Calling all skin gurus: I need help with sun damage!

I am 26, but unfortunately I spent some 20-odd years in the sun *every damn day* as a tennis player--without any sunscreen! (I now want to go back in time and drop-kick my reckless younger self). As a result, I have considerable, visible sun damage in the form of:

-Standing fine lines. These appear when my face is at rest; some cross my face in a diagonal direction opposite from the others, and stretch from the lash line down to the middle of my cheek as you would see on people far older than myself.

-Slack/papery thin/crocodile-like skin under the eyes.

-Tear trough formation. This was a congenital problem, but has gotten much worse with age/sun damage. I have lost subcutaneous fat over the years and have very weak cheekbone structure to begin with, so my mid-face is very deflated.

-The slacking of under-eye skin has also contributed to the beginning of hanging naso-labial folds.

I now avoid the sun like the plague, apply La Roche-Posay Anthelios XL 50 throughout the day like it’s a religious ritual, and use .05 Tazorac nightly/Murad Vitamin C serum daily. I have done some Jessner’s peels, which produced an overall glow, and probably improved things on a celluar level, but I need the big gun treatments. I realize progress with peels takes patience and many treatments, but I want to graduate to a combo-TCA peel (35% TCA ? with Jessner’s or 70% Glycolic acid) to tackle those fine lines and perhaps do a little tightening.

My question(s): Will a medium-depth TCA (or series of them) have any effect on these lines? I know Phenol is the only “miracle cure” (with staggering side effects), and I’ve read Kosmed’s account of her experience, but is there a way to do a modified Phenol just under the eyes, or would that be disastrous? Should I be thinking about dermabrasion, or will that cause scars? After reading RealSelf reviews of laser stuff and DCGNA’s accounts, laser is definitely out. Is there anything else I could be doing? (Red light therapy? Maybe dermaroller?)

I’m so afraid of scarring and hypopigmentation with a TCA, so if anyone knows of good chemical peel docs in SoCal, I’m desperate! Anyone hear of these docs?: Peter Helton, Mitch Goldman, Robert Kotler, Dore Gilbert, Michelle Aszterbaum, John Bradford Fisher, Lorrie Klein, or Maurice P. Sherman, or Wendy E. Roberts? It’s such a stab in the dark. My method of doctor-hunting has entailed Googling scholarly articles/research on TCA and Phenol, and trying to see if the authors of the studies are docs nearby, but I just don't know.

Also, Kosmeds, if you’re reading this (you rock by the way—I’ve consumed as many of your posts as I can), I saw that you recommended Dr. Rullan for peels. He had some reviews that make me suspicious, one of which said his exoderm “did not even help with the shallowest of my scars or tiny fine lines, not even the red marks. I paid 5 grand and ended up with more scars and hypopigmentation.” Do you have personal experience with him or other docs?

Finally: These lines are really eating away at my self-esteem, and I can’t help but drive myself crazy for my indiscretion in my youth. I seriously can’t even look myself in the mirror anymore (save to apply sunscreen, heh). I’m really hoping for some rejuvenation here. Thanks a million guys, I really really appreciate it :)

I would start on getting more aggressive a regiment of Retina A. I would consult with Dr. Obagi - he works either in San Diego or Beverly Hills. Start there. I have heard though not from personal experience that when HE administers his blue peels - that they do work for the heavy lifting.

But consult few derms FIRST because your situation might not be as dire as you think.
You might just need proper products not a peel that you must be put asleep for. Or you might be a candiate for CO2 which is considered as one of the heavy guns.

Dermabrasion is way to harsh for under your eyes. CO2 lasers are often used in that area. I know Dr. Guyuron uses CO2 on this area/ if you go to his website under press and under videos- he mentions it.

Peanut,

If you haven't already seen it, I'd really recommend the EDS Skincare Forum to pick up even more tips for home care - the ladies there are really knowledgeable.

As to Retin A I agree with Julia Ione, this is really important. I have tried Obagi's Tretinoin, Jan Marini, been prescribed Retin A Micro from my GP but the best (in my opinion) is Biopelle Retriderm vitamin A serum. It's very light, easy to apply and comes in 0.5, 0.75 and 1% strengths. I use the weakest one and it's very effective for daily use without leaving me like a beetroot.

For eye lines, another personal recommendation is the C-Lipoic eye cream by Dermaquest with DMAE. It is fantastic for my under eye wrinkles and I use it between home TCA peels.

Obagi systems (and in my opinion Jan Marini Products) are quite harsh on fair skin for everyday or longterm use, also be prepared to look a mess for at least 1 month if you go on something like the Nu-derm.

But anyway, would consult with a good aesthetician or derm with a wide selection of product brands who could put together a tailored treatment package.

PS I'm around your age but my skin is very white and thin, I also have rosacea.

