As early as your mid- to late-20s and into your 30s, you may start to notice the very first signs of aging, which are usually subtle but still bothersome. What was once a smooth complexion may now be home to small sunspots, crow’s-feet, dark under-eye circles and uneven texture. Instead of letting the signs of aging get the best of you, take matters into your own hands and correct the changes that you’re seeing—you may even be able to prevent them from progressing as you get older with the proper plan of attack.
CROW’S FEET These small fine lines are easy to prevent and even easier to correct. Regular use of a highly moisturizing eye cream helps keep the delicate eye area supple and less prone to lines and wrinkles. To reduce their appearance and prevent new ones from forming, Dr. Tanne can inject the area with Dysport, Botox or Xeomin.
UNDER-EYE BAGS, DARKNESS AND PUFFINESS With age, the area under the eyes becomes dark and puffy. Makeup can help camouflage bags and circles, but injectables and proper skin care can reverse them. Hyaluronic acid fillers, such as Restylane, Restylane Silk and Belotero, can fill in hollows to give the illusion of fewer bags. You’ll also want to use retinol and a product with growth factors to thicken thinning skin around the eyes. Another method of treating dark circles is with conservative use of hydroquinone, which may be irritating to some. Chemical peels, Intense Pulsed Light (IPL)/FotoFacial,fractional CO2 lasers and eMatrix Sublative Rejuvantion can also help tighten the under-eye area.
HYPERPIGMENTATION Discolored skin can result from a variety of factors. Protecting your skin from the sun with a mineral based sunscreen is important, but in-office procedures and prescription-strength ingredients can make a difference, too. When treating sun spots, the first line of defense is almost always hydroquinone, which stops the production of pigment in its tracks. If your skin is still discolored, your doctor may choose to use a light laser, like IPL/FotoFacial, or a fractional laser, such as CO2RE fractional CO2, for more severe spots.
NASOLABIAL FOLDS If you’re starting to notice lines around your mouth that start at the corner of your nose and extend downwards, those are nasolabial folds, which, if not addressed, may worsen with time. Hylauronic acid fillers like Restylane and Restylane Lyft (previously known as Perlane) are best for filling in these lines, especially among women in their late 20s and early 30s. The next best thing to injectables that doesn’t necessitate the use of a needle are topical products containing hyaluronic acid that temporarily add some volume.
One reason why our facial features lose shape and become less defined is because of fat changes. Fat is essential for fullness but over time it starts to descend in some areas and shift position. Adding your fat or synthetic dermal fillers into your face, restoring volume especially to the mid-face, is a big breakthrough in cosmetic medicine.
The “Liquid Facelift”Restores Lost Definition Surgery is often the go-to for turning back the hands of time, but in the right patient with the right anatomy and realistic expectations, fillers and injectables can work wonders. For those who have lost volume in the face but are not experiencing the looseness that often comes with it, a “Liquid Facelift” may be what you need. Using a variety of fillers and injectables with a mix-and-match approach, Dr. Tanne can re-volumize areas that have become sunken or hollow, namely the temples, cheeks, lips and the jowls. The idea is to restore fullness to the areas that have lost it, not create a tight unnatural look.
Fill Out Thin Lips With Injectables Aging lips means thinning of the lips, which is a common concern among many women. Lips tend to flatten out, lose their Cupid’s bow and become longer. When using filler in the lips, it’s about restoring a youthful, natural looking shape and, if necessary, adding size. Fillers such as Restylane are the best choice for this. For vertical lines in the upper lip, Belotero and Restylane Silk help plump out those lines without adding volume to the lips. To treat deeper wrinkles around the mouth, Dr. Tanne often recommends fractional resurfacing with either eMatrix Sublative treatments or CO2RE fractional CO2 laser treatment, which can act like an eraser.
Plump Up Saggy Cheeks With Fillers Sagging cheeks, which is caused by a loss of fat and changes to the underlying bone structure, can lead to deep lines around the mouth. When the cheeks start to fall, so does the rest of the face. Adding volume conservatively to the cheeks can produce a natural appearance to smooth out the area and add lost fullness. If you are trying to achieve a lift in the cheek, Radiesse injected high in the outer cheek often gives excellent results.
