What to do about crepiness/texture, mostly around mouth and cheeks? (photo)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi and thank you for your question! Fractional CO2 laser is my first choice to improve the skin texture, but since you indicated that you are not ready for CO2 laser, my 2ns choice is microneedling (which can be done with various serums or PRP). In general microneedling achieves results similar to Fractional CO2 laser but at a lower level with less down-time and for patients who do not want to try fractional CO2 laser, it is often a good substitute. I hope it helps and good luck! 

I suggest seeing a cosmetic dermatologist to get you on a long term plan with lasers, microneedling/prp, Viva, Cosmelan, J Plasma, peels, scupltra, fillers, facials and skin care. Best, Dr. Emer.

hi, you seem to have a good baseline skincare regimen. I would consider using a filler like Belotero or Volbella to help fill in the finer lines around the mouth. As you suggested, a laser might be something to consider in the future as well. 

Hello and thank you for your question and pictures.Microneedling + PRP will help with the texture of your skin along with using retinols at home daily to help keep those cells stimulated and the skin exfoliated.Best to you,

PRP would be a very good idea to help fix the overall skin texture. Having the PRP microneedled or injected would both be procedures that would help your skin

Your photos don't show your skin texture very well, but certainly skin texture can be improved remarkably just by adding Platelet-Rich Plasma to your microneedling sessions as well as Radio Frequency treatments, such as Skinfinity RF. Just use the PRP in place of the usual microneedling gel in a series of 3 treatments about a month apart, but the full effect is really at 6 months post-treatment since these procedures stimulate skin rejuvenation.  What may be most prominent in your photos is a little accentuation of the marionette line (which appears as a droop in the corner of your mouth) and the nasolabial fold (the line from the bottom of your nose to the corner of your mouth).  I teach for Allergan and Galderma and serve on their National Advisory Boards, and can speak confidently that both Juvederm and Restylane would do wonders as cosmetic injectable fillers to lift these wrinkles.  I recommend you find someone who knows the advanced microcannula injection technique in place of the conventional hypodermic needle to minimize pain and bruising.  I suggest you find someone with great photographic results who actually specializes in doing these procedures--instead of someone who just does it occasionally.  Other options include laser technology, so I also suggest you review the other options presented by other doctors on realself after me.  Best Wishes, Garry R. Lee, MD, Look Younger MD, Las Vegas.