What Can My Derm Do to Help?
These days? A lot. "Dermatologists and plastic surgeons have a whole arsenal of light-based treatments available," says Dr. Friedman, who recommends pigmented-lesion lasers such as ruby, Nd:YAG, or Alexandrite for specific spots, and the Fraxel laser for allover improvement of substantial irregular pigmentation. For more subtle, diffuse discoloration, Dr. Wattenberg prefers a series of intense pulsed-light photofacials. Some spots can be zapped in one session; more stubborn or severe discoloration can require multiple treatments. Another option: glycolic, alpha, or beta hydroxy acid peels, which slough off the surface layers of skin, softening the appearance of uneven tone. Some doctors will combine peels with laser or light therapy, and they will almost always prescribe at-home treatment as well. "In-office procedures are quicker, but they work best when accompanied by home therapy," says Dr. Wattenberg. Costs for most in-office treatments vary depending on several factors (the size of the area being treated, the severity of your condition, and the going rates where you live); the average is about $500 per session for pigmented-lesion lasers; $1,000 for Fraxel; $150 and up for peels. (Bonus: Many of the treatments will also help with wrinkles.)
How Can I Fix My Skin's Texture?
Skin damage is cumulative — so by the time you've lived through everything from breakouts to years of sun exposure, while at the same time your cells are producing less moisture and collagen, even good complexions eventually become somewhat bumpy and uneven. Can you return to a baby-butt level of smoothness? Sorry, no — but you can improve your skin's look and feel.
The best way: Boost collagen with the right products. "We lose a lot of collagen as we age, so we definitely need to compensate," says Dr. Hirsch, who recommends prescription-strength retinoids such as Renova (No. 9) and Retin-A. They're so good at stimulating collagen, "they should be in the water," she jokes. If you wish for an even more dramatic change, talk to your doctor about the in-office peels and laser treatments that are used to treat age spots — most also have a positive effect on texture.
The at-home way: To get quicker (though less dramatic) results, use a home-peel kit, says Dr. Hirsch. Know that highly abrasive isn't better; in fact, those products will irritate sun-damaged skin, she says. Instead, stick to chemical options and avoid harsh, grainy scrubs.
To try: Good Skin All Bright 2 Step Facial Peel Pads ($30, Kohl's).
Need To Know
Is Hydroquinone Safe?
This effective spot-bleaching ingredient is banned in some European and Asian countries, largely because of studies in which cancer developed in rats that consumed extremely large amounts of it over extended periods of time. And last year, the FDA announced that it was reexamining the safety of hydroquinone. However, most U.S. experts — including the American Academy of Dermatology — stand firmly behind the drug. "Hydroquinone has been used over the last 40 years, and there has not been a single documented case of either skin cancer or internal cancer associated with it," says Dr. Friedman. Like all drugs, it needs to be used properly, and he recommends that his patients apply it no more than twice a day for no longer than six months. Adds Dr. Hirsch: "When used as intended, and for a finite time, this drug is safe and is the most effective treatment available for pigmentation. Period."