Treat Sun Damage with FotoFacial RF The natural aging process takes its toll on your skin over time. When combined with the effects of hormones, sun exposure and stress, it leaves you looking far from your best. FotoFacial RFsafely and comfortably treats age spots (also known as freckles, brown spots or sun spots) Rosacea, spider veins, sun damage, as well as uneven skin tone created by brown and red spots. With its bipolar radiofrequency, FotoFacial RF will simultaneously stimulate collagen production leading to softer wrinkles and tighter pores.
Refresh Your Skin With Fractional Laser Resurfacing As skin starts to lose its natural healthy glow and the signs of time become more evident, it can cause the face to appear aged and weathered. An effective way to reverse the look of dull, aged skin is with a fractional laser treatment. Whether we use CO2RE fractional CO2 laser (which usually requires only one treatment, but some downtime) or eMatrix Sublative Rejuvenation (which has no downtime but requires a series of about 3 treatments) both accomplish controlled fractional resurfacing, forcing the skin to heal and create new, healthy collagen and a smoother, more even surface.
Now that 2015 is finally here, it’s time to put your best foot forward and kick it into high gear so that you look your absolute best.
GET ENOUGH SLEEP Sleep does a body good. Not only will you feel better, a good night’s rest will leave you with less darkness and puffiness under your eyes and more evenly toned skin that looks fresh come morning. A good night’s sleep can also prevent unnecessary eating. Try to establish a set bedtime every night and never fall asleep with the television on.
EXFOLIATE ON A REGULAR BASIS Dead skin does nothing for your complexion. In fact, it makes your skin look lackluster and dull and can even make your makeup look muddy. The easiest way to get rid of pore-clogging dead skin is by exfoliating regularly with an exfoliator that’s compatible with your skin type. Treat your skin to the professional version, such as a microdermabrasion or light chemical peel, every four to six weeks.
HYDRATE INSIDE AND OUT When your body is void of water, your skin lacks the moisture it needs to look plump and healthy. Hydration is one of the easiest ways to look instantly younger and better—and it’s simple to do. To properly hydrate your body, make sure you drink at least eight glasses of water per day. To keep your skin looking healthy and full, apply moisturizer both day and night.
TAKE A TRIP TO THE DOCTOR For stubborn lines and wrinkles that require a little extra help, nothing does the job quite like injectables. Botox, Dysport and Xeomin work wonders on getting rid of hard-to-erase lines and wrinkles caused by smiling, laughing and squinting (think those that live around your eyes, between your brows and on your forehead), whereas hyaluronic acid fillers like Restylane, Perlane and Belotero can fill in hollows, wrinkles and folds for a more rejuvenated look. Collagen stimulating fillers such as Radiesse are excellent for restoring volume to the cheeks and also last longer than the hyaluronic acid fillers (about one year). Platelet rich plasma (PRP) such as Selphyl, uses your own platelets to “fertilize” the skin with your own growth factors. This “all-natural” treatment restores elasticity and makes you glow! For a long lasting result, fat transfer is an excellent, all natural way to restore youthful volume.
Did you know that dark under-eye circles are not caused by a lack of sleep, but by blood that pools in the vessels close to the skin? Dark circles are the result of blood that pools in the vessels that lie close to the skin’s surface, which is why they can be almost impossible to hide. This also happens when fat bulges out: light cannot be reflected properly, casting a shadow under the eye. Additionally, sun exposure can aggravate under-eye darkness by boosting melanin production, as can allergies, since they cause the veins to become congested and enlarged. A lack of sleep, as well as dehydration, can emphasize dark under-eye circles, but almost always sleep is not the culprit.
Some under-eye darkness is genetic, and related to inherently thin skin. The thinner the skin is under the eye, the more pigmentation shows through. Loading up on vitamin K, both internally and with topical products, can help since it strengthens and clots blood vessels to stop the pooling that causes the darkness. When it comes to concealing under-eye circles and bags, reach for a creamy hydrating concealer as opposed to a blemish-fighting one, which may contain drying ingredients like salicylic acid that are usually too harsh for the under-eye area.
Dark under-eye circles can be difficult to fix, especially if there are cultural or genetic ties. Hydroquinone can help to lighten the area to some degree if the problem is more about discoloration than shadowing. If the darkness is related to melasma, you’ll see more of a dramatic difference with a skin lightener. Excessive sun exposure only intensifies dark circles, so always wear a mineral based sunscreen formulated for the eye area and protect your eyes from the sun at all times with sunglasses.
