Welcome to Ask A Derm, a monthly feature where board-certified dermatologist Shereene Idriss is on hand to answer your most pressing skin-related questions. Though nothing can substitute a visit to Dr. Idriss’ practice at Union Square Dermatology, think of this as your skincare primer before your appointment date arrives. Get to know Dr. Idriss a bit better through her Top Shelf here, and through her Instagram account, @shereeneidriss. Got a question you’d like Dr. Idriss to answer? Ask away at [email protected].

Upgrading A Sensitive Skin Routine

Dear Dr. Idriss,

My skin is extremely sensitive. Like, turn-red-at-the-mere-mention-of-any-new-product-sensitive. Because of that, I’m always afraid to try something new. But, at the same time, I’m getting older and I’d very much like to upgrade my skincare routine. Right now I’m using the most basic, unfussy, fragrance-free products. They’re great for keeping sensitivity at bay, but they’re doing absolutely nothing for my ever-growing fine lines. And I can’t really stand it anymore! So, my question for you Dr. Idriss is, how can I go about incorporating more efficacious products into my routine? Can I at all? Or should I resign myself to a lifetime of boring, uncomplicated skincare?

Sincerely,
Sensitive And Upset

Dear Sensitive,

Fear not! You’ve come to the right place! First and foremost, the best anti-aging solution is prevention, so always, always use sunscreen. Physical blockers (like sunscreens that have zinc and titanium, for example) are better than chemical sunscreens for people with sensitive skin—they’re less irritating. [Ed. note: Dr. Idriss cites Elta MD and Colorescience in her Top Shelf.] If you want to be more reactive to your changing skin and not just proactive with the use of sunscreen, go ahead and venture down the retinoid route. Try an over-the-counter retinol first. You don’t want to get into prescription strength retinoids just yet, as those tend to be more aggressive and harsher than their over-the-counter counterpart. I would recommend starting with the lowest concentration possible, which is usually .25-percent. Use it once a week for a couple of weeks so your skin can adapt, and slowly add more retinol days in your routine for a couple of weeks so you know your skin can really tolerate it. Slow and low is your way to go. If you're too scared to go down the retinol route, look for creams with peptides that help with collagen production. Also, just exfoliating with glycolic acid every once in a while has also been proven to help build collagen. And glycolic acid tends to be "light," so it's not going to peel your skin or irritate like salicylic acid, for example, would.

In my experience, Botox and fillers do not really trigger sensitive skin. Rosacea, for example, doesn't flare up because of Botox. Doing either Botox or fillers as an in-office procedure can be an easy adjunct to OTC remedies, and if you're very nervous, you can always ask your doctor to test out half a syringe in a small area on your face. That way, you can get an idea of how your body will react to it, and you can decide whether or not to move forward. I hope this helps and I’m excited for your expanded skincare journey!

On Botox For Sweating

Dear Dr. Idriss,

Awards season is coming up, and I feel like each year I hear about the craziest beauty treatments that are used on the stars. One thing that comes up year after year is how celebrities Botox their underarms. Not because they’re worried about wrinkles or anything—because apparently it stops sweating. Now I believe this works, but...how? I’m a serious sweat-er and I’d like to know! And does the sweat redirect to another part of your body? If I get Botox in my underarms, will my eyelids or some other weird place start to sweat?

Sincerely,
Sweater Weather

Dear Sweater,

Treating your underarms with Botox is considered to be a localized treatment—it's only going to stop the sweating in the area being treated. The way it works is that it blocks the nerves that activate your sweat glands. Normally your sweat glands will respond to your nervous system. So if you're nervous, your body will secrete a certain chemical that activates sweat glands, and in turn, you produce more sweat. But the Botox in treated underarms blocks that activation from happening. However, your nerves will continue to signal the sweat glands in other parts of your body to produce sweat as it normally would. Keep in mind that your skin is your body’s largest organ, and your armpits are only a small part—your body will easily compensate and self-regulate by releasing sweat in other areas. That’s not to say you will begin to sweat profusely in weird places. Your skin covers such a large surface area that it can easily adapt without you noticing any significant changes at all. If you are still interested, keep in mind that Botox has been shown to last anywhere from 12 to 16 weeks. For people with really bad hyperhidrosis, otherwise known as excessive sweating, three to four months is probably a better treatment schedule. For everyone else, a once or twice a year Botox regimen is probably the most that’s needed.

A Hyperpigmentation Treatment Stronger Than Vitamin C

Dear Dr. Idriss,

I used to have terrible acne in my teens and 20s, and I’m so grateful that period is over in my life. But in my 30s I was confronted with another issue: hyperpigmentation. My dark spots are like my ghosts of acne past. I’ve been good about sunscreen as well as vitamin C, and yet they are still there! How can I level up my treatment and get these marks off my face for good?

Sincerely,
Haunted

Dear Haunted,

It all depends on your skin type and the amount of sun exposure you actively have. And also, you have to think about whether you’re treating a few small dark spots or a larger area, the latter of which would need something called a “field treatment.” IPL is a gentler option for beginners. However, don't be fooled because not all IPLs are treated equally, and can easily cause you to burn if not done correctly—make sure you’re getting treatment from a board certified dermatologist! A Q-switch Alex laser, for instance, is a beautiful option for localized brown spots, whereas a more intense procedure such as a Fraxel is a better option when it comes to treating larger surface areas. Not all spots are at the same depth, so some spots can be treated very easily because they're more superficial, but other times you think it's superficial but it ends up being deeper and will require more treatment. The best advice is to go into any treatment with patience and to also know that once you've treated your brown spots you may still develop other new ones. I know that’s annoying, but I don’t make the rules here! I just relay the facts!

Shereene Idriss

Photo via ITG