Red Light District

and other dermatologic routes to potentially happy endings

First, a hearty 🙏 for taking the time to read HNTFUYF. A flood of new readers continues to pour in daily. If you’re happy to find yourself here, would you please tap the little ❤ above?

Some of my favorite places to visit in Tokyo are drugstores, where there’s a phantasmagoria of options for just about any hair, skin, nail, or dental issue you could imagine. I don’t speak Japanese, so my purchases are often accompanied by a kind of Charades. They can occasionally be challenging, like when I wanted to be sure the extra-large fizzing tablets I was buying were for cleaning a night guard rather than a toilet bowl. (They were—but I still wonder if they had been toilet-friendly, what the nice clerk would’ve thought about why I was aggressively pointing to my mouth.)

Masks, obviously, but not even half of the kaleidoscopic selection!

On the topic of phantasmagoric options, a few illuminating words about light therapy. It can make your head spin to consider the many, many different kinds touted to benefit the skin. And because one reader (thank you, Ann B.) has persistently inquired about whether the red light therapy recently promoted by an unreliable source can also brighten skin and reduce fine lines and wrinkles, I asked dermatologist Laurel Naversen Geraghty, who generously shared her time and wisdom, for the lowdown.

Geraghty pointed out that red light therapy sneakily operates under a few aliases: photobiomodulation, low level laser light, LED therapy, cold laser therapy, biostimulation, phototherapy, and more. Studies of varying reliability back up claims that red light therapies offer such potential benefits as reducing precancers, inflammation, and wrinkles; calming acne; and healing wounds. Based on current research, Geraghty says red light therapy probably does have some potentially beneficial effects on the skin. But significantly more research is needed to understand what results one can expect, which skin conditions may respond to it, which type of red light devices are most effective, at what intensity they must be used, and how many treatments are needed to see a benefit (especially regarding relatively gentle red light devices for at-home use). The bottom-line question Geraghty (in a playful, summertime mood) shot back to me: Why waste time on a puny squirt gun when a super soaker does the job faster and better? Because there’s a roster of other in-office treatments that are supported by stronger evidence and deliver much more visible results more quickly.

The one exception Geraghty notes is red or blue light therapy used to target, treat, and prevent precancers of the skin, effectively reversing and removing sun damage. It’s called photodynamic therapy in which a topical—Levulan (or aminolevulinic acid)—is applied to the skin and left on for an hour or more prior to light exposure for approximately 17 minutes. Note that the combination of the acid with the lights is key. I had this treatment about six months ago and was extremely happy with the improved texture of my skin; in fact, I can’t think of another treatment I’ve been happier with. (An added benefit: The treatment is covered by some insurance, including Medicare.)

As for other in-office treatments maybe worth opening up your wallet for? Geraghty recommends IPL (intense pulsed light), which she calls a workhorse for fair-skin types, especially the freckle-prone. IPL can help reduce facial blood vessels, sunspots, and melasma; even out skin tone; and remove visible signs of sun damage, all without significant downtime. A single treatment can make a visible difference; three sessions have the potential to transform the look of your skin. I’ve had several IPL treatments and was pleased that it seemed to reduce redness and even out my skin tone.

More richly-pigmented skin types do well with rejuvenating lasers, such as the 1064 Nd:Yag and the PicoToning laser, says Geraghty. These can rejuvenate skin, stimulate collagen, and help remove spots or dyspigmentation in a safe way, and healing tends to be rapid. I’ve had several similar Pico laser treatments, too, and was pleased with the brightening I saw afterward. (Meaning my skin looked better somehow; more uniform coloration, mostly.)

In olive- or darker-toned complexions, there’s a higher risk of dyspigmentation and other side effects from laser and light therapies; Geraghty emphasizes that these kinds of treatments should be performed by a well-trained dermatologist or a provider who works under the guidance of one.

Finally, radio frequency microneedling is an excellent and relatively new therapy for stimulating collagen, tightening skin, reducing wrinkles, and generally softening signs of aging—without a lot of pain or downtime. I recently had this treatment on my lower face and neck (thank you, dermatologist Estee Williams) and am curious to see if I’ll notice an effect in my skin’s quality.

As Geraghty points out, it can be really hard to know which treatments will be the most efficacious for you. But you don’t need to play Charades. If you choose a doctor who’s well educated about the many light, laser, and energy-based therapies available, you’re more likely to have a treatment (or a series of treatments) customized to your unique situation and desires. And please, friends: Never forget to do your exercises.

Book Club News, ICYMI

Though I’ve been a latecomer to audiobooks, once I discovered them I couldn’t get enough. I borrow them from the public library, but as I’ve mentioned before, sometimes the library steals them back before I can finish. So I'm happy to share I'm partnering with Chirp to launch an audiobook club of biographies and memoirs called “Unfiltered Women.” It’s free to subscribe and Chirp offers great deals. Plus, you obviously get to keep the book to listen to at your leisure.

Full transparency: At this point, I’m choosing not to receive payback for sign-ups, but I do hope to get the benefit of introducing HNTFUYF to Chirp subscribers.

Here’s how it works. Every other month I’ll announce a new book club pick that we’ll listen to together. You’ll have a chance to share your thoughts on the book a few weeks later and hear what other readers thought, too. My first pick is the memoir Blood, Bones & Butter: The Inadvertent Education of a Reluctant Chef by Gabrielle Hamilton. I often encourage you to quit objectifying yourself and to instead turn your attention outward, where there’s so much to be appreciated. Hamilton is not only a master of extreme attentiveness, but also a gifted chronicler of what she sees—and she sees...everything. It’s enormous fun to follow her path from spunky kid and lover-of-backyard-barbeques to the founder of what was one of the most beloved restaurants in the world. Delicious reading.

To get started, go to chirpbooks.com/val and press FOLLOW to join my club. (Again, it’s free and there is NO commitment.) There, for a limited time (uh-oh, the offer will end today!) you can buy Blood, Bones & Butter for only $5.99, including a 50% discount with code VAL50.

Val Asks You

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

HNTFUYF, a Payola-Free Zone

Readers, a few of you have wondered aloud to me if I get a cut from sales when I mention a product. I do not. I only mention products I’d like to buy myself, and therefore think you might like, too. I share this so you know my recommendations are offered without obligation. The only financial contributions I receive from these posts are from those of you—thank you!—who have generously subscribed. All posts and the archive are free; there’s no paywall.