Q&A with Dr Sam Bunting about skincare and RéAura
Cosmetic dermatologist Dr Sam Bunting answers skincare and anti-ageing questions.
Dr Bunting has a wealth of experience in solving skincare problems as she runs a busy private practice in Harley Street, where she sees patients with a variety of complaints. She offers advice on skin conditions from pigmentation to milia spots, adult acne to maintaining youthful skin.
This Q&A was sponsored by Philips RéAura, the UK's first laser skin rejuvenation device for women to use in their own homes. It is based on Fraxel® technology and means women can achieve professional-level results at home.
Q. SchrodingersMew: I am 21 and have a really uneven skin tone. My cheeks and nose get very red and the colour never seems to fade. Is there anything I can do to improve this or is it permanent?
A. Dr Sam Bunting: Sounds like it's possible you have early-stage rosacea. It would be worth seeing a medical professional to confirm the diagnosis. In the first instance, it's good to use daily sunscreen and a gentle skin care regime is recommended. Know your triggers for flushing and manage accordingly. If it's really bothersome, then an in-office light-based therapy like IPL might be a good option for you.
Q. Iceflower: I would like to know how to diminish age spots/pigmentation. I have skin that tans easily and never burns, so I foolishly wasn't very careful about sun protection. As I've gotten older, patches of pigmentation have appeared on my upper cheekbones. Any advice on getting rid of them?
A. Dr Sam Bunting: It's important to know what the cause of your hyperpigmentation is - age spots might be the explanation, but it is also possible that you may suffer from melasma. You will definitely benefit from using sunscreen on a daily basis going forward.
If you are unsure about the diagnosis it would be worth seeing a dermatologist. Melasma is best treated topically. However, if age spots are the issue then you would definitely benefit from using Philips RéAura.
Q. Greypuddle: I have pigmentation from pregnancy but also sensitive, rosacea-prone skin. Are there any products that can reduce pigmentation without antagonising sensitive skin?
A. Dr Sam Bunting: The best treatment for you would be a prescription-only treatment containing Azelaic acid. This can actually help with both conditions. I would recommend Skinoren cream (available on prescription). A gentle skin care regime and daily broad-spectrum sunscreen is recommended.
Q. Hatewashing: How do you get rid of post-inflammatory hyperpigmentation? I have had it for years on my calves. Is there any treatment for dark skin?
A. Dr Sam Bunting: This is a common and often persistent problem with dark skin types. It can respond to topical hydroquinone, under expert guidance. You should also avoid strong sun exposure, as this can result in further darkening of hyperpigmented areas. Finally, using a body lotion containing AHAs may be of benefit. I like NeoStrata Lotion Plus AHA 15.
Q. shuz: Following childbirth last year, I had hyperpigmentation on my cheeks. I then had a horrendous glycolic peel (20%). My cheeks actually lost colour and I now had hypopigmentation. Following intense treatment with a dermatologist, my skin repigmented but now I have darker patches on my cheeks as well as lots of small spots under my skin. How do I treat the small spots?
A. Dr Sam Bunting: Poor you! Sometimes treatments can create problems but it does sound like your issues are rather complex. If your spots are acne-type spots, you would benefit from the use of a retinoid at night and possibly a pigmentation suppresser such as Azelaic acid in the morning- but in view of your history, this would be best under dermatologist guidance.
Q. skandi1: Is the Phillips RéAura suitable for those suffering from rosacea?
A. Dr Sam Bunting: Unfortunately, RéAura does not help with rosacea. In fact, there is a possibility that any inflammatory condition might be exacerbated by using RéAura, so we wouldn't recommend it.
Q. Linda98: I have a dark patch of telangiectasia on one of my cheeks - I suffer from rosacea. Would the RéAura help with lessening the redness?
A. Dr Sam Bunting: RéAura is not designed to target red blood vessels, so we would not recommend using it in this case.
Q. Error404: I have very dry skin and also what I think is a bit of rosacea on my cheeks. Does dry skin and rosacea often occur together? I've been using Evening Primrose Oil for the last couple of months with a little improvement to the rosacea. Is it worth carrying on, as I know EPO can take some time to work?
