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Sun damage has a way of appearing gradually — and then seemingly all at once. Brown spots, uneven tone, rough texture, and fine lines may become more noticeable long after the beach days, outdoor workouts, and everyday exposure that caused them.
So, can Fraxel really reverse sun damage? The short answer: Fraxel can significantly improve many of the visible signs of sun damage, helping the skin look clearer, smoother, and more even.
But its benefits may reach beyond what is visible: Fraxel Dual is also FDA-cleared to treat actinic keratoses, common precancerous skin lesions caused by cumulative sun exposure.
Fraxel is a fractional laser treatment that targets microscopic columns of skin while leaving the surrounding tissue intact. This fractional approach supports the skin’s natural renewal process and stimulates fresh collagen production.
Fraxel Dual uses two wavelengths, allowing treatment to be customized based on the patient’s skin and concerns. It can address both superficial pigmentation and deeper signs of aging, making it an especially versatile option for sun-damaged skin.
This is where “reversing sun damage” becomes much more than a cosmetic conversation.
Actinic keratoses, often called AKs, are rough or scaly precancerous lesions that develop after years of UV exposure. While not every actinic keratosis becomes skin cancer, some can progress to squamous cell carcinoma — which is why evaluation and treatment by a dermatologist matter.
Fraxel Dual’s 1927 nm wavelength is FDA-cleared for the treatment of actinic keratoses. In the clinical study supporting that clearance, patients who completed a series of two to four treatments experienced an average 83.5% reduction in actinic keratosis lesions at six months. Treatment was studied on the face as well as sun-exposed areas including the arms, hands, and chest.
Research has continued to explore whether nonablative fractional laser treatment may offer longer-term benefits for chronically sun-damaged skin. A retrospective study of patients with a prior history of facial basal or squamous cell carcinoma found that 20.9% of laser-treated patients developed another facial keratinocyte carcinoma, compared with 40.4% of matched patients who had not received the laser treatment.
In other words, the treated group experienced about half the rate of subsequent facial skin cancers during the study period. These findings are extremely promising, but they do not mean Fraxel is proven or FDA-cleared to prevent skin cancer.
The study showed an association — not definitive cause and effect — and further research is needed. Fraxel also does not prevent melanoma and should never replace broad-spectrum sunscreen, protective clothing, routine full-body skin examinations, or treatment recommended for a suspicious lesion.
What the research does suggest is exciting: fractional laser treatment may help clear visibly damaged and atypical cells while supporting healthier skin renewal and a more appropriate response to future UV damage.
For the right patient, Fraxel may offer the rare combination of cosmetic rejuvenation and meaningful treatment of precancerous actinic damage.
Fraxel may be recommended to improve:
Although Fraxel is most commonly associated with the face, it can also be used to treat frequently exposed areas such as the neck, chest, and arms.
Fraxel can noticeably reduce the appearance of many brown spots, but results vary depending on the type and depth of pigmentation.
In the days following treatment, areas of pigment may initially appear darker or develop a bronzed look before gradually flaking away as the skin renews itself. Some patients see meaningful improvement after one session, while others benefit from a customized series of treatments.
A consultation is essential because not every form of discoloration should be treated the same way. Melasma, for example, requires a particularly thoughtful treatment plan because heat and inflammation can sometimes trigger or worsen it.
Fraxel can treat existing visible damage and is FDA-cleared to treat precancerous actinic keratoses, but it cannot prevent all new sun damage — or guarantee that skin cancer will not develop.
Results are best maintained with daily broad-spectrum sunscreen, protective clothing, routine skin examinations, and a dermatologist-recommended skincare plan.
Think of Fraxel as a powerful reset for the appearance and quality of the skin — not permission to skip SPF afterward.
Protecting the skin following treatment is especially important while it is healing and more sensitive to environmental exposure.
Fraxel downtime depends on the treatment settings and the area treated. Redness, warmth, swelling, bronzing, and a dry or sandpaper-like texture can occur as the skin renews.
Most patients plan for several days of visible recovery, although exact healing time varies.
Following the personalized aftercare plan provided by your NicholsMD provider — including gentle skincare and diligent sun protection — is an important part of achieving the best possible result.
At NicholsMD, we typically recommend a series of three Fraxel treatments for the most comprehensive correction.
Because Fraxel works fractionally, treating approximately 33% of the targeted skin during each session, the series allows us to progressively address sun damage while giving the surrounding skin time to heal.
With each treatment, cellular renewal and collagen production continue, gradually revealing smoother, brighter, healthier-looking skin with more even tone and texture.
Fraxel is one of the most effective ways to address multiple signs of sun damage within one personalized treatment plan.
Rather than targeting only one brown spot or one fine line, Fraxel can improve the overall tone, texture, and quality of the treated skin, while also offering an FDA-cleared treatment option for actinic keratoses.
The key is choosing the correct settings, treatment schedule, and aftercare for your individual skin. At NicholsMD, Fraxel treatments are thoughtfully customized to help deliver meaningful correction while supporting natural-looking results.
If sun spots, uneven tone, or rough texture are making your skin look more weathered than you feel, a personalized Fraxel consultation can help determine the right next step.
Schedule a consultation with NicholsMD to discover whether Fraxel is right for your skin, concerns, and goals.
Sunscreen is one of the most important parts of any skincare routine, but choosing the right one can feel surprisingly complicated. Mineral or chemical? Tinted or untinted? Is one safer? Is one better for sensitive or acne-prone skin?
The truth is that both mineral and chemical sunscreens can provide effective protection against sun damage. The best sunscreen is the one that works well with your skin, fits comfortably into your routine and is worn consistently.
Here is how mineral and chemical sunscreens differ — and how to decide which formula may be best for you.
