What procedure can improve my skin surface to help it look smoother? (Photo)

Question

Hello what dan help my skin surface look smoother? I already useAHAs, salcylic acid, retinol and have had 2 Coolpeels.

Michael A. Persky, MD · Answer

Hello E,

I would treat you with Fraxel CO2 laserand platelet rich fibrin.  Each time you have this treatment your skin texture and scarring will improve.  Good luck and be well.
Michael Persky, MD
Encino, CA

Nelson Lee Novick, MD · Answer

Improving overall skin texture typically requires a combined approach of daily use of Rx strength retinoids and alpha hydroxy acids for several months and a series of in-office maximum strength glycolic or salicylic acid superficial peels or Jessner's Solution. Manually performed dermarolling Microneedling (no need for the added expense or risks of RF microneedling) may also be used. The precise combination approach suited to your needs can best be determined following an in-person, close-up examination of your skin by an experienced, board certified cosmetic dermatologist. With the proper combination of at-home and in-office treatments, optimal results can generally be expected in about six months. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your routine and treatment history—you’re already doing many of the right things, which is great to see. When someone is using AHAs, salicylic acid, retinol, and has undergone treatments like CoolPeel, yet still feels their skin texture isn’t as smooth as they’d like, it usually means we need to go a bit deeper or take a more targeted approach.

There are a few effective options to further refine skin texture:

Fractional laser resurfacing (more aggressive than CoolPeel):
While CoolPeel is a lighter CO₂ treatment, deeper fractional lasers can penetrate further into the skin to improve texture, fine lines, and mild scarring. These tend to provide more noticeable smoothing but may involve a bit more downtime.
Microneedling (with or without radiofrequency):
This helps stimulate collagen and can significantly improve uneven texture, enlarged pores, and mild scarring over a series of treatments. RF microneedling, in particular, can give more pronounced results.
Chemical peels (medium-depth):
Since you’re already using topical exfoliants, a professionally administered medium-depth peel can help resurface the skin more effectively and improve overall smoothness.
Skin boosters / biostimulatory treatments:
Injectable skin boosters or treatments that stimulate collagen can improve hydration and skin quality from within, leading to a smoother appearance over time.
Barrier repair and balance:
Sometimes, using multiple active ingredients can slightly compromise the skin barrier, which paradoxically makes texture appear worse. Ensuring proper hydration, barrier repair, and spacing out actives can make a noticeable difference.

In many cases, the best results come from combining treatments—for example, pairing microneedling with targeted skincare adjustments or alternating with more advanced resurfacing treatments.

It’s also important to set realistic expectations: achieving perfectly smooth skin isn’t always possible, but significant improvement in texture, clarity, and overall radiance is absolutely achievable with the right combination approach.

Rebecca Gelber, MD · Answer

Thanks for the question. You've made a great start so far. When I help a patient decide what treatment will best help them achieve their goal, I really try to be clear with them what result will make them the happiest. Are you mostly looking to improve surface texture? Or also improve deeper acne scars? It makes a difference in what treatments will target the depths of that issue.

It is also important that the treatment be right and safe for you, which is partly determined by you prototype. Lighter skin color with light eyes allow for more aggressive treatments to be done safely, whereas the darker the skin type, the more care must be taken and sometimes it takes a series of lighter treatment.

Finally, think about what you are able to manage in terms of being out of the sun and downtime. Having thought through all these things will help your provider come up with the best treatment plan for you,

Unless you are much darker than your picture makes you appear in my office I would combine a BBL (great for collagen building, skin tone evening and most importantly slowing skin aging) with Clearsilk (also great for collagen building and can help scarring) and either Moxi if you just want surface texture or Halo / Tribrid (a combination of Moxi and Halo) if you would like to also work on the deeper scars.

What procedure can improve my skin surface to help it look smoother? (Photo)

Answers (4)

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