A. Dr Sam Bunting: Yes, dry skin and rosacea do often occur together. A gentle skin-care routine should help manage dryness. I don't think EPO will be of benefit.
La Roche-Posay Rosaliac AR Intense serum is one of the few over-the-counter products I've found to be helpful in this troublesome condition. If the main issue is broken capillaries, then broad-spectrum sun protection on a daily basis is recommended. Beyond this, lasers that target blood vessels would be the treatment of choice. But if you are experiencing red spots and whiteheads, then seek a medical opinion as topical or oral antibiotics would be helpful.
For more practical tips please check out my blog post on rosacea.
Q. bochead: I've recently developed eczema on my eyelids. Can you recommend anything that isn't really heavy and is also hypoallergenic to use as an eye cream? Also, is there a brand of mascara and remover you'd recommend?
A. Dr Sam Bunting: With eczema on the eyelids, you need to eliminate the possibility that you are using something you have become allergic to - though it's quite common for the reaction to be an irritant one, rather than true allergy. The best thing is to use an uncomplicated regime, like fragrance-free and preservative-free Avene Tolerance Extreme cleansing lotion and moisturiser until things settle down. Stop everything else.
Once things have settled, you can restart to introduce products one at a time. Be aware that you might be reacting to any of the components of your skincare routine, not just the ones you use around the eyes. If it persists or recurs, it might be worth getting your GP to refer you to a dermatologist for patch testing to establish if common things like fragrance or preservatives are the issue, so you know what to avoid.
Q. Grumpster: I became very run-down four years ago and developed guttate psoriasis over most of my body. The condition has now largely resolved itself but I'm left with stubborn patches of psoriasis on my elbows. I can improve their appearance by applying Dovobet ointment but I've been told not to use this medication continuously as it thins the skin. Whenever I stop, the condition reappears. I use an emollient cream (Diprobase) and have seen a skin specialist to discuss the possibility of light therapy, but I don't have time to attend hospital several times a week. I know direct sunlight can help with psoriasis but I tend to avoid it because I also suffer from rosacea. My GP and specialist have given me the impression that this is just something I have to live with. Is there anything else I can do?
A. Dr Sam Bunting: Psoriasis is typically a chronic condition and the elbows are a very common site, as you probably know. I would recommend using a non-steroid base prescription cream in rotation with your Dovobet, such as Silkis ointment. This will minimise the exposure to steroids and also maintain your responsiveness to Dovobet.
A good regime is to use Silkis twice a day, Monday to Friday, and Dovobet on the weekends. Managing lifestyle factors will also help keep the disease under control, ie through stress reduction.
This is a great website for more psoriasis information.
Q. Gracelo: Is there anything I can do to prevent senile keratosis?
A. Dr Sam Bunting: Do you mean seborrhoeic keratosis? If so, apart from sun avoidance and wearing a broad-spectrum sunscreen, we haven't yet found a way to prevent them from arising, unfortunately. They can be frozen off with liquid nitrogen or removed under local anaesthetic if they really bother you. This isn't usually covered by the NHS, as they are a benign entity.
Q. Spuddings: I'm resigned to the fact that I have melasma on my upper lip, chin and forehead that I can't do anything about. But I've yet to find a decent enough sunblock/sun screen that actually prevents it from getting any worse and that is good enough to wear under make-up. I don't sunbathe and I wear a hat as often as possible, but that isn't such a good look for day-to-day activities.
A. Dr Sam Bunting: There are definitely ways to treat and improve melasma, so don't give up hope. l get excellent results with prescription skincare range Obagi Nu-Derm. This system also incorporates a cosmetically elegant broad-spectrum SPF 50 sunscreen with zinc oxide, which works really well. I prefer physical filters to chemical ones in this condition. It's important to avoid waxing the upper lip, as this can worsen the pigmentation on the top lip.
Read my blog post on melasma for more information.
Q. EwanHoozami: Is there anything you could recommend to rid my upper arms of pesky keratosis pilaris? The lumps are getting bigger as I get older.
