Birthmarks, freckles, and moles are among the individual characteristics that make us unique, like the wood grain in a piece of burled walnut. But while a smattering of freckles across our cheeks might be lovely, a crop of age spots or acne scars—not so much. Of course, each of us tends to be more aware of our own irregularities than other people are. You may be convinced that your date is staring at that birthmark on your cheek or that your client is distracted by the mole above your lip, but chances are that they aren’t. Some people become so self-conscious about such perceived physical flaws that they perform poorly in job interviews and feel insecure in social situations. If you're one of them, take stock of your options:
Flat pigmented birthmarks can be covered with opaque corrective makeup made especially for that purpose.
Moles, vascular birthmarks (raised, reddish birthmarks containing blood vessels), and other lesions can usually be removed, depending on their size and location. Of course, removal generally leaves a scar, which can make you even more self-conscious than before. In most people, these small surgical scars tend to fade and shrink over time.
Some moles and other lesions become cancerous. Talk to your dermatologist or other health care provider immediately if you notice a change in a mole's borders, color, texture, size, or symmetry, or if the mole bleeds or changes in any way.
Dermabrasion is a technique in which the skin's surface is abraded or brushed to remove acne scars, age spots, fine wrinkles, and other imperfections. The procedure is performed by a dermatologist or cosmetic surgeon on an outpatient basis. The top layers of the skin are removed during the procedure, and the resulting abrasion looks and feels something like a full-face carpet burn. This angry red skin forms a crust as it heals, giving way a week or two later to smooth pink. If the skin is deeply pitted by chickenpox or acne, sometimes dermabrasion is combined with small skin grafts called "punch grafts." Dermal fillers can also be used to reduce pitting.
Dermabrasion does carry risks, such as infection, bleeding, overgrowth of scar tissue, and too much or too little pigment in the resurfaced skin. Microdermabrasion is a more superficial procedure that requires several treatments and produces less dramatic results.
Another way to remove the top layers of the skin is to apply a chemical irritant. A chemical peel is a somewhat less aggressive technique than dermabrasion, and its effects may not be as impressive or long lasting. The risks of the procedure are similar to those of dermabrasion. Chemical peels should be applied by a dermatologist or other licensed professional. Home chemical peels can cause infection, scarring, and permanent changes in skin color.
A surgical laser can be used to target specific areas of the skin for resurfacing. Lasers are also useful for tattoo and hair removal, and they can improve the appearance of spider veins in the cheeks or near the nose. The procedure carries virtually the same risks as dermabrasion, with the additional risk of accidental eye injury.
Injectable dermal fillers
A range of dermal fillers has been developed for cosmetic and reconstructive uses. Some of these products are synthetic, others are of bovine (cow) or porcine (pig) origin, and a few are made from purified cadaver cells. (It's not as creepy as it sounds.) Some hyaluronic acid fillers are extracted from rooster combs. Another option is to graft the patient's own fat from another body site.
Dermal fillers can restore youthful volume to the cheeks, smooth out large folds and creases, remove fine furrows and wrinkles, and plump the lips. They won't restore elasticity to extremely slack skin, however, and the filler is eventually broken down and absorbed by the body. Bruising and swelling usually occur, and infection, clot formation, allergic reactions, and other adverse effects are risks of the procedure.
Botox (injectable botulinum toxin)
Injection of Botox paralyzes the muscles that cause overlying skin to wrinkle when we smile, frown, and produce other facial expressions. Thus the procedure minimizes wrinkles and keeps them from becoming more deeply etched into our faces. Conservative use of Botox allows a range of facial movement, but overreliance on it can produce an unnatural, frozen look. Risks are similar to those of dermal fillers. In addition, an inexperienced practitioner may place the injections at the wrong site, causing an eyelid or corner of the mouth to droop until the product's paralyzing effect wears off in several weeks.