Val Answers Your Top 20 Skincare Questions

Q: What can I do about large pores and acne scars besides cover them up? I want to go barefaced in the summer.

A: And by "barefaced" you mean wearing only sunscreen, right? The most effective treatment for large pores and acne scars, says Tina Alster, MD, clinical professor of dermatology at Georgetown University Medical Center, is fractionated laser skin resurfacing. The Fraxel re:pair and Dual lasers tighten pores and encourage collagen formation, which minimizes the divots of acne scars. You need a series of three to five monthly treatments; average cost is $750 to $2,000 each (but many doctors offer discounted packages).

Keep in mind: Fraxel treatments work on a wide range of skin tones but shouldn't be performed after recent sun exposure.

Q. Will I have better skin if I spring for regular facials?

A: If by "better" you mean "moisturized with a subtle glow," then yes. But you won't get more dramatic changes like improved skin tone, fewer breakouts, or smaller pores. "A classic facial—which usually includes steam, cleansing, and, sometimes, extractions—is good for mild benefits like unclogged pores and hydration," says Anne Chapas, MD, assistant clinical professor of dermatology at New York University Medical Center. Be careful, though, about add-ons like a chemical peel, she says. A peel can improve the skin over four to six sessions, but Chapas has seen problems like scabbing from overly aggressive treatments.

Keep in mind: If a spa facial isn't in your future, an at-home peel (like Dermalogica Gentle Cream Exfoliant, $37; dermalogica.com) and a supermoisturizing mask (like SkinCeuticals Biocellulose Restorative Masque, $144 for six; skinceuticals.com) can give you similar results.

Q: Suddenly, my favorite fragrance seems to be giving me hives. What's up with that?

A: What's probably up are your memory T cells, which can react to an allergen days, months, even years after exposure, says Valerie Callender, MD, associate professor of dermatology at Howard University. One of the most common causes of allergic contact dermatitis (ACD) is fragrance ingredients. But don't give up on your perfume just yet; some of these ingredients are also found in skincare and haircare products and laundry detergents. Decrease your exposure to all scented products, says Paradi Mirmirani, MD, a dermatologist at Kaiser Permanente in Vallejo, California. Then apply your fragrance on the inside of your arm to see if that's what's causing your reaction.

Keep in mind: A doctor can give you a patch test to determine if you have ACD; if you don't, you may have irritant contact dermatitis, which, though often less serious, can also cause a rash.

Q: Which do I put on my face first, sunscreen of moisturizer?

A: What you apply first depends on the kind of sunscreen you use. A physical block (containing titanium dioxide or zinc oxide) can be applied over your moisturizer. But a chemical sunscreen (avobenzone or oxybenzone), which works by interacting with your skin to absorb the sun's rays, must penetrate whatever is already on your face in order to be effective, says Heidi Waldorf, MD, associate clinical professor of dermatology at Mount Sinai School of Medicine. So it's smart to apply this type before anything else.

Keep in mind: In summer, unless your skin is very dry, you can probably use just one product: a moisturizing sunscreen. I like PCA Skin Protecting Hydrator SPF 30 ( $34, pcaskin.com for stores) and Yes to Cucumbers Soothing Daily Calming Moisturizer with SPF 30 ($15, yestocarrots.com)

Keep reading: What's the best moisturizer for you?

Q. How can I get rid of the deep vertical lines on my upper lip?

A: Those lines are really the only thing I don't like on my face. (Unless you count the spaghetti sauce I discovered on my chin after dinner the other night. I didn't much like that, either.) A three-step approach works well to eliminate the lines, says Deborah Sarnoff, MD, clinical professor of dermatology at New York University Medical Center. Injections of a filler like Juvéderm or Restylane can fill them in. A very small amount of Botox, injected into the sides of the mouth, can prevent the kind of puckering that helps to cause them. Finally, one treatment with a fractional CO₂ laser can get rid of them for more than ten years (with three days to a week of redness and swelling and a cost of $1,500 to $4,500).

Keep in mind: If you choose to go this three-pronged route, it's critical that you see a board-certified dermatologist or plastic surgeon experienced in the treatments (too much filler can look unnatural—as I'm sure you've observed—and too much Botox around the mouth can affect your shpeesh).

Keep reading: What are your skin treatment options?

Q: How can I figure out my skin type? 

