I don’t know whether to attribute it to the new products I’ve been trying, stress, hormones or diet.  When I get stressed, I don’t eat right. And hell, at 43, much like at 16, I have absolutely no clue what these hormones are doing.

Of course, with all this playing out all too obviously across my face, I appreciated the timing of Paula Begoun’s recently released report on acne.  Apparently, I am not alone.  Acne affects an estimated 95 percent of the population, regardless of skin color or type.  The report says that yes, my breakouts are probably due to all of the above, and tells me how to fight the flaw, and not let the flaw win.

It is most interesting to note, however, that every natural instinct we have for eradicating those complexion killers is just wrong, wrong, wrong.  And contrary to popular belief, none of it makes them disappear any faster.  You can’t squeeze them or scrub them gone.  The report discourages harsh skin care products.  Astringents like witch hazel won’t dry up that little geyser any quicker, and in fact, if the skin gets dried out, it can’t heal.  Dry skin is also a breeding ground for the bacteria that grow pimples.  Who knew?  Similarly, don’t use products, such as bar soap on your face or waxy styling products on hair that will touch your forehead. These will leave a residue that will clog pores and clogged pores are part of what started this whole mess in the first place.

If acne is a serious issue for you, you need to get Begoun’s report (anyone who is serious about skin care at all should be on her mailing list), because treatment is very individual, depending on your skin type and lifestyle.  Her extensive recommendations include products with salicylic acid or benzoyl peroxide, but she encourages a regular, gentle cleansing routine as the best approach.  Alternatives such as Tea Tree Oil treatments or the use of sulphur are discussed and the report is a must-have before making a decision with your dermatologist about prescription methods.  All the latest on new treatments such as Dapsone, updates on the use of antibiotics, vitamin supplements and other topicals are covered in her report.

Fortunately, my face cleared up in a few weeks, so I was able to give up re-living my pizza face years.  Now if I could find a routine to clear up my social life as easily…

Laser skin resurfacing is a popular way of rejuvenating wrinkled or scarred skin, but the first step in the procedure has to be understanding all the words being tossed around. Ablative. Non-ablative. Fractional. Erbium. CO2. Oy.

According to the American Society of Aesthetic Plastic Surgery, more than 500,000 laser resurfacing treatments were done in 2009, and nearly 73 percent were non-ablative, such as Fraxel Restore.  Non-ablative resurfacing means the laser heats the layers of skin below the surface to stimulate collagen and promote new cell turnover.  (Trade names include Fraxel Restore, Laser Genesis, Lux 1540.)

Ablative skin rejuvenation procedures “remove” that top layer of skin, burning it away so it is replaced with fresh new skin.  Another term often used is “vaporize.” If it sounds painful and drastic, it is.  It can take three weeks for the oozing and crusting to subside, and three months for the redness to go away.  (Laser names include Fraxel Repair, Active FX, SmartXide DOT)

Lasers involved will either be CO2 – carbon dioxide – based or erbium-based.  According to WebMD.com, CO2 lasers have been used for many years to treat a variety of skin issues.  This type of laser penetrates more deeply than erbium lasers, and the heat can also affect the surrounding area.  The erbium lasers are recommended for people with darker skin tones because they don’t penetrate as deeply and there is less chance of burning surrounding tissue.

The procedure now referred to as the gold standard is fractional ablative laser resurfacing, which is described as “(drilling) tiny holes deep into the skin” in this WebMD.com video.  Doctors have found that by making a number of smaller penetrations with a CO2 laser over an area of scarred or wrinkled facial tissue, the number of treatments and amount of down time are greatly reduced.

Often, non-ablative laser treatments require several appointments.  Patients opting for fractional ablative resurfacing report results after one treatment.  There is a lower risk of infection and little or no crusting and oozing afterward.  According to RealSelf.com reviewers, though, it is still a painful treatment.  And the cost for any laser facial skin resurfacing ranges from $500 to $5,000.

• Here’s another good explanation of ablative, non-ablative, fractional comparison. 

In a kind of anti-aging transfusion, the Selphyl System uses ingredients from a patient’s own blood as an injectable facial filler to smooth wrinkles around the mouth and nose, fill in hollow cheeks and pock marks and lessen acne scars.