A. Dr Sam Bunting: I recommend using exfoliating gloves with your regular shower gel and using a body lotion that contains 10-15% glycolic acid, twice daily for two weeks. This will certainly treat the bumpiness; unfortunately nothing much will change the redness. You should then be able to maintain these results with regular exfoliation and use of the body lotion 3-5 times a week.
For more info, read my blog post on Keratosis Pilaris.
Q. Gnomi: What kind of anti-ageing products should you use if you are in your early 30s but your skin is still spot-prone? I find lots of products sit very heavily on my skin and make me break out.
A. Dr Sam Bunting: First-line treatment for anti-aging and spots is a topical vitamin A derivative, over-the-counter retinol or retinaldehyde. I really love Avene Triacneal.
Using regular sunscreen all year round is an integral part of any anti-ageing programme but look for one that is non-comedogenic.
On inflamed spots a 2.5% benzyl peroxide-based spot cream works well. Ensure that you are not using cosmetics or a skincare regime that clogs you up - again look for the term non-comedogenic. Beyond that you may need to visit a dermatologist for a prescription-only regime
For more info read my blog post on acne and ageing.
Q. Choclatespread: At what age should I start to use anti-ageing creams? Also I have oily/combination skin. Is there a product I can use to give my face a glow?
A. Dr Sam Bunting: Ageing is individual – it is usual that by the mid to late 20s there are subtle changes around the eyes and perhaps the skin is generally less radiant. Without sounding boringly repetitive, regular sunscreen is the first anti-ageing product people should start to use daily. For radiance, alpha hydroxy acids (AHA) are a good place to start-use in the morning, under sun-screen. Then at night use a gentle retinoid. Start off with a gentle over-the-counter preparation, and build up to using daily over weeks, not days as they can cause a little irritation initially. I like Medik8 3 TR serum, which contains 0.3% retinol.
Q. KatieScarlett: Disregarding all the hype, what actually works in terms of anti-ageing that can be bought over the counter?
A. Dr Sam Bunting: 1. Broad spectrum sunscreen – I recommend SPF 30 all year round to my patients
2. Topical vitamin A derivatives like retinol
3. Alpha hydroxy acid (AHA) like glycolic or lactic acid
4. Antioxidants – the best in my opinion is vitamin C, which must be properly stabilised and stored, as it is easily degraded by light. I like Obagi and Skinceuticals Vitamin C serums - expensive, but a worthwhile investment.
Q. therealmrsk: I will be 40 next year and after looking relatively younger than my age for the past 10 years, life is catching up with my skin. I have very thin skin around my eyes, leading to under-eye dark circles and saggy eyelids. I also have milia above my cheekbones. What can I use that is sensitive yet does the job?
A. Dr Sam Bunting: The same elements as mentioned in my answer to KatieScarlett above – in particular, vitamin A derivatives and alpha hydroxy acids will help reduce the formation of milia. Avoid oily products, especially eye make-up remover, which can lead to the development of milia in the delicate eye area. If bothersome, they can be extracted by a sterile needle by an experienced professional. A good, non-oily, eye make-up remover is Simple's Kind To Eyes Eye Make-up Remover.
Q. Mollusk: At the tender age of 34, my neck is already going. It's crepey and seems to have lost elasticity. Are there any creams or supplements that actually work? If not, what are my other options, besides surgery?
A. Dr Sam Bunting: The neck is a difficult area, much like the skin around the eyes. We tend to forget about protecting it from the sun. Daily use of sunscreen in this area is absolutely crucial. Topical retinoids will help a bit, although you need to go slow as this is a sensitive area.
Finally, consider a treatment called Restylane Vital - an injectable treatment derived from hyaluronic acid, which can help restore some of the skin's original elastic properties.
Q. julesmeister: I have suffered with acne all my life. I'm currently using MD Formulations Anti-Blemish Kit, which has worked great for 12 months in conjunction with taking Ovranette contraceptive pill, but recently I have got a lot more pimples on my cheeks and chin. What anti-aging products would you recommend for someone acne-prone with oily skin?
