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Recently, I received quite the multi-faceted question on the FutureDerm Facebook page:
My question is 1. What treatment would you recommend to get rid of acne scars, dark spots, sun damage and small spider veins (on my nose) ? 2. After I get this treatment I really want to protect my skin from further damage so what daily treatments would you recommend for mild acne, oily skin?
I’d really love some advice as I’ve been living with bad skin pretty much my whole life. Thank you in advance:)
Wow – what an interesting question! But don’t feel bad – cases like these are very common in medicine, where very rarely “textbook” cases are seen with just one ailment.
You didn’t mention your skin tone. Many darker skin types do not react as well to some of the more invasive procedures, like IPL, because they tend to have more reactive melanin production and can scar more easily. Similarly, those with darker skin tones can sometimes have a reactive darkening to hydroquinone known as ochronosis. While rare, this is a concern, particularly with 4% hydroquinone.
As always, this advice is provided as a guideline. It is very important that you consult with a board-certified, experienced dermatologist for an individual consultation.
TOP TIER: IPL Photofacials
Skin before and after IPL treatment. Source: Realself.com
- Cost: About $300-500 per session (usually takes 2-7 sessions); average $2300 total. One month between procedures is generally recommended.
- Time of procedure: 30-90 minutes
- Recovery time: Minimal downtime
- Effects last: May be permanent (depends on your lifestyle, UV exposure, etc.). Takes 1-2 weeks to see the full effect.
For your specific array of problems, IPL Photofacials are truly a godsend. They have been clinically proven to treat:
- Sun spots
- Broken blood vessels (telangiectasias)
- Oily skin/acne
- Fine lines and wrinkles
How It Works: From Bedside to Benchside
During an IPL treatment, your eyes will be covered, and a cool gel is placed on your skin. For 30-90 minutes, the smooth glass portion of the handpiece will be gently applied to your skin. You may feel a very slight sting, like the snapping of a small rubber band. This “sting” is the laser emitting energy at wavelengths that fragment melanin and help to dissolve hemoglobin in blood vessels, making them less visible.
At the end of the treatment, your face is cleansed, and a moisturizer with sunscreen is applied. If your skin is particularly reddened or swollen, you may be given an icepack.
Side Effects and Duration
- Redness and bruising generally subside in 1-2 days.
- Age spots may paradoxically look darker for 3-7 days, and then subside thereafter.
- Crusting may last up to ten days.
- The skin is completely healed from a treatment after one month.
- Transient hypopigmentation is a common side effect, where the skin looks lightened for a period of time before returning to its normal state (Lasers in Dermatology and Medicine, 2012).
It is important to speak with your dermatologist or aesthetician before undergoing treatment due to these potential side effects.
MID-TIER: Jessner’s and TCA Chemical Peels
Dysport treatment for crow’s feet. Source: Realself.com
- Cost: About $300-500 for TCA peel; $100-200 for Jessner’s
- Time of procedure: Less than 1 hour
- Recovery time: About 1 week for TCA peel; 2-3 days for Jessner’s (if not less)
- Effects last: 3-5 months
TCA (trichloroacetic acid) peels and Jessner’s peels can be used separately or together. When used together, Jessner’s is considered a “prep” for the deeper TCA, which helps it to be more effective in the short term, and last longer in the long-term. A Jessner’s peel is a superficial peel that is sometimes used alone to refresh young skin (teens, 20s) or mild acne. On the other hand, TCA peels vary from 10-35%:
- 10% is superficial. Considered a bit stronger than Jessner’s. Will take 2-3 days to peel/reach full effect.
- 20% can reach the papillary dermis. Will take 5-7 days to peel/reach full effect.
- 30-35% can reach the deeper papillary dermis. Will take 7-10 days to peel/reach full effect.
What the Studies Show
TCA peels have been clinically proven to treat discoloration, skin tone, texture and fine lines and wrinkles. The disadvantage to TCA and Jessner’s peels in comparison with IPL is that these treatments do not help broken blood vessels.
However, the advantage is that TCA and Jessner’s peels are considered to be more safe than IPL for those with olive and light brown skin, though risks still exist for scarring.