Mineral sunscreen, sometimes called physical sunscreen, uses zinc oxide, titanium dioxide or a combination of both as its active ingredients. These mineral filters create a protective layer on the skin that absorbs ultraviolet radiation while also reflecting and scattering a portion of the sun’s rays.
Mineral sunscreen is often recommended for sensitive, reactive or rosacea-prone skin because zinc oxide and titanium dioxide tend to be well tolerated. It is also commonly used following treatments such as Fraxel, chemical peels or microneedling, when the skin may be temporarily more sensitive, although patients should always follow their provider’s specific post-treatment instructions.
The potential downside is cosmetic. Some mineral sunscreens can feel thicker or leave a visible white cast, particularly on deeper skin tones. Fortunately, newer formulations are increasingly lightweight, sheer and easy to wear under makeup.
Chemical sunscreen uses UV filters such as avobenzone, octisalate, octocrylene and homosalate. These ingredients absorb ultraviolet radiation and convert it into a small amount of heat that is released from the skin.
Chemical formulas are often popular for daily wear because they tend to be lightweight, blend easily and dry down without a white cast. They can be especially appealing for patients who prefer fluid, gel or invisible sunscreen textures.
Some people with sensitive skin may experience stinging or irritation from certain chemical sunscreen formulas, particularly around the eyes. However, that does not mean all chemical sunscreens will cause irritation. The complete formula — including fragrance, alcohol and preservatives — can matter just as much as the sunscreen filters themselves.
Neither category is universally better. Both mineral and chemical sunscreens can protect the skin effectively when they offer broad-spectrum coverage, have an SPF of at least 30 and are applied correctly.
The more useful question is: Which sunscreen are you most comfortable wearing every day?
Mineral sunscreen may be a better fit for someone with highly sensitive skin, rosacea or recently treated skin. Chemical sunscreen may be preferable for someone who wants an invisible, lightweight finish that layers easily under makeup. Hybrid sunscreens, which combine mineral and chemical filters, can offer a balance between the two.
Ultimately, consistency matters more than category. A beautifully formulated sunscreen that you apply every morning will provide more benefit than a technically “perfect” formula that stays in the bottle.
Chemical sunscreen has become the subject of significant misinformation online. While some chemical filters can be absorbed into the bloodstream, absorption alone does not mean an ingredient is harmful or unsafe.
What is well established is that repeated, unprotected UV exposure contributes to sunburn, premature skin aging, discoloration and skin cancer. Sunscreen remains an essential part of a complete sun-protection strategy.
Patients who are uncomfortable using chemical UV filters can choose a mineral formula containing zinc oxide, titanium dioxide or both.
The answer should never be to skip sun protection altogether.
For sensitive or rosacea-prone skin, a fragrance-free mineral sunscreen is often the best place to start. Zinc oxide and titanium dioxide are generally gentle, while fragrance and certain inactive ingredients may trigger redness or irritation.
If sunscreen consistently stings or burns, it may also be a sign that the skin barrier is compromised. In that case, simplifying the skincare routine and consulting a dermatologist can help identify the source of the sensitivity.
Acne-prone skin can use either mineral or chemical sunscreen. Instead of focusing only on the type of UV filter, look for a formula labeled non-comedogenic, oil-free or suitable for acne-prone skin.
Some patients prefer a lightweight chemical gel or fluid, while others like the matte finish of a mineral sunscreen. If one sunscreen causes congestion or breakouts, the issue may be the specific base or inactive ingredients, not the entire sunscreen category.
Daily SPF is especially important for acne-prone skin because UV exposure can make post-inflammatory hyperpigmentation and lingering acne marks appear darker and last longer.
For melasma, hyperpigmentation and stubborn dark spots, a tinted broad-spectrum sunscreen is often the strongest choice. UV exposure is not the only factor that can worsen pigmentation. Visible light can also contribute to melasma and discoloration, particularly in medium-to-deep skin tones.
Tinted sunscreens typically contain iron oxides, which provide additional protection against visible light while helping the formula blend more naturally into the skin. For this reason, the tint is not simply cosmetic — it can play a meaningful role in a discoloration-focused skincare plan.
A common sunscreen myth is that mineral sunscreen works instantly while chemical sunscreen must “activate” for 20 minutes. In reality, every sunscreen needs time to settle into an even, protective film.
Mineral, chemical and hybrid sunscreens should all be applied before sun exposure according to the instructions on the product label. Applying SPF as the final step of the morning skincare routine gives it time to set before makeup and outdoor activity.
Regardless of whether the formula is mineral or chemical, look for:
Sunscreen should be applied generously to all exposed skin, including frequently missed areas such as the ears, hairline, neck, chest and backs of the hands.
Reapply approximately every two hours when outdoors, as well as after swimming or heavy sweating. Makeup containing SPF can offer additional protection, but most people do not apply enough makeup to achieve the SPF listed on the label.
A dedicated sunscreen should still serve as the final step of the morning skincare routine, one of the three skincare items in Dr. Nichols’ Trifecta.
Mineral and chemical sunscreens are both effective options. The right choice depends on your skin type, concerns, preferences and lifestyle.
Sensitive, rosacea-prone or recently treated skin may benefit from a gentle mineral sunscreen. Someone who prioritizes an invisible, lightweight finish may prefer a chemical formula. For melasma and discoloration, a tinted sunscreen with iron oxides can provide an added layer of protection against visible light.
Most importantly, sunscreen should feel easy enough to use every day. Consistent sun protection helps preserve collagen, prevent discoloration, protect treatment results and support the long-term health of the skin.
Not sure which sunscreen belongs in your routine? Schedule a consultation at NicholsMD for personalized skincare recommendations based on your skin, lifestyle and aesthetic goals.
At NicholsMD of Greenwich, aesthetic care has never been about changing the way someone looks. It is about preserving what patients love, strengthening what time naturally takes away and helping the skin function at its best.
