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Skin Rejuvenation: Ask the Dermatologist

Dermatologist Susan Evans, MD, answers your questions about skin rejuvenation.

Question:
I use a 2% salicylic acid cleanser and benzoyl peroxide acne cream, but I've heard salicylic acid and benzoyl peroxide can negate the antiaging effects of retinols. What kind of anti-aging night cream do you recommend I use?
Answer:

The combination of salicylic acid and benzoyl peroxide increases the risk of overdrying your skin. As your skin matures, there is a greater requirement for hydration. For antiaging benefits, use retinol cream nightly. Retinol has demonstrated the ability to increase cell turnover and encourage new cell growth.

Question:
I have developed wrinkles on my face after a 35 pound weight loss. What should I do?
Answer:

Significant weight loss can also affect the fat pads around your cheeks and eyes, creating a "hollowed/wrinkled" appearance. Your next step (other than regaining your weight) would be to have an evaluation by your plastic surgeon or dermatologist. Your surgeon may recommend fillers, fat transfer, or stem cell micro-injections to restore volume to your face.

Question:
What can I do to treat the bags under my eyes? It doesn't matter if I have plenty of rest or not. I still wake up with bags under my eyes!
Answer:

Severe bags under the eyes are also known as festoons. Your condition may require an evaluation by your surgeon. If you are the appropriate candidate, there are several minimally invasive techniques to remove the fat pads without an external incision. This is known as a transconjunctival technique.

Question:
I'm getting the fat from my belly taken out. Since it's not liposuction, will it leave my belly skin hanging? I'm a mid-size woman who is 52 years old. I work out at least 3 times a week.
Answer:

The best way to address your concern is to evaluate the quality of your skin prior to your procedure. If you skin lacks elasticity, contains significant stretch marks, or your abdomen is "hanging" below your beltline (known as abdominal pannus), there is a good chance that if you only remove the fatty deposits, you may be left with loose, hanging skin.

Question:
I have had an "age spot" on my face for many years, but now a red, raised area is growing in the same area of the age spot. In the last two weeks, it has grown quickly. What should I do?
Answer:

Any sudden change in the area, border, color or diameter of a skin lesion warrants immediate attention by your physician!

Question:
I read that olive oil is good for hydrating the skin. Is it safe to leave on my face overnight, and is it OK to use as an eye makeup remover?
Answer:

Olive oil is a wonderful moisturizer. Olive oil is non-comedogenic (non pore-clogging). Natural olive oil will also work well on sensitive skin. Olive oil can be used as a makeup remover.

Question:
What is the best type of product to use to keep lips moist? I have tried many products, and even make sure to use them at night -- every night -- and my lips seem to absorb the moisture instantly. Is there a particular ingredient that works best?
Answer:

Your first step is to exclude any medical problems such an infection or any changes associated with skin cancer. Next, you may consider adding a small amount of over-the-counter hydrocortisone cream at .05% strength to your moisturizer if your lips are severely dry and chapped.

Question:
Is it true that diaper rash ointment makes a good facial mask? If so, how much should be applied? How often is it safe to use, and how long do you leave it on?
Answer:

Many diaper rash ointments contain zinc oxide and/or vitamin A and vitamin E. These compounds have well-documented healing properties and are good for the skin. The biggest downside is the residual white film left on your skin from the zinc oxide.

Question:
Is it absolutely necessary to use a toner after washing my face?
Answer:

Toners are not an absolute necessity for your skin care regimen. A toner is designed to help remove excess surface oils to allow moisturizers or antibacterial washes (in acne treatment preparations) penetrate into the skin. Avoid toners with a high alcohol content; this may lead to excessive drying of the skin.

Question:
What causes milia? How can I avoid getting these?
Answer:

Milia, also known as whiteheads, are very common white pimples that can occur in persons of all ages. They appear mostly on the upper cheeks, nose, and chin of infants. This occurs when dead skin cells and sebaceous matter gets trapped near the skin surface rather than exfoliating naturally.

Common causes of milia include the use of thick and heavy cosmetics, or poor-quality products that are not suitable for the skin that prevent the sloughing-off of dead skin cells. Excessive sun exposure makes the skin thick, which leaves it unable to exfoliate naturally.

Question:
There are many antiaging products available, but they seem to be for people with "normal" skin. I am 56 years old, have fair, sensitive skin, and the products I have tried are too irritating. What can I do to fight wrinkles?
Answer:

Incorporate products that are designed for sensitive skin (hypoallergenic). Avoid the use of products that contain excessive fragrances, parabens, or preservatives. These additives may cause an allergic reaction on sensitive skin. You may want to consider an evaluation by a dermatologist who is familiar with nonsurgical facial rejuvenation techniques. Options may include fillers and stem cell transfer.

