What an age we live in. Over the past two decades, the breadth of products available for purchase on the internet has skyrocketed. You can buy groceries, at-home genetics kits, and even cars online. It’s more convenient, to be sure. But what about products and services that fall into a gray area, like medical care?
If you’re a committed DIYer, you may be intrigued by at-home versions of professional cosmetic treatments offered in dermatologists’ offices—from chemical peels you’d expect to pay hundreds of dollars for, to devices that let you remove your own moles—that are now sold online. All are just a click away and priced well below the cost of professional cosmetic skin treatments.
So, you can purchase them… but should you?
“The problems with many of these ‘at-home versions’ of office-based therapies range from being ineffective to potentially dangerous,” cautions dermatologic surgeon Kathleen Suozzi, MD, director of Aesthetic Dermatology at Yale Medicine.
Before using any of these at-home devices and products, you should talk to your dermatologist about whether you’re a good candidate for them and if you are at risk for any of the side effects, she says.
We asked Dr. Suozzi and dermatologic surgeon Sean Christensen, MD, PhD, to rate the effectiveness and safety of some common DIY beauty products available online.
DIY chemical peels
Rating: Potentially dangerous and disfiguring
“Of all the at-home cosmetic treatments available, this is potentially the most dangerous,” says Dr. Suozzi.
Peels are used to chemically exfoliate the skin. When used correctly, peels can reveal fresher, younger-looking skin and remove signs of aging, like wrinkles and age spots.
Online, there are medical-grade, trichloroacetic acid (TCA) peels for sale. “That’s very strong. I am surprised these can be purchased online for cosmetic purposes,” says Dr. Suozzi. She cautions that a topical application of 75 percent TCA can burn or cauterize skin tissue, potentially leading to ulcers (oozing sores) on your skin, as well as deep tissue damage.
“If you are applying a 75 percent TCA to your entire face, you are at significant risk for scarring, which could be disfiguring and permanent,” she says. The chemical erodes the skin, which also opens the door for bacterial and viral infections. If left on too long, you could get the equivalent of a second- or third-degree chemical burn, says Dr. Suozzi.
TCA peels are used in the office setting to treat precancerous lesions, called actinic keratoses, and for treatment of fine lines and wrinkles. However, it is important to have a medical professional apply the peel to monitor for the desired clinical outcome and prevent dangerous consequences. “These medical-grade acids are used in the laboratory setting for research. They may be available for purchase, but that doesn’t mean they’re safe for cosmetic use,” Dr. Suozzi says.
Not all chemical peels you can apply at home are that dangerous, though. Light glycolic peels (10 percent preparations) could be recommended by a dermatologist for at-home use, assuming the patient does not have sensitive skin, she says.
Before trying any chemical peel yourself, though, bear in mind that, depending on your skin color, chemical peels can cause hyper- or hypopigmentation (darkly or lightly pigmented spots on the skin). Therefore, this is not something to try on your own without seeking professional guidance first, says Dr. Suozzi.
Mole, skin tag and tattoo removal pens
Rating: Potentially dangerous and disfiguring
“These are basically soldering irons—battery-powered units with a small metal tip that heats up to the point where it can burn and permanently damage the skin,” says Dr. Christensen, who practices in Yale Medicine Dermatology's Branford and New Haven locations. He recommends staying away from devices designed to remove skin lesions (like moles) altogether.
There is a significant risk for scarring, he says. “If you think this product is going to remove a ‘spot’ on your face, but instead it leaves you with a scar, that’s not a good trade-off,” he says.
Another problem is that you may be targeting a mole or growth that should be examined by a dermatologist and sent to a lab to be biopsied.
“Something that looks like a brown spot may actually be a skin cancer,” Dr. Christensen says. While at-home mole pens might remove the surface of the spot, an undiagnosed skin cancer will continue to grow underneath the skin and eventually resurface.
“I saw a patient who tried to remove what turned out to be a basal cell carcinoma on the shoulder with an at-home treatment,” Dr. Christensen says. “It caused an ulcer that took several weeks to heal, and it only partially treated the skin cancer. The carcinoma recurred two years later and required a more extensive surgical procedure because it had grown around the scar.”
Many mole pens also claim to remove skin tags and tattoos. If you use one to get rid of a skin tag that has been diagnosed by a dermatologist, you are taking the risk of trading the tag for a scar. In the dermatologist’s office, a skin tag can be clipped off or frozen with liquid nitrogen. The out-of-pocket expense is fairly small, and may be worth talking to your doctor about before taking matters into your own hands.
If you’re thinking one of these devices might be useful for erasing a tattoo, don’t get your hopes up. Dr. Christensen says it’s unlikely these devices could effectively erase a tattoo; complete tattoo removal is not always possible even with the powerful lasers that target specific pigments used in-office by doctors. Depending on the colors in the tattoo design and the patient's skin, the outline of the tattoo may still be visible even after repeated treatments.