Central to Dr. Nichols’ approach is one of her favorite terms: collagen banking.
Much like investing for the future, collagen banking means proactively supporting the skin before — or as — the visible signs of aging begin to appear. Because the body’s natural collagen production gradually declines over time, treatments that stimulate new collagen can help preserve the skin’s firmness, structure and resilience for years to come.
This philosophy is at the heart of #NaturalAtNichols. Rather than chasing an overnight transformation or treating every patient with the same formula, NicholsMD creates thoughtful, long-term treatment plans designed to help each patient look refreshed, rested and unmistakably like themselves.
Treatments such as Sculptra®, The Greenwich Secret™, platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) work in different ways to support the body’s regenerative processes. Depending on the patient and treatment area, they may help improve age-related volume loss, fine lines, skin texture, laxity, crepey skin and even thinning hair.
So, which collagen-stimulating treatment does what? Here are the questions patients ask most frequently at NicholsMD of Greenwich.
Not exactly. Sculptra is a biostimulatory injectable made with poly-L-lactic acid. Unlike traditional hyaluronic acid filler, which adds immediate volume to a specific area, Sculptra works gradually by stimulating the body’s natural collagen production.
Over time, this can help restore underlying support, improve skin quality and soften the appearance of age-related volume loss. Results develop progressively, making Sculptra especially appealing to patients who want to look refreshed without appearing as though they have had obvious work done.
It is collagen banking in one of its purest forms: encouraging the skin to rebuild its own support rather than simply adding volume.
Depending on the patient’s anatomy and personalized treatment plan, Sculptra may be used to:
Every Sculptra treatment at NicholsMD is customized. The goal is never more volume simply for the sake of volume — it is strategic support in the areas where collagen loss has begun to affect the appearance of the face or body.
Think gradual, not overnight. Because Sculptra stimulates the body’s own collagen production, improvements develop progressively in the weeks and months following treatment.
The change can be subtle enough that others notice a refreshed appearance without being able to pinpoint exactly what has changed. The number of sessions and amount of product recommended will depend on the patient’s age, anatomy, degree of collagen loss and long-term aesthetic goals.
The Greenwich Secret™ is NicholsMD’s signature skin-rejuvenation treatment combining radiofrequency energy with microneedling. The treatment creates controlled microchannels in the skin while delivering heat into targeted tissue depths, stimulating the skin’s natural healing response and supporting new collagen and elastin production.
While Sculptra helps rebuild support from within, The Greenwich Secret focuses more directly on the skin’s tone, texture and firmness. It is one of our favorite ways to improve skin quality while maintaining a completely natural-looking result.
The Greenwich Secret may be recommended for concerns including:
It can be performed on the face, neck, décolletage, abdomen, knees and other areas of the body, depending on the patient’s needs. For younger patients, The Greenwich Secret can be a proactive collagen-banking treatment. For patients already noticing visible changes, it can help encourage the skin to repair, remodel and strengthen itself.
Yes. In the right patient, combining treatments that work through different mechanisms can create a more comprehensive result. Sculptra can help restore deeper structural support, while The Greenwich Secret addresses the quality, texture and firmness of the skin itself.
Rather than treating one isolated concern, this combination allows providers to consider how the skin, collagen and underlying facial structure work together.
Timing matters, however. At NicholsMD, every combination-treatment plan is carefully sequenced according to the patient’s anatomy, skin quality, lifestyle and goals.
PRP, or platelet-rich plasma, and PRF, or platelet-rich fibrin, are regenerative treatments created from a small sample of the patient’s own blood. After the blood is processed, the platelet-rich portion is isolated and used strategically in the skin or scalp.
Platelets contain growth factors that play a role in the body’s natural repair processes, making PRP and PRF versatile options for both aesthetic rejuvenation and hair restoration.
Although the two treatments are related, they are prepared differently. PRF creates a fibrin matrix that allows platelets and growth factors to be released gradually, while PRP produces a platelet-rich plasma preparation that can be injected or paired with other treatments.
PRF may be used beneath the eyes to improve the appearance of hollowness, crepey texture and dark under-eye circles in appropriate patients. Because the eye area is delicate — and under-eye concerns can have several different causes — a consultation is essential.
PRF is not a replacement for every under-eye treatment, but it can be an appealing regenerative option for patients who want gradual, natural-looking improvement.
PRF may also be used to support collagen production and improve the appearance of fine lines, wrinkles and overall skin quality. PRF EZ Gel creates a gel-like preparation that can provide subtle support in select areas of the face.
It can be especially appealing to patients interested in a treatment derived from their own blood rather than a traditional dermal filler.
PRP can be injected into the scalp as part of a personalized hair-loss and hair-restoration treatment plan. Platelet-derived growth factors may help support healthier follicles and fuller-looking hair in appropriately selected patients.
At The Hair Lab™ at NicholsMD of Greenwich, PRP and PRF may be incorporated into a broader dermatologist-led plan that considers scalp health, the cause of the patient’s hair loss and complementary in-office or at-home treatments.
PRP or PRF may also be paired with procedures such as microneedling. Applying the platelet-rich preparation alongside a treatment that activates the skin’s healing response can further support collagen production, smoother texture and overall radiance.
PRF may be used in the décolletage or cleavage area to improve skin quality and provide subtle, natural-looking rejuvenation. Depending on the concern, it may also be combined with other collagen-stimulating treatments as part of a customized plan.
Here’s the secret: you don’t have to choose only one.
Each treatment supports collagen and rejuvenation in a different way:
The right choice depends on much more than the concern a patient sees in the mirror. A personalized treatment plan should also consider skin quality, facial anatomy, age, lifestyle, treatment history and how the patient wants to look years from now.
That is the real meaning of collagen banking: making intentional investments in the skin today so it can remain stronger, healthier and more resilient over time.
