As a beauty editor who struggled with adult acne for more than a decade, and as someone who has a wedding coming up, I am very familiar with these things: the dozens of possible acne solutions (both medical and lifestyle), the deep complex emotions that come with persistent breakouts, and the weird looming feeling of a high-pressure date on the horizon. So, if getting clear skin for your wedding date is important to you, I’d like to think I’m unusually qualified to share my advice.
First, some background…
In case you haven’t already Googled ad nauseum, adult acne is incredibly common. According to the American Academy of Dermatology the number of adults with acne is increasing, with an estimated 15% of cis women experiencing it.
“Most women have hormonal acne, which is jawline acne and sometimes the central face,” says Dr. Heather Woolery-Lloyd, a dermatologist in Miami. “It tends to be more inflammatory cystic acne with papules, versus comedones like blackheads and whiteheads.”
This is what makes acne tricky to treat in the late 20s and early 30s age group, when women statistically tend to marry. It’s usually not about getting the right clay mask or making sure every skin care item you use is labeled non-comedogenic — this kind of acne is often deeper and necessitates a systemic solution. It can also be a bit mysterious. In my case, after trying many different approaches in an attempt to avoid oral isotretinoin (known by its defunct brand name, Accutane), I found that spironolactone and eventually, yes, Accutane, were the right remedies for me.
Consider this your ultimate pre-wedding checklist for getting clear skin on your wedding day.
When Should You Make Your First Acne Treatment Appointment?
“A year in advance is ideal,” says Dr. Dhaval Bhanusali, a dermatologist in New York City. “But there are still really good options at six months out. After that point and the closer we get to the [wedding] date, the more limited our tools, but there’s always something we can do to help improve acne at least somewhat up until the month of.” This timing is echoed by most derms as it not only allows treatments to work their magic, it affords time to change course if a treatment doesn’t work and to address remaining scars. (I personally needed a little over six months to get my skin in shape — more on that below.)
“The worst is when we treat a patient too close to the wedding and when I see them after their honeymoon everything has really kicked in and they’re like, ‘I wish I had this skin for the big day!’” says New York City dermatologist Dr. Dendy Engelman. “Your wedding is an occasion that typically involves a lot of details and timelines — make sure your needs are on that list, too.”
Go to that first appointment with all the makeup and skin care you use so your derm can suggest a good plan, potentially with products you already have and some swaps (although it’s common that people use too many trendy products, triggering more acne and scarring).
“Even if you do manage to keep your acne in control with over-the-counter treatments, wedding stress can cause last-minute flare-ups and you could get a big pimple right before, so it’s best to start a relationship with a dermatologist regardless,” says Dr. Woolery-Lloyd.
What Acne Treatments Do Dermatologists Recommend?
There is a wide range of options with really great track records in treating acne, whether topical, oral, or light and laser treatments. Your derm will create a custom plan that includes different combinations of those options based on your acne history, acne type, skin tone, timeline, and tolerance for certain side effects (and costs). Here are the main go-tos in most derms’ toolkits.
Topical Acne Treatments
“A topical retinoid is the baseline for everybody with acne, whether a year, six months, or even just a month out,” says Dr. Bhanusali. “It reduces acne and also improves the pigment, texture, and tone — the results are like an Instagram filter.” It takes about four to six weeks to start seeing the benefits, but up to four and five months for the “filtered” look. Dr. Bhanusali says prescription retinoids (like tretinoin) are better than over-the-counter retinols, but since you need to work your way up to higher strengths over time, the more mild over-the-counter options are a good way to begin.
“Some lucky people can clear up mild hormonal acne with a benzoyl peroxide (BPO) wash and over-the-counter adapalene (a retinoid) called Differin,” says Dr. Woolery-Lloyd. “But most will need some kind of prescription.” She likes a regimen of daytime topical dapsone (an anti-inflammatory) plus a nighttime prescription of retinoids with benzoyl peroxide — this can often clear mild to moderate acne in about 12 weeks. Dr. Engelman is also a big fan of Onexton gel which is a BPO-clindamycin combination that is a really effective spot treatment and probably the fastest topical remedy, she says. The over-the-counter version is La Roche Posay Effaclar Duo.
Oral Acne Treatments
If you have severe acne, Accutane is often the go-to as the results are reliable, significant, and lasting, and what derms consider the closest to an acne “cure.” “It pretty much guarantees you’ll be clear for your wedding,” says Dr. Woolery-Lloyd. But some people are hesitant to take it and doctors also like to avoid oral medication unless essential. Accutane requires a fair amount of doctor's visits, protocols (as it can cause birth defects if you become pregnant while on it), can be very drying to the body, can potentially worsen depression, and takes multiple months to work — usually eight months total from your first appointment until peak results. That was almost exactly the timeline I needed once I finally decided to bite the bullet and take Accutane. I think it’s absolutely worth considering as it ended up being the final treatment I landed on, but every body is different.
Another common oral medication is spironolactone, used off-label for hormonal breakouts in women. “Spironolactone is an androgen blocker and so effective,” says Dr Engelman. “I love it because it's not an antibiotic, but we're helping to block the effects of the hormones in the skin.” It takes four to six weeks to start seeing reduced breakouts and about three or four months for the benefits to peak.
