I look older than I really am. I'm wondering what is causing the problem, and how it can be remedied. (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

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

90% of prematue aging is caused by sun damage so I hope that you are wearing a great mineral/ physical sunscreen daily and reapplying often. That said, genes, diet, sleep, stress and supplements (or lack thereof) can make a major impact on your skin and general appearance. You will likely benefit from a vampire facial with PRFM, an advanced form of PRP (platelet-rich plasma) with microneedling with an FDA approved device. It uses your own growth factor to stimulate your own stem cells for a younger you! The microneedling stimulates collagen production as well.
Too many medspas are doing this incorrectly and with substandard equipment so please do your research. A great medical grade HydraFacial will also help brighten your skin and address your unique needs. And high quality medical grade skincare will transform your skin. I am passionate about antiaging at my Boca Raton practice Bawa Medical, and so I hope that my answer helped!