#1

So, yes, I lured you in with promises of disgusting pictures of my face.

There is a possibility I will be visiting Seoul Korea this summer (both my daughters independently will be studying there). Given the focus Korea seems to have on the beauty industry (and the weakness of the Won) I am seriously considering getting a “tune up” while there. For those of us who are experts in this field (I’m not) I would love your thoughts on what you might have me consider. I am attaching pictures of my face skin so you have actual information from which to consider treatments.

To be clear, I am not against surgery but not interested for myself; i am really thinking treatments such as laser refinishing (fraxel, therma-age, CO2, etc) or injections or something like that; I’m partial to lasers but will consider anything. I’d prefer nothing that needs to be re-performed every six months (like botox or fillers) because i’d just do that in the US instead (I’m not yet but considering it).

I’ve never yet had anything done: no botox, no retinol, no lasers, nothing other than basic facials. I don’t yet take rapamycin or any other longevity drugs other than collagen, magnesium, Vit D, astraxanthin, and GlyNAC. I dont really do much other than wash my face/skin regularly, and am considering tretinoin (but what percent? — is 0.1% too string for someone like me? I do like a value…) I have most of my hair (albeit getting pretty grey) but just now starting to see it thin at the temples (I notice it). I’m 53 if that puts my skin/hair into perspective. Oh: and i have (mild) vitiligo which makes dermatologists nervous doing anything.

Thank you.

(Prepare for the hideousness…)

IMG_3874
IMG_38741284×2778 483 KB

IMG_3872
IMG_38721920×2560 181 KB

IMG_3871
IMG_38711920×2560 253 KB

3 Likes
Rapamycin Frequently Asked Questions (FAQ)
#2

Not to single any expert out, but I am particularly interested in what you @LaraPo would suggest here. Thank you.

#3

Overall you appear to have a pretty good skin. There’s some discoloration with sun spots on your cheeks. Wear sunscreen every day and reapply frequently. Wrinkles around eyes don’t spoil the look imo. You can reduce wrinkles around your eyes and on your forehead by having Botox injections, but keep in mind that if you do it, you won’t be able to raise your eyebrows and your eyebrows may even drop a little giving you a “tired” face. If you start retinol, you’ll have to avoid sun all the time (is it even possible in South Korea?). Your skin is pretty good imo, so why even bother?

5 Likes
#4

Not an expert, but I do it all… so…

I don’t know enough about vitiligo so take everything I say with a grain of salt.

  1. tret.
    Your instinct is correct, unless you want to deal with it, I’d start with a smaller dose. 2x per week to begin. You can use the higher dose, but I’d DEFINITELY buffer it (put a nice thick lotion on first so less absorbs). You want to make sure your face is not damp.

  2. you probably know this, but if using tret, you need to be religious about spf… I would be regardless. SPF 50, don’t bother with 30, but 30 better than nothing!

Some heat devices, and I don’t know which ones, melt fat in your face… just research carefully

There are some rx creams that can help with spots.

IPL is a fairly innocuous laser (not technically a laser and just light) and can get rid of freckles and some spots. It takes a few treatments and not perfect

There is nothing I know of in SK that we don’t have, but I am clueless on that topic.

Also, your face looks good to me and I see just a little redness and mild spots, meaning, you look like everyone else to me. But it’s also a close up and maybe I don’t see this clearly enough.

I’m thinking, if anything, tret and spf… and if anything, maybe ipl ?

I’m not seeing a case for $$$ lasers etc.

I personally don’t want to see men with no wrinkles.

an rx of tret through curolgy or dermatica, or similar service, even if you only do it once, is nice because you can find out through them what else they might recommend, like the bleaching cream to address discoloration. (If you don’t see an offer for an almost free first month, message me and I’ll send you a link for a discount, but I think they usually offer that for anyone.

If you want more advice, this facebook group is excellent… Carolyn Hirons Skincare Freaks

6 Likes
#5

Thank you, @LaraPo — much appreciated.

Yes, botox is the obvious choice and I’ve considered it (I may be the inly person in NYC not using it) butt like you I’m not as concerned about that “look” with wrinkles, but more that I’d like to prevent them from getting worse over the next 50 years (so keep the muscles from making them deeper). But it hasn’t convinced me yet. And your “droopy eyelid” warning will probably nix this.

I’m not as good with my sunscreen; this is a clear area for improvement. Also some of the spots you may be seeing is the discoloration from rhe vitiligo: it gets more noticeable/contteasty over the summer.

The retinol is for preserving the skin, and less trying to make me look much younger. The warning about zero sun is taken, and i can probably do that.