At NicholsMD, the goal is not for someone to ask, “What did you have done?” It is for them to say, “You look amazing.” That’s #NaturalAtNichols.
Ready to begin your personalized collagen-banking plan? Schedule a consultation at NicholsMD of Greenwich to discover whether Sculptra, The Greenwich Secret, PRF, PRP or a customized combination may be right for you.
The newest approach to anti-aging is not about chasing every line or adding more volume. It is about improving the health, strength and overall quality of the skin.
At NicholsMD of Greenwich, patients are increasingly asking for treatments that help their skin look smoother, brighter, firmer and more even — without changing the features that make them look like themselves.
This movement toward skin quality reflects a larger shift in cosmetic dermatology: away from obvious correction and toward personalized, natural-looking rejuvenation. Rather than focusing on one wrinkle or brown spot, a skin-quality treatment plan considers the complete picture, including texture, tone, pores, pigmentation, firmness, collagen loss and overall radiance.
Treatments such as Fraxel® laser resurfacing and The Greenwich Secret™ RF microneedling can address different aspects of skin quality, while Aura 3D skin analysis gives providers a more detailed understanding of what is happening both on and beneath the skin’s surface.
The result is a smarter, more customized approach to anti-aging — and one that aligns naturally with the #NaturalAtNichols philosophy.
Skin quality describes the characteristics that make skin appear healthy, smooth and resilient. It is influenced by several factors, including:
Traditional anti-aging conversations often focus heavily on wrinkles and volume loss. While those concerns still matter, patients are now looking more closely at how the skin itself looks and functions.
Someone may have minimal facial volume loss but still feel that their complexion appears dull, uneven or weathered. Another patient may be less concerned about individual lines and more interested in improving crepey texture, enlarged pores or early laxity. That is why better skin quality has become one of the most important goals in modern aesthetic dermatology.
Healthy-looking skin can influence the appearance of the entire face. When the complexion is smooth, even and radiant, facial features often appear naturally more refreshed. This has led to a growing preference for treatments that improve the skin itself rather than creating an immediate or obvious change.
Patients want to look rested and polished while still looking completely like themselves.
At NicholsMD, this approach is closely connected to collagen banking: proactively supporting the skin’s collagen before — or as — the visible signs of aging begin to appear. Because natural collagen production gradually declines over time, treatments that stimulate collagen can help maintain the skin’s structure, firmness and resilience.
For some patients, improving skin quality may mean correcting accumulated sun damage with Fraxel. For others, it may mean strengthening the skin with RF microneedling. In many cases, the most effective plan involves a thoughtfully timed combination of treatments.
The goal is not perfection. It is skin that looks healthier, stronger and naturally rejuvenated.
Fraxel is a fractional laser treatment used to improve visible sun damage, pigmentation, fine lines, uneven texture and acne scarring. Instead of treating the entire surface of the skin at once, fractional laser technology creates microscopic treatment zones while leaving surrounding tissue intact.
This activates the skin’s natural renewal response and supports the production of new collagen.
Fraxel may be especially beneficial for patients concerned about:
Fraxel can target certain types of pigmentation and visible sun damage while simultaneously improving texture and fine lines. This makes it a valuable option for patients who want to address multiple skin-quality concerns within one treatment plan.
However, not every brown spot is the same. Pigmentation may be caused by sun exposure, melasma, post-inflammatory changes or other conditions. A professional skin evaluation is important before selecting any laser treatment.
Downtime depends on the specific treatment settings, the area being treated and the patient’s individual skin. Redness, swelling, dryness and a bronzed or sandpaper-like texture may occur as the skin renews itself.
At NicholsMD of Greenwich, every Fraxel treatment is customized according to the patient’s skin type, concerns, lifestyle and tolerance for downtime.
No. Depending on the patient and concern, Fraxel may also be used on areas such as the neck, décolletage and hands — areas that commonly reveal accumulated sun exposure and changes in skin quality.
The Greenwich Secret™ is NicholsMD’s signature treatment combining radiofrequency energy with microneedling to improve skin texture, firmness and overall quality.
Microneedling creates controlled microchannels in the skin, while radiofrequency energy delivers heat into targeted tissue depths. Together, these technologies activate the body’s natural healing response and stimulate the production of new collagen and elastin.
The Greenwich Secret may be recommended for concerns including:
Both treatments can improve skin quality, but they use different technologies and may be selected for different concerns.
Fraxel uses fractional laser energy and is frequently chosen for concerns such as sun damage, brown spots, fine lines and uneven texture.
The Greenwich Secret combines microneedling with radiofrequency energy and may be selected when the primary goals include collagen stimulation, firmness, pores, acne scarring, crepey skin or mild laxity.
The choice is not always one treatment versus the other. When appropriate, Fraxel and The Greenwich Secret may be incorporated into a longer-term treatment plan to address different aspects of the skin.
Yes. Skin quality does not stop at the jawline. Depending on the patient’s needs, The Greenwich Secret may be used on the:
Treating beyond the face reflects another important change in modern aesthetics: patients are increasingly interested in maintaining healthy-looking skin across the entire body.
Effective treatment begins with understanding the skin.
The Aura 3D skin analysis at NicholsMD of Greenwich provides a detailed assessment that helps providers evaluate facial features and visible skin concerns from multiple perspectives.
Rather than relying solely on what can be seen in the mirror, advanced imaging can help identify and document concerns such as pigmentation, texture, redness, pores, lines and other changes in the complexion. This information allows the NicholsMD team to create a more precise and personalized treatment plan.
Aura imaging can also establish a visual baseline before treatment. As the patient progresses through a skincare, laser or collagen-stimulating plan, updated imaging may help document changes that can be difficult to notice from day to day.
