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The latest advancements in the search for the fountain of youth

Posted on April 1, 2018

The passage of time is inevitable, whether we are 32 or 92. But it is possible to turn back the clock through a range of procedures that can improve skin’s texture and tone, soften lines and wrinkles, shrink pores, and shore up sagging skin. With so many options, just which to choose?

In general, physicians say patients are asking for tweaks and treatments that will rejuvenate the skin without days or weeks of downtime. “The trend has been to move away from surgery and toward non-invasive procedures,” says Dr. Reza Tirgari of Avalon Laser in Carlsbad and San Diego.

Dr. Jennings Staley of Del Mar’s Skinny Beach medical spa agrees. “Patients want faster results with shorter recovery, and are willing to get several treatments to achieve optimal effect versus one very powerful, often more risky, treatment,” he says. And it’s not just older people booking appointments. “Millennials are also influencing aesthetics medicine in a way that has never been seen,” says Dr. Staley. “This demographic is more ready to invest in preventive medicine and beauty maintenance than their predecessors, and now occupy over 20 percent of the seats in the average med spa nationwide, outpacing baby boomers for the first time.”

But other experts point out that less may not be enough to achieve the best results. “In general, the better result is proportional to more downtime. What has changed is that the downtime is not painful, just unsightly,” says Dr. Mitchel Goldman of La Jolla’s Cosmetic Laser Dermatology.

“In the right circumstance, a higher downtime procedure performed once will yield far better results than a no-to-little downtime procedure performed many times,” says Dr. Melanie Palm of Art of Skin MD in Solana Beach. “However, patients’ needs and daily activities are an important consideration and should be weighed in formulating a treatment plan.”

For those considering plastic surgery, Dr. Paul Chasan of Ranch & Coast Plastic Surgery in Del Mar says a typical facelift can last from seven to ten years with variations based on genetics, skin type, and lifestyle. “Those patients with darker pigments and better skin types tend to last longer,” he says. “Also, patients who continue to do Botox and skin care treatments will increase the longevity of their facelift. Another factor is exercise. Those who exercise tend to have better results.”

Dr. Sirius Yoo of SKY Facial Plastic Surgery in 4S Ranch says times and surgical techniques have changed for the better. “Modern facelifts do not pull the skin at all,” he points out. “They lift the fibromuscular layers that support the skin. The goal is to keep patients looking like themselves but with the clock pushed back ten to 15 years.” Dr. Yoo points out that facial plastic surgery addresses laxity (looseness) of the lower face and neck for which there are now no great substitutes. “An enormous amount of research and development is going into this field and I’m hopeful that at some point we will have a decent alternative to the surgical facelift.”

These experts all agree that patients should do their homework. Research doctors (preferably board-certified in dermatology or plastic surgery), ask for recommendations, and seek several consultations.

Here are some of the newest and most effective procedures to help you improve the skin you’re in.



Fillers & Injectables

Neuromodulators such as Botox or Dysport soften facial lines, while fillers like Restylane and Juvederm enhance lip fullness and decrease sunken cheeks. Sculptra is intended to correct deep wrinkles and folds such as smile lines.

“There is nothing that competes with Botox for convenience, lack of downtime, and quality of results,” says Dr. Chasan. “There are very few things that can make a patient look five years younger with a ten-minute treatment.” He is also excited about defining cheekbones with Radiesse. “Today we do much less surgical cheek augmentation because using a filler such as Radiesse is so effective.” Dr. Yoo says Juvederm Volbella, used to plump lips and treat facial lines, is popular in his practice. “The great thing about Volbella is that it’s as silky and smooth as the shorter acting fillers, but lasts twice as long.” Dr. Melanie Palm favors a combination of Botox or Dysport, an injectable filler, and light and laser treatments about every 6-12 months. “Patients shouldn’t look ‘done,’ just the best version of themselves,” she says. “I hope it is the age of the anti-Kardashian lip!”

Photorejuvenation/Laser Resurfacing 

Intense Pulsed Light (IPL) treatments consist of high-intensity bursts of broad-spectrum light to reduce redness, sunspots, brown spots, and broken blood vessels. Lasers rejuvenate skin, treating fines lines, tattoos, acne scars, visible blood vessels, and sunspots.

According to Dr. Goldman, a variety of ablative fractionated lasers, such as the carbon dioxide (CO2) and Erbium-YAG, give the best results but have a longer recovery time. Those lasers direct intense beams of light that destroy the top layer of skin. Nonablative lasers, on the other hand, don’t break the skin’s surface but, rather, heat up the skin below, spurring collagen growth to tighten and firm. Fractional lasers target smaller areas for more gradual results and a faster recovery time.

The hot topic at national dermatology meetings, says Dr. Palm, is combining different lasers during a single treatment. She often combines an IPL photofacial to treat discoloration and tone with a nonablative laser called ResurFX, similar to Fraxel, to improve texture and stimulate collagen. Patients can wear makeup the next day.

For extensive sun damage and wrinkles, Dr. Palm uses a variety of therapies. “I will combine photodynamic therapy (combining IPL with a blue light and a photosensitizing chemical called aminolevulinic acid) with a CO2 fractionated laser skin resurfacing procedure.” Laser-treated skin is especially sensitive to sun, so sunscreen is a must.

Skin Tightening 

Treatments such as Thermage use a powerful, noninvasive radio frequency (RF) technology called ThermaCool, designed to slowly tighten and firm the skin. “For the last decade, radiofrequency has been slowly emerging as the next revolution in skin rejuvenation,” says Dr. Palm. “Once properly harnessed, I think we will see much more dramatic results in facial, neck, and body tightening.” Dr. Tirgari recommends combining Thermage with microneedling devices such as Vivace RF to help older people maintain tight and toned skin.


Microneedling, used with a topical numbing medicine, creates tiny pinpoint breaks in the skin, deep enough to draw blood. “Those tiny pinpricks induce the skin’s wound healing response, which can lead to new collagen and elastin production, skin rejuvenation, and improvement of acne and acne scarring,” says Dr. Laurel Geraghty, a Stanford-trained dermatologist who writes extensively about skin care. Microneedling can be done on its own or in conjunction with platelet rich plasma (PRP). “PRP is your own blood spun down in a centrifuge to gather all these beneficial growth factors that can be applied to the skin after microneedling,” she says. Dr. Staley says that this so-called “Vampire Facial,” despite the scary name, “is single-handedly our favorite procedure which can restore a more youthful appearing skin. “The results are unlike anything we can achieve with lasers or peels. Platelet rich plasma is a game-changer in aesthetics.”


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