Interview with Dr. Haleh Bakshandeh, Board-Certified Dermatologist on Skincare in Every Stage of Life

Dr. Thais Aliabadi and Mary Alice Haney spoke with Dr. Haleh Bakshandeh, a board-certified dermatologist in Beverly Hills with more than 20 years of experience, about practical, science-backed skincare across the decades. Her approach balances prevention, realistic expectations, and tailored interventions—whether the concern is teenage acne, pregnancy-safe treatments, perimenopausal skin shifts, or tasteful cosmetic enhancements.

Table of Contents

• Why a decade-by-decade approach matters
• Treating sun damage, lasers, and the skin barrier
• Microneedling: collagen stimulation without heat
• Acne across the ages: teens, adults, and gender differences
• Over-the-counter essentials and practical daily routines
• Pregnancy and skincare: what’s safe?
• Perimenopause and menopause: understanding collagen loss and hormonal effects
• Retinoids: when to start and how to tolerate them
• Lasers, radiofrequency, and red light therapy
• Fillers: philosophy, types, and avoiding the overfilled look
• Ingredient deep dive: pigment, melasma, and brightening
• Practical lifestyle guidance: gut, sleep, alcohol, and one-body thinking
• Practical product picks and sunscreen basics
• Where to start and how to choose a practitioner
• FAQ
• Final perspective

Why a decade-by-decade approach matters

What changes in the way we should care for skin as we move from our teens into our 20s, 30s, and beyond?

We think about skin care like a long game. Each decade has its own priorities because the biology changes. In the teens, sebaceous activity is high, which drives acne. In the 20s and 30s, prevention is king—this is where sunscreen, antioxidants, and early anti-aging act to minimize future damage. By the 40s and into perimenopause, hormonal shifts reduce oil production and collagen starts to decline, so maintaining barrier health and stimulating collagen are central concerns. The right treatments at the right time let us prevent steep declines rather than trying to play catch-up later.

Treating sun damage, lasers, and the skin barrier

Are lasers always a good option? Is there ever a time that’s too early?

Lasers are powerful tools, but they are not always first-line. The decision depends on the amount of accumulated sun damage and your skin type. Ablative lasers like CO2 can produce dramatic, long-lasting improvements in texture and fine lines, especially for fair skin with significant photodamage. But they are aggressive, require downtime, and can disrupt the skin barrier if overused.

We favor a conservative, staged approach for most patients: smaller procedures spaced out so the skin has time to repair. The goal is to stimulate remodeling without excessively compromising barrier function. If someone has minimal sun damage, they rarely need ablative treatment in their 20s. For others with heavy sun exposure, an earlier intervention can be appropriate.

What is the risk of being too aggressive with lasers?

Overaggressive treatment can damage the skin barrier and increase trans epidermal water loss, leaving skin dry, irritated, and more susceptible to problems. It may also cause pigmentation issues, especially in darker skin types. More is not necessarily better: thoughtful, conservative treatment delivered by a trusted professional will give superior long-term results compared with repeated aggressive interventions.

Microneedling: collagen stimulation without heat

How does microneedling work, and how often should it be done?

Microneedling creates controlled micro-injuries that provoke the skin’s natural wound-healing pathways. Those channels stimulate collagen, elastin, and other repair signals without heat. For general rejuvenation, we often recommend a stack of three treatments spaced four to six weeks apart, then maintenance every three to four months. For acne scarring or pigment issues, we may extend beyond the initial three to achieve deeper remodeling. As always, the exact protocol depends on severity, skin type, and treatment goals.

Acne across the ages: teens, adults, and gender differences

Are teenage boys and girls different when it comes to acne?

Yes and no. Hormonal drivers vary by gender, and that affects treatment options. Females have additional effective systemic options such as combined oral contraceptives and spironolactone—both can be game-changers for hormonal acne. These are not options for males because spironolactone is an androgen blocker and can disrupt male hormonal physiology. Topical treatments, antibiotics, and isotretinoin remain options for boys, and topical spironolactone formulations can sometimes be used in males.