Two patients may describe the same concern, such as dullness or uneven skin, but require completely different treatment plans. One patient’s uneven complexion may be primarily related to sun damage. Another may have redness, textural changes or a combination of concerns.
Aura-guided planning gives providers additional information to help determine which treatments and skincare products may be most appropriate.
Depending on the findings, a personalized skin-quality plan may include:
The technology does not replace provider expertise. Instead, it adds another layer of information to support more thoughtful recommendations and track a patient’s progress over time.
The right treatment depends on what is affecting the quality of the skin.
Fraxel may be recommended when the primary concerns include:
The Greenwich Secret may be recommended when the primary concerns include:
Most patients actually benefit from both treatments at different points in their aesthetic plan. Others may be better suited for an entirely different technology based on their skin type, pigmentation, degree of laxity and treatment goals.
This is why skin analysis and an in-person consultation are essential. The most popular treatment is not necessarily the best treatment for every patient.
At NicholsMD, anti-aging is not defined by the absence of every line. It is about maintaining skin that looks healthy, balanced and resilient at every age.
Fraxel can address visible sun damage and uneven texture. The Greenwich Secret can support collagen, firmness and smoother-looking skin. Aura 3D skin analysis can help providers see the complete picture and build a more precise treatment plan.
Together, these tools represent the future of natural-looking aesthetic care: advanced technology guided by experienced providers and customized to the individual. Because the goal is never to look treated — it is to look refreshed, radiant and unmistakably like yourself. That is #NaturalAtNichols.
Ready to learn more about your skin? Schedule a consultation and Aura 3D skin analysis at NicholsMD of Greenwich to discover which skin-quality treatments may be right for you.
If you’ve ever looked closely in the mirror and wondered, “Why are my pores so big?” you’re definitely not alone. Large or visible pores are one of the most common skin concerns we hear about at NicholsMD, especially around the nose, cheeks, and T-zone. And if you’ve spent any time on TikTok or browsing the skincare aisle, you’ve probably also seen countless products promising to “open,” “close,” or “shrink” your pores.
So, can you actually shrink your pores? The short answer: not exactly. Your pores don’t open and close like tiny doors, and you can’t permanently erase them. But you can absolutely make enlarged pores look smaller and less noticeable.
The key is understanding why your pores look enlarged in the first place.
Pores are normal openings in the skin associated with hair follicles and sebaceous, or oil, glands. Everyone has them, and they serve an important function. What we commonly call “large pores” are simply follicular openings that have become more visible. Pore size and appearance can be influenced by several factors, including:
That’s why treating large pores isn’t as simple as finding one miracle “pore-shrinking” product. The best treatment depends on why your pores are noticeable.
If you have naturally oily skin, you may be more likely to notice enlarged pores, particularly around the nose and central cheeks. Sebum travels through the follicle to reach the surface of your skin. Higher levels of oil production are associated with more visible pores. This is also one reason someone with oily or acne-prone skin may notice larger-looking pores at a younger age.
Think of this less as your pore physically “growing” and more as it becoming increasingly noticeable. Oil, dead skin cells, and debris can accumulate inside a pore. As the follicle becomes congested, the opening can appear larger. Blackheads can make pores particularly noticeable because the dark material inside the follicle creates more contrast against the surrounding skin.
This is the part people often overlook. Large pores aren’t always an oil problem. As we age, our skin gradually loses collagen and elasticity. When the skin surrounding a pore has less structural support, the pore can begin to look larger or more elongated. This is why someone who never struggled with noticeable pores in their 20s may suddenly start seeing them in their 30s, 40s, or beyond.
Another reason to wear your SPF. Repeated UV exposure contributes to collagen breakdown and changes in skin elasticity. As the support around the pore decreases, pores can become more visible over time.
No. Despite what you may have heard, pores do not contain muscles that allow them to physically open and close. Hot water or steam can help soften oil and debris, which may make it easier to cleanse the skin, but they don’t “open” your pores. Similarly, splashing your face with cold water does not permanently “close” them.
What we can do is keep pores clear and improve the skin surrounding them so that they appear smaller. That distinction matters.
If your goal is to minimize the appearance of large pores, we typically think about three things:
Depending on the cause and severity of your enlarged pores, this may involve a combination of at-home skincare and in-office treatments.
Retinoids are one of our favorite ingredients for improving overall skin quality. They help normalize cell turnover, prevent pores from becoming clogged, and support collagen production. Over time, this can improve skin texture and make pores appear less prominent.
Depending on your skin, your dermatologist may recommend an over-the-counter retinol, like our favorites from SkinCeuticals, or a prescription retinoid such as tretinoin.
If clogged pores and oil are the primary issue, salicylic acid can be especially helpful. Because salicylic acid is oil-soluble, it can penetrate into the follicle and help remove excess oil and dead skin cells. Keeping the pore clear can make it look less noticeable.
Yes, SPF belongs in the pore conversation. Because chronic UV exposure contributes to collagen loss and reduced skin elasticity, daily broad-spectrum sunscreen is one of the simplest ways to prevent pores from becoming more noticeable with age.
If large pores are bothering you, take a look at what you’re putting on your skin. Products labeled “non-comedogenic” are formulated to be less likely to clog pores. This can be especially important if you have oily, acne-prone, or congestion-prone skin.
And remember: more skincare isn’t always better. Using too many harsh or irritating products can disrupt your skin barrier without actually addressing what’s causing your pores to look enlarged.
This is where we can go beyond what your skincare routine can accomplish at home. If pores remain noticeable despite a consistent skincare routine, in-office treatments can address some of the underlying factors that contribute to their appearance, particularly texture, acne scarring, oil production, and collagen loss.
At NicholsMD, your treatment plan may include one or a combination of treatments depending on your skin.
For patients concerned with enlarged pores and excess oil, Pore-Minimizing MiniTox is one of our favorite options for creating a smoother, more refined-looking complexion.