A. Dr Sam Bunting: Adult acne in women is a complex disorder. You would benefit from a medicated programme based on prescription-strength retinoids at the very least. I would advise seeing a dermatologist as this condition causes lots of misery, is usually very treatable in experienced hands and over-the-counter therapy may not be sufficient to keep it under control.
For more info read my blog post on how to achieve clear skin.
Q. Dontbugmemalone: I have numerous milia spots (30-40) on my face, mostly under my eyes. They have spread on to my forehead, nose and above my top lip. I have been to several cosmetologists and had treatment in which they pop and squeeze the spots. It's painful and it doesn't seem to help. Is there any treatment I can get which will help me get rid of the spots permanently?
A. Dr Sam Bunting: The important thing is to avoid beauty habits that might create the problem – look for non-comedogenic products and avoid oily eye make-up remover as mentioned before. Milia spots do generally need to be manually extracted. Try incorporating AHAs and a retinoid into your skin care regime for prevention.
For more info read my blog on milia spots.
Q. Dawndonna: I'm 54 and have the occasional patch of psoriasis on my face. I have fine lines, heavier lines, wrinkles, a greasy T-zone with large pores and dry cheekbones. I have the skin of a 14-year-old adolescent. Any skincare suggestions?
A. Dr Sam Bunting: You have classic combination skin. Don't despair, you would still benefit most from a topical retinoid. I would recommend going slowly and starting with a gentle over the counter product. Large pores will benefit from the collagen building aspect of a topical retinoid. Start gently with an over-the-counter product like Avene Ystheal at night and, of course, a daily sunscreen. Topical vitamin C will also be helpful.
Read this blog post for more info on dealing with large pores.
Q. MakeTeaNotWar: I have super-dry skin and no matter how much water I drink or moisturisers I use, it doesn't improve. What can I do?
A. Dr Sam Bunting: Avoid over-cleansing and using anything that foams. Make sure you apply your moisturiser when your skin is damp to lock in moisture. Look out for niacinamide as an anti-ageing ingredient, which will help your skin maintain its natural barrier function. Good brands for dry skin include Avene, Cetaphil and Eucerin. Finally, make sure you get plenty of omega-3 acids in your diet, salmon three times a week, for instance.
Q. beeny: I am Indian but have pigmentation on my forehead and chin area. I also have an oily T-zone and it's really hard to keep make-up on. What can I try?
A. Dr Sam Bunting: Look for a cleanser that contains 1-2% salicylic acid to combat the oiliness in the T-zone. Then try a pigment-suppressing product like La Roche-Posay Pigment Control on your trouble areas. Finish with a light oil-free moisturizer, like Cetaphil moisturising lotion, and wear sunscreen daily – as always.
As a final note, it might be worth taking a vitamin D supplement as darker skin types don't usually make enough Vitamin D in winter, because of low levels of UVB. I recommend HealthAid Vitamin D3 Spray at 1000iu daily.
Q. snailsontour: I have a number of sun spots on the side of my face, and also on the backs of my hands. I always use sunscreen to try and prevent them worsening, but are there any topical treatments that will remove them?
A. Dr Sam Bunting: You are absolutely right; sunscreen should be the first step. Make sure you carry it in your handbag and reapply after hand washing throughout the day. There are lots of treatments available now for tackling hyperpigmentation. One has to be careful with the backs of the hands because the skin is thin. I like Avene D-Pigment. Start using the products every other day and build up daily use gradually to minimise irritation.
A good alternative for topical therapies would be the Philips RéAura, which can be used not only on the face but the chest, neck and backs of hands.
Q. Lizel: What would the RéAura process be if you were using a retinoid cream?
A. Dr Sam Bunting: We would not recommend you use RéAura while using a Retinol cream. All you need is to cleanse and moisturise and use daily sunscreen. I advise a minimum SPF 30.
