Skin Flaws, Correcting (cont.)
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.
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.
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.
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.