For reference, I went on and off spironolactone throughout my 20s. It would be very effective at about three months, I would get my scars lasered away, and look great after about four months. Then, I would taper off of it and my acne would come back, hence why I ultimately went on Accutane. (I’ve required no acne treatments in the last four years since I completed Accutane.)
Lasers & Lights
Acne laser and light treatments can be very effective but are usually not covered by insurance, whereas the above treatments often are. Derms usually turn to intense pulsed light treatments such as BBL (BroadBand Light) which blasts skin with a specific blue light wavelength that targets acne bacteria (note: this isn’t an option for darker skin tones). This requires a few sessions monthly. Dr. Engelman is a big fan of the acne setting on another IPL called the Stellar M22. These treatments reduce acne, but can also have bonus benefits for skin tone and texture.
Finally, an exciting new laser called AviClear will become available to patients later in 2022. The laser targets sebocytes (the part of your skin glands that produces sebum) to reduce production, and dermatologists say the results rival that of Accutane.
What If My Wedding Is Almost Here & I’m Still Breaking Out?
Three Months To Go
If your wedding is in less than three months, oral medications are likely needed. Most derms will suggest short-term antibiotics. “There’s a low dose doxycycline that’s like an aspirin for the skin. It calms down the inflammation but doesn’t affect your gut and vaginal microbiome,” says Dr. Engleman. “Dermatologists can often overprescribe antibiotics, so I rarely prescribe them anymore, unless it’s a short-term circumstance like an event. I put myself on it for the week of my own wedding just to make sure I didn’t break out!”
Two Weeks To Go
If your acne is not severe (more like whiteheads and blackheads), a salicylic acid peel is often a safe route to try to clear up congestion and bumps in all skin tones, and lends a nice fresh glow. You’ll want to do it at least two weeks before the wedding and at a reputable clinic; at a dermatologist’s office is best. Most derms won’t do much in the two weeks before a big day. “Anything new the month before a wedding leaves the possibility of adverse reactions and scarring, you want to be super careful and not introduce many new things in that time frame, especially if not with derm supervision,” says Dr. Bhanusali.
One Week To Go
In the week of the wedding, if you have a surprise breakout (or two, or three, or four), a cortisone shot is the way to go. This is a very common last-minute solution for red carpet regulars and can shrink a pimple in 24 to 48 hours. In fact, one of the best tips I learned from Dr. Engelman was to pre-book a derm appointment a week before your wedding. You can cancel it if you don’t end up needing it, but you’ll have a backup plan for a flare of acne or stress hives or any other skin surprise.
Some doctors will prescribe high-dose prednisone, an oral steroid, for three days the week prior to the wedding. “It’s also not a long term fix, but in the short term it works really well before big events,” says Dr. Bhanusali.
How Can I Treat Acne Scars Before My Wedding?
“It depends on the baseline, but oftentimes acne is the easy part — the scarring is the tough part,” says Dr. Bhanusali. “We could be dealing with redness that happens like post-inflammatory pigmentation and erythema, or we could be looking at true scars like divots.” A lot of the topicals and lasers used in an acne treatment plan also reduce pigment and some texture issues simultaneously, but many patients still have leftover spots and scars after the active acne has calmed down.
Some topicals can help, especially with pigment scars, but if you don’t have several more months to work toward scar reduction, in-office treatments can yield awesome results. Unfortunately, most scar treatments are not covered by insurance, but may be very worthwhile if you'd like to get it off your mind.
Peels For Acne Scars
“For texture scars, there's three types: ice pick, boxcar, and rolling scars,” says Dr. Woolery-Lloyd. “The deep ice pick scars are tricky, but patients with lighter skin tones can have them treated with an intense TCA peel applied with a toothpick inside the scar — it kind of burns the inside of the scar and helps it seal. But this isn’t an option for darker skin tones.”
Lasers For Acne Scars
Deep scars can also be treated by “punching out” the scar, which essentially means cutting it out of skin and controlling the healing, or an erbium laser, which is amongst the most aggressive. For less severe scarring, Halo and Fraxel lasers are go-tos. And if it’s mostly just red marks you’re grappling with an IPL can work beautifully.
“Pre-COVID I always considered downtime when deciding how aggressive we could go with lasers,” says Dr. Bhanusali. “Now because many people work remotely I will actually err on the side of more aggressive with more downtime — sometimes five days to two weeks — but scars are a real medical condition. It’s trauma to the skin, so you can’t just dip your toe in.” An important note: Lasers can cause scarring in darker skin tones when used in untrained hands. Look for a board-certified dermatologist who can speak about how they approach different skin tones.
Fillers & Microneedling For Acne Scars
If peels and lasers aren’t for you, look into a special filler called Bellafill which is FDA-approved for lifting up some depressed scars and microneedling (or microneedling with built-in radiofrequency), which is an excellent option for texture issues — both are appropriate for all skin tones. “The only downside to micro-needling is you can't do it in patients with active acne,” says Dr. Woolery-Lloyd. Similar to Fraxel, microneedling creates microholes to trigger natural healing (e.g. collagen production) for smoother, fresher skin that naturally looks its best for your big day.
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