During the procedure, a doctor (plastic surgeon, dermatologist) draws a vial of blood from the patient.  It is placed in a centrifuge, where the platelets and fibrin are separated from red and white blood cells. It is the platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) that are injected back into the patient.  The PRFM doesn’t plump the area, but stimulates new cell growth and collagen production.  Sort of like regenerating yourself.  Anti-aging.org says that it can be used on any area of the body, too.

Using self-made substances as filler isn’t new.  Autologous fat transfers, in which fat is liposuctioned from one area and injected into another, are used to plump everything from lips and face, hands or areas of the body that need contouring. Fat transfers have been problematic, however.  Fat sometimes gets lumpy when relocated, and there is no predicting the absorption rate. Injecting one’s own stem cells  to promote cell growth and stimulate collagen is new and holds great promise, especially if the transfer continues to heal itself.

In the new world of stem cell transfer, however, Selphyl is unique in that it uses blood.  According to various websites, you see results in about three weeks.  How long they last isn’t exactly clear.  Some claim a year to as long as 18 months, but considering this procedure was introduced in 2009, we’re not quite ready to take that as gospel.

The upside of these autologous transfers is that there is no chance of having an allergic reaction since the cells were produced by you.  It is also a fairly quick procedure, taking about 20 minutes.  Anti-aging.com says the PRFM/PRP stays fluid under the skin and doesn’t form lumps.  It also says risks are low and problems are rare, but Realself.com doctors answering a question about autologous platelet transfers cite an article that suggests clots could form in a facial vein.

The cost estimate we found was $1,100 for one treatment, a bit higher than traditional injections, but of course, they are doing more work.  Despite the pros associated with the Selphyl System, many remarking on RealSelf.com are just not ready to try it, and are sticking to old fashioned fillers like Restalyne.  We tend to agree, it needs more testing.  We’re all for trying something new and different, but we just don’t want to be the first when it comes to our faces.

Hyaluronic acid fillers – or brand names you’ve heard of like Juvederm, Restalyne and Radiesse  – have replaced collagen injections in the face, because the synthetic fillers “last twice as long as collagen, look and feel natural, and are versatile – they can be used in a variety of creases, lines in the face, and to enhance the lips,” says Dr. Jeffrey Dover, author of The Youth Equation and Director of SkinCare Physicians in Chestnut Hill, Massachusetts.   Fillers can be used to erase acne scars, as well as those pesky  “parentheses” that appear between your nose and mouth, aka nasolabial folds.  HA is a substance that occurs naturally in the body, binding moisture and providing plumpness.  As we age and it degrades, the skin can sag or wrinkle.

The  three you hear about most often are Juvederm, Restylane and Perlane, and they’re all a little different.

• Juvederm: ­ An injectable gel, this is the first FDA-approved HA dermal filler proven to be safe and effective for persons of color, according to dermanetwork.org.  Physicians say it is smoother than its counterparts, making it the best choice for plumping lips. The results are immediate and in most cases swelling goes away in about 24 hours.
• Restylane:  ­ Because it is made up of smaller HA molecules, Restylane works better in treating fine lines.  It may take swelling 2-3 days to disappear after Restylane treatments and up to a week for the results to  be noticeable, “which is understandable if they’re hidden under swelling” says Dr. Dover.
• Perlane:  ­ Though it is made by the same company, this gel contains more hyaluronic acid molecules than Restylane, making it more effective when lifting and filling areas that benefit from a denser concentration, such as deep skin wrinkles, scars and  creases.

Radiesse and Sculptra are a couple other names you hear about and all can be used to complement one another in conjunction with Botox or Dysport for reshaping and re-sculpting the face.

Considering that they are temporary, fillers can be pricey at an average of somewhere between $500-$800 per per syringe, and often clients need more than one if the area of treatment contains deep lines.  The fillers are less temporary than they use to be – collagen lasts about three months, but new fillers can remain for six months to a year.

If you do opt for the needle, but don’t like the final look, they’re reversible – sort of.  HA filler results can be neutralized by injecting hyaluronidase, an enzyme that absorbs the filler. Results, however, are really mixed. Most of the RealSelf.com reviewers forced to use the enzyme were disappointed, using adjectives like “melting” to describe their results.

