Fashion & Beauty: Skin Sense Fashion & Beauty
In the Pink for Valentine's Day

Fixes to Put Your Best Face Forward

BY RACHEL HERSCHENFELD, M.D. - DERMATOLOGIST

According to the information on the back of my shampoo bottle, 15 percent of women send themselves flowers on Valentine's Day. I find that hard to believe. As far as I know, none of my friends have ever done that, and I think I would have run across at least one person sending themselves flowers by now, if almost one out of every seven women did. This is not to say that I can't understand why some women would want to send themselves flowers. Valentine's Day can magnify insecurities about being loved and feeling attractive. Fortunately, there are a few quick fixes that can still make a difference in the appearance of your skin in time for the big day.

A few simple steps can improve the appearance of your skin even at the last minute. Avoid overdrying with soap or toners. Instead, use a gentle, hydrating cleanser, such as Cerave. Or exfoliate with a mildly abrasive scrub like Dove Gentle Exfoliating Daily Facial Cleanser. Always use a moisturizer, especially if you are going to apply makeup. Hydrated skin looks and feels smoother, and make-up is easy to apply evenly and smoothly on moisturized skin. If you plan ahead and give yourself some time, there's even more you can do.

Botox is well known as a quick, reliable way to smooth lines on the forehead and around the eyes. But did you know that it can improve your smile? Botox can be used to lift the corners of the mouth that turn down with age, turning an unintentional frown into a content, happy expression. It can also be used to make an asymmetric smile even, to smooth "smoker's" lines around the mouth, and to prevent the upper lip from riding up and showing too much gum line with smiling. Botox can also lift the tip of the nose and smooth a wrinkled chin. Botox in the lower face must be administered with care by a physician who is familiar with these applications to avoid interfering with normal expressions, but in the right hands it is a home run.

Light-based procedures continue to evolve, and many provide significant improvement with little down time. If you're still committed to waxing or plucking to remove dark facial hair, consider laser hair removal. Multiple treatments are required for the best results, but hair is usually noticeably thinner after each session. Nd:YAG lasers, such as the LaserGenesis, can improve facial redness and skin texture. Many patients see improvement after one or two treatments, although optimal results are seen after a series of 4 to 6 treatments. Broad-spectrum light sources, such as the Titan, can help to firm sagging skin under the chin and on the neck. Improvement continues for three to six months after treatment, but may be noticeable soon after the first treatment. You can leave the doctor's office and go right back to work, or play, immediately after any of these procedures.

Even when you can put your best face forward, Valentine's Day can be challenging, and this, unfortunately, can be reflected in your skin. Conditions such as acne, rosacea, psoriasis and eczema are known to become worse in some people when they are under stress. If you suffer from one of these problems, make sure to be consistent with your treatment regimen to minimize the effects of stress around any important social event. Don't worry too much, however, about tasting chocolates from your valentine. Conventional wisdom holds that chocolate is bad for your skin. In fact, recent studies of diet and its effects on the skin have implicated consistently increased dairy intake with acne flare-ups. One study showed that restricting high glycemic foods (such as those containing sugar and white flour) is associated with improving acne. There is no evidence, however, that occasional consumption of sweets makes acne consistently worse. And for most of us, indulging in a bit of chocolate will just make Valentine's Day a little sweeter.

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More About Doctor Herschenfeld, M.D.

Dr. Rachel Herschenfeld's practice is based in Wellesley, Massachusetts. After graduating from Harvard Medical School, she completed residencies in Internal Medicine and Dermatology, then joined two other dermatologists to found Dermatology Partners, Inc. Dr. Herschenfeld is board certified in Dermatology, and is a Fellow of the American Academy of Dermatology. Dr. Herschenfeld performs cosmetic procedures including Botox, Restylane, collagen, Sculptra, and laser treatments for many conditions.
Dr. Rachael Herschenfeld is a practicing dermatologist. Her answers here should not replace medical advice. To submit a question, e-mail skincare@washingtonpost.com. We reserve the right to edit submitted questions for length and clarity and cannot guarantee that all questions will be answered.

Doctor Q&A

My son has acne. He was using Differin .1% and Benzaclin 1-5% gel, and it worked beautifully. All his acne was under control. However, our insurance has changed to a high deductible. What can he use that would cost less?
- J.F.
You have a few options here. Differin, or adapalene, belongs to a family of acne medications called retinoids, which also includes tretinoin (the active ingredient in RetinA) and tazarotene (the active ingredient in Tazorac). Tretinoin is available in generic preparations which may cost less. Benzaclin contains two active ingredients: benzoyl peroxide, which is available in many over -the-counter preparations such as Stridex Power Pads and PanOxyl Acne Gel 5% , and clindamycin, a topical antibiotic that is available in generic formulations. So, ask your physician if these substitutions would be appropriate and see if you can get some new prescriptions.
I am 32 and have always had very sensitive skin. I have tried over-the-counter moisturizers but they all sting my face, particularly the ones with SPF in them. The only moisturizer I have been able to use is Origin's Constant Comforter. I have tried Clarins SPF 40 and have had good luck with that. Are there other moisturizers that I'm just not aware of that are good for very sensitive skin?
- O. B.
I recommend fragrance-free products and products designed for people with multiple contact allergies for my patients with sensitive skin. One example is the Vanicream line of products which includes cleansers, moisturizers and sunscreen. Cerave moisturizing cream and cleanser are also good for sensitive skin. Both of these lines are available over the counter at many pharmacies.
I'm 34 years old and 4.5 months pregnant, and my skin is out of control. My acne is much worse than it ever was when I was a teenager. I'm getting huge, painful zits all over my face and they seem to take weeks to go away. Before I got pregnant I used to get compliments on my skin all the time, but now I can't stand to look in the mirror. Will this go away once my hormones return to normal?
- K. G.
Acne often gets worse during pregnancy, and usually gets better after delivery when hormone levels return to normal. But you don't have to wait until then for your skin to improve. There are effective acne treatments that are safe during pregnancy. These include topical antibiotics, creams containing azeleic acid, cleansers and creams containing glycolic acid, and even oral antibiotics in some cases when acne is severe. You should see a dermatologist who is familiar with managing acne during pregnancy to decide which regimen is right for you.

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