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To capture the real meaning of pores, you need to fuse the word's two definitions: "a minute opening" and "to study attentively." That is to say, tiny holes with which people are obsessed.
"Patients at every age complain about large pores," says Diane Berson, MD, an assistant professor of dermatology at Weill Cornell Medical College in New York City. "Unfortunately, as we get older, pores get larger."
The same rogue factors (smoking, sun exposure) that contribute to wrinkles, loose skin, and brown spots lead to saggy pores. "UVA rays and free radicals degrade collagen, the skin's support fibers, and decrease elasticity," says David E. Bank, MD, a dermatologist in Mount Kisco, New York. Empty pores are, obviously, less visible than clogged ones. "The goal is to keep pores clean and at their smallest," says Bank, who notes that the steaming and cooling of traditional facials won't actually shrink pores. "Heat softens sebum to reduce clogging, while cold water constricts blood flow and tightens skin," he says. "But neither changes a pore's size."
Berson suggests using both a chemical exfoliant such as Bioré Pore Perfect scrub (a 2 percent salicylic-acid cleanser) and a collagen-building prescription retinoid cream like Tazorac to dissolve waxy sebum. "You have to increase cell turnover and strengthen the tissue to see results," she says.
Pigmentation may also be a culprit behind more noticeable pores. "Melanin, along with sebum and dead cells, works its way up the inside of the channel and adds to a plug's dark appearance," says Daniel Maes, PhD, the vice president of research and development at Estée Lauder. The brand's Idealist Pore Minimizing Skin Refinisher contains the enzyme melanase, which eliminates some pigment buildup; glucosamine, a sugar derivative that helps break down blockages; and light-reflecting polymers that diffuse microshadows caused by aged, stretched-out pores. According to company studies, subjects observed a 69 percent reduction in pore size after four weeks of twice-daily application.
For long-term pore perfecting, doctors are taking a page from steam-happy aestheticians and turning up the heat. A series of Photodynamic Therapy (PDT) sessions, in which an energy source such as blue light or Intense Pulsed Light (IPL) activates Levulan (the topical prescription form of aminolevulinic acid), is one of the most effective killers of acne-forming bacteria. The reaction also shrinks oil glands, so pores appear smaller. The next generation of PDT combines Levulan with the recently FDA-cleared Isolaz, a vacuum-tipped machine that generates broad-spectrum light to treat acne and evacuate pores. Mitchell Chasin, MD, a Livingston, New Jersey, laser surgeon, is currently evaluating the duo. After a first pass with the Isolaz to "pull out sebum and dead cells," he coats skin with Levulan, then does a second round of Isolaz. "A clear passageway could let Levulan penetrate even deeper into the dermis," Chasin says.
Not everyone is convinced that Isolaz treatments can minimize pore size permanently. "Reducing their content will decrease their size temporarily," says Dennis Gross, MD, a dermatologist in New York City. "But pores will definitely fill up again."
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