Mirror, Mirror on the Wall: Who Do I Need to Call?

Are you avoiding your reflection because of wrinkles, deep furrows and creases, dark spots and sun damage? If so, you're not alone. After we hit our 40s, the person staring back at us in the mirror may look our true age but not reflect what we feel inside—usually 10 to 15 years younger.

Blame it on decreasing levels of estrogen. That's right—estrogen helps retain collagen in the skin and in our joints.

Everyone wants to look younger, but not like we've had obvious work done. Most of us want to look better and more well-rested and leave everyone guessing at our secret to the fountain of youth.

Read more about cosmetic skin procedures.

Reducing wrinkles, dark spots and sagging skin is just a dermatologist visit away. Here's my Goldilocks advice: Consider the middle road—just enough, not too much and not too little.

Essential Questions

There are two main questions to ask yourself to help you decide what you want to do:

1. What do I want to change about my appearance?

2. What is my budget?

For wrinkles

There are injections of botulinum toxin (Botox and Dysport) that freeze facial muscles to prevent wrinkles from worsening. If used on an ongoing basis, deep creases and fine lines will fill in gradually and be less visible.

These injections can treat the fine and deep lines in the forehead that make us look constantly worried or angry. It's a great treatment for the lines between the brows that telegraph anger even when we're resting. The injections also help with the laugh lines between the corners of the eyes and the hairline. In tiny amounts, they're even effective for the fine lines on the upper lip.

The injections usually last three to six months, depending on how you react to the injections.

The cost ranges from $300 to $750 per site injected. There is no downtime for these injections.

In addition to treating wrinkles, these injections can be used in the forehead to prevent migraines and headaches.

For deeper creases

Fillers and some of the pulsed and intermittent laser treatments work well.

Here's my advice: Whatever you do, please do NOT use permanent fillers. These don't dissolve over time and can leave the skin with large and small bumps and an uneven look. Fillers that dissolve over time are injections that get reabsorbed after several months and fill in the deeper creases. There is no downtime and the results are immediate.

The cost is $500 to $1,500 depending on the number of areas injected

For a more lasting result, laser treatments work well. This will remove some of the surface layer of the skin, which creates a smoother appearance. For this, you will have one week of downtime, when your skin becomes red and the surface layer peels off, revealing a much softer, smoother appearance.

The cost ranges from $3,000 to $5,000.

For both of these, results are improved with ongoing microdermabrasion every two to three months and continuous use of sunscreen.

For dark spots and sun damage

There are various creams that contain hydroquinone that help lighten the skin over time. Retinol creams will also help the skin turn over or exfoliate, slowly reducing the appearance of dark spots. The cost ranges from $100 to $200 per tube, which can last one to three months.

Pulsed laser treatments and chemical peels both do the same thing and are very effective. They help remove the surface layer of the skin, which has dark spots. This leads to smoother, lighter skin tones. There is at least one week of downtime for each.

The cost ranges from $1,800 to $5,000.

For both of these, the results are improved with ongoing microdermabrasion every two to three months and continuous use of sunscreen.

Downtime

It's important to be realistic about the downtime after laser or chemical peels. Your health care provider may minimize what you're likely to experience.

I had a TCA chemical peel about two years ago to help prevent some of my dark spots from becoming cancerous. The downtime was not what I expected. After two days, my skin became so tight that it started to crack. It was very red and peeling in small and larger sheets. When a friend stopped by the house unexpectedly and saw me, she burst into tears.

I didn't feel comfortable leaving the house for about five days. The benefit was that once the skin healed, my face did and still does look years younger.

Yes, I'd recommend it, but be aware of the side effects.

This blog originally appeared on Nurse Barb. Barb Dehn is a women's health nurse practitioner, award-winning author and nationally recognized health expert. She practices with Women Physicians in the Silicon Valley of California.