MEMBER QUESTION:
I've got a lot of dark scaring from acne problems. How can I get rid of them faster? Also what can be done about craters that have formed due to acne?

RODAN:
The dark marks are a common aftermath from a healing pimple. It's called postinflammatory hyperpigmentation and is not a true scar.

First, you must get control of your acne so that you don't continue to get more of these brown spots once the pimple has healed.

Second, in order to remove these brown spots, a combination approach works best. The use of hydroquinone-bleaching agent in a 2% to 4% range used over the entire face once to twice per day, along with daily exfoliation, will help to gradually fade these dark marks over a period of two to four months. Microdermabrasion (a procedure performed either in an aesthetician's or doctor's office) is a deeper form of exfoliation and will allow the hydroquinone-lightening agent to work a little faster. This procedure must be performed every two weeks for approximately 6 to 8 treatments.

The other part of your question, namely the shallow acne scars, can be a permanent fixture on one's face. Removing them is quite difficult and requires treatments performed either by a dermatologist or plastic surgeon. These treatments include CO2 laser or dermabrasion which creates a wound in the skin following which the skin heals with a less noticeable scar. Another alternative involves plumping up the shallow scars with a filling agent like collagen or Restalyn (or other hyaluronic acid derivative) to minimize the depth of the scar. These injections must be repeated approximately every year to maintain correction.

MEMBER QUESTION:
I have had seborrheic keratoses removed several times by liquid nitrogen at a dermatologist's office. Assuming everything else about my skin is OK and reasonable, is it safe to have this done by someone less qualified, and presumably much cheaper? Could you recommend (generically of course) what kind of professional qualifications I should look for?

FIELDS:
Seborrheic keratoses are very common. These tan to dark brown, velvety to course growths, occur commonly on the trunk as well as the face, and can be few or many. After treatment they have the right to grow back and they will pop up.

Dermatologists are most qualified for the treatment of these. Some family practitioners also understand the difference between these growths and melanoma and are able to treat them. Since, however, melanoma can masquerade as these innocent lesions; we really cannot safely refer you to any other specialty.

You may ask your local dermatologist to give you a cash discounted rate to destroy them all instead working with your insurance.

MEMBER QUESTION:
I would like to have my spider veins removed with a laser. I don't have too many yet, but judging by my mother's legs it will continue to worsen. If I have the procedure done now, is there a chance those same veins will come back in the future?

RODAN:
Great question. I've been treating spider veins for many years and I can tell you that while doctors treat the visible ones, new ones are destined to come out years later.

The gold standard of spider vein treatment -- known as sclerotherapy -- is still injections. These veins can be injected with a variety of substances, including concentrated salt solution, and other drugs like Sotradechol. These solutions cause an irritation in the vessel wall which causes collapse of the vessel and eventual death of the vessel. Since these vessels are not important for your circulation and of cosmetic concern only, losing them is no big deal. This sclerotherapy procedure must be repeated several times at monthly intervals for adequate treatment.

You asked about laser treatment. I can tell you from experience, using the laser it is not as good as injection. Many patients ask about it, however, because they believe it is more effective and less painful. Leg vein laser treatment is very painful, expensive, and not as effective in removing the veins as injections, and is also more fraught with side effects, like scarring and permanent pigmentation.

MEMBER QUESTION:
I have large pores that are on my face -- mostly on my cheeks and chin. I've been going to the dermatologist but stopped because it was getting so costly. I was wondering if you could recommend something that could be helpful regarding this matter.

FIELDS:
The most common complaint that Dr. Rodan and I hear, both in our offices and out, is "Doctor, I hate my pores, what can I do about it?"

Pores are genetically predetermined, but through aging and hormonal cycles do seem to spread and get larger on our faces. The sebaceous glands under our skin do grow larger as we age, particularly in the nose and forehead regions.

The treatment for pores includes daily exfoliation with either a scrub soap, washcloth, done gently. Next is to apply either a tretinoin product from your dermatologist (Retin A, Tazorac, Differin) nightly. Microdermabrasion by a professional is also helpful if done weekly and used with a prescription grade tretinoin. Daily use of SAL acid in leave-on lotions, as well as retinol over the counter can be helpful for this chronic condition. In all cases, we are unplugging the pore and clearing it of oil and debris, but unfortunately we are unable to shrink the sebaceous gland that lies beneath.