How to F*ck Up Your Face

surprise! it's opposite day!

The doctor hesitated just before leaving me in the hands of a physician assistant in the treatment room. “You can call your next post, ‘How to F*ck Up Your Face!’” she said gleefully as she slipped out the door.

“Ha,” I said to her back.

In fact, I f*cked up my face a long time ago the way many of you may have: presenting it to the sun like a sacrificial lamb, praying to the gods to give my pale complexion some color, an even tone, a hue compatible with the Beach Boys tunes I loved. What I sacrificed was my skin’s health and beauty, because what I got in return was damage of many kinds. We’re talking hyperpigmentation (dark spots), laxity, and skin cancer (Basal cell, removed by Mohs surgery).

I mentioned I was concerned about recurrences several months ago to dermatologist Orit Markowitz during a check-up. She was sympathetic. There’s a good way to head off the likelihood of more problems, she told me. According to studies, photodynamic therapy, approved by the FDA for pre-cancerous skin lesions and certain cancerous lesions (as well as enlarged sebaceous glands and acne), is highly efficient for treating superficial, non-melanoma skin cancer. (It’s also covered by some health insurance plans, including Medicare.) The therapy even offers a salutary side effect: excellent cosmetic results in the gift of improved skin texture.

Well then sign me up, I said, which is how two weeks ago I found myself having my face scrubbed vigorously with a gauze pad soaked in rubbing alcohol—it’s as uncomfortable as it sounds; wait, more uncomfortable—and then painted with aminolevulinic acid (ALA), a photosensitizing compound activated by a specific wavelength of daylight. The acid stings, particularly on just-scrubbed skin, and sits on the face for about an hour.

You might unwisely spend that time in the treatment room belatedly googling potential side-effects, among them: discomfort ( ✅ ), itching ( ✅ ), burning ( ✅ ), swelling (oy), redness ( ✅ ), peeling (not yet). You wouldn’t see anything that made you want to run out of the room screaming—that would come later—and you’d be relieved when the PA returns to wipe off the ALA.

She hands you a pair of swim goggles, very tight ones. Then…the lights. Picture a metal box the size of a microwave lined with what looks like seven rows of glowing tubes. Now picture a kind PA gently maneuvering that box over your head, so your face is almost touching the lights. (It’s open in the back, where unfortunately you do not have eyes.) To this most confining and claustrophobic experience, the appropriate response is to desperately cry, Wait! Wait! Your head would be released from the box so you might grab your AirPods (to be distracted by your favorite prophet of doom, Rachel Maddow). Thus fortified, you would allow your head to be returned to the box with a fan positioned underneath to cool your burning skin as the ALA reacts to the light. Sixteen minutes would pass by uneventfully—not counting the active killing fields on your face—and the light box would again be removed.

Here’s what I looked like right after the treatment. This photo doesn’t quite capture the fiery nature of my forehead and cheeks, which continued to spark in isolated areas for days.

Whoa.

The more pre-cancers on the skin, apparently the more “exuberant” the reaction. My face, shrieking from the rooftops, seemed very exuberant. According to the consent form, some individuals see “fabulous” results. “Exuberant” and “fabulous” both sound propitious, but five days post-treatment, you’d be forgiven if you mistook my face for this fine leather accessory.

In grade school, did you ever smooth a light layer of Elmer’s Glue on your palm so you could have the delicious satisfaction of peeling it off? As I write this, glue = skin and palm = face. It may take a couple of weeks for a final result. The doctor advises that best results may require several treatments.

If you have sun damage, such as actinic keratoses (precancerous rough spots) or non-melanoma skin cancer (basal cell or squamous), you might want to ask your dermatologist about photodynamic therapy. The unpleasantness of the treatment now could save you more “exuberant” unpleasantness later. Wouldn’t that be “fabulous?”

In keeping with this week’s theme…

“Don’t Ask Val” doesn’t answer your urgent questions, Vol. 1

Yes, you there, with the blackout designer shades, bangs, and curtain of blonde hair?

Q: How old do you think I am?

A: Is that you, Goldie? Anna? Er…no, Melanie? Sorry, but since I turned, I don’t know, 50, I can’t tell anyone’s age unless they’re under 18. Show me a child and I can give you her age within three months. Show me a person over 18 and they could be 20, 35, 48, or 70. Why is that?

Anyway, how old do I think you are? I won’t guess; don’t ask me.

Val Asks You

Don’t be shy! What’s your most vexing or intractable appearance issue? Send me your beauty-related questions. If I don’t have a good answer, I’ll find someone who does.