Question:
How do you erase age spots on the face at the age of 65?
Answer:

Your first step is to make sure that the "age spot" is not an early skin cancer. Once this is excluded, your dermatologist can prescribe a combination of exfoliating agents and brightening compounds that may contain hydroquinone, bearberry, or kojic acid to even your skin tone.

Question:
I'm 45 years old and have had oily skin most my life. On my face, my skin doesn't look like other people's skin. My pores are so large around my nose -- you can clearly see large pores filled with dirt. How do I expel the dirt and help make my pores appear smaller so as not to be able to see them?
Answer:

Large, open pores that that appear dark are referred to as open comedones. The darkened areas within the pores are a result of oxidation (and melanin deposits) of the underlying trapped oils and not "dirt."

Your first step is to begin with a treatment regimen that includes exfoliation (glycolic acids), hydration, non-comedogenic natural oils, and compounds that contain a retinoid. A retinoid will increase cell turnover and encourage new cell growth.

Question:
What are the main causes for dark circles under the eyes? I'm 45 years old, and I have a 3-year-old child. My stress level can be a little high at times. Can this be a cause for my dark circles? What can I do to eliminate them?
Answer:

Stress, lack of sleep, and facial edema (swelling) can contribute to dark circles. Obviously, the first thing to do is get more rest. You should sleep at least 8 hours per night, followed by limiting your salt intake in your diet.

Next, consider implementing measures in your daily routine that will encourage the blood vessels around your eyes to constrict or shrink. Apply a cool compress to your eyes and use compounds that contain topical caffeine, such as green tea bags. These measures will help tighten those leaky vessels.

Question:
I am looking for a sunscreen suitable for rosacea skin, as well as a moisturizer that will not set off a flare.
Answer:

If you suffer from rosacea, look for sunscreens that contain zinc oxide or titanium dioxide. Avoid compounds that incorporate preservatives, parabens, or artificial fragrances. It is important to carefully read the ingredients list. Many sunscreens contain chemicals that will cause hypersensitivity/allergic reactions for rosacea sufferers.

Question:
I am 51 years old and never took much care of my skin as I was raising kids. I want to start taking care of my skin, but I don't know how to start.
Answer:

Your first step is to avoid overexposure to the sun, and do not smoke. Sun damage and smoking are the primary causes for premature aging. At age 51, you should have an initial evaluation by your dermatologist to assess your overall skin health and exclude any precancerous changes.

Question:
How can cracked skin at the fingernail tips be helped?
Answer:

Your first step is to maintain good hygiene for your hands. Keep your nails clean and dry. File your nails in one direction, avoid removing your cuticles, or cleaning too deeply under your nails. Moisturize your hands with natural almond, vitamin E, or avocado oil.

If you suspect an underlying infection, your hands should be evaluated by your physician.

Question:
I have a nickel-sized brown spot on my cheek under my eye. When I tan, or am in the sun, it darkens and gets bigger. What is it called, and what can I do to eliminate it? I am 57 years old and postmenopausal. I'm taking hormones.
Answer:

Large brown spots on your face that are changing in area, border, or color should be evaluated by a dermatologist to exclude any precancerous lesions. Once this is determined, your dermatologist may suggest laser removal or a series of chemical (glycolic) peels, followed by skin brightening agents (depending on your skin type) that will help remove these lesions.

Question:
What are the best natural oils to use for moisturizing and diminishing wrinkles, and are they effective as a standalone treatment?
Answer:

Natural oils such as vitamin E, almond, and avocado work well to help hydrate your skin without clogging your pores. Well-hydrated skin cells will help to decrease the appearance of wrinkles. However, for effective wrinkle reduction treatment, your regimen should incorporate exfoliation and the use of retinoid-based compounds.

Question:
I am 61 years old. I have white bumps in the soft tissue under my eyes. I would like to know what they are, and most of all, how to get rid of them. In the past, I have tried to prick them and remove the soft stuff inside, but it is too painful.
Answer:

The most common cause of white bumps in the 60s is either milia, sebaceous hyperplasia, or xanthomas, all conditions that are benign. Your first step should be to check your cholesterol level (lesions may be associated with elevated cholesterol), followed by an evaluation by your dermatologist for removal. Unfortunately, these lesions rarely resolve without treatment.

Question:
I am 27 years old, but I look like I am 37. It makes me feel bad. What can I do about it?
Answer:

Your first step is to limit sun exposure and avoid smoking. Smoking and sun damage are the No. 1 causes for premature aging.

