Thinking about Botox? A peel? Best fixes for your skin

Consider these options if you’ve already tried…
Vitamin A creams (such as Rx retinoids or ones with retinol) and alpha hydroxy acids, such as glycolic and lactic, which help soften wrinkles by stimulating new collagen growth; and, of course, broad-spectrum sunscreen, to fight off the free radicals and sun damage that cause lines in the first place.

BOTOX
Sessions: 1 every 3 to 6 months
Cost: $300 to $1,000 a session
Downtime: O days
Ouch factor: 2 out of 5

For fine lines: “If you begin using Botox or other freezers as soon as you notice subtle expression lines and continue as you age, you can absolutely prevent certain wrinkles from forming,” says Dennis Gross, M.D., a cosmetic dermatologist in New York City. There’s also nothing better for treating movement-related lines you already have: “Even in your 30s, you usually end up with 100 percent smoothing,” says Patricia Wexler, M.D., associate clinical professor of dermatology at the Mount Sinai School of  Medicine.

What can I expect? You will feel a slight pinch from the needle; injection sites might be red and puffy for a few hours.

SUBLATIVE REJUVENATION
Sessions: 3 to 5
Cost: $350 to $1,500 a session
Downtime: Up to 2 days
Ouch factor: 2 out of 5

For noticeable creases:  Do needles make you cringe? A series of light peels or laser treatments can erase lines by boosting collagen production. You can also try sublative rejuvenation, which uses radio frequency energy to heat skin, tricking it into producing more collagen.

What can I expect? When the device is used on the mildest setting with a numbing cream, pain from sublative rejuvenation is minimal. Your skin will be pink for a few hours afterward, and you’ll have to go back for several follow-up treatments.

FILLERS
Sessions: 1 every 6 to 12 months
Cost: $700 to $1,400 a session
Downtime: 2 days
Ouch factor: 3 out of 5

For deeper wrinkles: When lines are deep enough to feel with your fingers, derms may opt to inject a hyaluronic acid–based filler, like Restylane or Juvéderm, to bulk up the area directly under wrinkles. You’ll need a treatment every 6 to 12 months, but some fillers stimulate your own collagen production, helping stretch the time between injections, says David Bank, M.D., a dermatologist in Mount Kisco, New York.

What can I expect? Most hyaluronic acid fillers have pain-killing lidocaine mixed in—ask for these, as they are much less uncomfortable. You can go back to work when done, but you may experience a day or two of swelling, along with some bruising. Skip the gym for two days; raising blood pressure can exacerbate swelling.

Make-up tricks to take 5 years off your face

If over-the-counter medications don't treat your acne, you may need a prescription retinoid cream, cortisone shots or laser treatments.

CORTISONE SHOTS
Sessions: 1
Cost: $150
Downtime: None
Ouch factor: 3 out of 5

For one giant zit: “A cortisone shot can be a lifesaver for someone who wakes up with a deep, painful cyst that doesn’t respond to topical medication,” says Jeannette Graf, M.D., assistant clinical professor of dermatology at the Mount Sinai School of Medicine. Injecting the anti-inflammatory medication cuts inflammation from the inside, shrinking it down in 12 to 24 hours. (Don’t use this method as your first line of defense for an annoying but painless whitehead, however.)

Will it hurt? As much as, say, a flu shot in your face. “You’ll feel a sting for the three to six seconds it takes to inject the drug, although certain spots, like the nose and upper lip, are more sensitive,” says Hema Sundaram, M.D., a cosmetic dermatologist in Washington, D.C. Afterward, the zit will likely be a bit swollen for a few hours but will eventually recede.

