Your Skin: Are You Doing Too Much or Too Little?

Either Way, Your Face Loses. Here's How to Get Amazing Results in Four Simple Steps

From the WebMD Archives

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Most women obsess about wrinkles the way teens obsess about pimples — but fine facial lines aren't the only age giveaway. Dermatologists agree that the single best way to look younger is to deal with all four big issues: wrinkles, yes, but also sagging, discoloration, and redness. "The key is to treat your face as a whole," says Robert Weiss, M.D., associate professor of dermatology at Johns Hopkins University. "If all you work on is wrinkles, no one will ever tell you what great skin you have." Does that mean skin care becomes your day job? Nope. You can get major results in minimal time, either at home or in the doctor's office. Here, the best advice for anyone who's already celebrated her 30th birthday.

Read Your Face: The 4 Signs of Aging

Sagging Skin

Gravity does take its toll, but something else is at work here: Over time, the skin's underlying structure breaks down, robbing our faces of their definition, youthful plumpness, and resilience. Skin also renews itself much more slowly than it once did. Thanks to all these factors (not to mention genetics, weight changes, and sun damage), skin starts to sag and hang (that's where jowls come from). And some doctors say that once skin starts to slacken, pores often look larger, as if they've been stretched out of shape.

What you can do at home: No easy fixes here. "Tightening sagging skin requires more intervention than any other problem," says Ranella Hirsch, M.D., spokesperson for the American Society for Dermatologic Surgery. A good moisturizer will plump skin temporarily, Dr. Hirsch says. But if the cream is too heavy, it will clog those oversize pores. The best at-home solution: what the beauty industry calls an "active" treatment, such as an over-the-counter vitamin A (known as retinol) cream, vitamin C serum, and alpha or beta hydroxy acids (AHAs or BHAs). These usually go on at night and help skin renew itself faster and look firmer. Try Garnier Nutritioniste Ultra-Lift Firming Moisture Cream ($15, drugstores), which contains vitamin A.

As for pores, you can't shrink them, but you can minimize their appearance, says Jeanine B. Downie, M.D., a dermatologist in Montclair, NJ. "Pores will look smaller if you keep your skin clean and protected from the sun," she says. If they really bother you, try pore-minimizing makeup or a cream like Dermadoctor Picture Porefect Pore Minimizing Solution ($40, And, of course, daily sunscreen is a must. Try Skin Effects Sun Effects Sunscreen Lotion ($16, CVS).


What a doctor can do: Not interested in a face-lift? That's fine — there are noninvasive procedures worth investigating. Both infrared and laser treatments help stimulate the development of new collagen and "get heat deeply into the skin to help tighten fibrous bands," explains Dr. Weiss, who is also vice president of the American Society for Dermatologic Surgery. Ask your doctor about the Palomar Lux DeepIR, Cutera Titan, or CoolTouch. "Although we haven't found the perfect device for dealing with sagging skin, the technology is getting better all the time," Dr. Weiss says. And although these treatments are pricey and you'll need several sessions, the results are visible and impressive. To help improve the look of enlarged pores (and speed up skin's renewal process) at a much lower cost, ask a doctor about a prescription for Retin-A. "Whether you're dealing with acne or wrinkles, it's been proven to work on many levels," says Dr. Hirsch.

Rough Texture (and, Yes, Wrinkles)

Why can't we all have baby-smooth skin? As your body ages, it produces less oil (which means the skin, especially the top layer, gets drier); plus, your skin's under-the-surface structure is not as elastic or supple as it used to be, so it takes longer to bounce back than it once did. The visible results of these changes: fine lines, deep wrinkles, dry patches, crepey areas, and increased healing time for scars and breakouts.

What you can do at home: Moisturizer helps, but it can't do the entire job. To treat texture issues along with the dryness, go for an active treatment, one that's as strong as your skin can tolerate. This will chemically exfoliate the surface and speed up the renewal process so your skin looks smoother. Try Neutrogena Healthy Skin Face Lotion ($10.50, drugstores). But don't overdo it or fixate on one area. "A lot of women I see get focused on one or two wrinkles in particular," says dermatologist Manjula Jegasothy, M.D., director of the Miami Skin Institute. "They overtreat those areas with something very irritating, which only creates more problems," she says. If your skin is reasonably tolerant, do an at-home peel or use a microdermabrasion kit at least once a month. Relax your face whenever possible, since scrunching and squinting only contribute to the problem. (You can also reduce squinting by wearing sunglasses and having your eyes checked to see if you need new glasses.)