Co2 laser is not used for under eyes or in isolation much any longer, at least not by doctors who've been paying attention the last few years. It causes 'raccoon' eyes just as it will cause 'clown mouth'. It can also cause ectropion. Some may use Erbium but even that is falling out favor.

I've heard some swear by the Obagi system and I've hear others say it was awful. I tried it. I was unimpressed.

RetinA and suncreen are, long term, your best bet. A medium TCA, if done by a good/experienced derm might be helpful, especially if you're younger. Phenol in isolation is like Co2 in isolation, it will cause demarcation. You don't want that.

And, contrary to what you read on the internet by some doctor worshiper, I'm not against the laser industry just for the sake of being against them. I'm against deceit, lies and greed. It just so happens the laser industry is rife with all three.

This is what a fractioanl Co2 did to someone's face:

Thank you all very much for taking the time to reply. As far as Retin-A goes, I am using .05 Tazorac, which, as I understand it, is basically the same thing as Retin-A? My last derm contended that it's a bit more powerful than Retin-A for aging concerns--anyone know if this is true? I would like to go up to .1, and maybe the gel form, which I think Kosmeds recommended over the cream as it penetrates the skin deeper?

Quno--you say you do at-home TCA peels? I have always been fearful of that since TCA is so strong and can wreak havoc on skin with scarring, etc, but I have read many forums where women say they swear by at-home application. Which brand do you use, and do you pretreat the areas first Glycolic acid or Jessner's solution at all? (I hear that combining it makes it more effective, as it allows greater diffusion of the TCA into skin).

As for laser, does it just depend on the doc? There's such contradictory accounts, with some people raving about it and others having irrevocable damage. If it does cause fat loss, I definitely can't risk it as I already have such a hollowed out orbital rim area with tear trough depression. I've thought of filler, but that doesn't seem to turn out right (exhibit a: Jen Aniston).

Anyway, thank you all so much again :)

I have had Fraxel twice not the CO2 one with no problems with Dr. Obagi. I have Dr. Haworth laser my scar with Fraxel twice with no problems.

I think deep peels can look waxy and shiny verging looking burned.

I have used Obagi system as administer by Dr. Obagi himself. I get compliments on my skin all the time - it is one my of better features. This is what has worked for me.

Ummm...I'm not a PA person. LOL. It's just a pic for Pnut to show not all outcomes are as expected. Pictures speak volumes that words cannot convey.

For so long, all I could do was talk about bad outcomes with these devices but now people are no longer afraid to show their faces and what is happening to them. It all started with Angela Walker (Awalk from Realself) when she showed her entire non-recovery on RS via pics, up until her death in 2009. It has blossomed in the last few months to many people are now willing to show their faces and what has happened. Doctors, very few however, are beginning to take note that more and more bad/unexpected outcomes are happening--no matter who the operator of the device is--from the top laser gurus to some med spa.

Anyway, this is not my thread and I did not mean to hijack it. Just wanted Pnut to know there are no guarantees with lasers or light treatments. It's an undetermined variable as to what causes some to have good outcomes and others not so much. I have never said everyone has a bad outcome. I've always said the bad outcomes are a very low percentage but no way to predict if you will be in that lower end of the percentages. You have to weigh the risks and be willing to take them as there's no way to know, regardless of the doc or the machine.

I think in the properly selected candidate a deep peel can be miraculous--older women with lots of wrinkles.

I have presented to three docs for deep peels and all three shot me down. Guyuron was comfortable using CO2 to try to diminish a few scars, however, I wasn't really impressed with the efficacy of that procedure.

Not sure how "cryptic" DCNGA's statement was: "......contrary to what you read on the internet by some doctor worshiper, I'm not against the laser industry just for the sake of being against them."
But can tell you it was meant for garner. Dig--OK but have a look what garner said:



In short, it was a 'come back' to garner.

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NOTICE:

I'm having COMPUTER PROBLEMS and can hardly get on the internet or get to my e-mail. It's taken me like 6 hours just today to try to post this message. So, no e-mails or PMs to me until I can remove this message. I have no idea what the problem is. It started with Google Chrome not loading any pages for me. TT helped to uninstall but ran out of time and it would not re-install. CAn't explain the computer problem other than to say I'ts hard for me to access the net or my site.

Bugjune, I am female. And I'm glad you gave a makeup tip because I have found that most concealers/ foundations exacerbate the appearance of lines so I've only been using La Rochey tinted sunscreen and Benefit bronzer as my makeup routine. But since sunscreen always gives off such a shiny gleam, I'm trying to find a good powder to go over it so I don't blind people with the shine--anybody have a good one?

I think I'm going to consult with a few derms, maybe Obagi, and try a series of medium peels. Anyone know how those blue peels compare to a tca? I've seen some mixed reviews on the efficacy of the blue peel, esp in regard to fine lines, but maybe i'd have good results if it's administered by the man himself as Julia said. Now just it's time to find a good derm! (gah)