In our weekly Post Your Face column, Dr. Robert Freund answers readers' cosmetic surgery questions, and shows them how they'd look if they underwent the enhancement. To post your own face, visit postyourface.com.

The Patient's Question:
At 35, how is it possible that I still have pimples, yet parts of my skin are dry and red? I've also been bothered by my deep nasolabial folds since my early 20's. Help!

Post Your Face

The patient before and after the hypothetical surgery. Courtesy Photos


Dr. Freund's Answer: You describe some very common skin issues that appear to be contradictory. Let's break them down.

Acne can be caused by many factors:
  1. Hormones or genetics, which means you can only treat the problem as it occurs.
  2. Oils can block pores causing a buildup of bacteria. Keeping the pores open and oil production low can help with these concerns.
  3. Dry skin can create dead skin buildup around the pore and block it
So what can you do?
  1. Apply a light moisturizer to the dry areas of your face. Not all parts of your face may be equally dry, so use it most heavily in the driest places.
  2. Exfoliate with a buff-puff or facial scrub, once or twice a week but no more. Many people try to beat acne by scrubbing on a daily basis. I myself used to do this, but this leads to raw skin that is dryer and more prone to oil production and more acne. Moderation is key!
  3. Reduce oil production if this is part of the problem, with Benzoyl peroxide, beta-hydroxy acids (salicylic acid), or Retin A. All can help slow oil production and the subsequent acne.
  4. When acne becomes inflamed and infected, topical or oral antibiotics may be warranted. If so, see a Board-certified dermatologist.
Finally, both your nasolabial folds (B) and tear trough hollows (a) are deeper than expected for someone of your age. I would suggest a filler to correct both problems. The only caveat is that the amount of volume necessary to fill both areas may be significant (4cc's for the tear troughs and 2cc's for the nasolabial folds) and require large amounts of off-the-shelf fillers, which could be cost prohibitive.

So I'd prescribe fat transfer as a solution. Remember, the fat we use comes from your own body and the procedure can be done in a doctor's office under local anesthesia. The cost is about $2,500. I also prefer the Viafill system, as it gives durable, smooth results.

I discuss fat transfer, fillers and caring for all types of skin in my new book, "A More Beautiful You - Reverse Aging Through Skin Care, Plastic Surgery and Lifestyle Solutions."

Respectfully submitted,
Robert M. Freund, MD, FACS

The health or medical information in this article is for informational purposes only and is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. Please consult your doctor or a qualified healthcare provider with any questions.