Certain areas of the face are prone to fat loss—others are not. The cheeks and eyes frequently fall victim to the effects of volume loss first; the lips, eyes and temples eventually catch up.
Around the Upper + Lower Eye Sockets The majority of fat in the face is in the cheeks, and as these pockets deflate, a depression forms from the inner corner of the eyes straight downward (called a tear trough or hollow). The appearance of hollows is related to loss of fat and bone expansion. Since the same amount of tissue is occupying a larger volume, the result is that the eyes look hollow. Sometimes, the fat protrudes, creating a bag. Adding a hyaluronic acid filler or fat restores volume, making the eyes the focus of the face.
Around the Brows A loss of fat and fullness in the brows coupled with lines and wrinkles between the brows and on the forehead can create a saggy brow and hooding on the upper lids. Fillers and fat are the most common ways to fix the problem. Just a little bit of volume (using a filler like Restylane) helps, and it is even more dramatic when combined with a neuromodulator (Dysport, Botox or Xeomin) for an overall rejuvenating effect. The combination of fillers (injectables or fat micro-grafts) plus a neuromodulator produces a better result than either one alone.
At the Temples You wouldn’t think of the temples as an area of concern but they are. As fat diminishes from the temples, they become sunken and appear narrow. Hollow temples can call unwanted attention to the cheeks. Filler such as Restylane, Perlane and Radiesse, used to gently, soften the area for a more youthful look. Fat micrografts are a good alternative and give a more permanent result.
In the Cheeks The cheek area is one of the first parts of the face where a loss of volume is noticeable. As the fat in the cheeks begins to descend, it creates nasolabial folds (smile lines) around the mouth and a flattened look in the cheeks, making you look “tired”. To correct the folds and the cheeks, the natural volume needs to be restored, using either injectable fillers or fat micro-grafts, for a refreshed, natural look.
In the Lips The lips are made of collagen, oil and tissue—not fat—but they too experience the effects of volume loss as they start to thin out. While fillers or fat can help to reinstate plumpness in the lips, the surrounding lines need to be softened with either laser resurfacing or a combination of Botox, Dysport or Xeomin and fillers (I prefer Restylane and Belotero).
At The Corners of the NoseDown Toward the Mouth As the fat in the cheeks begins to fall, there is less support for the skin around the mouth, causing folds to develop in the area where the end of the nose and the lips meet.
On the Jawline The jaw area loses definition with time and the natural contours become boxy and saggy. Volume loss in the jaw area usually comes along with a lack of structure in the cheeks. Injections of hyaluronic acids, Radiesse or fat can all help reshape and revolumize the area.
The Skin Smoother Crystal free DiamondTip™ Microdermabrasion removes the topmost layer of skin, delivering optimum exfoliation for softer, smoother, supple and vibrant skin. This is accomplished by gently abrading the skin with a variety of stainless steel tips imbedded with laser cut diamond chips, while using suction to remove the dead skin cells and stimulate collagen production.
Similar to microdermabrasion, the SilkPeel™ Dermalinfusion™ System combines non–invasive exfoliation with deep delivery of patient–specific solutions directly to the skin without the use of crystal or other chemical exfoliants. These serums are infused deep into the skin where they are most effective, deeply delivering the vitamins, antioxidants, and other therapeutic ingredients that your skin needs most.
As early as your mid- to late-20’s and into your 30’s, you may start to notice the very first signs of aging, which are usually subtle but still bothersome. What was once a smooth complexion may now be home to small sunspots, crow’s-feet, dark under-eye circles and uneven texture. Instead of letting the signs of aging get the best of you, take matters into your own hands and correct the changes that you’re seeing – you may even be able to prevent them from progressing as you get older with the proper plan of attack.
Crow’s-Feet These small fine lines are easy to prevent and even easier to correct. Regular use of a highly moisturizing eye cream helps keep the delicate eye area supple and less prone to lines and wrinkles. To reduce their appearance and prevent new ones from forming, I like to inject this area with Dysport, Xeomin or Botox.
