Best Cosmetic Treatment for Scarred Skin

September 4, 2018 8:53 PM

My skin is pretty bruised and scarred after 10 years of obsessive picking and hair pulling. Two expensive months of having lovely gel nails reduced my nail biting significantly. What similar sort of investment should I make to address the damage to my skin that would need to be done professionally by a doctor or cosmetician?

I have dry, acne prone skin and a pebbly, textured forehead. I also have moderate to severe dermatillomania and trichotillomania. Every inch of my face has been messed with by me at some point over the last decade, but where it used to heal itself over time, the scars and bruising are now just staying around. I don't have any pockmarks which is a miracle, but I do have pores that are now permanently open due to excessive picking.

What's been the best for you when it comes to toning down red/purple/brown scarring or bruising on your face? Chemical peels? Laser? I am willing to pony up for this treatment or series of treatments because a) my face deserves it and b) I know an investment of this kind will keep my fingers away if I see really good results.

posted by Hermione Granger to Clothing, Beauty, & Fashion (10 answers total)

Best answer: Fraxel laser is the ‘big guns’ answer to this. It’s painful (get the numbing cream to apply before your sessions) and pricey, but it really works. Good practitioners will be able to give you more specific recommendations for additional or alternative treatments. Ask for their portfolio and talk to previous patients before committing to any procedure. Fraxel will leave your skin red and irritated for a week or so (it’s like a bad sunburn and can peel) and it’s SUPER important that you not pick while it’s healing, so you’ll need to figure out if that’s realistic for you. If not, a less intense series of spot treatments might be preferable.

You can also try chemical peels, whether at an aestheticians office or by purchasing a kit through Make Up Artists Choice. You’ll have to be very careful with this and follow the directions exactly, but it’s reasonably priced and they have good info on their site about how to do the different treatments and what works for which conditions.

With your history I would strongly encourage you to go to a professional — you can do follow up facial treatments at home later to maintain but jumping in on your own may not yield the best results.
posted by ananci at 10:07 PM on September 4, 2018 [3 favorites]

Best answer: Search for medical spas in your area and read reviews. Medical spas offer laser, peels, and other spa-like treatments at dermatologist Rx strength, and might work better for you than luxury/franchise day spas, where estheticians have to meet minimum product sales goals or they get fired. Often in those settings they have only have one or two lines of product they can sell and they can only do peels up to a certain strength as per state law. A medical spa is more expensive, but I feel the advice they give is more honest, and you get to talk to a real MD.

It sounds like you would be a good candidate for a medium depth chemical peel of some kind (maybe trichloroacetic acid?) and a new skincare regimen that makes your skin look and feel soft and smooth afterward to minimize picking temptation. If you do try a peel, make sure you are vigilant about sun protection afterward, you will burn more easily and faster. Usually people need to do a series of five or six treatments spaced out a few weeks apart (for light and medium depth peels) to see the full results, so don't expect a huge change after 1 treatment unless you go for a strong/deep peel with something like 20%+ acid ingredient, Rx strength. A deep peel can produce a big change but you need to make sure you have time to heal afterward (people often take several days off work) and that you won't pick while it's healing.

I pick my face too, and found that Clarity products really improved the texture of my skin and made me want to pick less and less. The bumpier my skin feels, the harder it is for me to avoid picking it. Talk to a dermatologist about the right ingredients to look for, grab some samples of different things, and soon you'll be able to make informed choices on your own about which products to use. Once I tried Clarity's hyaluronic acid & squalene serums and learned the science behind those ingredients, I was sold. I found cheaper versions online with similar simple formulations that work just as well for me. Since they're not marketed as luxury skincare like Clarity, I can afford to use them long term. Another thing that I love now is chemical exfoliants - I used to only exfoliate with scrubs, or a tool like a washcloth/Korean bath mitt, but after I discovered how effective an over the counter glycolic acid cleanser is, I can maintain the skin texture I like without so much physical irritation.

If you have a light complexion and darker hair, and find that your hair pulling is triggered by small hairs on your upper lip, chin, or cheeks, laser hair removal might be a good investment to take away that temptation. It is surprisingly easy these days to find discounts on it such as with Groupon.
posted by zdravo at 10:20 PM on September 4, 2018 [3 favorites]

You might find RealSelf useful for researching some of these treatments (full disclosure: my partner helps build their website, though he has used it himself for researching various procedures).
posted by batter_my_heart at 11:08 PM on September 4, 2018 [1 favorite]

The thing that really helped simmer down my trich was medical treatment for my anxiety via SSRI's. Currently I'm off the zoloft but my trich and skin picking haven't started back up, despite a confluence of anxiety-inducing things happening at once that, in the past, would have totally caused me to wreck areas of my skin. Either the few years on an SSRI helped me unlearn bad habits or I've gained enough unharmful coping methods while I had the assistive push of drugs to keep me from falling into my old ways, I don't know. Either way, do try to see someone to talk about medication, either starting a low dose of something and seeing how that works with you, or tweaking what you're already taking to take your physical tendencies into account.
posted by Mizu at 11:26 PM on September 4, 2018

Best answer: Broad-spectrum sunscreen! (Japan/Korean sunscreens: PA++++) Protects your skin from future damage while you're getting treatments with acids and lasers, and over time general redness and inflammation will reduce too.
posted by nicebookrack at 11:27 PM on September 4, 2018 [2 favorites]

Microneedling (professional, not a derma roller) might be a nice addition to whatever else you do.
posted by catspajammies at 2:06 AM on September 5, 2018

If you have access and insurance/means to pay, I highly recommend consulting a dermatologist. Even if it turns out that the best treatment for your issue is something non-prescription, the doctor can do better assessment and recommendations than anyone else. The dermatologists I have been to have never been reluctant to recommend something over the counter if they thought it was appropriate; if you fear that they may recommend expensive laser treatments just for the business, got a second opinion.

(The ones I've been to all routinely drench me in samples, too!)
posted by The Underpants Monster at 8:19 AM on September 5, 2018 [1 favorite]

Retin-a cleared up my skin such that there was nothing to pick, and got rid of some bumps/marks I thought were permanent. And while it was in the worse-before-it-gets-better phase, it would have hurt WAY too much to pick.
posted by kapers at 8:31 AM on September 5, 2018 [1 favorite]

Best answer: Absolutely go see a dermatologist to see what your options are for overall treatment. Dark spots are likely Post Inflammatory Hyperpigmentation. Which isn’t exactly a scar and can be helped my topical skin. I started on Retin A Micro about two months ago. (I still have some scabbing and flaking but much of my skin is clear, dark spots going away, and even my vitiligo edge is looking better.) A one time laser treatment or peel will not help recurring acne. Note that any skin treatment will likely cause some flaking or peeling initially so be aware of that if that may trigger your skin picking.
posted by Crystalinne at 11:47 AM on September 5, 2018

Best answer: Electrolysis for unwanted facial hair.
posted by Jacqueline at 10:10 PM on September 5, 2018