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Pay attention! I am about to share the ultimate beauty secret, the secret to anti-aging.

The desire to stay young and beautiful is a natural part of the human psyche and we are apparently willing to pay big bucks to achieve it. Americans spend billions of dollars each year on anti-aging products and services in a desperate search of the fountain of youth. Each new product we try offers a new opportunity to look younger, but they often prove to be nothing more than disappointment in a bottle. So… how can we avoid disappointment and achieve real results? The answer lies with a comprehensive approach. To understand the benefits of a comprehensive approach you should first try to grasp some of the basics of the aging face. After all, if we do not understand the aging process how can we know how to prevent or correct it?

What is a comprehensive approach to aesthetics in relation to the aging face?
Comprehensive Aesthetics uses a variety of treatments and products to cover a large scope of issues associated with the aging face. Aging occurs on many levels of the face, including the bone structure, muscular level, fat or volume distribution and finally the dermal and epidermal levels of the skin. To achieve the most ideal results it is necessary to address the affects of aging at each level, in order to do this a variety of treatments are needed. We also can not ignore the effects of lifestyle and general health, as both play a major factor in aging.

Aesthetic Professionals and Interdisciplinary Collaboration
Aesthetics is a branch of philosophy or science pertaining to the nature of art and beauty. Aesthetic professionals are those whom are specially trained in the art of beauty. Utilizing a full team of medical aesthetic professionals, including a Plastic Surgeon, Dermatologist, Nurse Injector, Estheticians and Certified Laser Technicians, we are able to take advantage of an interdisciplinary collaboration. Each professional possess a special set of skills that contributes to a truly comprehensive approach toward an attractive, youthful face.

Bone

Bone adds to the volume of the face and provides structural support to the other layers of facial tissue and skin. As we age there is a significant loss of facial bone which contributes to biometric volume loss. The bones that define your nose, and upper jaw and brow bone recede and the bones of the eye socket gradually widen. The jawbone also recedes and becomes less defined, reducing the angle of the lower jaw. Even the skull shrinks with age, further adding to excess facial skin. The loss of structural support creates noticeable changes in the other layers of tissue, simply put – when the bones that define your face recede your skin begins to droop.

Bad news ladies, we begin to see bone loss as early as our 40’s, where men may not notice bone loss until their mid 60’s. Hormones can play a factor in bone density. As we age bone density can decrease, leading to diseases such as osteoporosis. Your doctor can help you monitor and address issues of bone density loss. Maintaining a healthy diet with enough calcium vitamin D and magnesium can also help prevent bone density loss.

Once bone loss has occurred you can take action with aesthetic treatments. Injectable fillers such as Sculptra can add volume and support for a more youthful and defined face. Sculptra is injected below the skin to correct the effects of fat loss and natural age-related bone loss. A plastic surgeon can also strategically place fat into the face or use facial implants to make up for bone loss.

Muscle

Below the facial skin and fat, is muscle. The muscle and connective tissue add support to the overlying fat and skin of the face. As our face ages the ligaments stretch and the supporting system begins to elongate causing the face to droop or sag. When the face is sagging due to muscle, this is usually the time for surgical intervention. During a facelift the underlining muscles and tissues are lifted. If you are not ready for surgery, you may consider Ultherapy which does work at the top of the muscle (SMAS) and gives a modest non surgical lift. Keeping in mind that a non-surgical treatment will always provide a non-surgical result. Ultherapy will not remove excess skin or reposition fat pads, but it will tighten skin and provide a modest lift. Ultherapy is perfect for early intervention and probably as good as it gets without surgery.

Muscle contraction can also cause lines and wrinkles. The muscles we use to make expressions become etched in our face over time, this is most noticeable with the vertical lines between our brows commonly referred to as frown lines, as well as crows feet around the eyes and the lines across our forehead. At first these lines are only noticeable with facial movement, but with out preventative action they are constantly visible even without movement (this is referred to as wrinkles at rest). Botox or Dysport injections are used to treat the lines and wrinkles caused by muscle contraction. It is a good idea to consider these types of treatments early on to prevent the lines from becoming “permanent”. Once the lines and wrinkles have become permanently etched into the skin, fillers may be used to lift the area along with laser resurfacing to smooth the skin or in some more severe cases surgery may be recommended.

Fat and Volume Distribution

A youthful face has the right amount of fat in the right places. As we age some areas of the face loose fat while others gain fat. The areas of fat also become farther apart and the fat pads appear as separate structures rather than a smooth continuous layer.

Fat provides support and volume in the face, as we age this valuable fat begins to decrees. Fat loss creates overall volume loss which contributes to folds, lines and wrinkles. The signs of volume loss can be noticed as early as our 30’s and becomes more significant in our 50’s. As we lose fat in our mid face, we begin to notice things like sunken or flat cheeks, heavy lines and folds around the mouth. Volume loss can also be seen around the temples, near the brow bone and under the eyes. When volume is lost under the eyes, it creates a hollow look and dark circles. Injectables such as Sculptra, Juvederm and Restylane can be used to replace volume to the face. Fat injections can also be used as a more long term approach to replace or add volume. Fat transfer or fat injections is a process in which a plastic surgeon removes fat from one area of the body and places it in another. ( How wonderful is that?! )

Fat accumulation is often seen under the chin and along the jawline creating an undefined jawline and the dreaded jowls. Bags under the eyes are also the result of fat accumulating in the wrong area. A plastic surgeon can perform a blepharoplasty to remove the fat bags under the eyes. The jowls and fat along the jawline can be corrected with a facelift as fat pads are repositioned, but if you are not ready for surgery fillers can be strategically injected to help contour the jawline. If you opt for fillers over surgery you may consider adding Ultherapy prior for a modest lift. Again…. a non-surgical treatment will never give a surgical result.