Under-Eye Bags, Darkness and Puffiness With age, the area under the eyes becomes dark and puffy. Makeup can help camouflage bags and circles, but injectables and proper skin care can reverse them. Hyaluronic acid fillers, such as Restylane, Juvéderm or Belotero, can fill in hollows to give the illusion of fewer bags. You will also want to use a topical Retinol product to thicken thinning skin around the eyes. Another method of treating dark circles is with conservative use of hydroquinone, which may be irritating to some. Chemical peels,FotoFacial RF (Intense Pulsed Light-IPL) or fractional CO2 lasers can also help tighten the under-eye area.
Hyperpigmentation Discolored skin can result from a variety of factors. Protecting your skin from the sun is important, but in-office procedures and prescription-strength ingredients can make a difference, too. When treating sun spots, the first line of defense is almost always hydroquinone, which stops the production of pigment in its tracks. If your skin is still discolored, your doctor may choose to use a light laser, like IPL, or a fractional laser for more severe spots.
Nasolabial Folds If you’re starting to notice lines around your mouth that start at the corner of your nose and extend downwards, those are nasolabial folds, which, if not addressed, may worsen with time. Hylauronic acid fillers like Restylane and Perlane, or Radiesse, are best for filling in these lines, especially among women in their late 20s and early 30s. In reality, these lines are due to loss some loss or shrinking of the cheek fat, which makes the skin sag, creating the fold from your nose downward. A bit of filler just below the cheekbone starts lifting the fold, then some filler in the fold completes the rejuvenation.
Sunscreen Although all of the above tips will correct what time has achieved, the single most important way to prevent the signs of aging is with the diligent daily use of mineral based sunscreen! This should be a dedicated layer which is not part of you moisturizer or makeup. We prefer products with a high percentage of zinc oxide. Wear this as your last layer, over any other skin care, but under makeup. Using a mineral based sunscreen every day, rain or shine, will give you the maximum benefits from these fantastic anti-aging treatments.
Each filler that I use in my practice has its own set of characteristics that make it the right choice. “I tell my patients that what we use depends on what area of the face needs improvement, how long they want the results to last, and how much downtime they can endure,” says Dr. Susan Stevens Tanne, medical director of Cosmetic Laser MD.
For my patients that have never tried any type of fillers or injectables, I usually recommend that they begin with fillers made of hyaluronic acid, such as Restylane, Belotero or Perlane, since they can be reversed if you don’t like the way you look, and they fade over time.
Some of my patients need more significant lifting and/or filling of the cheeks, and filling of the chin area. I see this in patients as they age, with shrinking of the fat pads that normally act as scaffolding for the skin. This is also common in those who are very thin, or are hard-core exercisers. This type of hollowing results in a gaunt, tired look. I use Radiesse or Perlane for a more significant filling effect in these patients. Filling these larger areas require that the filler be placed deeper, which is why Radiesse works well in these patients. “Done properly, my patients achieve very natural looking youthful results, which lasts from six months to one year and sometimes longer,” says Dr. Tanne.
“One of the biggest improvements in the placement of injectable fillers has been the introduction of microcannulas, which I have been using almost exclusively for the past couple of years. Rather than using sharp needles that can result in significant bruising, a small pilot needle is used to just puncture the skin, which has been numbed, and then the needle is removed and replaced with a blunt tipped cannula. This method required much less numbing and is more comfortable for the patient. A microcannulas has a rounded, closed end, rather than a sharp cutting end, typical of traditional needles, and a small side opening to allow the filler to flow out. Patients have responded very favorably to this method, and love the almost total absence of bruising”, says Dr. Tanne.
For some patients, fat transfer is the preferred treatment rather than using synthetic filler in their face. To obtain the fat, a microliposuction procedure is done, removing only a very small amount of fat after you have been carefully numbed with an anesthetic solution. You may be a little swollen for a few days after this part of the procedure. The fat is then spun in a centrifuge to remove any oils and debris, before being re-injected into the face. Unlike fillers, fat transfer requires some downtime, ranging from a few days to one week, if the fat is placed in multiple areas of the face. Fat can be a more cost-effective option for patients that are using many syringes of filler every year, and can be a long-term solution. However, since this can produce a long-term to permanent result, I usually only recommend this option for patients that have tried synthetic fillers several times previously. One added bonus is that fat contains your stem cells, which gives a youthful smoothness and vibrancy to the skin.