Genetics is the most powerful predictor of severity. We see teenagers who follow great hygiene and diet, yet still have severe acne because a strong family history drives more intense disease. Conversely, lifestyle and environmental factors such as diet, stress, or occlusion (football gear, helmet straps) can exacerbate but usually are secondary contributors.

What’s the practical acne algorithm for teens and young adults?

We usually start with the least invasive options and escalate as needed:

• Mild acne: topical treatments—benzoyl peroxide, topical retinoids (adapalene/Differin), salicylic acid cleansers, and gentle exfoliation.
• Moderate inflammatory acne: add oral antibiotics such as doxycycline or tetracycline, combined with topical therapy.
• Hormonal acne in females: consider combined oral contraceptives or spironolactone when appropriate.
• Severe nodulocystic acne or scarring risk: isotretinoin (Accutane/isotretinoin) under careful monitoring.

Manual extraction and professional facials have a role when there is persistent congestion that simple topicals cannot clear.

Is isotretinoin safe? How do you counsel worried families?

We call it isotretinoin rather than Accutane because that is the generic family name. Isotretinoin is highly effective for severe acne and is one of the most closely monitored medications we prescribe. Baseline and periodic bloodwork—chiefly liver enzymes and lipid panels—are necessary because the drug is metabolized by the liver. We also counsel about teratogenic risk in females: strict pregnancy prevention is essential while on therapy. When managed appropriately, the drug is safe and life-changing for many patients. It does not reduce fertility, and it does not harm future pregnancies when used under proper precautions and stopped before conception.

Over-the-counter essentials and practical daily routines

What are the everyday essentials we should all be using?

Sunscreen is the absolute non-negotiable. Beyond that, we recommend a vitamin C antioxidant serum in the morning to protect against oxidative stress and help with brightening. At night, a retinoid (when tolerated) remains the gold standard for collagen stimulation and cell turnover. If retinoids are intolerable, gentler alternatives include azelaic acid, glycolic acid, and over-the-counter retinols or adapalene. Barrier repair moisturizers containing ceramides, glycerin, and humectants are critical—especially as we age and the barrier becomes more vulnerable.

Should you wash your face in the morning and at night? Cold or hot water?

Washing your face at night is mandatory. Removing sweat, environmental pollutants, and makeup prevents ongoing oxidative damage and clogged pores. Morning cleansing is optional for many people; if your skin is dry, you can often rinse with water or use a gentle cleanser. Warm water is comfortable and effective—extreme hot water can strip oils and exacerbate dryness. The core rule: cleanse thoroughly at night and protect during the day.

Pregnancy and skincare: what’s safe?

How does pregnancy change the skin, and what treatments are safe?

Pregnancy is unpredictable. Some people experience a skin glow; others develop melasma, breakout flares, or changes in hair. Many acne medications are contraindicated during pregnancy. Safe topical options include azelaic acid and vitamin C, both of which can help acne and hyperpigmentation related to pregnancy. Sunscreen remains essential. Always consult your provider, but azelaic acid is a practical, pregnancy-safe ingredient that helps with both acne and melasma.

Perimenopause and menopause: understanding collagen loss and hormonal effects

What happens to skin during perimenopause and early menopause?

We see substantial biologic changes. There are fewer estrogen receptors in the skin and scalp, and estrogen production falls. This combination reduces sebum production and contributes to dryness. Within the first five years of perimenopause, collagen can decline by roughly 30 percent. Fat redistribution, skeletal changes, and diminished barrier function create textural changes and increased fine lines.

The good news is that early, proactive strategies can blunt the trajectory of decline. Hormone replacement therapy, when appropriate and guided by a gynecologist, can help maintain skin quality. Topical therapies that stimulate collagen—medical retinoids, professional microneedling, and energy-based devices—remain useful. We emphasize barrier repair, consistent sun protection, and lifestyle measures as core elements at this stage.

Do oral collagen supplements help?

Evidence for oral collagen supplements is mixed. While some studies show modest benefits for skin elasticity and joint health, we find procedural stimulation and topically applied medically effective agents (like retinoids) to yield more direct, predictable collagen synthesis. If patients enjoy collagen peptides and feel they benefit, we do not discourage use, but we set realistic expectations and continue to prioritize proven topical and in-office modalities.

