Can you recommend a cosmetic dermatologist in NYC?
November 10, 2023 7:46 AM Subscribe
I've got some brown age spots on my face that I'd like to get rid of. Not melasma. A) Do you have a good cosmetic derm to recommend? B) Do you know what procedure I need to get rid of these? And/or C) Do you have any suggestions (that work) for getting rid of these at home on my own? Thanks!
I will MeMail you the name of mine, who I am happy with
posted by virve at 11:49 AM on November 10, 2023
posted by virve at 11:49 AM on November 10, 2023
If your main concern is brown spots, I think you have a decent shot at getting rid of them at home with the following over-the-counter stuff. The prescription options might do it faster, though, and might even be cheaper if you have good prescription coverage:
Tretinoin (Retin A) has successfullly gotten rid of brown spots for me (see, for instance, here, but the phenomenon is very well documented in the scientific literature). It's prescription, and has the added bonus of general anti-aging effects. Retinol and Retinal, which are over the counter, are in the same class but are weaker and non-prescription. If you wanted to try that before paying to see a derm, it might be worth a shot. Retinoids are quote strong, even OTC, so you want to go slow and moisturize well.
15-20% Azelaic acid, also prescription, helps fade brown spots. Again, you can get weaker forms of azelaic acid over the counter (the Ordinary sells an OTC 10% lotion that I personally didn't find terrible).
Vitamin C can also help depigment brown spots. If you're going to go for ascorbic acid, you want to aim for 10-20% concentration, below 3.5 pH, ideally formulated with ferulic acid and vitamin E. Skinceuticals is the famous (and very expensive!) one, but Timeless has one, as do Maelove and Geek and Gorgeous. (I'm actually about to try the Geek and Gorgeous version of vitamin C this month for the first time; Timeless previously broke me out, but my skin is a massive diva, so you'd likely be fine.) Ascorbic acid can cause redness/irritation, so again, go slow, and maybe wait to introduce it if you're starting retinoids too. Additionally, ascorbic acid is light sensitive and degrades within about 3 months of production, so best to have it in an opaque container or wrap tin foil around it (in other words, avoid sunlight), put in the fridge, possibly decant into a small bottle for use, and try to use quickly (Geek and Gorgeous actually makes a mini-bottle to keep on the counter, and decant a weekly amount into that from the main bottle in the fridge). If your ascorbic acid solution starts going yellow/brown, it's oxidized and is no longer good. If you can't handle ascorbic acid, you can look into vitamin C derivatives, e.g. 5% magnesium ascorbyl phosphate. My understanding is that there isn't as much research on their efficacy vs ascorbic acid, but that many find them useful for different issues. I personally use that Timeless 5% MAP twice daily, and like it a lot, but I am not specifically targeting hyperpigmentation issues currently.
There are also topical "brighteners", which I believe typically work through inhibiting melanogenesis by suppressing tyrosinase). These include things like bilberry extract, licorice extract, alpha arbutin, etc.
If none of these topicals work, there are lasers that specifically target brown pigments, available in many dermatologists' offices. This would be the fastest but the most expensive approach.
posted by ClaireBear at 4:24 PM on November 10, 2023 [2 favorites]
Tretinoin (Retin A) has successfullly gotten rid of brown spots for me (see, for instance, here, but the phenomenon is very well documented in the scientific literature). It's prescription, and has the added bonus of general anti-aging effects. Retinol and Retinal, which are over the counter, are in the same class but are weaker and non-prescription. If you wanted to try that before paying to see a derm, it might be worth a shot. Retinoids are quote strong, even OTC, so you want to go slow and moisturize well.
15-20% Azelaic acid, also prescription, helps fade brown spots. Again, you can get weaker forms of azelaic acid over the counter (the Ordinary sells an OTC 10% lotion that I personally didn't find terrible).