A: It's easy. Wash your face with a cleanser designed for normal skin; rinse well, and pat dry with a soft towel. Now pick up a copy of Alan Bennett's The Uncommon Reader. It's a short, funny book, and if you're undistracted you can probably finish it in about an hour—exactly when your skin will be ready to evaluate. How does it feel? If it's tight, ashy or flaky, your complexion is dry, says Susan Taylor, MD, assistant clinical professor of dermatology at Columbia University. If you're oily only across the forehead, down the nose and on the chin, you've got combination skin; and if you need to blot your whole face with a tissue, you're oily. If your face feels irritated or slightly itchy, you likely have sensitive skin.

Bottom line: Once you've established your skin type, repeat the test four times a year, because your skin probably changes seasonally.

Keep reading: Top 10 skin myths—a dermatologist tells all

Q: Why isn't there a way to get rid of acne immediately and permanently? 

A: Hear, hear! We've pretty much figured out how to dissolve fat, prevent wrinkles, shoot people into space (and even bring them back); how hard can it be to get rid of acne? Actually, harder than you'd think, because acne results from a complicated process involving a plugged pore, oil, bacteria and inflammation, and it's also influenced by genetics and hormones, says Katie Rodan, MD, clinical associate professor emeritus of dermatology at Stanford University School of Medicine. A shot of cortisone directly into a pimple reduces inflammation in a day or two, and the oral prescription medicine isotretinoin can give long-lasting results with cystic or severe acne, but the best way to prevent acne is by using a combination of ingredients that address each step in the breakout process, including salicylic acid to disrupt the plug, benzoyl peroxide for protection from bacteria and sulfur for its anti-inflammatory effect. Recent research shows that milk and milk products may aggravate acne, so it might be wise to avoid them.

Bottom line: You can treat the superficial causes topically, but because acne involves genetics, the only permanent solution will involve gene therapy—and we're not there yet.

Keep reading: Val's adult acne cures

Q: Do more-expensive skincare products have some kind of "professional strength"?

A: Price alone has nothing to do with the strength and effectiveness of skincare products, says Cheryl Burgess, MD, medical director at the Center for Dermatology and Dermatologic Surgery in Washington, D.C. A drugstore mask or moisturizer can have the same concentrations of active ingredients as one from a department store or spa. But there is a correlation between the strength of a product and whether it's prescription or over-the-counter, says Burgess. A prescription product will likely contain a higher concentration of active ingredients than an OTC formula.

Bottom line: The price and strength of a product do not necessarily correlate.

Keep reading: The facts about cosmetic procedures

Q. I'm 26. When should I start using anti-aging products?

A: The day before yesterday (and I wish I'd followed my own advice). Leslie Baumann, MD, director of the Baumann Cosmetic and Research Institute in Miami Beach and author of The Skin Type Solution, says she tells patients as young as 18 to use ingredients that have been shown to slow the effects of aging. When it comes to wrinkles, prevention is key, so it's important to conserve collagen, hyaluronic acid and elastin, all of which keep skin looking plump and firm. Retinoids and antioxidants help preserve all three. For nighttime, Baumann suggests using a prescription retinoid product like Retin-A, Tazorac, Differin or Renova—in conjunction with a daily moisturizer containing antioxidants like idebenone, coenzyme Q10, lycopene, vitamin C, vitamin E and ferulic acid. She points out that the best anti-aging product is sunscreen, used every day, even indoors (where UVA rays can work their bad chemistry through windows).

Bottom line: If you're old enough to ask the question, you're old enough to be using anti-aging products.

Keep reading: Get Val's skincare regimen

Q. Does pore-minimizing makeup shrink your pores? 

A: No, but it makes them appear smaller—which is a fine enough trick, if you ask me. Some formulas incorporate optical diffusers, which are very good at blurring the look of the pore, making it appear less noticeable.

Bottom line: Pore minimizers containing silicone can make your skin look flawless, but their residue is resistant to soap and water, so cleanse with makeup remover.

Keep reading: The easy guide to flawless skin

Q. Which is a better body moisturizer: cream, oil or lotion? 

A: The best way to treat dry skin is to seal in moisture by forming a protective layer over it, says Elizabeth Tanzi, MD, co-director of laser surgery at the Washington Institute of Dermatologic Laser Surgery. In order of effectiveness: oils, creams and lotions. The difference is the oil-to-water ratio, Tanzi says: Creams have more oil than water, and lotions have less.

