Q. I am totally confused about what kind of skin care would be good for my face. I am a middle-aged woman who has some sun damage from my younger days, but otherwise fairly decent skin quality. My goal is to minimize wrinkle formation and help fade some of the brown spots on my cheeks. Nothing that I have purchased from the cosmetics counter has helped very much and I have spent a small fortune. Is there a skin care program that you recommend for most women?

A. There is no single answer for every person regarding what will repair damaged skin, or what will help maintain good skin quality. The skin care business in the United States is a multi-billion-dollar business, and unfortunately much of what is purchased by the consumer does not do what it advertises. The problem with consumer grade skin care products is that they have to be safe for the entire population and therefore, a product may work fine on one type of skin but will do nothing for another. For example, an exfoliator may work for someone with thinner skin but will do nothing for someone with oily skin. If you are trying to correct a skin problem, then a program that is customized to your skin type and your specific problem will offer the best chance of delivering results.

In my practice, I believe it is important to do the following four steps for basic skin care: cleanse, exfoliate, stimulate and protect your skin. For cleansing, we use a gentle cleanser that is matched to your skin type and contains a mild exfoliator to eliminate the dead, dry skin on the surface. Next, a product that stimulates the production of new collagen in the skin. There are several types of stimulators, the most common of which is Retin-A®. It works by creating a mild inflammatory reaction, (thus the reason why the skin gets red and flaky in some patients), and this inflammatory response stimulates collagen which helps slow the formation of fine lines. Finally, for protection of the skin, sun screen is critical as it blocks most of the harmful effects of UV radiation, which slows the formation of wrinkling and reduces the risk of skin cancer. For patients who are sensitive to Retin-A®, there are alternatives to help stimulate collagen formation. Once a patient has been on a monitored skin care program for 3-6 months, we reevaluate the skin, so modification of the program can take place if necessary for correcting more challenging issues that may not respond to a basic skin care program. The important thing is that a customized skin care program is monitored and modified as needed to make sure that you achieve the results that you are looking for. As for cost of a medically monitored skin care program, it is no more expensive and often less expensive than what is purchased in the department store. It is more effective than products that are not tailored to your specific needs. Skin care specialists (aestheticians) are available for consultation at both plastic surgeons’ offices and dermatologists as well.