a superficial treatment that may help fine lines and wrinkles when used with the right skin care products. There are many different types of chemical peels available, some are superficial and others can go to deeper layers of the skin. They should be done by your aesthetic/cosmetic dermatologist in order to have the best results and minimize risks.

Question:
Do any of the new laser resurfacing procedures help diminish pore size?
Answer:

The newer fractional CO2 lasers, my favorite is the Lumenis Encore, do help diminish pore size very effectively. However, there is no treatment to eliminate pores entirely.

Question:
I used to have very large round cheeks when younger, and now as 55, I have nasolabial creases worse than friends 10 years older. But it’s just excess skin, not muscle, so I wondered what the least invasive, lowest-risk options are? The "weekend lifts" seem great, but I've heard not so good reviews.
Answer:

There are excellent nonsurgical treatments available. Radiofrequency treatments such as Thermage can help tighten the skin and give a little lift, soft tissue fillers and volumizers such as Radiesse and Sculptra placed in the correct areas of the cheeks along the jaw line and nasolabial folds can rejuvenate, tighten and lift very nicely, and the results can last 2-4 years with touch ups intermittently after that to maintain and enhance the results. If you are set on a facelift, I would recommend seeing a board-certified plastic surgeon to have all your options explained in detail.

Question:
What is the most effective way to remove facial hair, i.e. chin and lip area? Do lasers work as effectively as electrolysis? Should I get treatment only at a medical doctor’s office, or are salons trained to do laser hair removal? Thank you for the reply.
Answer:

Laser hair removal is the most effective and lasting way to remove hair in the right candidate. It works best for those with lighter skin and darker hair. Usually 6-8 treatments are needed and sometimes intermittent touch ups are needed as a single treatment every year or so to maintain the results. The treatment does have risks and should be done by or under the close supervision of your dermatologist in order to minimize risk of burns or discoloration after the treatment and to maximize the efficacy of the treatment.

Question:
I have a skin tag/mole on my face that bothers me. It does not hurt but it is not pretty either. I have heard that I can remove it using dental floss. Is this true?
Answer:

The best and safest way to remove any lesion on your face is to have it done by your dermatologist or plastic surgeon. The problem with dental floss is that you can have irritation, discoloration, and even infection, which might leave a lasting mark on your face.

Question:
I had my son 19 months ago, and I still have some loose skin on my belly from my pregnancy. How can I tighten up the extra skin?
Answer:

Radiofrequency treatments such as Thermage can help tighten the skin in this area to some extent. Your dermatologist will be able to evaluate and determine if this is the right treatment for you.

Question:
What is "fraxel" and how does it compare to a CO2 laser peel?
Answer:

Fraxel is a non-ablative erbium-glass treatment that has been used to improve acne scars and uneven pigmentation with some success. Usually 4-6 treatments are needed. There is usually little down time with redness and scaling for a few days after the treatment. Fractional CO2 treatments build on the gold-standard CO2 resurfacing laser for improvement of lines, wrinkles, sun damage, and other signs of aging. Usually only a treatment is needed but it is ablative, which means that there is greater recovery time, usually about 7-10 days.

Question:
Is the lifestyle lift a good, safe procedure? I would like a tiny pinch to lift the sag.
Answer:

I have seen mixed results from this procedure, and my recommendation to my patients has been to seek the advice of a plastic surgeon for a complete evaluation and further guidance.

Question:
I was wondering about permanent makeup and the effects on facial skin. I was considering semi or permanent eyeliner. How will this affect my skin and eyelid tissues?
Answer:

Permanent eyeliner can be very natural and highly effective in creating a natural contour and outline for the eyes with very low risk of allergy or change to eyelid tissue. Be sure to be evaluated and treated by a board-certified permanent makeup artist for the safest treatment and best results.

Question:
I am African-American and I have balding or alopecia in my hair. I have stopped using any type of chemicals on my hair so now it is all natural. Would using Rogaine for men help my hair to grow faster than using Rogaine for women? My dermatologist recommended Rogaine for men and I want to make sure this is OK.
Answer:

Rogaine (minoxidil) can be effective if there is no scarring and the follicles are intact. Rogaine for men is more effective, but some of the product is absorbed into the body and can cause increased unwanted hair growth in areas such as the chin or other areas of the face.

Question:
Is there an OTC version of Latisse? What is it called? Is it effective? Thanks!
Answer:

There are no over-the-counter versions of Latisse. There are products that call themselves eyelash conditioners, but Latisse is an FDA-approved product that contains a drug that would not be legally available in OTC products. The good news is that Latisse is eye-safe, has FDA approval, and is highly effective for growing lashes.

Thank you for joining us for WebMD Ask the Dermatologist.

WebMD Ask the Specialist Transcript

Reviewed by Doris Day, MD on January 20, 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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