Acne isn’t just for teenagers anymore. On a recent episode of Lipstick on the Rim with Molly Sims and Emese Gormley, board-certified dermatologist Dr. Kiran Mian of Hudson Dermatology & Laser Surgery shared why so many adult women are still battling breakouts, what social media gets wrong about skincare, and the real deal behind trending treatments like Botox, fillers, and microneedling with PRP.
Hormonal Acne: Why It Keeps Showing Up on Your Chin
“The biggest trigger I see in adult women is hormonal imbalance,” says Dr. Mian. While teenage acne tends to show up in the T-zone, hormonal acne in adults often appears on the lower face—jawline, chin, and around the mouth.
Hormonal shifts due to menstrual cycles, stopping or starting birth control, PCOS, or stress can all lead to deep, cystic breakouts that don’t respond to traditional cleansers or spot treatments.
"This kind of acne is more inflammatory, more persistent, and more likely to scar," Dr. Mian explains.
In-office treatments like microneedling with PRP, laser therapy, and prescription retinoids can help, but Dr. Mian emphasizes that hormonal acne usually needs a multi-layered approach, which may include topical treatments, supplements, and lifestyle changes.
Adult Acne vs. Teenage Acne: Why the Same Products Don’t Work
One of the biggest misconceptions is thinking all acne is the same. Teenagers typically have oilier skin and more surface-level clogged pores. Adults, however, deal with inflammation, hormonal triggers, and compromised skin barriers.
"Adult acne needs gentler products and better hydration support," says Dr. Mian. "Over-exfoliating will just make it worse."
She often sees patients overusing actives like glycolic acid, benzoyl peroxide, and salicylic acid, which can lead to redness, dryness, and rebound breakouts.
Retinoids: Still the Gold Standard (But Are You Using Them Right?)
Retinoids—whether over-the-counter or prescription—remain the most dermatologist-recommended treatment for acne and anti-aging. But misuse is common.
"I see patients using them too often, or layering them with other exfoliants," Dr. Mian says. "Start slow. Think of it like training your skin."
She recommends applying retinoids just a few times per week at first, always paired with a moisturizer, and never on wet skin (which increases absorption and irritation).
For sensitive skin or those just starting out, she prefers adapalene or newer formulations that are designed for tolerability.
From Fillers to PRP: What Aesthetic Treatments Are Worth It
Modern dermatology isn’t just about breakouts—it’s also about restoration and prevention. Dr. Mian breaks down the most requested aesthetic procedures in her office:
- Botox: Best used preventatively, starting in your late 20s or early 30s to soften lines before they become etched.
- Fillers: “We’re moving away from volume-overload. My patients want to look like themselves, just more refreshed.”
- PRP Microneedling: Especially effective for acne scars and skin texture. “It’s your own growth factors stimulating collagen.”
- Lasers for acne scars: Fractionated lasers can dramatically improve texture and pigmentation left behind by breakouts.
“Everything we do should support the skin’s barrier and structure, not overwhelm it.”
Dr. Mian’s Take on Cosmetic Treatments That Deliver
Not all cosmetic procedures are created equal, and Dr. Mian doesn’t shy away from setting the record straight.
“I think it's about proper evaluation, coming up with a plan and expectations,” she explains.
For women in their 30s, 40s, and 50s looking for skin rejuvenation, she often recommends microneedling with PRP, resurfacing lasers, or biostimulators like Sculptra.
“If you do three or four microneedling sessions in a row with PRP, it can significantly smooth out the skin, improve texture, pigmentation, and blemishes.”
But not everything trending on social media is worth the splurge. While exosomes are buzzy, Dr. Mian is hesitant: “Right now, it’s too early to really spend a lot of money on exosomes… we don’t really know what’s in it or what it’s doing.” Her advice? Stick with proven treatments and seek out providers who use them strategically—not just what’s trending.
The Dangers of Skincare Overload
With social media pushing 10-step routines and endless product layering, Dr. Mian sees a new kind of patient: someone with skin that’s red, inflamed, and sensitized—not from a medical condition, but from using too many actives.
“Sometimes the best thing you can do is stop everything and go back to basics,” she says.
Her advice: cleanser, moisturizer, and SPF. That’s it. Once the skin has recovered, targeted treatments can be slowly added back in under professional guidance.
How to Know It’s Time to See a Dermatologist
If you’ve tried countless products with no improvement, or if your acne is leaving marks or scars—see a dermatologist.
At Hudson Dermatology & Laser Surgery, Dr. Mian offers customized treatment plans that combine medical therapy with cutting-edge procedures.
"We don’t believe in one-size-fits-all. Your skin is unique. Your plan should be too."
Watch the full episode of Lipstick on the Rim with Dr. Mian here.
Medical & Cosmetic dermatology in Hudson Yards
From advanced medical treatments to cutting-edge cosmetic procedures, Hudson Derm offers comprehensive care tailored to your skin’s needs—all in the heart of Hudson Yards.