Vitamin C can also help depigment brown spots. If you're going to go for ascorbic acid, you want to aim for 10-20% concentration, below 3.5 pH, ideally formulated with ferulic acid and vitamin E. Skinceuticals is the famous (and very expensive!) one, but Timeless has one, as do Maelove and Geek and Gorgeous. (I'm actually about to try the Geek and Gorgeous version of vitamin C this month for the first time; Timeless previously broke me out, but my skin is a massive diva, so you'd likely be fine.) Ascorbic acid can cause redness/irritation, so again, go slow, and maybe wait to introduce it if you're starting retinoids too. Additionally, ascorbic acid is light sensitive and degrades within about 3 months of production, so best to have it in an opaque container or wrap tin foil around it (in other words, avoid sunlight), put in the fridge, possibly decant into a small bottle for use, and try to use quickly (Geek and Gorgeous actually makes a mini-bottle to keep on the counter, and decant a weekly amount into that from the main bottle in the fridge). If your ascorbic acid solution starts going yellow/brown, it's oxidized and is no longer good. If you can't handle ascorbic acid, you can look into vitamin C derivatives, e.g. 5% magnesium ascorbyl phosphate. My understanding is that there isn't as much research on their efficacy vs ascorbic acid, but that many find them useful for different issues. I personally use that Timeless 5% MAP twice daily, and like it a lot, but I am not specifically targeting hyperpigmentation issues currently.
There are also topical "brighteners", which I believe typically work through inhibiting melanogenesis by suppressing tyrosinase). These include things like bilberry extract, licorice extract, alpha arbutin, etc.
If none of these topicals work, there are lasers that specifically target brown pigments, available in many dermatologists' offices. This would be the fastest but the most expensive approach.
posted by ClaireBear at 4:24 PM on November 10, 2023 [2 favorites]
Just to provide a slightly more concrete answer, my practical recommendation would be:
- First, get on a retinoid (ideally: prescription tretinoin; if not: non-prescription retinol/retinal/maybe differin). This is going to be one of the heaviest-hitters topically for hyperpigmentation, and also does really good things in terms of general skin health (collagen formation, etc.). Get acclimated to the retinoid and gradually move up in strength, until you are using at least a medium-strength retinoid (0.04% or more) 4-5 nights a week with very little or no peeling/flaking. This will take months to possibly a year or more if your skin is very sensitive.
- If you want, during this time you could add in something non-irritating, like a brightening serum. I wouldn't do this until your skin is fairly well acclimated to the retinoid. Maybe The Ordinary alpha arbutin serum, or something with niacinamide (just an FYI, a small proportion of people are sensitive to niacinamide, including yours truly: you'll know quickly if you're in that camp).
- Then, if the hyperpigmentation isn't resolved to your satisfaction, I'd add in vitamin C. The reason I suggest that is because, like retinoids, vitamin C notoriously has many skin benefits beyond just helping with hyperpigmentation. I'd start with ascorbic acid to see if it's tolerable. I personally might start with Geek and Gorgeous, simply because the price is reasonable, they're communicative about sending out fresh batches, and anecdotally, reviews seem to suggest it may be slightly less irritating than some other options. But it really doesn't matter which you choose, as long as you pick something within the parameters I mentioned above (%, pH, etc.). Use it in the morning because topical antioxidants can boost sunscreen protection. Go slowly, maybe starting with 1-2 mornings a week and seeing how your skin reacts. If your skin can't acclimate, maybe time to explore vit C derivatives and/or other vitamins (e.g., topical niacinamide).
- If the brown spots aren't gone, I'd then throw in azelaic acid (and a brightener or two, if you didn't previously).
- Last resort is laser. Or, if you simply want to get the spots gone now and have the money, you could do laser instead of the above. Might take multiple treatments? If your spots are dark, you might need laser anyway instead of topicals.
- Oh, forgot to mention: super important to wear sunscreen from now on, if you don't already. Otherwise you're just treading water at best. Dark spots can be hormonal, but can also be caused by the sun: in any case, over half of all skin aging is caused by the sun. They make facial sunscreens that are fairly cosmetically elegant nowadays, and I'm happy to give some recommendations if you'd like (especially if you specify your skin type [oily, dry, combo] and/or preferences).
posted by ClaireBear at 4:51 PM on November 10, 2023 [4 favorites]
- First, get on a retinoid (ideally: prescription tretinoin; if not: non-prescription retinol/retinal/maybe differin). This is going to be one of the heaviest-hitters topically for hyperpigmentation, and also does really good things in terms of general skin health (collagen formation, etc.). Get acclimated to the retinoid and gradually move up in strength, until you are using at least a medium-strength retinoid (0.04% or more) 4-5 nights a week with very little or no peeling/flaking. This will take months to possibly a year or more if your skin is very sensitive.