We talk a lot about reducing under-eye puffiness, but we know that some of you suffer from another issue: eyes that look sunken and hollow, especially for those who have more slender faces. However, there is help for those who may be genetically predisposed to hollow eyes or have lost soft tissue and bone density, which can make the eyes appear sunken.
PRODUCT FIX: Applying products with vitamin C can reduce the dark circles that sometimes accompany eye hollowing. Retinol is a good ingredient to help the fragile skin become stronger, and humectants will add a bit of a plumping effect under the eyes. If you find that you have dark circles too, a prescription of hydroquinone can help to lighten up under-eye shadows.
FILLER FIX: At the first signs of hollowing, a filler composed of hyaluronic acid such as Restylane or Belotero or fat can help to fill in the spots that appear in the tear troughs. Hyaluronic acid fillers, which last for about 6 months, are effective in filling deficient areas under the eyes when it is injected deep into the tissue. Fat grafting involves taking a small amount of fat, usually from your belly. We then mix the fat with Selphyl to promote new blood vessel formation in the grafted fat. This combination is re-injected into the under-eye hollow (tear trough) giving you a long term to permanent improvement.
Think fillers and injectables serve the purpose of just erasing lines and filling wrinkles? Guess again. While these “liquid miracles” may have originally made their mark as wrinkle eliminators, they are now just as well-known for their sheer ability to lift and contour ill-defined and aging features.
When injectables and fillers were first introduced, they pretty much served one purpose: to fill wrinkles. Over time, and with safe off-label experimentation, their use has became more widespread as the effects of volume loss is a constant complaint. In different compartments of our face there is a shifting of the fat pads and re-absorption. Reconstructing the face with filler allows the architecture of the framework of the face to be lifted and restores the youthful contours. With only a handful of product options available, the main difference between filling and lifting comes down to where the filler is placed and how deep.
1. Straight Lifting With Some Volume Perlane: Fills in deeper, thicker lines and folds. Because of its denser nature and thickness, it provides good lift to areas of the face like the cheeks and lower part of the face. Radiesse: Lasts about 1 year. Immediately smoothes out folds around the mouth, lifts the cheeks and the area between the cheeks and the eyes and the jowls. In terms of the longer-lasting fillers, this is said to give more lift.
2. More Volume, Some Lifting Restylane, Juvéderm and Belotero: Lift and contour but on a more superficial level for those that don’t need as much structural improvement for areas like under the eyes, marionette lines and for lip augmentation.
When you want to look and feel younger, your face is the front and center battleground of that fight. And while there are a few ways to surgically make the face look years younger (facelift, neck lift, even a nose job), many women might not be ready for the commitment or cost of a surgical procedure. If not, there are “best practices” for rejuvenating the face without reaching for the scalpel. Here are some of the best treatments to get a younger face without surgery.
SKINCARE – First and foremost, start with a good skin-care routine. Routine skin care by trained, experienced estheticians is invaluable in producing, improving and monitoring the skin. Let’s face it – beautiful skin always creates a more youthful look. A comprehensive skin-care program that may include professional products and treatments (like microdermabrasion and facial peels) can minimize sun damage, soften fine lines, reduce acne, rehydrate dry skin and brighten dull, aging skin.
INJECTABLES – If you want to take it one step further, a cosmetic physician has more options available to make the face look younger. Before finding the best method for facial rejuvenation, your doctor has to take into account your age. When you are younger, we’re getting rid of wrinkles with products like Dysport, Botox and hyaluronic acid fillers such as Restylane, Juvéderm and Belotero. For restoring more volume in an aging face my choice filler is Radiesse.
LASERS – Noninvasive radio-frequency treatments, on the right patient, can work wonders. I am a big fan of eMatrix Sublative Rejuvenation and Sublime Skin Tightening (the eTwo duo). I also love to treat with FotoFacial RF for color correction and eMatrix for texture improvement with my FotoMatrix combo. For a more significant result CO2RE Fractional CO2 Resurfacing is my go-to treatment. It is an ablative laser, but it’s not as invasive as making incisions. It is a very effective tool in treating fine lines, irregularities and brown spots. With one treatment, a major improvement can be obtained.
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