As one ages, the soft tissue of the face starts to sag and also lose its thickness of the layer of fat under the skin.  With the lower eyelid and cheek, there can develop a separation between the cheek fat due to sagging, and prominence of the lower eyelid fat, leaving a groove between the eyelid and cheek.  A non-surgical way of addressing this is with an injectable filler that can fill in the gap between your lower lid and cheek.  This can work very well in experienced hands.  A more definitive way is with lower eyelid surgery and/or a mid-face lift.

The chemical peel I generally use (TCA) does not reduce acne scarring.  I recommend full face CO2 laser resurfacing.  This is performed under general anesthesia in the operating room.  I feel this is the best treatment for non-active acne scarring.

The peel I use is 35% TCA (tricarboxylic acid).  Your skin will begin to peel after 5-7 days and maybe take 10 days to fully peel.  Your skin will be red for a few weeks during which you will need to avoid sun exposure and keep ointment on your fresh new skin.  In general, makeup can be reapplied after 3 weeks.

I almost exclusively use injectable hyaluronic acid (HA) fillers in the face.  There are several products available which work well.  This is composed of a naturally occurring substance found in the skin and is not made from animal products.  Although mentioned as a potential risk, I have never seen an allergic reaction to this product after injection.  There are studies which suggest that this type of filler stimulates collagen formation which is desirable in long-term reduction of wrinkles.  This is an absorbable filler that lasts approximately 10 months.  I know of no long term deleterious effects after injection of HA fillers.

Redness, or erythema, following a skin resurfacing procedure is part of the normal healing process. For a medium depth chemical peel such as 35% TCA, the redness usually subsides after 10-14 days. For deeper resurfacing, such as CO2 laser, the redness lasts 2-4 weeks. In general, makeup can be applied to camouflage the redness once the skin has re-epithelialized.

The chemical peel I perform most is a 35% TCA (tricarboxylic acid) peel. This is considered a medium depth chemical peel. It works well for hyperpigmentation caused by sun exposure but is not intended to treat acne scarring. Acne scarring requires a deeper form of treatment, such as CO2 laser resurfacing.

I currently use 35% TCA (tricarboxylic acid) as a medium depth chemical peel. This is beneficial for mild to moderate sun-damaged skin and reduces areas of hyperpigmentation as well as fine lines. Patients can repeat the chemical peel after 3-4 months, but often one peel is enough to provide an acceptable outcome.

Posted by William E. O'Mara Jr., M.D.

If you have some isolated areas of acne scarring, dermabrasion is a good method of treatment. As I have said before, deeper acne scars need to be removed before dermabrasion will provide the final optimum result. Dermabrasion is the process of removing outer layers of skin with tactile force, like sanding down a surface. A chemical peel removes those outer layers by placing an agent onto the skin that causes the outer layers of skin to peel off, leaving a fresh new layer to resurface. I personally do not perform a deep phenol peel which could help your condition, but I do perform laser skin resurfacing which I feel works well. With both dermabrasion, laser resurfacing, and chemical peels, there is a risk of skin lightening. The deeper you go, the longer it takes for you to heal, but the results are more dramatic.

Posted by William E. O'Mara Jr., M.D.

In my experience, glycolics or salicylic acids do not penetrate deep enough to remove the pigmentation or significantly rough skin. Those are considered light peels.  I prefer a medium depth peel using TCA (tricarboxylic acid). This will remove most of the pigmentation in most patients, but the peel can be repeated after approximately 3-4 months. Down time is about two weeks, but makeup can be applied after 10-14 days.

Posted by William E. O'Mara Jr., M.D.

There are a number of ways to answer that question, but I usually begin with evaluating the person asking it. In all patients, I advocate maintaining adequate hydration, sun protection, and a consistent skin care regimen. Younger patients are better candidates for chemical peels, while patients who have signs of skin excess are better candidates for face lift procedures. Nevertheless, caring for the skin is a continuous process whether or not it involves surgical procedures. Looking young is not only a state of mind but a state of persistence!

Posted by William E. O'Mara Jr., M.D.