Zein E. Obagi, MD

Before we do any peels, on all patients of all skin types, we prep the skin aggressively. We also have a comprehensive skincare program for patients after the peel to help control pigmentation that in many cases is expected in some skin types. Eventually the pigmentation will likely fade but you should make sure your dermatologist has placed you on a comprehensive skincare program post-peel.

At 72, you would still potentially be a candidate for a peel. I would suggest you see a dermatologist for a formal evaluation where you can review your health history and any medications or issues that may prevent you from receiving this treatment.

Our office sees patients with melasma from all over the world. We specialize in it. Melasma requires a comprehensive cream program, chemical peels, and sun avoidance. We have great success treating melasma this way and then maintaining creams to prevent the pigmentation from returning. Our controlled depth peel is one great modality used to control melasma for patients who seek perfection. We also have the 3 step peel which significantly helps pigment control when used with the cream program. 

First- you must make sure your doctor is treating your rosacea correctly. Constant use of antibiotics ends up making rosacea worse in the long run.  For the redness of rosacea,  A PDL (laser) can also be used very well but needs to be repeated once per month to help control it. Sunscreen and avoiding heat/saunas, etc also help with the redness. 

Many years ago, full C02 laser ablation was utilized a lot. But we were seeing a lot of side effects like scarring, pigmentation issues, persistent redness, and a marble like quality to the skin. Now with fractional laser ablation technology- resurfacing can be performed in a much more safer way. In my practice, we utilize fractional laser resurfacing for its safety and efficacy. 

Frazel works well for acne scars but must be used in the right way and with the right settings. I see many patients in my clinic who have had fraxel that has done very little for their acne scars. We combine fraxel with a controlled depth peel and we are aggressive with fraxel to get adequate leveling of the scars. 

Accutane does not start working immediately. In most cases, the first month your acne may be worse or may flare. After about 6 weeks is when I start seeing the major benefits from Accutane. It is important to be patient while on this medication. 

You have have rosacea. It is important you get evaluated by a dermatologist. A program to address your rosacea may include creams, oral medications, and/or the pulse dye laser. 

Lasers can make melasma worse. I would use a comprehensive cream program and then consider TCA based chemical peels. We see A LOT of patients with melasma in our clinics and have tremendous success treating melasma. One thing to remember, melasma will return. After such procedures it is important to continue the treatment program to keep it at bay. 

We rarely use laser for melasma because lasers can make melasma worse. I prefer to treat melasma with creams and peels. I have had great success with this approach.