I probably should have mentioned: South Korea has a seriously advanced dermatology intervention and plastic surgery industry, and it’s much cheaper ;(and the dollar is strong there). It’s not just “cheap” like Turkey or Mexico.

1 Like
#6

Thank you for your comments, @Beth .

No need for heavy lasers is probably good. And now i am terrified to “melt fat from my face” as this gives it volume.

The advice on tret is appreciated. I haven’t used it so I’ll need to take it slow. And never leave during the day (this is easier than you’d think in NYC).

And thank you for the suggestion on curolgy or dermatica — I’ll definitely take you up on that. But i had thought perhaps its better to start tret in the Fall, and not early summer.

1 Like
#7

Maybe i should ask a different question now that I have closeup pictures if my face on the Internet (which i thought would allow an impartial assessment of what I might need):

I was “hot” to perhaps try something to dramatically improve my skin, and while in South Korea because they have a wide array of advanced services (perhaps not much different than here in NYC) but art a much cheaper price. I had thought perhaps an advanced laser treatment that would be $10k here in NYC (multiple treatments) but you (collectively) are suggesting there really isn’t anything obvious.

So, if I instead wanted to prep my skin to look essentially like this for the next 50 years, what should I do treatment/procedure-wise )with the understanding I should vehemently wear sunscreen and stay out of the sun, and use moisturizer). This is where the retinol was supposed to come in but perhaps this is overkill. And also I could care less about my existing wrinkles, but I have been told that using botox now would prevent new/deeper wrinkles.

And I certainly don’t want to emulate Bryan Johnson (nor spend anywhere near that kind of money) but as a separate question iif I wanted to look 30 again, what would you suggest? (I am unlikely to do this but I am still curious what I’d need to do.) By “looking 30 again” i wouldn’t ever consider anything which may make me look younger initially but will later make me look awful, including facelifts/tucks (never unless i was in a massive accident), fillers (I’m mot a good maintenance person, and see far too many people who have fillers and it makes their face wrinkle in new/natural ways which look far worse). I’d only be interested in things which would make me healthier.

Thank you.

1 Like
#8

Here is some verbal vomit for you….

If you want to keep wrinkles from getting worse, the only thing I know of that truly works very well would be Botox. It is maintenance though, as you know. And the key is finding an excellent provider. Someone great will leave you looking natural. I know the name of one of the top people in NYC (just message me), but he will also sell you a million dollars in lasers, so if you were to go to him, go and ONLY do Botox. The key is finding someone excellent so you only soften slightly to keep what is existing from progressing. There is a fine line (pun intended) from softening to frozen/drooping. Not inexpensive though. Unless you got a name, I wouldn’t randomly let anyone here or in SK give me Botox. Many people do bargain shop their botox with great results, but I have petite features and things could go wrong very easily.

I’ve done a very expensive laser from a ‘top’ person (to minimize risk) and I’m not sure I even see a difference. Co2 under anesthesia. Caveat is my skin was very good to begin with. I didn’t burn my face off like some of my friends who looked like burn victims afterwards (black and crusty). Their results were more drastic but there is much more risk with that… and two years later, one said the result didn’t last (15k later). It’s not that all those things don’t work. I believe many do, but maybe not equally on everyone. Some people here might be buying some of these things for home use, but not sure where they have left that… maybe someone will chime in.

The most proven thing is tret, so I really feel tret and spf are the very first step for you. Various types of lasers come and go. Tret has not waivered. No reason to do other things before the affordable low risk basics that are known quantities. I also don’t believe there is a reason to wait for the fall. The experts don’t stop using tret during the summer. If you want to start small, and no reason not to, get a good quality retinol and then graduate to tret afterwards. Medik8 is a great line, but $$$. There are cheaper that will be just as good, but I just don’t know who makes the good stuff (that fb group would be a great source for brands). But, you can also get .025 or .05 tret and use up to 3x per week and buffer it which will probably be less expensive. Caroline Hirons (skincare expert) says studies show there is no reason to use any of it more than 3x per week… and she even sells a retinol (hers would be good quality too, skinrocks). I use my dermatica between 4-5 x per week, fwiw. If my skin is being reactive, I’ll mix a drop with lotion to buffer it that way.

You said you aren’t perfect with your spf, so I’m thinking you don’t have an spf 50 you love? US chemical sunscreens suck, so I’d start with buying beauty of joseon spf 50 for $14 from iherb (I give the source because Amazon sells fakes). It’s Korean :). They are known to have the most elegant formulations that don’t feel like spf… but this one is also not very water resistant, so it’s not your beach spf, but it’s great for all other times, and it’s cheap enough that you’ll be generous applying.