Laser hair removal devices
Rating: Potentially ineffective with some danger of visible skin damage
At-home hair removal devices fall into two main categories: diode lasers and intense pulsed light (IPL) technologies. The diode laser targets the melanin (pigment) in the hair follicle, which absorbs the heat and destroys the hair. The IPL, a light source that delivers a range of light waves, heats and destroys hair follicles.
“Both the diode and IPL are used in-office, but the main difference with these at-home devices is there’s a much lower amount of energy being delivered,” says Dr. Suozzi. That means they’re less powerful. They are less effective at heating and destroying hair, but are “overall, pretty safe” because they are preset to only deliver a specified amount of energy, she explains. At-home devices have a smaller “spot size,” meaning they target a smaller surface area, so it can take longer to treat an area than it would in a dermatologist’s office.
Even at lower energy settings, redness (erythema), burning and irritation can occur with these devices, she says, especially if treating delicate skin on the face or bikini area.
The risk of developing pigment changes might be the most important reason to avoid using at-home hair removal devices. “If people with darker skin use them, it can lead to issues like hyperpigmentation or hypopigmentation [dark or light spots on the skin],” says Dr. Suozzi. Either pigment disorder can sometimes be evened out with professional treatment, using lasers or skin creams such hydroquinone, but the results aren’t guaranteed.
For patients with darker skin tones, she recommends an in-office treatment using the Nd:YAG laser. Its longer wavelength targets pigment in the hair follicle, not in the skin.
Also, dial back your expectations if your hair is light. “If you have fine or blond hairs, these devices are not going to work,” she says. A dermatologist will tell you if your hair color is too light for treatment. But if you opt to treat unwanted hair at home, first consult the skin and hair color chart included in the product details online to be sure your hair and skin color are within the product’s recommended use range before buying.
Rating: Potentially ineffective
You may have heard about collagen—it’s a component of the skin that makes it taut. But you might not be aware that the only way collagen production is stimulated is when the skin needs to repair an injury. When micro-needling is done by a dermatologist, small needles are used to make microscopic punctures in the skin to stimulate collagen production.
When performed in the office, micro-needling devices can penetrate the skin up to 2 mm into the dermis. With at-home micro- or derma-needling rollers, the needles are just 0.25 mm. They also aren’t equipped with the “pumping” system that pushes the needles into the skin during an office-based treatment, Dr. Suozzi explains. Therefore, these at-home devices only penetrate the outermost surface of the skin.
“At that depth, these devices are very unlikely to have any benefit for dermal remodeling [new collagen formation],” she says. However, she notes that they may be helpful in other ways. “They may have a benefit on skin exfoliation and on allowing topical treatments such as vitamin C or retinoids (vitamin A derivatives) to penetrate the skin better,” she says.
She prefers in-office fractional lasers (such as Fraxel or Clear & Brilliant) as alternatives to at-home micro-needling. Both lasers can stimulate the production of new collagen and help improve tone in aging skin.
If you do opt to try micro-needling devices at home, though, Dr. Suozzi urges caution, advising users to go easy and avoid bearing down on the roller. Always clean the device appropriately with rubbing alcohol before and after each use because “when you’re puncturing your skin even microscopically, you can open a portal for infections,” she says.
Rating: Potentially modest benefits
Light devices use red or blue LED (light emitting diode) lights to reduce the appearance of wrinkles, brown spots and acne. In some at-home product descriptions these are sometimes incorrectly referred to as photodynamic therapy or PDT.
“That is a misuse of the term,” says Dr. Christensen, because PDT treatment is performed by a dermatologist to remove actinic keratoses by first applying a prescription photo-sensitizing medication and then exposing it to a light source to target and kill abnormal cells.
“These online devices only use the light treatment,” he explains, “and the light is generally much less intense than what we have in the office. So, these are not really PDT; they are just blue or red LED bulbs.”
While these light devices are not powerful enough to remove deep wrinkles, they may be “both modestly effective and relatively safe” for treating mild acne, says Dr. Christensen. He notes that there is research showing intense blue light has beneficial effects on acne. Blue light has been shown to decrease P. acnes, the pathogenic bacteria involved in acne formation.
“There are clinical studies that show improvement in acne that is comparable to standard treatment with benzoyl peroxide [a traditional, topical acne medicine],” he says. “In fact, there is FDA approval for home use of some of the ‘light-based acne masks’ you can now find for sale.”
According to Dr. Christensen, research has also shown some evidence that red-light devices may help stimulate collagen production. “If you’re using some of these light-based devices to try and improve general skin tone and texture or to treat mild acne, that’s probably a more reasonable way to use them than to expect you’ll zap away deep wrinkles.”
“With any of these at-home treatments, you have to set your expectations appropriately,” he says. “None of these treatments are as effective as what you can do under the direction of a physician. Cosmetic treatments have come a long way in improving the look of aged skin, but there are no devices that can turn back the hands of time completely.”