Retinoids: when to start and how to tolerate them

When should someone start using a retinol or prescription retinoid?

Many of our acne treatments are also anti-aging tools. If you’re using retinoids for acne in your 20s, fantastic. If you are primarily using them for anti-aging, we recommend starting in your 30s. The key is consistent, patient use. Retinoids can cause initial irritation—redness, dryness, peeling—but these effects usually improve with gradual introduction.

I have sensitive skin. How can I tolerate retinol?

Start slow. Apply once or twice a week for the first several weeks and chase the retinoid with a barrier-repair moisturizer. If irritation persists, consider gentler alternatives: adapalene, azelaic acid, glycolic acid, or over-the-counter retinols with lower concentrations. Patch testing and working with a clinician are essential for sensitive skin to avoid chronic irritation.

Lasers, radiofrequency, and red light therapy

Which energy-based treatments are worth considering now?

We like ultrasound- and radiofrequency-based treatments that deliver energy deep into the dermis rather than heating the surface. These can stimulate collagen remodeling with less surface disruption and often less risk of pigmentation issues. Chemical peels are experiencing renewed popularity because they can refresh skin tone without the heat energy lasers deliver, which can sometimes exacerbate melasma.

Does red light therapy work?

Yes, if you use a high-quality device consistently. Red light stimulates cellular processes linked to repair and collagen production. A practical home protocol is around three times per week, but results depend on device quality and consistent use. Like any at-home tool, regularity matters: products do nothing if we do not use them.

Fillers: philosophy, types, and avoiding the overfilled look

Is filler still popular, and how should we think about it?

Fillers remain an important tool for restoring volume lost to time. They are not one-size-fits-all. There are thicker, robust fillers that mimic bone support, and finer fillers that smooth small lines. Mid-range materials hydrate and subtly plump lips and soft tissue. The best approach is conservative and strategic: sprinkle filler appropriately in structural areas early, rather than waiting until major volume loss forces heavy correction. That approach avoids an overfilled appearance and achieves a natural outcome.

What should patients expect after lip filler?

Expect swelling, particularly in the first 48 hours. We always advise patients not to judge results immediately and to wait at least three to four days before assessing the outcome. A conservative initial volume and a follow-up plan to adjust as needed minimizes unnatural results and decreases the likelihood of panic at the immediate post-procedure swelling.

Ingredient deep dive: pigment, melasma, and brightening

What ingredients actually help with melasma and stubborn pigmentation?

Melasma is often driven by hormones, sun exposure, and heat. For topical management, ingredients we look for include:

• Tranexamic acid — effective for some types of melasma and useful in topical formulations.
• Kojic acid — a melanin production inhibitor that complements other brighteners.
• Hydroquinone — still one of the most effective agents for stubborn pigmentation; rotation and supervised use avoid long-term issues.
• Vitamin C — antioxidant and brightening support useful in morning routines.

We approach lasers cautiously in melasma-prone skin because heat is a trigger; chemical peels and topical regimens often provide safer, more predictable outcomes.

Practical lifestyle guidance: gut, sleep, alcohol, and one-body thinking

How much does lifestyle matter for skin?

Everything is connected. Gut health influences inflammation, which affects skin. As we move through perimenopause, supporting the microbiome with probiotics can be helpful. Sleep, hydration, nutrition, and minimizing alcohol and smoking are foundational. The cumulative effect of those choices is profound. We like the analogy of a single car: you only get one body, and how you care for it now shows up later in your skin and overall health.

Practical product picks and sunscreen basics

What are the essentials for a morning routine?

Morning essentials we recommend:

• Gentle cleanse if needed
• Antioxidant serum, such as vitamin C
• Moisturizer with humectants and barrier-supporting lipids
• Broad-spectrum sunscreen, SPF 30 or higher

Sunscreen choice is personal. The best sunscreen is the one you will actually use daily. Chemical and physical (mineral) sunscreens work similarly in practice; mineral blockers contain zinc oxide and titanium dioxide and may leave a white cast on some skin tones. Start with SPF 30 as a baseline and reapply when needed. Makeup is not a substitute for sunscreen.