What a doctor can do: Treatments abound, from injectables like Botox (which relaxes furrowed areas) to peels (deep chemical exfoliation) and laser resurfacing (another form of intensive exfoliation). All will dramatically improve your skin's surface texture, but all require multiple treatments — not cheap — as well as regular maintenance (frequency depends on the specific treatment).

Discoloration and Dullness

Though we hate to see a new wrinkle, it's often random facial spots and patches of darkness that make us look tired or older. In fact, one Procter & Gamble study found that people were perceived as older simply because of their skin tone. Pigmentation problems are often a result of sun damage. "In the movies, makeup artists who want to quickly age a character often do it the easy way: by painting on constellations of brown spots and sun damage," says Dr. Hirsch. If that can make a 30-year-old movie star look 70, imagine what it does for the rest of us. Another instant ager: dullness, which usually results from dead cells collected on the surface of the skin.

What you can do at home: First, study your skin when it's clean. If you see unevenness, start using the active combination of vitamins A and C to help skin turn over old cells and reveal new ones faster, advises Dr. Weiss. The result is brighter skin and less noticeable pigmentation. Try Philosophy Save Me ($60, You can also use a gentle facial scrub like Nivea Q10 Gentle Spa Micro-Dermabrasion Kit ($20, drugstores) or an at-home peel like Good Skin All Bright 2 Step Facial Peel Pads ($30, Kohl's) up to four times a month, depending on how blah your skin looks. Bathe in sunscreen daily (an exaggeration, but you get the idea) to prevent further discoloration, and apply bronzer to help disguise problem areas.

What a doctor can do: If you have only a few superficial spots, ask about a light chemical peel or microdermabrasion, which will take off the top layer of skin, says Joshua Wieder, M.D., an associate clinical professor of dermatology at the University of California, Los Angeles. If you need a more potent plan, look into a series of Intense Pulsed Light (IPL) treatments. The improvement is gradual, Dr. Wieder says, but freckles and other dark spots eventually lighten dramatically or disappear altogether.


Redness and Sensitivity

Skin gets thinner and more delicate over time, and blood vessels weaken and enlarge, so many women develop this type of discoloration as they age. Age-related redness can be heightened if you also have reactive skin (meaning you flush easily), visible "broken," or dilated, capillaries, or rosacea.

What you can do at home: While active products are usually very helpful, they're a mistake for women who have sensitive skin. If a cleanser or moisturizer tingles or burns, trade it for a gentler product that doesn't irritate your skin. Try Purpose Gentle Cleansing Wash ($6, drugstores) and Cetaphil Moisturizing Lotion ($10, drugstores). If you're already using anything with retinoids, AHAs, or BHAs, scale back to a more gentle cream with antioxidants like green tea, soy, or idebenone. Try Prevage Anti-Aging Treatment ($150, department stores). Tip: Even if you don't have rosacea, dermatologists say, you may benefit from using products designed to treat that condition. Try B. Kamins Chemist Booster Blue Rosacea Treatment ($70, And in general, handle your skin with care: no scrubbing, picking, or unnecessary roughness, especially in the superdelicate undereye area.

What a doctor can do: Prescription medications that usually help include MetroGel (generic name: metronidazole), a topical, and Oracea (generic: doxycycline), which comes in pill form. In addition, an M.D. can use certain lasers to zap blood vessels and thereby help alleviate redness. One example: A pulsed-dye laser, like Vbeam or V Star, will reduce unwanted rosiness without leaving bruises and can target specific blood vessels. You should see a noticeable difference after two to four treatments, but laser therapy is pointless if you don't add sunscreen to your daily routine, says Dr. Wieder.

Your Simple Daily To-Dos

Although skin care is individual, there are easy steps everyone can follow to get her complexion in great shape. The starting point: You can and should use an "active" treatment, but you need to pick one your skin will tolerate. Otherwise, your face will just end up looking red and irritated. (The one group that should not use an active treatment: women with a tendency for redness.) So pay attention to your skin's reactions and adjust your routine accordingly. "With any active [especially Retin-A], you'll experience a break-in period involving some irritation. But stick with it, being careful to use only a pea-size amount. Start with two or three applications a week and work up to using it every night," Dr. Hirsch advises. "Over six to eight weeks, your skin will adjust and the redness and flaking will disappear."


Every morning: Use a gentle cleanser if your skin feels dirty. Otherwise, just put on your moisturizer, then sunscreen.

Every night: Remove your makeup with a gentle cleanser (to get skin really clean, massage it for more than a minute, then rinse). Pat dry. Apply your active treatment (a gentle antioxidant cream if you have sensitive skin, or a retinoid or AHA/BHA if your skin is more tolerant). Finish with a basic (nonactive) moisturizer to hydrate skin and counteract any dryness or peeling brought on by the treatment.

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