Keep reading: When does a skincare product expire?

Q. So many products claim to get rid of undereye circles. How do I know which one to buy? 

A: If your complexion is fair, your (red or purplish) dark circles are probably caused by blood vessels just below the skin. If you're olive or darker, your (brown) circles are probably caused by pigmentation. Look closely in a mirror, and press on the skin; if the color decreases, your circles are more likely from blood vessels, says Heidi Waldorf, MD, associate clinical professor of dermatology at Mount Sinai School of Medicine in New York City. In this case, you might consider treatment with the V-beam laser, which zaps the vessels, causing them to disappear. For pigment-related shadows, Waldorf typically starts with creams containing retinoids (prescription tretinoin or tazarotene or over-the-counter retinols), to reduce pigmentation and increase cell turnover, and hydroquinone, a bleaching ingredient. Other helpful ingredients to look for are kojic acid, alpha hydroxy acids, kinetin and azelaic acid.

Keeping the area well hydrated can improve the appearance of either kind of undereye shadow and make it easier to apply concealer; use eye creams containing glycerin, petrolatum, dimethicone or kinetin. Gels containing caffeine will temporarily tighten the skin, too, Waldorf says. If topical creams seem to irritate the area or make the circles worse, or if the skin is burning, itching or scaling, see a dermatologist. The cause of the darkness could be eczema, for which you may need a prescription topical anti-inflammatory cream.

Keep in mind: First figure out what's causing your undereye shadows; creams can reduce only the pigment-related type.

Keep reading: 4 steps to conceal undereye circles

Q. My face is always shiny even though I use blotting papers and powder. Help! 

A: "This can be a challenging problem," says Jeannette Graf, MD, assistant clinical professor of dermatology at Mount Sinai School of Medicine. But you already know that. Graf suggests using a cleanser with witch hazel, and following it with a lotion containing oil-absorbing microsponges. Next, try applying a foundation primer—the silicone in it gives your skin a matte finish—wherever you get shiny (on your forehead, say). Then, over an oil-free foundation or tinted moisturizer, use a brush to apply a veil of loose powder (don't use your fingers; they can transmit oil).

Keep in mind: Avoid drying out your skin, since that can cause oil glands to go into overdrive.

Keep reading: Val's basics for a fresh and flawless look

Q: Come on, do I really need an SPF if I'm inside all day? 

A: Say you're in your office, sporting a vintage midnight blue Yves Saint Laurent velvet jacket with silk lapels. It starts to rain. Will it kill you to go out without an umbrella? Of course not, but you won't be doing your jacket any favors. Now, if you think of your skin as a commodity at least as valuable as a vintage bolero—and I know you do—you'll apply a similar kind of reasoning to your face. Getting to work, dashing out for a salad midday and going home all expose your skin to damaging UVA/UVB light, says Brad Katchen, MD, founder of SkinCareLab in New York City. And UVA rays, which cause premature aging of the skin, are transmitted through glass, so if you're lucky enough to have an office with a window, you may be getting a daily sunbath at your desk. Using a moisturizer with SPF is an easy way to apply protection.

Bottom line: You probably get more sun exposure than you think, so use an SPF 15 lotion even if you spend most of the day inside.

Keep reading: 7 never-fail sunscreens

Q. My moisturizer has an SPF 20. My foundation has an SPF 15. Am I getting a combined protection of SPF 35? 

A: I understand your thinking on this, but, no. You're getting only the highest SPF protection you wear.

Keep reading: Why would you want an SPF 100+?

Q. If I had the time, I'd research everything about sun protection. But why should I? That's your job. What must I absolutely know about sunscreen? 

1. Wear it. All over. Recently, on a Florida beach, I realized I hadn't applied sunscreen on my toes, which had been peeking innocently out of the umbrella shade. Zorched. Remember to use an SPF of at least 15 on your lips, too, because they're often exposed, says Debra Jaliman, MD, assistant clinical professor of dermatology at Mount Sinai School of Medicine. Also on your ears, your Achilles tendon and anything else that happens to stick out. A shot glass full should be enough to cover you.