Relaxing muscles and filling in crevices is much like sculpting clay with water to achieve a smoother and more youthful appearance.  Fillers are temporary and expensive, but often a good “trial run” to see what the results might look like before you opt for the scalpel.

Let’s get the snorts and guffaws over with: Cosmetic tattooing, or micro-pigmentation, does involve someone sticking inked needles into your face. And, in the spirit of full disclosure, this will be a pro-permanent makeup article.  I immediately went home and had it done.  But I am getting ahead of myself.

The process has many names, but it is the same technique that produced pin-up girls on the forearms of WWII veterans, skulls on the biceps of bikers, and little butterflies on the shoulder of your underage daughter – electric needles are used to inject permanent dye into the skin.  Cosmetic tattooing is used to help with reconstructive surgery, simulate facial hair lost through chemotherapy or alopecia, cover scars or, in my case, address laziness.  I like to wake up with makeup.

Micro-pigmentation uses extremely small pigment granules for coloring on the face or other sensitive areas of the body, because it is for esthetic enhancement rather than art.  Estheticians apply permanent eyeliner, lip liner and full lip color, eyebrow enhancement, beauty marks, areola recreation, as well as scar camouflage.  The dyes used for makeup are different than the ones used for a Grateful Dead logo and the procedure is relatively quick and mostly painless. Depending on the size of the area, it takes around 40 minutes to an hour, and two sessions are needed with a couple weeks in between treatments.  There is mild discomfort, but most specialists use a topical anesthetic to numb the skin.  The cost varies – anywhere from $300-$500 for eyebrows, up to $2,000 for areola work and it is likely that the work will fade after a few years, especially if you spend a lot of time in the sun.

The bad news is that while there are lots of different colors and pigments, “none, including the hair dye henna, are actually approved by the FDA for skin injection,” says WebMD.com.  Risks include infections, inadequate sterilization of the needles, allergic reactions, scarring, and bleeding of the dye into surrounding skin.  The American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood because of the risk of hepatitis or HIV contamination.  Most states now heavily regulate and inspect tattoo parlors, but consumers should be sure to do their research, check references and above all, make sure the environment is clean.

Having said all that, the results can be fabulous (I told you this was a PRO article.) Tattooed eyebrows, when done correctly, are indistinguishable from real ones.  Faded lips have new color and scars disappear.  I have worn thin eyeliner since I was 12 years old, but sight problems were making it more and more difficult to apply well.  Two sessions and two years later I have positively no complaints and awaken, like the women on my trip, suspiciously well made up.  Now if I could just tattoo out the wrinkles…

Then why does photorejuvenation keep cropping up on spa menus and dermatology specialty lists?

Sometimes spelled with two words, photorejuvenation is a jabberwocky process that covers a broad spectrum of skin care.  “Photo” in this case, is a combination form of speech meaning light or energy – in other words, this is another laser technology. The rejuvenation reflects the depth and intensity of the treatment.

It is used for a wide range of skin treatments from erasing birthmarks and tattoos to reducing fine lines and acne scars.  It is minimally-invasive and treats only the needed areas while leaving the surrounding tissue intact.  It is typically performed on the face, but we have read about photorejuvenation being used to treat the neck, chest and hands as well.

Used as an anti-aging technique, the basic process involves infrared light from LED lamps that heat the top layer of skin, which results in skin cell stimulation and regeneration. Collagen and elastin are supposedly produced in this procedure, which causes the skin to be smooth where it was wrinkled, bright where it was dull, tight where it was loose (basically the same effect the dryer has on your jeans.)  There is no discomfort and depending on the surface area to be treated, it can take anywhere from 20 minutes to an hour.  But the downtown is almost non-existent.  The work goes on beneath the skin, so a client can return to normal activities within a day.

When used to treat more serious issues like acne scars or rosacea, photorejuvenation processes are intensified by the laser technology.  Heat-based (thermal) or intense pulsed light (IPL) energy devices can be used in conjunction with topical treatments or even chemical peels.