Question:
I have uneven skin tone and little sun spots on my skin. What can I use that will even out my skin tone so it isn't blotchy-looking? Is there a night cream that helps to even out skin tone?
Answer:

Your skin care regimen should include an exfoliator (glycolic or salicylic acid) followed by hydration, and finally, the use of compounds that contain the ingredient tretinoin.

Question:
What is the best antiaging treatment/skin care for people who have acne?
Answer:

Your approach to acne is similar to most effective skin care regimens. Simply add an antimicrobial cleanser (to reduce skin surface bacteria), followed by a skin care regime that includes an exfoliator (glycolic or salicylic acid), followed by hydration, and finally, use a compound that contains retinoin.

Question:
I have combination skin. Which kind of foundation will suit me?
Answer:

If your skin is very oily, look for compounds that are "oil free." For dry skin, look for compounds that are non-comedogenic and hydrating. For combination skin, first determine if your skin is more oily or dry, and go from there. Cream-to-powder bases work great for combination skin. Mineral foundations work well on all skin types, especially sensitive skin.

Question:
I know retinol products are good at reducing fine lines and giving the skin a more youthful appearance, but mild retinol products leave my skin flaky, and it's difficult to apply makeup evenly. How do I cope with the flaking? I also want my new skin to shine through and be able to wear makeup that looks even.
Answer:

Make sure your retinol-based products do not contain other components that may cause an allergic reaction. Avoid products that contain parabens, phenols, and fragrances. Also, if you are hypersensitive to retinol, avoid daily use. If you are experiencing irritation, use retinol-containing compounds every 3 days. You may also apply a mild hydrocortisone cream to help soothe the irritation.

Question:
I am 73 years old and have age spots on the back of my hands. What can I do to eliminate them?
Answer:

Your first step is to have an evaluation by your dermatologist to exclude the presence of any precancerous lesions. Once this is determined, your dermatologist may suggest laser removal or a series of chemical peels (glycolic peels) followed by skin brightening agents (depending on your skin type) to help remove these lesions.

Question:
I am 56 years old. I spent a lot of time at the beach when I was growing up. I have fair skin that can freckle and burn. Now the skin on my face seems dry. I have sagging eyelids and wrinkles everywhere. I need help to navigate the large variety of products that make a lot of claims. Should I start with a dermatologist?
Answer:

Given your history, you are at risk for precancerous skin lesions. Your first step is an evaluation by your dermatologist.

Question:
I am in my 70s, and my skin is very dry, and my pores are getting larger. What can I do to help moisturize my skin and reduce the enlarged pores?
Answer:

Your first step is to begin with a treatment regimen that includes exfoliation (glycolic acids), hydration with non-comedogenic natural oils (vitamin E, avocado, or almond oil), and incorporate compounds that contain the ingredient tretinoin. Tretinoin will increase cell turnover and encourage new cell growth.

Question:
My lips have gotten very thin. What can I do?
Answer:

As we age, our lips may thin due to a loss of volume from diminished fatty tissue or thinning of the underlying muscle. Your first step is to avoid smoking and sun damage. Sun damage can accelerate the aging process.

Your dermatologist may recommend fillers to "plump" your lips. Avoid permanent fillers or non-FDA-approved fillers (silicone).

Question:
I am soon turning 40, and I have noticed dark moles appearing all over my body. I used to have only 5 moles. I now have almost 10 new moles. What causes these dark moles? Most people call them beauty marks.
Answer:

Your first step is to have an evaluation by your dermatologist to exclude precancerous lesions. Many individuals, especially African-Americans and Hispanics, suffer from benign moles referred to as dermatosis papulosa nigra, or DPNs. These "moles" are usually benign, but may increase in number as you age.

Question:
I understand there is a laser procedure for bags under the eyes. This problem is not from lack of sleep, or too much salt in my diet. It is hereditary, and seems to get worse with age. I am 58 years old. What is the procedure called, and what is the approximate cost?
Answer:

There are several skin resurfacing lasers that are designed to improve the appearance of fine wrinkles on the skin. It is impossible to remove eye bags with only laser resurfacing.

The "eye bag" is a much deeper structure within the eye socket. Combining laser resurfacing with eye bag removal (blepharoplasty) is possible, but it may increase the risk of subsequent complications. Overly aggressive laser resurfacing combined with blepharoplasty may cause permanent scarring, and pull the eyelid down into an unnatural position (ectropion).

Thank you for joining us for WebMD Ask the Dermatologist. See other videos and transcripts about skin care and beauty at WebMD Ask the Dermatologist.

WebMD Ask the Specialist Transcript

Reviewed by Susan Evans, MD on May 18, 2011

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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