Q. IfYoureHappyAndYouKnowIt: I have a deep pore/hole on my cheek which won't go away. Will the RéAura help with this?
A. Dr Sam Bunting: Unfortunately, RéAura is not intended for scarring. However, if your problem is simply large pores then anything which helps build collagen over time may improve their appearance.
Q. babycatts: I have sun spots on the sides of my face/cheeks which fade over the winter and spread across my face during the spring/summer months. I am fanatical about wearing SPF 50 on my face and always wear a hat, all to no avail. I am currently using the Clinique Dark Spot Corrector, which I think is helping. Would the RéAura permanently remove these?
A. Dr Sam Bunting: If the diagnosis is sun spots then the Philips RéAura should help reduce these. It's important to exclude melasma as a possible cause of your hyperpigmentation as topical therapy would be indicated. And always remember your broad-spectrum sunscreen!
Q. Jux: I have lots of broken veins on my face and have to wear foundation to try to tone them down. Is there a better way to deal with them? Is laser treatment any good?
A. Dr Sam Bunting: Laser treatment tends to be the most successful way of managing broken blood vessels on the face. It's important to seek expert advice with a laser specialist. Broken vessels are commonly a consequence of either rosacea or sun exposure and daily sunscreen is a must.
Q. cazza40: I have some chickenpox scars on my face from when I had chickenpox as a child. Can I do anything to reduce or improve their appearance or is it too late ?
A. Dr Sam Bunting: Scarring is always challenging. However I have seen good results using mirco-needling with the dermastamp on these kinds of scars. This is best in conjunction with a collagen-stimulating skincare regime based on retinoids and Vitamin C.
Q. magnolia74: I have a really deep number 1 between the eyebrows, is Botox the only option?
A. Dr Sam Bunting: Botox would be the treatment of choice in this area. If the line is very deep then dermal filler may also be necessary to get rid of the line. But the most important thing is to stop excessive muscular activity, which is leading to the creasing of the skin - which is exactly what Botox does.
Q. mrsshackleton: The tramlines from my nose down to my mouth are very visible. Are fillers the best way to deal with these and if so how natural do these appear?
A. Dr Sam Bunting: Yes, dermal fillers are the right treatment for this problem. The key is to see an experienced practitioner who will discuss the treatment with you in-depth and manage your expectations. The type of dermal fillers I'd recommend for you are based on hyaluronic acid. When done well, they look very natural.
Q. apismalifica: My fingers and thumbs keep splitting open. My thumbs in particular tend to be very painful and the skin around the ends flakes off in quite large pieces, as well as splitting open and bleeding at the tips and joints. Is there anything I can do to improve this?
A. Dr Sam Bunting: It sounds likely that you have eczema affecting your digits. Are you washing your hands a lot? This is a common cause of these symptoms. The key is to wash with a soap-free cleanser like Dermal 500, wear gloves where possible and moisturise after washing hands. If this does not help, it would be worth seeing your GP as you might need a prescription steroid cream to manage the symptoms or refer you for further tests.
Q. Tweet2tweet: I have dry patches, large open pores on my nose and fine lines. I drink at least one litre of water every day and moisturise morning and night. Is there anything I can do to calm everything down?
A. Dr Sam Bunting: Dry patches are often a consequence of using too harsh a cleanser. Try a gentle basic skin care regime (try Cetaphil Gentle Cleanser and Moisturising Lotion) and consider introducing a gentle retinoid to tackle the fine lines and big pores. And remember to use daily sunscreen.
Q. birthdaypanic: I am in my mid 50s and my skin looks tired and in need of firming. What is the best treatment to rejuvenate my skin?
A. Dr Sam Bunting: Upgrading skincare to incorporate the key anti-ageing elements mentioned in my answer to KatieScarlett will benefit you immensely. I'm a big fan of medical needling to improving the quality of the skin in the 40s and 50s. It's safe and effective with minimal downtime, and very safe when performed in a doctor's office.
As an alternative, Philips RéAura would offer an additional benefit. Essentially, you want to stimulate new collagen production to increase the skin's firmness and also stimulate cell turn over in the outer layers of the skin to increase brightness. Either approach works well.
Last updated: almost 2 years ago