Kathleen J. Smith, MD

I do not recommend using face oils with retinA, particularly if you break out at all. I would recommend a product with dimethicone or cyclomethicone. In addition, ceramide containing moisturizers have been show to work very well with trentinoin either prior to or after application of the Retin-A, and can decrease irritation in individuals who are irritated by tretinoin.

Prior to having facial fillers I recommend that individuals with active gum disease see a dentist and be treated. Oral gum disease is a biofilm which is secondary to bacteria that induce an inflammatory response. Although the inflammation induced by the biofilm may induce proteases as well as hyaluronidase which could decrease the life of any hyaluronic acid filler such as Juvederm this should not occur as rapidly as you describe. There may be some initial swelling that goes away in a couple of days.  However, I believe the biggest risk from active gum disease is that it may predispose to facial biofilms with an filler.

It does look like you have female pattern alopecia which is associated with individuals with polycystic ovary syndrome.  You may also be experiencing some hair loss termed telogen effluvium, which commonly occurs after child birth. In addition to anti-androgens such as spironolactone and birth control pills which can be beneficial in female pattern alopecia, individuals with polycystic ovary syndrome have increased androgens that is associated with more broad metabolic and hormonal dysregulation.  It may be helpful to your general health as well as treating your hair loss if you see someone who specifically deals with skin and hair problems seen in individuals with polycystic ovary syndrome

I would initially do a shave removal of this lesion that appears pedunculated with a base that is smaller than the lesion itself. You will then get a pathologic diagnosis, which I think is important for this pigmented lesion. This will healing in relatively quickly and with not need sutures. In general the face heals in very quickly, and should leave you a nice cosmetic result. However, there is a chance that there may be some lesion deep and thus some residual pigment.

It does look like you have pattern or androgenetic alopecia. The first thing you need to do is to make sure your doctor has eliminated any abnormalities in your hormonal levels and other metabolic perameters.  There are a couple of conditions that do result in androgen excess, that are not tumors, and one that is actually relatively common in polycystic ovary syndrome (you do not need to have demonstrated ovarian cysts).  In addition, to topical minoxidil products, which non-specifically induce prolongation of the hair cycle and thickening of the hair, there are also oral, topical, and some new light sources that may be useful in the treatment of pattern alopecia. Remember minoxidil products are very dependent on being used daily and most twice daily,  and if stopped even for a short period of time the positive effects go away almost immediately.