- If you want, during this time you could add in something non-irritating, like a brightening serum. I wouldn't do this until your skin is fairly well acclimated to the retinoid. Maybe The Ordinary alpha arbutin serum, or something with niacinamide (just an FYI, a small proportion of people are sensitive to niacinamide, including yours truly: you'll know quickly if you're in that camp).
- Then, if the hyperpigmentation isn't resolved to your satisfaction, I'd add in vitamin C. The reason I suggest that is because, like retinoids, vitamin C notoriously has many skin benefits beyond just helping with hyperpigmentation. I'd start with ascorbic acid to see if it's tolerable. I personally might start with Geek and Gorgeous, simply because the price is reasonable, they're communicative about sending out fresh batches, and anecdotally, reviews seem to suggest it may be slightly less irritating than some other options. But it really doesn't matter which you choose, as long as you pick something within the parameters I mentioned above (%, pH, etc.). Use it in the morning because topical antioxidants can boost sunscreen protection. Go slowly, maybe starting with 1-2 mornings a week and seeing how your skin reacts. If your skin can't acclimate, maybe time to explore vit C derivatives and/or other vitamins (e.g., topical niacinamide).
- If the brown spots aren't gone, I'd then throw in azelaic acid (and a brightener or two, if you didn't previously).
- Last resort is laser. Or, if you simply want to get the spots gone now and have the money, you could do laser instead of the above. Might take multiple treatments? If your spots are dark, you might need laser anyway instead of topicals.
- Oh, forgot to mention: super important to wear sunscreen from now on, if you don't already. Otherwise you're just treading water at best. Dark spots can be hormonal, but can also be caused by the sun: in any case, over half of all skin aging is caused by the sun. They make facial sunscreens that are fairly cosmetically elegant nowadays, and I'm happy to give some recommendations if you'd like (especially if you specify your skin type [oily, dry, combo] and/or preferences).
posted by ClaireBear at 4:51 PM on November 10, 2023 [4 favorites]
I've noticed that using both retin-A and azelaic acid, as ClaireBear mentioned, has mostly faded an inoffensive mole/freckle I've had for decades, along with doing the intended good things for my acne and rosacea. I get prescription forms of both, and wear sunscreen on my face every day.
posted by metonym at 4:51 PM on November 10, 2023 [1 favorite]
posted by metonym at 4:51 PM on November 10, 2023 [1 favorite]
Forgot to mention: you may also have some success in fading hyperpigmentation with hydroxy acids, especially alpha hydroxy acids (AHAs). You could use serum versions a few times a week in a low/medium strength (say, 10-20% strength). About 2x/week, I personally use this one, which is 15% lactic acid with a vit C derivative and hyaluronic acid (moisturizing/hydrating). I have sensitive skin and don't find it upsets my skin. For me, it actually helps get rid of a bit of lingering tretinoin flakiness, since it's an exfoliant. The same company also makes a glycolic acid version. (Glycolic acid is typically thought to be a stronger AHA than lactic.) Or, you could try a series of periodic stronger AHA peels (e.g., 30% glycolic acid peels).