2. Use a broad-spectrum product—one that blocks UVA (more deeply penetrating) and UVB (burning) rays. Look for one containing either zinc oxide or titanium dioxide (physical sunblocks) and/or Parsol 1789 (a chemical ingredient also called avobenzone), or Mexoryl, all of which provide considerable UVA protection.

3. Reapply. Even if the residue from the creamy base of the product remains on your skin, the block or screen may not. Coat yourself every two hours, says David H. Herschthal, MD, professor of dermatology at the University of Miami School of Medicine. At the beach or pool, a water-resistant product may not wash off but may rub off after you towel yourself dry, so you'll still need to reapply.

4. Choose a sunscreen suitable for your skin type. If you have dry skin, look for an emollient cream and avoid products with an alcohol base. Liquids and gels are better suited to oilier skin.

Keep reading: Readers share their sunscreen stories

Q. I'm suspicious of marketers. Do people like me with very dark skin really need sunscreen? 

A: You may not get sunburned, and the melanin in your skin will protect you longer, says Herschthal, but the radiation from UVA rays can still cause wrinkles and even skin cancer.

Keep reading: Tips for different skin types

Q: How do firming body lotions work? 

A: A colleague here in the office claims that she gets a tighter bottom when she applies firming body lotion. One of the reasons I'm fond of her is that, among her many other lovely qualities, she is a terrific optimist. I say, if you think your bottom looks better and that makes you happy (and why wouldn't it?), more power to you. Keep using the stuff. But in the sometimes dark and often skeptical world of Ask Val, firming lotions are good for one thing only: moisturizing. That will improve the appearance of the skin temporarily, says Arielle N.B. Kauvar, MD, clinical associate professor of dermatology at New York University Medical Center. The antioxidants added to some formulas may help reduce collagen breakdown but will not stimulate new collagen and skin thickening, Kauvar says.

Bottom line: Though firming lotions can plump up your skin with moisture, there's no evidence that the ingredients produce long-term effects.

Q: Do creams and lotions containing collagen deliver it into the skin? 

A: "There has been no scientific evidence to suggest that there is enough penetration of collagen transepidermally to be deposited in the dermis," says Neil Sadick, MD, clinical associate professor of dermatology at New York Presbyterian Hospital–Weill Cornell Medical Center in New York City.

Bottom line: The doctor said no.

Keep reading: What women doctors know about skincare (that you should too)

Q: Is it more effective to use products from only one skincare line than to mix different brands? 

A: If you're like most women, you probably use products that contain active ingredients (alpha hydroxy acids to treat aging skin, for example). Typically the ingredients and products in a skincare line are formulated to work synergistically to maximize results and minimize side effects, says Jennifer Linder, MD, assistant clinical professor of dermatology at the University of California, San Francisco. But many of Linder's patients make the mistake of mixing the strongest products from several lines, which irritates their skin. It's especially important to be careful with retinoids, alpha hydroxy acids, hydroquinone and salicylic acid; the skin can become overstimulated if these ingredients are used simultaneously.

Bottom line: If you use only a gentle nonsoap cleanser, moisturizer and sunscreen, you can mix brands with abandon. But if you're trying to target specific skin conditions, it's better to stick with only one line.

Keep reading: Should you apply sunscreen before or after moisturizer?

Q: How can I get rid of spider veins on my legs? 

A: Among the many useless, inane things I've often wondered about: Wouldn't those intricate patterns of blood vessels be more appropriately called spiderweb veins? Anyway, if they're large enough to be threaded with a tiny needle, sclerotherapy—the injection of various chemical solutions into the blood vessels—is the best option, says Tina Alster, MD, clinical professor of dermatology at Georgetown University Medical Center in Washington, D.C. The solution irritates the vein's lining; tissue inflammation results, which causes the blood vessel to collapse and fade.
The procedure used to sting because of the nature of the solutions; now that there are better ones, it's nearly painless, says Alster. Most people experience temporary mild redness and swelling along the course of the treated veins. The treatment takes 10 to 30 minutes, depending on the number of veins; often both legs can be done in a single session. If you hate needles, you could try vascular laser treatments instead, though they're a little more uncomfortable because they zap the veins with heat, Alster says.

Bottom line: The best time to treat spider veins is in winter, when your legs are covered and more easily protected from the sun. (Tanned skin reduces visibility of the veins during the procedures and increases the risk of posttreatment hyperpigmentation.) Avoid sclerotherapy immediately before or during menstruation because of heightened sensitivity. You can expect to pay $350 to $1,000 for either procedure.