Unlike traditional Botox injections that target deeper facial muscles to soften expression lines, MiniTox involves more superficial placement of a neuromodulator within the skin. This technique can help temporarily reduce oil production and improve the appearance of enlarged pores, leaving the skin looking smoother and more polished.
It can be especially helpful for patients who notice persistent oiliness, visible pores through the T-zone, or skin that quickly becomes shiny throughout the day.
While MiniTox cannot permanently shrink your pores, it can help make them appear smaller and improve overall skin texture, making it a great option when your goal is that smooth, filtered-looking finish without the filter.
The Greenwich Secret™ is our signature treatment that combines radiofrequency microneedling with a customized topical infusion. Microneedling stimulates the body’s natural healing response and collagen production, while radiofrequency delivers energy deeper into the skin.
For patients concerned about enlarged pores, uneven texture, acne scarring, or overall skin quality, improving the collagen and support surrounding the pores can help make them appear less noticeable.
Traditional microneedling can also be an effective option for improving the appearance of large pores and uneven texture. By stimulating collagen production, microneedling helps improve the overall quality and smoothness of the skin.
It’s particularly helpful when enlarged pores are accompanied by acne scars or textural concerns.
Depending on your skin type and concerns, laser treatments may also be incorporated into a pore-minimizing treatment plan. Resurfacing and fractional laser technologies can help improve texture, stimulate collagen, and address sun damage, all of which can contribute to the appearance of enlarged pores.
The right laser depends on your skin tone, sensitivity, downtime preferences, and other concerns you’re hoping to address at the same time.
Chemical peels can help exfoliate dead skin cells, improve congestion, and smooth uneven texture. For patients whose pores look larger because of oiliness, congestion, or acne, a customized peel may be incorporated into a broader treatment plan.
If your skincare hasn’t changed but your pores suddenly seem more noticeable, collagen may be the missing piece. Younger skin generally has greater elasticity and structural support around each follicle. As collagen and elastin decline with age and accumulated sun exposure, that support weakens.
The result? A pore that once looked tiny can begin to appear wider, longer, or more noticeable. This is why our approach to treating enlarged pores can change with age. For younger patients with oily or acne-prone skin, controlling oil and congestion may be the priority. As we get older, treatments that improve collagen, elasticity, and skin quality may become equally important.
No treatment can completely eliminate your pores, and we wouldn’t want it to. Pores are a normal part of healthy skin.
The goal isn’t “poreless” skin. The goal is to make enlarged pores less visible by addressing the factors contributing to their appearance.
Results also require maintenance. Oil production, aging, sun exposure, and collagen loss don’t simply stop after a treatment. A combination of daily skincare, sun protection, and strategically selected in-office treatments typically provides the most comprehensive approach.
There isn’t one universal best treatment for large pores because not everyone’s pores are enlarged for the same reason.
If you’re younger with oily, congested skin, your plan may focus more heavily on salicylic acid, retinoids, chemical peels, and acne management.
If you’re noticing large pores alongside fine lines, laxity, or changes in skin texture, collagen-stimulating treatments like microneedling, radiofrequency microneedling, or laser resurfacing may make more sense.
And if you have acne scarring in addition to enlarged pores, we may create a combination treatment plan to address both.
This is where having your skin evaluated by a dermatology provider can make all the difference. Instead of simply treating the pore you see in the mirror, we can determine why you’re seeing it.
You cannot permanently change pores into tiny, invisible openings, but you can make them appear smaller. Keeping pores clear, controlling excess oil, protecting collagen, and improving skin texture can all reduce their visibility.
The nose contains a high concentration of sebaceous glands, so pores in this area can be particularly noticeable. Oil production, congestion, blackheads, and genetics can all contribute.
Sometimes pores become more visually noticeable because of changes in hydration, lighting, or temporary irritation. Over-cleansing or using harsh products can also disrupt the skin barrier. Your cleanser should leave your skin clean, not stripped or tight.
Aging can contribute. As collagen and skin elasticity decrease, the structural support surrounding the follicle changes, which can make pores appear larger.
Facials can help with congestion, hydration, and overall skin texture, which may temporarily make pores look less noticeable. However, they cannot permanently eliminate pores. For more significant concerns, your provider may recommend collagen-stimulating or resurfacing treatments.
If there’s one thing we want you to remember, it’s this: Pores are normal.
You don’t need perfectly “poreless” skin, regardless of what a filter, beauty ad, or social media trend might suggest. But if enlarged pores, congestion, acne scars, or uneven texture are bothering you, there are effective ways to improve their appearance.
At NicholsMD, we take a dermatologist-led approach to understanding what’s actually happening in your skin and creating a personalized treatment and skincare plan around it. Because the best treatment for large pores isn’t necessarily the newest viral product, it’s the one that addresses why your pores look enlarged in the first place.
If you’re searching for how to tighten loose skin above the knees, the good news is that we now have more options than ever. The right treatment depends on what’s actually causing the appearance of your knees. For some patients, the primary concern is skin laxity. For others, it’s crepey texture, wrinkles, collagen loss, excess skin, or a combination of several factors.
At NicholsMD, we take a personalized approach to knee rejuvenation and may recommend one or a combination of treatments based on your skin and goals.
One of the most exciting advancements for sagging knees is Ultherapy PRIME. Ultherapy PRIME recently received FDA clearance to improve the appearance of skin laxity on the knees, giving patients a non-invasive option specifically cleared for this notoriously difficult-to-treat area.
Using microfocused ultrasound with real-time visualization, Ultherapy PRIME delivers energy beneath the skin to stimulate the body’s natural collagen-building process. Over time, that new collagen can help improve the appearance of lax, sagging skin around and above the knees.
