Out, Damned Spot!

She's got the job and the wardrobe. Now if there were something she could do about those zits. . . Ariel Levy takes aim at acne with a costly new treatment.

One morning when I was in seventh grade, my mother asked me if I thought I needed to stay home from school. I wasn't sick, and it wasn't a snow day. But I did have a pimple the size of a softball on the tip of my nose. My mom may be the least vain woman in America. She never wears makeup, never colors her hair, and the only time I've ever seen her in heels (little ones) was at my wedding. When she had breast cancer, she got a double mastectomy and had to convince the doctors she didn't want implants. (They insisted that living without breasts would be too traumatic for her, but they didn't know my mom.) So when the least vain woman in America suggests you look too ridiculous for public viewing, you know you've got a problem. I stayed home for two days.

I got some doozies in my teens. I've never had those vast, lava-like swaths of acne you see in the "before" pictures; mine was more of the single shining-star variety - one angry, tenacious monster at any given time. It was humiliating to walk down the halls of Mamaroneck High School with an enormous pimple on my cheek or my chin or my forehead, but at least I had the consolation of knowing I wasn't the only one. Besides, in my teens, I was insecure about so many things. Zits were just a drop in the bucket.

To my mother's horror, I turned out as vain as they come. I spend more on my clothes than she would probably spend on furniture, and I own enough shoes to start a small boutique. But it's sort of preposterous walking out of the house in some expensive outfit with a fabulous bag when I have a honking red zit on my chin. As my peers are starting to talk about Botox and their first gray hairs, I am still afflicted with acne, the plague of a teenager. I would describe myself as a confident person, but when I'm interviewing someone important for my job, or going to an elegant restaurant, or giving a speech, or doing any of the other things that I feel lucky and proud I get to do in my adult life, having a major zit is an unwelcome reminder of my awkward adolescent self. And if I had a sense of humor about acne when I was going through puberty, I've since lost it. Will I be 80 years old with white hair, a Chanel suit, and pimples?


I've tried everything. In high school it was Noxzema and Clearasil; in college Clinique astringent and Umbrian clay masks; in my 20s I used ProActiv Solution, which did help for a while, but as always, the zits came back. I went to dermatologists a few times, but they never offered any real solutions. The topical treatments they gave me were so itchy and unpleasant that I never stuck with them. And when it comes to cortisone injections, I've never been able to commit to the expense and hassle of going to see a doctor for a shot every time I have a pimple. (I'd be going every day.) I have always been unwilling to try Accutane or any oral antibiotics prescribed to treat acne, because the side effects are too severe. I knew a girl on Accutane whose mouth was all dry and flaky; one imagines she was dry all over. No thank you. As vain and as much of a shopaholic as I am, I suppose in some ways I am still my mother's daughter. When it comes to spending time and getting hurt, my vanity wanes. But I have finally grasped that all the hours and dollars I've spent over the years shopping for products and applying concealer and, yes, picking my zits are adding up - to nothing. It's time for a new solution.

Recently, I was searching the Internet and read about Isolaz, a new procedure developed by scientists in Pleasanton, CA, in which a dermatologist "vacuums" and lasers your skin and, supposedly, banishes your blemishes for good. I became filled with the kind of hope I had when I bought my first tube of benzoyl peroxide, and decided to book an appointment with celebrity dermatologist Dr. Fredric Brandt.

"Cystic acne," pronounces Brandt, a man with a Willy Wonka vibe - high-pitched laugh and wild attire. The first time I see him, he's wearing lime-green Prada eyeglasses and a checkered jacket, and his bottle-blond hair is moussed into peaks. He recommends one session a month with the laser for four or five months. The Isolaz is the only FDA-approved "photopneumatic" device, meaning it combines pulsed light ("photo") to kill acne-causing bacteria with vacuum suction ("pneumatic") to physically extract oil and grime from deep in pores. Over time, treatments cause the skin's sebaceous glands to shrink, which means reduced oil production and tighter, cleaner pores. Results are long-lasting, and the treatment is painless, he tells me. Visions of clear skin dance in my head . . . the years of being the only grown woman at a dinner party with an erupting volcano on her cheek are over. At $500 a session, they'd better be.


First a nurse positions a steamer over my face, just as a facialist would. After 20 humid minutes, I'm rosy and sweaty, and Brandt wheels in the Isolaz machine, which looks like something you'd use in an alien abduction. He puts on protective goggles and approaches me with a hose that has an attachment very much like the kind I use to suck dust off my drapes. But true to his promise, the procedure doesn't hurt. It takes less than 10 minutes and feels kind of like little electric hickeys all over my face. Afterward my skin is red and irritated, and Brandt tells me to use a special cream from his own line for post-laser calming. He also tells me to use his Poreless Cleanser, two prescription topical medications, moisturizing lotion, and sunscreen in the morning. I ask him if he's joking. He isn't.

I assume that nobody really follows a regimen this intense, so I wait for the redness to wear off and my skin to become magically, flawlessly clear. (I've been to Madonna's dermatologist! Surely I deserve to be acne-free.) I use Brandt's products, but I neglect to get the two prescriptions filled. Days turn into weeks, and still I am a pizza face. My high hopes start sputtering. Finally, I fill the prescriptions and start dutifully cleansing, applying my Clindagel, then my sodium sulfacetamide lotion, then moisturizer, then sunscreen every single morning and repeating the whole thing every night (minus the sunscreen). By the time my next Isolaz appointment rolls around, I am as zitty as ever but much more frustrated.

"Everyone's skin is different!" Brandt replies brightly when I ask him if my complexion should be clearing up yet. He then proceeds to suction and light-pulse my face. The results the second time are just as disappointing as they were the first. On any given day, I have at least one colossal pimple on my face, and now in addition to the time I spend meticulously dotting on oil-free concealer, I am also layering on what feels like 400 other potions. My mother is right: Vanity is for fools.

Then one morning, shortly after my third Isolaz session, I look in the mirror and realize something truly amazing: I am pimple-free. Not even an itty-bitty whitehead. Same thing the next day, and the next. I am giddy.

At Brandt's suggestion, I have several more Isolaz appointments to seal the deal. And I become positively religious about skincare. I get up earlier to do all my steps. When I travel, I decant 3-ounce portions of my various prescription potions into little containers. (My cosmetics bag now takes up half my suitcase.) I am higher maintenance than I ever imagined possible, and I almost look forward to applying my medicines and creams and gels. Every little step is part of the bigger miracle of zitlessness. I stop picking at my skin and squeezing every little blackhead that comes along, because you just don't mess with a miracle.

"What did you do with your skin?" my mother asks the first time I see her after Isolaz-ing. I explain the doctor's visits and the endless routine, expecting judgment. But I'm surprised by the reaction I get: "It was about time you took care of that."

Ariel Levy is a staff writer at The New Yorker and the author of Female Chauvinist Pigs: Women and the Rise of Raunch Culture. To find a doctor offering Isolaz, visit isolaz.com.