Minimally invasive can also mean minimal results, and that’s the bad news about photorejuvenation.  The good news is that the technology is constantly changing and improving, the cost relatively low – anywhere from $1000-$3000, and if you aren’t satisfied with the results, you may have the procedure again.

By that time, they may have a whole new jabberwocky way of describing it.

• Consumer Guide to Plastic Surgery has a physician’s roundtable discussion on the procedure.
• American Health and Beauty can give you a list of doctors in your area that perform photorejuvenation.

So what is this art of which he speaks?  According to yourdentistryguide.com, procedures include:

• Inlays/onlays: a different way of addressing a filling or structural damage. A “filling” is designed in a lab then bonded over the problem area. Benefits of inlays/onlays according to docshop.com is eliminating sensitivity and eventual tooth loss; made-to-match teeth -  inlays are practically invisible; they won’t expand or contract with extreme temperature changes like metal fillings can; they are long-lasting and because they are bonded on, can strengthen teeth. The price range is $625-$1,200 per inlay/onlay.
• Composite bonding: “A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light,” according to yourdentistryguide.com and the cost range is $300-$1,600 depending on the tooth, the dentist’s skill and the region of the country.
• Veneers:  Made popular by celebrities, veneers are basically composite or porcelain slipcovers that are bonded over problem teeth to cover chips, cracks and/or discoloration. According to mynewsmile.com, the cost per veneer can be anywhere from $975-$2,200.
• Braces:  Invisalign and clear braces have boosted the popularity of adult orthodontics without the worry of being called metal mouth. Invisalign can range from $5,000-$7,700 for the complete treatment.
• Dental implants: The replacement of missing or damaged teeth which involves surgery to place the post for the prosthetic tooth in the jawbone. The complete procedure takes several visits. The cost of the surgery can range from $1,000-$2,5000 per implant (if no  bone grafting or special procedures are required), with a similar cost for the implant itself.

Some procedures, such as orthodontics and fixing chipped or broken teeth are often covered or more likely, partially reimbursed, by dental insurance.  But individuals should check their personal policies or with their dentists.

Of course, putting your bling in your mouth — getting a gold tooth, like Flavor Flav has or Johnny Depp did to play Captain Jack Sparrow; and the growing diamond implant trend in India and the U.K. – are also considered cosmetic dentistry. Finding a dentist to do them is another story all together.

This aversion to tweezing has led me on a personal quest to find the best possible, least painful or at least the quickest way to remove unfeminine follicles from what is apparently the single most sensitive area of my entire body.

The search recently veered toward Southeast Asia and the practice of eyebrow threading, a process now featured in malls across the U.S., in which hairs are removed with a (drum roll) thread.  The hairs are entwined in a long cotton string and quickly yanked right out.

Yes, threading sounds like plucking, and basically, it is, except on a broader scale instead of one at a time.  It is touted as a chemical-free alternative to waxing, can be done to any part of the face (chin, upper lip, cheeks) and many women say it is less painful (not to mention less expensive than waxing).  Threading also allows the brows to be more easily shaped than the rub-and-rip way waxing works.  Threading results will generally last three or four weeks.

Homework done, I decided to “string it” and it was pretty cool.  Threading sounds like the plucking (there’s that word again) of a guitar string. Zing, zing, zing goes the string on my face. It’s quick, but for me, definitely NOT painless.  The hurt factor was about the same as waxing, although I didn’t have the same burning sensation.  I had a lot of redness, but it was gone in less than two hours, whereas with waxing, I have been freakishly red for six hours or more.  Did I mention I’m a little sensitive there?  The young Cambodian woman who did the threading noted that it was unusual to be so tender.

The downside to threading is that often, it’s done at a small kiosk in the middle of the mall as shoppers stream around you like ants headed for a picnic.  Reclining in a dentist-type chair, you can hear the running commentary of the people who stop to watch as they talk about what the practitioners are doing to your face. Just remember, there are worse positions your neighbors could catch you in, right?  The cost is comparable to waxing anywhere from $15-$35.

On the day I was threaded, the woman who preceded me had her chin and lip done in addition to her eyebrows, said it didn’t hurt at all and she had no noticeable redness.  Additionally, my skin didn’t break out in the 24-36 hours after the threading, as it oftne does after waxing. (I mentioned being sensitive, right?)  For that alone, threading earns two eyebrows up.