I have no idea how old you are, but trust me, if there was a way, including surgery, to make one look 30 again, I would have already done it :). I don’t have a bunch of friends who all the sudden look 30, ya know. Better and younger, certainly!

Another affordable thing is derma rolling… you can buy a roller cheaply and do it yourself. Do not get longer aggressive needles for home use. I have one but have only used it 10x over 5 years because I’m lazy :). I think this would be a subtle thing.

Also, Nuface or a like device. Those things do actually work, but it’s subtle, and it’s HIGH maintenance. I sold mine on eBay because I just didn’t want to keep it up. I was a skeptic but enough people said they work that I thought it was worth trying.

Modern day facelifts are a different animal and don’t make people look younger but worse as they did in the days of yore. But, those modern techniques must be done by pros, and if you are not traveling, it’s $$$$. You are no where near ready for that but just sharing this tidbit. That tight windblown look is not a thing in the right hands.

Oh, and incase I didn’t mention it, curolgy/dermatica can mix multiple things into your tret formula, and that is why I like them. It’s a cheap way to start, and then you can continue with them or once you know what you like, then you can source on your own. If I recall, a generic retin a rx might be aprox $100? But that tube will last FOREVER because you only use a pea sized drop.

2 Likes
#9

Also adding…

Laser safety…. There are some people online who got the same laser I did who said it ruined their skin forever… this is why IF you should ever go down that road, I’d recommend choosing a provider VERY carefully

And after religious spf and tret, if you wanted to add in other popular ingredients, vit c and niacinamide are two things I use and have been popular for a long time. I hear some use azelaic acid for some conditions, too. I can’t even tell you what they do, but easy and not expensive, so I just do it. (Vit c best during the day because ‘they say’ it helps spf work better). Not everyone’s skin tolerates it.

And lastly, I remembered my sis in law has been battling 3 different skin conditions, and one is what you have. I recommended she give up dairy and gluten for 3 months, and to her chagrin, gf made a huge difference. I”m not sure which condition it helped, but I will ask her. This works for so many skin conditions that it’s something you might try? Also probiotics.

An rx helped for one of her things, and I’ll ask if it’s what worked for your vitiligo (I assume your derm gave you something?).

Again, check with your derm on any of these things incase it could make your vitiligo worse.

1 Like
#10

Thank you, @Beth for such an unbelievably thoughtful and detailed response. I’m going to break up the discussions into your topics to deal with them separately.

Also: if I didn’t mention it before, I’m 53, so old enough that i can look “youngish”, and I also see many of my compatriots look old. Many of them move like an old person. I personally feel the same as when I was 30. I am optimistic and energetic. I work out so things arent heavy and my movements are fluid. I can wear a tight shirt and look good (but I’m not “cut” nor “swol” and definitely DEFINITELY don’t look like I can squat 350, and I’d like to work on being cut but that’s a discussion for another day). I don’t need to look “young” (i.e. I’m not wearing baggy pants with a skateboard and a baseball cap off-center on my head) but “youthful/energetic would be fine…

I live in NYC and it seems like most people use fillers; they may use botox as well, but it seems trye people who 15 years ago used botox now use fillers. I’m talking about people I see everywhere on the street, in reattaurants, etc. — it is painfully obvious to me, and generally looks terrible (there’s a “NYC look” I’ve heard from older women from elsewhere where they get this lion muzzle look from puffed out lower face). I see this with celebs all the time and i think “ how could you have destroyed yourself so badly???”

There are others here who look fantastic — like they’ve done zero work other than been bitten by a vampire (or have a “blood boy”) — but they never want to discuss/reveal what they’ve done. By the way: I do mean FANTASTIC. 70 year olds who could pass for 40 easily if not for their mannerisms, wardrobe, and speech patterns. (Picture a young Millennial inhabited by the ghost of a Boomer.) Truly clear, unblemished elastic skin with no wrinkles. I’ve seen them up close; been to their homes. And their derma secrets are secrets they will take to the grave (since most of them as 70 this might not be long) so no recommendations.

I’ve been to very good/conservative dermatologist here for my vitiligo (I tried a very laborious laser “cure” at one time which I was told halfway through that it may last 18 months if I was lucky). These doctors have discussed with me my skin quality and they came to the same conclusions you and @LaraPo came to: my skin is fine, and they, too, don’t see a need for lasers ( I requested fraxel as a longterm preventative measure and was rejected), but thought judiciously-administered botox would be a plus. I’m not likely to go this route unless I thought it would preserve my face (ie prevent more wrinkles). So, yes, I do have a doctor who could do this in a conservative manner (without overdoing it or changing my facial folding/structure) but haven’t taken the plunge. And I’m highly unlikely to do this in another random country because it’s cheaper.

