kevin,
welcome to
RP.
i'll just mention one things the others didnt. to me, the biggest problem here is the 'pasty' skin you've added. by pasty here we mean too monotone and not enough texture or shadow or variation. it all sort of looks the same, making it look flat and 'doll-like'. so, frankly, on a face like this, i'd tend to only clean up obvious blemishes or artifacts and leave most of the skin alone. you might do a contrast/lightening, but even on that i'd tend to do very little.
there was a movie with robin williams as a robot that wanted to look human. he finally gets his wish and the guy doing the face says a line i've always remembered.... 'it's all about the imperfections!'. retouchers shld always remember that line
craig