Should You “Prep” At Home First?
In general, yes, though it is best to speak to your dermatologist or aesthetician about your specific case first. Preparation is typically Retin-A or glycolic acid or 4% hydroquinone daily for four to six weeks. This will make the peel more effective, as well as it starts to lessen pigment production and dissolve existing pigment in the skin before the TCA/Jessner’s peel.
For those with more sensitive skin, it may be recommended that TCA peels may be performed without prep. These patients must understand that the results may not be optimal, recovery may be longer, and risk of discoloration is greater.
Last Tier: Take an aggressive approach at home.
Unfortunately, there is not an effective “all-in-one” over-the-counter treatment for acne scars, dark spots, sun damage, and small spider veins. There is a combination approach:
For acne scarring and sun damage: If your scars are not raised, try microdermabrasion. If your scars are raised, use retinoids: either prescription tretinoin (Retin-A) or a potent retinol formula. [Read more: What Can Be Done for Acne Scars?]
For dark spots: Try hydroquinone if you do not have olive or dark skin. My favorites? The original Age Advantage Spot Life Serum ($57.98, Amazon.com), with hydroquinone, kojic acid, and retinol. I also like PCA pHaze 13 Pigment Gel ($32.50, Amazon.com), with hydroquinone, kojic acid, and the AHA lactic acid.
For small spider veins: Sadly, there’s not much you can do at home. I recommend trying Lumixyl Revitaleyes ($65.00 retail, EnvyMedical.com), which contains Haloxyl®. Haloxyl® is a formulation that reduces the appearance of dark circles by calming inflammation and facilitating the release of bilirubin and iron from skin tissues. In clinical studies using Haloxyl, 60% of participants noticed visible lessening in the appearance of dark undereye circles within two months of twice daily use, according to the textbook Formulating, Packaging, and Marketing of Natural Cosmetic Products.
The idea of me recommending an undereye treatment for on-the-nose blood vessels is that the Haloxyl® may calm the bilirubin and iron pigmenting the blood vessels in the first place. But is this a perfect solution? Absolutely not.
Long-Term: As always, use what I call the “big five”: Retinoids; antioxidants; niacinamide; peptides; and sunscreen. My well-touted favorites are Skinceuticals CE Ferulic ($107.00, Amazon.com) and NIA 24 Physical Sunscreen SPF 30 ($42.95, Amazon.com), but I also love the new Neutrogena Ultra Sheer Dry Touch Sunscreen SPF 85 ($8.99, Drugstore.com) for ultima supremo sun protection.
The retinoid treatment is perhaps the easiest to choose: The gold standard is prescription tretinoin, 20 times more potent than over-the-counter retinol. But if prescription is not an option, there is 0.5% retinol in Skinceuticals Retinol 0.5 ($32.95, Amazon.com), 0.6% retinol in Green Cream Level 6 ($42.95, Amazon.com) 0.9% retinol in Green Cream Level 9 ($49.95, Amazon.com), and 1.0% retinol in Skinceuticals Retinol 1.0 ($52.00, Amazon.com). Use these products only at night, as retinol can make your skin photosensitive. You may want to start with a lesser concentration of retinol, applied every 2-3 nights, and gradually work up to nightly use.
As for a nightly moisturizer over top of your retinoid (if desired), niacinamide and antioxidants have been found to have beneficial effects against wrinkles, in various studies. My favorite moisturizer with niacinamide is Olay Regenerist, while my favorite antioxidant moisturizer is RevaléSkin Night Cream.
Once a week, in lieu of your usual nightly routine, use a glycolic acid treatment, provided again that your skin can handle it. (Consult your dermatologist if you are unsure.) Two of my favorite glycolic acid peels are MD Skincare: Dr. Dennis Gross Alpha Beta Daily Face Peel ($75.00 for a thirty-day supply, Sephora.com) and Peter Thomas Roth UnWrinkle Peel Pads ($45.00, Amazon.com).
No matter what your lifestyle or budget, you do have the ability to get rid of acne scars, dark spots, and sun damage! Small spider veins are still, however, only truly treatable at a clinician’s office. What are your favorite methods? Share in Comments!