Keep reading: 15 treatments for more beautiful skin

Q: Help! I have turkey neck! Short of surgery, is there anything I can do? 

A: Another reader recently wrote to me complaining of chicken legs; we seem to be having a moment of poultry-related beauty issues. The problem with turkey neck is that you can't get dramatic results without taking dramatic action. Think of your neck as a skirt that needs hemming, suggests (the metaphorically gifted) Alan Matarasso, MD, clinical professor of plastic surgery at the Albert Einstein College of Medicine of Yeshiva University in New York City. You can iron the skirt (meaning treat it with various lasers, which can help smooth the skin) and reinforce the fabric of the skirt (meaning apply creams like retinoids that will encourage production of collagen and elastin), but unless you hem the skirt, you won't lose the excess fabric. You follow? And what does "hemming" entail? An incision behind the earlobes, suctioned fat, lifted and tightened muscles, and a small scar from behind the ears into the hairline. (Not to mention a recovery time of 10 to 14 days, and a cost of about $10,000.)

Bottom line: If your turkey neck is in full swing, neither lasers nor creams will make an appreciable difference. But before you send your neck to the tailor, think long and hard about what people see when they look at you. Your magnificent eyes and delicious smile may render your neck way less noticeable than you think.

Keep reading: What products to use on your neck

Q: When I get a bikini wax, the technician dips the wooden applicator into the pot of wax repeatedly. Could I catch anything? 

A: How are you feeling right now—good? I hope so, because if the technician isn't changing the pot of wax for each new client (ask her; she may not be), you could catch a lot of stuff you'd be a whole lot better off without. Infection in the vaginal area can be quite severe; you could be exposed to group A strep, staph, human papillomavirus and herpes, says Jennifer Linder, MD, assistant clinical professor of dermatology at the University of California, San Francisco. Waxing induces areas of microtrauma to the skin, making cross-contamination from client to client more likely, she says.

Bottom line: The technician should never double-dip the application stick; she should wear gloves during the treatment and use new paper or sheets for each client. If you're concerned about the cleanliness of a facility, take your waxable parts elsewhere.

Keep reading: How to prevent breakouts when waxing

Q: How can I keep my hands looking youthful? 

A: I love the look of mature hands; they seem to have earned the right to wear good jewelry. But there's lots you can do if you want youthful hands, says Deborah Sarnoff, MD, clinical professor of dermatology at New York University Medical Center. Hyperpigmentation (brown spots) can be eradicated with one treatment of a pigment-specific laser, like the Q-switched ruby or alexandrite. (A bleaching cream takes longer to work but will fade spots in about six weeks.) At night, apply a vitamin A prescription cream like Renova, or an over-the-counter retinol cream. Always remember to use an SPF 30 sunscreen on your hands to prevent new spots. If veins are your bugaboo, they can be diminished by injections of a filler like Radiesse or Sculptra.

Keep in mind: Wear cotton-lined or rubber gloves when you're working around the house and leather gloves when you're outside. And moisturize like crazy.

Keep reading: The secret to beautiful, line-free hands

Q: Since I turned 40, I've noticed that though my skin is dry, my eyelids have gotten oily. What's up with that? 

A: Some of the things you write to me about, my friends, would terrify a lesser woman. (Or maybe just a younger woman.) As for oily lids: First, if you have blurry vision, you should consult a doctor to rule out a couple of conditions that might cause oil on the lids, says Sapna Westley, MD, clinical instructor in dermatology at St. Vincent's Hospital and Medical Center in New York City. Though oil glands usually become less active during perimenopause and menopause, in some women hormonal fluctuations can cause overactivity of those glands, which can lead to oily skin around the eyes and nose, she says.

Or—I'm sure you've thought of this—you may be using too much eye cream. If you're finding it hard to wear eyeshadow or liner because it migrates off your lids, try an eyeshadow primer, which lays down a base that keeps your eye makeup in place.

Bottom line: Hormonal fluctuations can cause various changes in your skin; oily eyelids is one of them.

Keep Reading
6 dermatologists prescribe solutions to your complexion concerns
Skincare guide for your 20s, 30s, 40s and beyond
Val's own skincare regimen