During a facelift the underlining muscles and tissues are lifted, fat pads are repositioned, fat bags may be removed from under the eyes and volume may be added with fat injections as needed and excess skin is removed.

Skin

The surface layer of the skin is generally the first place we begin to notice the effects of aging, most of us begin to notice the effects of aging on our skin in our 30’s. As we age our skin has a reduction in collagen production, elastin, hyaluronic acid and skin cell turnover begins to slow. Uneven melanin production and distribution causes dark spots and skin discolorations. We begin to notice more broken capillaries, changes in skin texture, thickness, elasticity and moisture. When we are treating these issues in the skin we must first consider what skin functions are involve and what layer of the skin the problem begins.

The skin can be divided up into three basic layers Epidermis, Dermis and the Subcutaneous Layer (fat). When we talk about skin we are generally referring to the Epidermis and Dermis. The Epidermis is the top layer of the skin and the Dermis is the deeper layer.

Skin cell turnover in the Epidermis
The skin is constantly in a cycle of growth. The cycle of a skin cell is about six weeks, this is the time it takes for a new skin cell to rise to the surface of the skin and naturally slough off. As we age this process slows down and the dead skin cells begin to accumulate at the surface. When this happens the skin will have a dull appearance, rough texture, dark spots will become more dense and appear darker, and lines and wrinkles become more prominent. In addition to all of this, accumulation of skin cells can clog pores causing them to appear larger and lead to acne blemishes. The slowing of skin cell turnover begins in our 30’s, which is a good time to consider a medical based skin care regimen. Tretinoin (Retin-A), Laser and Chemical peels can stimulate skin cell turn over.

As the skin cell turn over rate slows so does wound healing. After an injury the skin takes longer to reepithelialize, meaning the top most layer of skin (Stratum Corneum) is not quickly replaced. This is why many Doctors and Estheticians recommend preconditioning your skin before surgery or skin treatments.

Collagen production
Collagen is important to youthful skin, but as we age collagen production slows down. Loss of collagen causes the dermal layer of skin to thin and reduces the skins ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). This leads to the domino effect, as loss of elastin causes laxity in the skin and reduced hyaluronic acid which cause skin to be dryer, less supple and thinner.

Professional chemical peels, laser and IPL treatments can help to stimulate collagen production. some treatments offer short term improvement in increased collagen production, treatments such as laser resurfacing and Ultherapy offer longer lasting effects. Beyond professional treatments, a skin care program that includes continuous use of Tretinoin (Retin-A), topical vitamin -C and full spectrum sunscreen will help with collagen production. Tretinoin (Retin-A) is an effective way to stimulate collagen synthesis. Vitamin C is nessacerry to produce collagen and it protects skin from both UVA and UVB, by neutralizing the UV rays. Sun exposure degrades collagen so it is essential to use a good sunblock daily. Another tip to prevent collagen loss add a topical Resveratrol to your night time skin regimen.

Pigmentation Melanocyte
A melanocyte is the cell that produces melanin (pigment), the melanin dispersed to keratinocytes, giving skin it’s color. As we age the cycle of melanin production and distribution becomes irregular.

As we age there is a reduction in the number of melanocytes. After age 30 the number of melanocytes decline about 6-8% every ten years. As the number of melanocytes decrease skin will become lighter, less even and white spots or patches (hypopigmentation) can be seen.

Browns spots and patches such as melasma, sunspots, age spots and freckles are known as hyperpigmentation. When a melanocyte produces more than normal amounts of melanin the result is hyperpigmentation. Furthermore the melanocyte doesn’t disperse the melanin evenly, so it is presented as dark spots or patches. Hormones and sun exposure are factors in even skin color.

There are many professional skin treatments that address hyperpigmentation, including chemical peels and Photofacial (IPL) treatments, however daily skin care is most important. Daily sun protection is necessary, this is not optional! Products containing hydroquinone suppresses tyrosinase, the enzyme involved in creating melanin. Botanical (plant based) lighteners can also help to suppresses tyrosinase, however alone are less effective than hydroquinone. Tretinoin (Retin-A) is also important, as it will help with even distribution of melanin.

Blood vessels
As we age the structural wall of the capillaries (tiny blood vessels) break down which results in broken capillaries. Flushing, redness and broken capillaries are treated with Photofacial (IPL / BBL) and laser treatments. Vitamin C can also help to strengthen capillary walls, I recommend a healthy diet with enough vitamin-C and a daily topical vitamin -C serum. A sunblock with Zinc oxide can further help by blocking some of the heat that causes blood vessels to dilate.

Lifestyle and Health

Our skin is a direct reflection of our health. All the skin care products and treatments in the world can only do so much, it is up to you to be proactive in maintaining your health.

– Work with your physician to maintain your health.
– Maintain a healthy diet with plenty of fruits and vegetables.
– Exercise contributes to a healthy body and hormone levels.
– Sun protection will go a long way to save your skin.
– If you smoke, quit!
– Limit alcohol consumption
– Drink plenty of water
– Get enough sleep
– Try to reduce stress (get a massage, take up yoga, relax)
– Hormones play a role in the aging process. Ask your doctor to monitor your hormone levels and discuss treatment options.

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