I wouldn't necessarily advise combining AHAs with tretinoin and ascorbic acid right away, since I think it would be rough on your skin to start them all at once, so I'm just putting all this out there as a point of information. I personally would still start with tretinoin and then ascorbic acid and/or azelaic acid, since, like metonym, I too had that combo (the prescription versions) remove a brown spot from my face.
posted by ClaireBear at 5:26 PM on November 10, 2023
I wouldn't necessarily advise combining AHAs with tretinoin and ascorbic acid right away, since I think it would be rough on your skin to start them all at once, so I'm just putting all this out there as a point of information. I personally would still start with tretinoin and then ascorbic acid and/or azelaic acid, since, like metonym, I too had that combo (the prescription versions) remove a brown spot from my face.
posted by ClaireBear at 5:26 PM on November 10, 2023
Sorry, one final comment. I suddenly remembered that there are those online dermatology outfits that will prescribe a personalized compounded cream for you that they send you periodically (every 2 months or so?). This would cut everything down to one application and also avoid the cost of seeing a derm and purchasing multiple products. I guess the utility of these online services also depends on your prescription coverage and whether or not what your in-person derm would prescribe for you would be covered by your insurance. (For instance, my tube of tretinoin micro gel is something like $5 with my insurance coverage, since it's for acne and therefore covered by my plan, but it would cost hundreds of dollars per tube paying out of pocket if not covered.)
So this online option may or may not be appealing to you, but thought I'd mention it. I think it's probably a better solution than compiling OTC things together yourself. Looking over my notes from last year, the options I found at that time included: Curology, Ro Derm, Apostrophe, Agency. There may be others. I've poked around on those sites but never actually ordered anything (I was swayed by the idea of getting everything in one cream rather than having to put on multiple things, but then decided just to keep what ain't broke!). They do have interesting ingredients that look very helpful. For instance, here are the ingredients Curology uses. In your case, I think azelaic acid, tretinoin, niacinamide, and tranexamic acid would be the most promising of their options. Looking at Ro Derm, they also have those four available for compounding prescriptions, as does Agency. I'm a little bit confused about Apostrophe's options (it looks perhaps like they only let you select premade formulas rather than get a personalized formula?). Also, I believe Curology only allows you three (?) ingredients in your formula, but I think some of the other sites may allow you more. Anyway, clearly I don't know very much about this, nor do I have personal experience, but I've come upon positive experiences in the subreddit I read, so I thought I'd touch on it. Looks like there are discounts for first-timers, too.
posted by ClaireBear at 8:07 PM on November 10, 2023
So this online option may or may not be appealing to you, but thought I'd mention it. I think it's probably a better solution than compiling OTC things together yourself. Looking over my notes from last year, the options I found at that time included: Curology, Ro Derm, Apostrophe, Agency. There may be others. I've poked around on those sites but never actually ordered anything (I was swayed by the idea of getting everything in one cream rather than having to put on multiple things, but then decided just to keep what ain't broke!). They do have interesting ingredients that look very helpful. For instance, here are the ingredients Curology uses. In your case, I think azelaic acid, tretinoin, niacinamide, and tranexamic acid would be the most promising of their options. Looking at Ro Derm, they also have those four available for compounding prescriptions, as does Agency. I'm a little bit confused about Apostrophe's options (it looks perhaps like they only let you select premade formulas rather than get a personalized formula?). Also, I believe Curology only allows you three (?) ingredients in your formula, but I think some of the other sites may allow you more. Anyway, clearly I don't know very much about this, nor do I have personal experience, but I've come upon positive experiences in the subreddit I read, so I thought I'd touch on it. Looks like there are discounts for first-timers, too.
posted by ClaireBear at 8:07 PM on November 10, 2023
Response by poster: Thanks for the wealth of info, ClaireBear, which will no doubt be of use to others as well. I do use tretinoin, but maybe pairing it with some of the other things you mentioned could help. My spots aren't super dark, so maybe wanting them 100% gone isn't realistic. Anyway, looks like there are some things for me to try before I shell out a ton of money for lasers.
posted by gigondas at 9:19 AM on November 11, 2023 [1 favorite]
posted by gigondas at 9:19 AM on November 11, 2023 [1 favorite]
Alternately, my mother doesn't use any skin care products (despite my best efforts). She went and had her brown spots lasered off once, and they are gone and have stayed gone for nearly a decade now. So, if you want to one and done, it is very possible.
posted by Mournful Bagel Song at 3:22 PM on November 13, 2023
posted by Mournful Bagel Song at 3:22 PM on November 13, 2023
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