ISOLAZ
Sessions: 6 to 8
Cost: $300 a session
Downtime: 1 day
Ouch factor: 2 out of 5

PDT
Sessions: 3 to 5
Cost: $500–$1,000 a session
Downtime: 3 days
Ouch factor: 3 out of 5

For painful acne: To treat the worst cases of acne, dermatologists rely on the Isolaz laser and on photodynamic therapy (PDT), which is similar to IPL. The Isolaz uses a vacuum to lift the skin gently and open pores to suction out oil; your derm will then shine a bacteria-
killing light deep into pores. Seventy-five percent of patients end up acne-free after six to eight weekly treatments, Dr. Wexler says. The other option, PDT, kills bacteria and shrinks oil glands by using a blue light on skin that has been pretreated with a light-sensitizing chemical known as Levulan. “It can put even severe acne into remission for 6 to 12 months,” Dr. Bank says. Your derm will help you decide which is best for your skin.

Will it hurt? Isolaz is relatively pain-less—you’ll feel a light tugging from the suction—and it may leave your skin extra rosy for a few hours. Like IPL, PDT treatments are also often likened to rubber bands snapping on the skin—annoying but tolerable. You’ll be red and swollen for a few days, then your skin will flake and peel. What’s key: avoiding the sun for at least 36 hours, as Levulan can leave skin more vulnerable to UV rays. Our tip? Do it before a long weekend so you can hole up and heal up.

PEELS:
Sessions: 1
Cost: $150–$350 a session
Downtime: 1 day
Ouch factor: 2 out of 5

For allover bumps and clogs: Light chemical peels, which stay on for about five minutes, bolster the effectiveness of any Rx-strength acne drugs you’re already using. They regulate hormones and oil production, giving the meds extra oomph. Types to look for: salicylic acid peels, Jessner’s peels (salicylic and lactic acids plus resorcinol) and modified Jessner’s peels with retinoic acid. The Vitalize and Rejuvenize peels “are the least irritating and most effective I’ve found, especially for skin of color, which can react to irritation by creating dark spots,” Dr. Sundaram says. Peels can also fade the dark marks some blemishes leave behind.

Will it hurt? Depending on the peel, you’ll feel some warmth and tingling and look a little pink right after your treatment. In about two days, the very top layer of your skin may begin to flake off (painlessly), and continue to do so for about three days. In other words, you can live your life; you just may not look your best.

10 Tips to Glowing, Healthy Skin

Consider these options if you’ve already tried…
A glycolic acid lotion in the morning or vitamin A cream in the evening to slough dull, pigmented cells; brightening products that contain soy, niacinamide, vitamin C, alpha arbutin or kojic acid; or prescriptions, including EpiQuin Micro (hydroquinone that’s microencapsulated to curb irritation).

IPL:
Sessions: 1 to 3
Cost: $100–$500 a session
Downtime: Up to 3 days
Ouch factor: 3 out of 5

For sun spots: Unlike freckles, sun spots don’t fade naturally in the fall, but Q-switched lasers or IPL can help erase them. The treatments, which flash short bursts of laser or light on the skin, are favored by derms for banishing brown spots on even hypersensitive skin of color. They hone in on unwanted pigment without affecting the lighter skin around the spot.

Will it hurt? After these treatments (which, when done in one tiny area, can feel like a hot pinprick or, again, a snapping rubber band), your spots will turn red for a few hours, then dark brown for about a week, before flaking off. (So don’t schedule it before a big event.)

FRAXEL
Sessions: 2 to 6
Cost: $1,000–$1,500 a session
Downtime: Up to 3 days
Ouch factor: 3 out of 5

For melasma: If seasonal spots like freckles don’t fade with products alone, derms can up the ante with lasers and peels. Whichever you and your doc decide on, “you need to treat pigment gradually, because if you irritate the skin, that can cause more pigment to form,” Dr. Graf says. Try glycolic peels—and staying out of the sun. Melasma (the often hormone-related splotches many women get during pregnancy) is the most difficult pigment issue to treat. Some derms suggest up to six sessions of fractional resurfacing using the Fraxel Re:Store Dual 1927 laser to create even-toned skin.

Will it hurt? If you decide to get fractional resurfacing, a thick layer of numbing cream, applied an hour beforehand, will slightly ease pain, Dr. Bank explains. You will be red and swollen for about three days. You can probably go to the office, but you might want to skip face-to-face meetings or any big presentations.

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