Unlike treatments that work primarily at the skin’s surface, Ultherapy PRIME allows us to visualize the layers of tissue we’re treating and precisely deliver ultrasound energy at targeted depths. There are no incisions or injectable fillers involved, and results develop gradually as your body produces new collagen.
For patients whose biggest complaint is, “The skin above my knees is starting to sag,” Ultherapy PRIME may be an especially exciting option.
If your knees are looking more crepey, wrinkled, or texturally uneven, we may also want to focus on improving the quality of the skin itself. The Greenwich Secret™ is our signature treatment combining radiofrequency microneedling with a customized topical serum.
Radiofrequency microneedling delivers controlled energy into the skin to support collagen remodeling while addressing concerns like laxity and texture. For the knees, this can be particularly helpful when the concern isn’t simply loose skin, but that thin, crinkled appearance patients often describe as “crepey knees.”
For patients with more noticeable loose or excess skin, Ellacor may be another option. Ellacor uses micro-coring technology to remove tiny cores of skin without traditional surgical incisions.
By physically removing small amounts of excess skin, micro-coring offers a different approach than treatments that rely primarily on energy or collagen stimulation. Because every degree of knee laxity is different, your NicholsMD provider can determine whether Ellacor, an energy-based treatment, or a combination approach makes the most sense for you.
If all three treatments can potentially play a role in knee rejuvenation, how do you know which one you need?
Think about what you actually see when you look at your knees.
If the primary concern is loose or sagging skin, we may focus on deeper collagen stimulation with Ultherapy PRIME.
If you’re seeing crepey texture, fine lines, or changes in the quality of the skin, The Greenwich Secret™ may be incorporated to address the skin more directly.
For more noticeable excess skin, we may discuss whether Ellacor micro-coring is appropriate.
And oftentimes, the answer isn’t choosing just one. Combining treatments that work in different ways can allow us to address both deeper laxity and the quality of the skin at the surface.
Your treatment plan should ultimately depend on your anatomy, degree of laxity, skin quality, goals, and the amount of downtime you’re comfortable with.
We spend so much time thinking about collagen loss and skin aging on the face, but the same changes are happening everywhere else, including your knees. Whether you’re starting to notice subtle crepiness or more visible skin laxity above the knees, today’s treatment options allow us to address these changes in ways we simply couldn’t before.
With Ultherapy PRIME now FDA-cleared to improve the appearance of skin laxity on the knees, alongside treatments like The Greenwich Secret™ and Ellacor, we can create a personalized approach based on your skin, your goals, and the results you’re looking for.
Ready to give your knees a little more attention? Schedule a consultation at NicholsMD to discover the right treatment plan for you.
If you’re serious about your skincare routine, chances are you’ve heard that you “need a retinol.” But then come the questions: What about tretinoin? Is tretinoin better than retinol? Which one is stronger? And which one should you actually be using?
Both retinol and tretinoin belong to the retinoid family, a group of vitamin A derivatives widely used in dermatology for concerns ranging from acne to signs of skin aging. But they aren’t the same, and stronger doesn’t automatically mean better for your skin.
Here’s what to know before choosing between them.
Retinol is a type of retinoid commonly found in over-the-counter skincare products. Once applied, it goes through conversion steps within the skin before becoming retinoic acid, the form that can interact with retinoic acid receptors.
Because of this conversion process, retinol generally works more gradually than prescription tretinoin. That doesn’t mean it isn’t effective. A well-formulated retinol can be a great option for patients looking to improve the appearance of fine lines, uneven tone, texture, and other visible signs of skin aging while easing into a retinoid routine.
Tretinoin is a prescription topical retinoid and is already in the active retinoic acid form. Dermatologists have used tretinoin for decades, and it has extensive research supporting its use for acne and photoaging.
Depending on your skin and treatment goals, your provider may prescribe different strengths or formulations. Because tretinoin is more potent, however, it may also cause more irritation, particularly when you first begin using it.
Yes. Tretinoin acts directly as retinoic acid, while retinol needs to be converted by the skin first.
But here’s the part that matters: stronger doesn’t necessarily mean better. If a product is so irritating that you’re constantly stopping and restarting it, you may be better served by a gentler retinoid you can use consistently.
Your skin type, sensitivity, current routine, goals, and previous experience with retinoids all matter when deciding which option makes sense.
Depending on the formulation and your individual skin, retinoids may be used to help address:
This is why retinoids are often considered a cornerstone of a well-designed skincare routine. But know that they aren’t an overnight treatment. Consistency over time is key.
Both can have a place in an anti-aging skincare routine.
Tretinoin has substantial clinical evidence supporting improvement in signs of photoaging, including fine wrinkles and uneven pigmentation. However, not everyone needs prescription-strength tretinoin to have an effective skincare routine.
For someone new to retinoids or with more sensitive skin, a high-quality retinol, like our favorites from SkinCeuticals, may be an appropriate place to start.
Someone with specific concerns or who has already developed a tolerance to retinoids may be a candidate for prescription tretinoin. The goal isn’t to use the strongest product possible. It’s to find the most effective routine your skin can tolerate consistently.
More isn’t always more when it comes to retinoids. If you’re new to retinol or tretinoin, your provider may recommend starting a few nights per week and gradually increasing frequency as your skin adjusts.
Using too much too quickly can lead to dryness, peeling, redness, sensitivity, and irritation. And when your skin barrier is irritated, adding even more active ingredients usually isn’t the answer. A slow, consistent approach tends to win this race.
Yes! Dr. Nichols’ Skincare Trifecta includes vitamin C and SPF in the morning and your retinoid at night. This allows you to incorporate both ingredients without layering multiple potent actives at the same time.
Of course, your exact routine should depend on the products you’re using and how your skin tolerates them.
One of the most common skincare mistakes we see is adding too many active ingredients at once. Using a retinoid alongside multiple exfoliating acids, scrubs, or other potentially irritating products can be too much for some skin types.
