A trip on Miami’s MetroRail from Dadeland North to the Civic Center station for retired Kendall school teacher Janis Prospero led to a marriage proposal.

“I have to say I have received one proposal of marriage from a fellow senior citizen while standing on the platform waiting for the southbound train,” Prospero, 73, says.

The gentleman was very mannerly, and began his conversation in the usual mundane way, asking about train schedules. Then he popped the question.

“I would ask you to marry me because I think you are very beautiful,” Prospero remembers the Spanish stranger saying.

One problem: Husband Joe, a professor at the University of Miami, might have something to say about that proposal. But, “He’s too busy with his scientific research to be the least bit concerned,” Prospero says.

Prospero has been seeing Dr. Ivan Camacho, an assistant professor of dermatology at the University of Miami Miller School of Medicine, for the treatment of parapsoriasis, a skin disease that leads to scaly patches and bears a resemblance to psoriasis. In addition, she works with Camacho to treat the usual signs of aging, such as wrinkles, lines around the mouth, bags under the eyes.

“If you’ve enjoyed a good appearance and have maintained a healthy lifestyle in weight and nutrition, you want to feel better about yourself in a youth-oriented society,” she said. “I thought it was time to seek advice on either cosmetic surgery or some other form of skin care.”

Cosmetic care

Today, the options for people like Prospero are vast.

Doctors have soft-tissue fillers to plump sagging faces or to fill in wrinkles. Traditional fractional resurfacing using lasers to slough away the superficial portions of the skin layer can regenerate new skin free of blotchiness and rough areas. Botox injections and topical creams are other popular choices.

Lasers and lights target many different areas of concern, such as port wine stains, broken blood vessels in the nose and cheek and other small blood vessels, rosacea and scars, says Dr. Keyvan Nouri, professor of dermatology at the University of Miami. Lasers are also used in the treatment of skin cancers, often caused by sun exposure.

“Women are staying active until much later in life, so you see women in their 50s to 70s that still have an active role in many fields of society and in high-level occupations who are interested in doing something about how they look,” Camacho says.

Women, and men, too, in today’s stressed economic times turn to cosmetic tweaks to appear fresher and, thus, more competitive at job interviews.

A visit to a doctor’s office often resembles the intro to Ryan Murphy’s recent cosmetic surgery cable drama, Nip/Tuck. That stylized, often over-the-top show always began with the flashy doctor asking the guest star of the week: “Tell me what you don’t like about yourself.”

“They will say, ‘What really bothers me is this line,’ so I start educating them about why they have that line,” Camacho says. “It’s not just a line. It’s a process of losing some of the bone on the cheeks, so the skin is sagging. They are losing some fat on the cheeks so that’s why there are prominent folds. The skin is not as doughy and thick as before. If they want to have a good effect we probably need to use all the different tools we have available.”

These instruments can include soft-tissue fillers to compensate for the atrophy of fat and bone, neuromodulators or anti-wrinkle injections such as Botox to smooth over lines, and moisturizers and retinoids to treat skin lesions.

Syneron’s new eMatrix technology is particularly useful for dark-skinned women. The system uses radio frequency waves to penetrate into the deeper layers of the epidermis without disturbing the outer layers of the skin and leaving dark blotches, a temporary by-product known as hyper inflammation on darker skin types.

“As opposed to other fractional lasers, you can go out afterwards and need no post-operative care and it gives very good results with less downtime,” says Bal Harbour cosmetic dermatologist Dr. Diane Walder, who began using eMatrix for some of her patients earlier this year. Traditional fractional laser treatments can leave swelling that usually subsides in a few days.

“These devices increase the elastic tissue and things that give your skin snap,” Walder says.

Acne in adults

Skin care isn’t always about wanting to look younger, however. Sometimes ailments that traditionally target the young need to be addressed, such as acne.

“There are a couple new studies over the last few years trying to battle the misconception that only teens have acne,” says Dr. Mariana Blyumin-Karasik, a staff physician at Memorial Regional Hospital in Hollywood. “As dermatologists we have been seeing signs that more individuals are having acne, especially women, but there have not been studies to prove that until now.”

A 2007 study of 1,013 participants aged 20 and above by a team of physicians at the University of Alabama at Birmingham found that 73 percent reported having acne. Half of the women ages 20-29 had acne compared to 42 of the men in the same age group. The figures declined with each decade of life, but women still outpaced the men two to one, even at age 50 and over when 15 percent of women had acne compared with 7 percent of the men.

“There’s no clear indication of why,” says Blyumin-Karasik. “There are some suspicions that there are hormonal influences in women compared to the men.”

Teenagers experience acne because of raging hormones in this time of life. Young men’s testosterone-surge tends to stabilize as they mature but women have surges through life during menstrual cycles, pregnancy and the use of birth-control pills.

Home maintenance

While age will eventually have its way, there are things you can do to keep your skin as healthy as possible.

Avoid too much exposure to the sun, don’t smoke, eat a diet of low-glycemic index foods such as vegetables, lean meats and fish, and whole grains, Walder suggests.

Having a good skin-care regimen begins before and immediately after visiting a doctor’s office for treatment. Much like brushing and flossing your teeth between dentist visits is a daily habit, so should skin care.

“It’s not just treatment but homework they can do to maintain their skin the same way they maintain their teeth,” Camacho says, suggesting the use of retinoid creams, moisturizers and antioxidants and sunscreens.

“What’s exciting now is we will soon, in the future, start seeing treatments that will use things like stem cells and special growth factors and hormones in more direct ways to stimulate our cells to stay more vital for longer,” Camacho says.

There’s hope for that MetroRail gentleman who may one day find his eligible traveling beauty.

Follow @HowardCohen on Twitter.