1 Like
#11

99% (or more) of the 70 year olds who look like 40 year olds have had surgery by excellent surgeons, as you probably know.

Young people who get too much filler drive me nuts, but that is from the pressure of the Kardashian/Instagram era.

In defense of the older women who look puffed out and fake, unless they want to go under the knife, it’s a choice of continuing to add filler to the point of having that ‘lion‘ lower face, or choose to have thin lips, a wrinkled philtrum, lost cheek bones and sagging jowls. Some people have no idea what they look like, but others absolutely know, but they have decided it’s a lesser of evils. If they didn’t have a puffed out lower face, it would be sagging quite a bit and people would be talking about how they’ve aged vs their awful filler. Which to choose, I don’t know? Some are lucky and don’t need much. Being heavy would help considerably! It’s a really hard line to walk and filler can delay surgery for years. I admire the people who are confident enough to do nothing.

15 years prior, Botox was all they needed to look younger, but 15 years means loss of volume and Botox doesn’t do anything for that… so they go down the filler rabbit hole… makes a lot of sense.

2 Likes
#12

Also, just to complete the treatment landscape ….

At 53 with plump looking skin, it’s nothing you are ready for, but sharing that there are alternatives to fillers these days… hydration treatments… one brand is Profhilo. I have not done these yet and just waiting and watching to see which ones/brands wind up on top and how long the treatments last to see if the $$ is worth it for me.

1 Like
#13

You don’t want to set off the vitiligo. That being said it seems that retin-a is likely to be a good candidate.

“The mechanism explaining the beneficial effects of tretinoin on repigmentation of patients with vitiligo is unknown, too (11). This phenomenon may be related to the protective effect of retinoic acid on autoimmune diseases like vitiligo. Retinoic acid inhibits proliferation of T helper17 and therefore inhibits auto-immunity, which could be the cause of the positive effects of tretinoin on repigmentation (12)”

Comparative Study of the Therapeutic Effects of Topical Mometasone Furoate 0.1% Plus Tretinoin 0.05% and Topical Mometasone Furoate 0.1% Plus Eucerin in the Treatment of Vitiligo.

Retin-a is dirt cheap, Goodrx, pharmacychecker.com or indiamart, you could start with 0.01% and then move to 0.05%. This is what I did. I’m 74, and have potato-white Irish skin and rosacea. I was surprised that the 0.01% did not cause problems, so I moved to 0.05% and had some flaking for a few weeks and now, I use it every day, face, neck (many warn not to do neck) and both arms/hands, and have done so now for 5 months, no issues.

IMHO, any person over the age of 40 ought to use Retin-A forever. LaraPo’s comment about sun in Korea is applicable, you’ll have to use a mineral-based spf50 and carry an umbrella, or…stop the retin-a when you go.

Consider a rapamycin cream, both Retin-a and Rapamycin show structural changes in the deeper levels of tissue, though I’m unsure about how to use the two.

I’ll agree with LaraPo, “your skin looks pretty good imo, so why bother” (with a heavy treatment such as CO2).

2 Likes
#14

Justin, why a mineral spf?
I don’t doubt you and sincerely asking

Until last year, I ONLY used mineral because I loved it and never found a chemical spf I liked, until BOJ (that I noted above). The only reason I switched is because I wanted to upgrade from my spf 30 to 50. I like some mineral spf 50s, but haven’t found one that is true love.

#15

Also, I’ve thought of retinol/retin a on hands but because i wash them constantly, I have been worried about lack of spf… have you addressed this?

My derm, fwiw, is against using tret on the body because too much vit A can be toxic. I have no idea if she is correct? Tret mixed with lotion would not be very expensive, so I was tempted, but I heeded her advice without knowing enough to feel confident. Thoughts? I did buy some retinol body lotion this year … very very low percentage, as they all seems to be. I haven’t used it enough to have an opinion.

#16

Either can work, mineral on non-mineral. Often folk look at “retin-a” OMG must use SPF 4,000. However, from what I’ve read the early stages of using retin-a cause a turnover of new skin also makes you susceptible, not only to the sun but even to wind (wind-burn). Meaning that one needs to be ultra-careful at the start of using retinoic acid.

I really don’t think it matters, though if one is in Korea, or as I will be, in Thailand and/or the Philippines I feel that I would need that SPF 126,000…… So much depends on where/what one is doing. Going shopping and intermittent exposures of short durations likely an SPF 30 is fine. In the Philippines SPF 50 is minimum. In the Philippines add an umbrella, and for me, literally try to avoid any exposure, yikes!