A simple routine consisting of a gentle cleanser, moisturizer, daily broad-spectrum sunscreen, and thoughtfully selected active ingredients is often more effective than an overflowing skincare shelf.
And sunscreen is especially important. Retinoids are often used to address signs of sun damage, so protecting your skin from additional UV exposure should be part of the plan.
Topical retinoids are generally avoided during pregnancy. If you’re pregnant, trying to become pregnant, or breastfeeding, talk with your dermatologist or healthcare provider about which skincare ingredients are appropriate for you.
There are other skincare options that may be recommended during this stage.
There isn’t a universal winner in the retinol vs. tretinoin debate.
If you’re new to retinoids, have sensitive skin, or want a more gradual approach, retinol may be a good choice. If you’re addressing acne or more significant signs of photoaging, your dermatologist may recommend prescription tretinoin.
At NicholsMD, our board-certified providers believe your skincare routine should be just as personalized as your in-office treatments. We consider your skin type, concerns, lifestyle, current products, and treatment goals to build a routine you’ll actually use.
When it comes to retinoids, the best product isn’t necessarily the strongest one. It’s the one that’s right for your skin.
Not sure whether retinol or tretinoin belongs in your routine? Schedule a consultation at NicholsMD for personalized recommendations based on your skin and goals.
If you’ve started noticing jowls, a less-defined jawline, or looser skin along your face and neck, but you’re not looking for surgery or significant downtime, XERF may be worth considering. XERF is a non-surgical radiofrequency treatment designed to address skin laxity and support collagen remodeling for a firmer, more defined appearance. But like any aesthetic treatment, XERF isn’t necessarily the right choice for everyone.
So, who is a good candidate for XERF? Here’s what we look for.
Who Is an Ideal Candidate for XERF?
XERF may be a good option for patients experiencing mild to moderate skin laxity who want to improve facial definition without surgery.
We especially consider XERF for patients who are beginning to notice:
XERF uses radiofrequency energy to heat targeted tissue and stimulate the body’s natural collagen-remodeling process. Rather than changing your facial features, the goal is to help lift, contour, and restore definition in a way that still looks like you.
Is XERF Good for Jowls and the Jawline?
The lower face is one of the areas where patients often begin noticing skin laxity first. You might see the beginnings of jowls, notice that your jawline isn’t as crisp in photos, or feel like the transition between your face and neck has become less defined. XERF can be used to address laxity through the lower face, jawline, and neck, making it an option for patients looking for non-surgical facial contouring and skin tightening. However, not every jowl is caused by the same thing. Skin laxity, facial volume, anatomy, and even the way different areas of the face age can all contribute. That’s why an in-person assessment is important before deciding that XERF, or any single treatment, is the answer.
What Age Is Best for XERF?
There isn’t one “perfect” age to start XERF. Some patients may consider treatment when they first begin noticing subtle laxity or loss of definition, while others may use XERF to address more established changes in the face and neck. At NicholsMD, we focus less on the number on your driver’s license and more on your skin, anatomy, goals, and degree of laxity. You don’t necessarily have to wait until sagging becomes significant to start thinking about collagen-banking treatments.
Is XERF a Good Option If I’m Not Ready for a Facelift?
For the right patient, XERF can be an appealing option when you want to improve laxity and facial definition but aren’t ready for, or interested in, surgical intervention. XERF is designed for patients seeking a natural-looking, non-surgical improvement with a treatment experience that can fit more easily into everyday life.
Does XERF Hurt?
Comfort is one of the reasons we’re excited about XERF. The treatment is designed to deliver radiofrequency energy while incorporating cooling technology for a more comfortable experience. No numbing is necessary (although we do offer Journavx and Pronox as added comfort options), and there is little to no downtime afterward. For busy patients who want skin tightening without adding significant recovery time to their calendars, that can be a major advantage.
How Many XERF Treatments Will I Need?
At NicholsMD, we typically begin with a series of two XERF treatments, although your exact treatment plan will depend on your skin and goals. Unlike a treatment designed to create an overnight transformation, XERF works by supporting your body’s natural collagen-remodeling process. While you may notice an instant contour, results continue develop progressively as that process takes place. This is one of the reasons XERF can work particularly well for patients who want their results to look subtle, refreshed, and natural rather than dramatically different.
XERF vs. Ultherapy: How Do I Know Which One I Need?
XERF and Ultherapy are both non-surgical treatments that can be used as part of a skin-tightening plan, but they use different types of energy and aren’t interchangeable for every patient.
XERF uses radiofrequency energy, while Ultherapy uses microfocused ultrasound energy. Which treatment makes the most sense depends on factors including your anatomy, degree of laxity, treatment goals, and the areas you want to address.
For some patients, the answer may even be a combination approach rather than choosing one treatment in isolation.
Who Might Not Be a Good Candidate for XERF?
Certain medical conditions, implanted devices, medications, pregnancy, or other individual factors may also affect whether radiofrequency treatment is appropriate for you. This is exactly why we don’t believe in choosing aesthetic treatments based solely on what’s trending. The right treatment should be based on your anatomy and your goals.
Is XERF Right for Me?
If you’re looking in the mirror and thinking, I still look like myself, but my jawline isn’t quite as defined as it used to be, that’s exactly the kind of conversation worth having with your provider.
At NicholsMD, our board-certified providers create personalized treatment plans based on your facial anatomy, skin quality, lifestyle, and long-term goals. XERF may be recommended on its own or as part of a larger plan to help you maintain natural-looking facial definition as you age. The goal isn’t to change the way you look., it’s to help you look and feel like the best version of yourself.
Interested in XERF for your face, jawline, or neck? Schedule a consultation at NicholsMD to find out if XERF is the right skin-tightening treatment for you. (LINK TO BOOKING PAGE)