Any favorite over-the-counter recommendations for beginners?

For teenagers and beginners who need accessible, effective care:

• Adapalene (Differin) — formerly prescription only, now OTC and a gentle retinoid-like option for comedonal acne.
• Gentle cleanser— non-stripping, fragrance-free for sensitive skin.
• Vitamin C serum in the morning for antioxidant protection and brightening.
• Sunscreen — SPF 30 or higher, reapplied during outdoor activities.

Where to start and how to choose a practitioner

How do we know when to see a professional and how to choose the right one?

Seek a trusted professional when acne is severe, scarring is present, or if you are considering energy-based devices or injectable procedures. Look for clinicians who:

• Listen to your goals and set realistic expectations
• Recommend conservative, staged approaches when appropriate
• Are willing to say no when a patient does not need aggressive treatment
• Offer a clear plan for follow-up and maintenance

A good clinician prioritizes safety and long-term skin health, not quick trends. Avoid practitioners who push repeated aggressive fixes without discussing alternatives or staged plans.

FAQs

When should I start using retinol?

We suggest incorporating retinoids by the 30s for anti-aging. If you’re using them earlier for acne, that’s fine. Start slowly and use barrier repair moisturizers immediately after application to reduce irritation. If prescription retinoids are intolerable, consider adapalene, azelaic acid, or milder OTC retinols.

Is a CO2 laser appropriate for everyone?

CO2 lasers are best for significant sun damage and fair skin types. They are ablative and require downtime, with a higher risk of pigmentation issues for darker skin. Non-ablative options, microneedling, or staged chemical peels are alternatives for many patients.

Can men be treated with spironolactone for acne?

Oral spironolactone is generally reserved for females because it blocks androgen receptors and can disrupt male hormones. There are topical spironolactone formulations that may be used in males, but systemic spironolactone is not recommended for men.

Are collagen supplements worth taking?

Oral collagen peptides may provide modest benefits for skin elasticity and joints in some people, but we prioritize procedures and topical therapies (like retinoids and microneedling) for predictable collagen stimulation. Collagen supplements can be part of a broader wellness plan, but should not replace proven dermatologic interventions.

How do I treat melasma without lasers?

We favor topical regimens and chemical peels for melasma. Ingredients like tranexamic acid, kojic acid, controlled hydroquinone use, and vitamin C can be combined thoughtfully. Lasers can sometimes worsen melasma by adding heat as a trigger, so proceed carefully and under expert guidance.

Which sunscreen should I use?

Pick an SPF 30 or higher broad-spectrum sunscreen that you will use daily. If you prefer mineral sunscreens, choose formulations with zinc oxide or titanium dioxide. If a chemical sunscreen feels better under makeup and you are consistent, that is a fine choice too. The best sunscreen is the one you apply every day.

How often should I microneedle?

For general rejuvenation: a series of three treatments spaced four to six weeks apart, then maintenance every three to four months. For acne scarring or pigment concerns, additional sessions may be necessary depending on response.

What should I do if my child needs isotretinoin?

Isotretinoin is highly effective for severe acne and is safe when closely monitored. We run baseline and periodic bloodwork to monitor liver enzymes and lipids, and counsel on pregnancy prevention for those who can become pregnant. Discuss risks and monitoring protocols thoroughly with the prescribing dermatologist or pediatric dermatologist.

Final perspective

We believe that aging is natural and can be honored while still using modern, evidence-based tools to look and feel our best. Prevention—chiefly daily broad-spectrum sunscreen, antioxidant protection, barrier maintenance, and sensible lifestyle choices—gives the most leverage over time. When targeted procedures or injectables are appropriate, conservative, staged care under a trusted clinician yields the most elegant, long-lasting results.

If you want to explore personalized options, book a consultation with a board-certified dermatologist who will listen, assess your skin objectively, and create a plan that reflects your goals and your biology.

This article was created from the video How to Take Care of Your Skin in Every Stage of Life ft. Dr. Haleh Bakshandeh | SHE MD for Dr. Thais Aliabadi’s website.