(I’ve had 3 basal cell carcinomas and one squamous cell carcinoma—from being proud of my suntan when I was a gardener at age 18—when “oh, the sun is good for you.”)

Some of the newer mineral ones seem impressive. There are questions about the chemicals in the chemical versions and quite frankly, I’ve had “ruined” days from burning eyes, even when I was careful about making sure I kept the chemical-based sunscreen away from my eyes. For me, that’s a strong, go-to mineral.

Try reading: “The Banned Sunscreen Ingredients and Their Impact on Human Health: A Systematic Review” See

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648445/

Try asking your dermatologist, “why, is it systemically absorbed, and how much?”

My dermatologist told me that my rosacea is caused predominantly by demodex mites (skin mites) and so prescribed Metronidazole (the antibiotic-antiparasitic Flagyl). Uh, hmmm…what about the study that proved that demodex mites live quite happily surrounded by Flagyl? (Yes there is a study if one looks for it.) The reality is that nobody really knows why Metronidazole works—it’s fascinating. But, in medical school it was: “Rosacea is caused by demodex mites and Metronidazole kills them.” End of story, except that it’s simply not correct.

“The dose is the poison.” So, does using retin-a on the face + hands, or face + hands + arms + shoulders create systemic poisoning? From what I’ve read: “no.”

The percutaneous absorption of topically applied tretinoin and its effect on endogenous concentrations of tretinoin and its metabolites after single doses or long-term use

https://www.sciencedirect.com/science/article/abs/pii/S0190962297700598

“Conclusion: Minimal percutaneous absorption of tretinoin was obtained after its topical application in cream formulations. Neither single-dose nor long-term treatment with topical tretinoin formulations appeared to affect the endogenous levels of tretinoin or its metabolite”

“Mean plasma concentrations of tretinoin after 28 days of treatment with either tretinoin emollient cream or tretinoin cream were not significantly changed when compared with the corresponding endogenous concentrations before treatment.”

I’m not sure I’d do my back, legs, face, arms, hands…. But I have no issue using it on my face, neck and hands/arms. I do find that on my neck I only use it maybe 4/7 days.

Or

Today using Goodrx.com Tretinoin cream 20g 0.05% costs a whopping $17.35, less than $1/gram.

Use Goodrx.com or try pharmacychecker.com or find a reliable seller here from India who sells Sirolimus and buy a dozen 20 gram tubes of 0.05% for maybe $3 a tube (note: shipping will cost much more).

Do keep in mind that I always advise people to listen to their Provider (NP/PA/MD/DO) and not to some guy’s opinion on the internet….

1 Like
#17

I’ll dig into more of this later, but on the stinging eyes aspect…

That is exactly why I’ve never worn chemical spf (until now)! 30 years ago, I finally realized I don’t have uncomfortable eyes. I only had to stop wearing makeup containing spf! I can even put BOJ chemical spf on my eyelids, so there might be a chemical that doesn’t bother you, but if you find a mineral you like, no reason to switch!

#18

Beauty is highly subjective (this year’s Miss Germany being one such example of strong reactions on both sides). For me, growing older gracefully is very attractive, more-so than the plasticly fake look of too much filler. Yes, you will have grey hair and wrinkles which will accumulate as you age.

From seeing a great number of these people who use fillers (not just women, believe me — Burt Reynolds is a tragic example) i think part of the issue is they become “numb” to the look and then feel they need more. I see this with younger people (many more women) as well: they get “filled” and then 3-6 month later they get more filled, and soon they have a dramatically different shaped face. I’d expect the doctors get numb to the look as well because i see many famous plastic surgeons who look like ttyey just got filled with helium, and they look worse than their patients.

Again, beauty is subjective, but I personally find the natural look is far more attractive than an “overfilling”.

1 Like
#19

What, Eric, you don’t like the look that Jocelyn Wildenstein has evolved? :wink: Definitely one of those situations where “less” is more.

67994795-0-image-a-87_1677149268930
67994795-0-image-a-87_16771492689301908×1146 135 KB

3 Likes
#20

Ugh, @RapAdmin , and you dont know the half of it: There are people i personally know and interact with who have transformed themselves into that blonde. Truly horrifying. And they don’t seem to realize it. Ive seen very attractive women in our social circles add and add and add until they are very unattractive (but not like that blonde). Obviously, subtly administered fillers can be game hanging for some skin/faces, but my experience seeing it occur over time is most people waaaaaaay overdo it.

2 Likes