• Wise Geek has a pretty good description of the process.
• There are tons of YouTube videos showing you closely what they do, including this one from a news program in Rhode Island.
• Here’s a site that reviews all the hair removal options, called, appropriately, Hair Removal Advice.

Microdermabrasion is the buffing of the skin with the grains of diamond (the hardest substance on earth) or aluminum oxide crystals. Like sandpaper, the buffers come in coarse grit, medium grit or a light grit. The process sloughs away layers of skin to make way for new skin to emerge. Having your face sanded in this way (do NOT try this at home after a trip to the hardware store) is also found to stimulate collagen production, a key protein for younger-looking skin.

In an article published in the Archives of Dermatology in October, University of Michigan researchers found that rougher the buffing the more effective in achieving the desired results.  According to the website Skin Inc., “the researchers found that the course-grit diamond increased the production of compounds associated with wound healing and skin remodeling. These included cytokeratin 16, which helps skin heal after injury.” They also found that getting a little rough produced antimicrobial peptides that fight infection as well as producing other substances that promote collagen production.  These changes didn’t occur when the medium-grit was used, nor was collagen production consistent when a wand with aluminum oxide crystals was used.

Microdermabrasion is one of several ways of reducing fine lines, “crow’s feet” and acne scars, in that group with laser resurfacing and chemical peels. It is generally considered a “lunch break” procedure because, for most people, it is relatively quick with no downtime needed afterward. It usually requires more than one treatment to be effective though, ranging in cost from $70-$250 per treatment.  Laser resurfacing and the harshest peels, which are more effective for severe scarring and deeper wrinkles, leave you wanting to wear a large brown paper bag over your head for weeks afterward.

The leader of the University of Michigan study, Dr. Darius J. Karimipour, an assistant professor of dermatology at UM, said his team was looking for ways to make microdermabrasion more effective and find out what stimulates the most collagen.

One way to make the process more effective is to use it in conjunction with a chemical peel. Having a peel first will make a gentler microdermabrasion as effective as a rough and hard session without a peel.

In 2008, microdermabrasion ranked as the 6^th most popular cosmetic procedure overall, right behind laser resurfacing and chemical peels. This 2009 study shows that if this is what you’re opting for, it pays to have your surgeon get a little rough.

• Here are reviews about the process.
• The American Society for Aesthetic Plastic Surgery is also a good place for information on microdermabrasion.
• What’s the difference between microdermabrasion v. dermabrasion?  Here’s a good explanation.

Candidates for chemical peels are people, increasingly men, who have acne and acne scars, sun damage, age spots or fine lines, or who just plain want to brighten their skin.  You are basically burning off the top part of your derma, so that newer, healthier, brighter skin will shine through.  Ethnic people must be very careful, as the process can wreck havoc on pigmentation and cause the skin to lighten unnaturally (seen Sammy Sosa lately?).  The office time is short while they mix and apply the peel, but the recovery times depends on the degree of the process.  It can be anywhere from 3 hours to 3 weeks.

• Light peel range:  generally an AHA or fruit acid peel: pink skin for a couple hours to three days.
• Medium peel range: generally a TCA product (Trichloroacetic acid); three to seven days healing time, depending on the skin
• Deep peels: TCA’s and Phenol products:  seven days to three weeks, and several of those days you are NOT going out of the house.

All peels are based on glycolic or fruit acids and the degree of the peel depends on how much the active ingredient is diluted.  Patients make those decisions with their specialist.

And speaking of specialists, chemical peels can be done by trained estheticians and not doctors.  The specific requirements differ state-by-state, and you should know what yours are before shopping around.

The cost:  from $200 to $1000.

The big players in the game are Obagi and Physician’s Choice, but there are many, many others.  Chemical peels can be obtained on the ‘net, but it is not recommended that you do this alone.  Many over-the-counter products don’t do enough, but the good ones could do WAY too much.

Here are other good resources on chemical peels as well as directories for choosing a specialist in your area:

• Cosmeticsurgery.com
• PlasticSurgery.org
• AmericanHealthandBeauty.com