Daily Skin Fix

Cosmetic dermatologists achieve a youthful, aesthetically pleasing, attractive face by following the 5 R’s of anti-aging treatments: Repair, Relax, Restore, Resurface, Re-drape.

• Repair Sun Damage–Reduce Lines, Wrinkles, Spots, Sagging
• Relax Muscle Action–Reduce Lines
• Restore Volume–Reduce Lines, Give Youthful Fullness and Lift Sagging Skin
• Resurface Skin Texture–Reduce Lines, Wrinkles, Pore Size, Scars
• Re-drape Sagging Skin–Lift and Firm

Let’s go on to Anti-Aging Skin Rejuvenation Plan— –Step #3–Restore Volume

One of the most aging changes that happens over time is the loss of volume in the face. With age there is a loss of  fat, muscle and bone causing an aged, hollowed out, haggard appearance. In youth fat is under the eyeballs, in the cheeks, the temples, and the eyebrows. Over time this is reduced and drops which causes a “flat” face. This can be seen most dramatically in profile. Patients tell me “my face is melting.”

In youth the widest part of the face is the cheekbones, narrowing to the chin; called the “triangle of youth.”  With aging, volume is lost under the eyes leading to under eye bags,  hollows, and dark circles. The eyebrows fall when fat is lost, causing hooding of the eyelids. The high apple of the cheek falls. As the cheeks descend they cause deep lines from the side of the nose down past the corners of the mouth. These lines are like an arrow pointing downward, and appear to drag the face and neck downward.  The temples are hollowed, often with visible veins. The jaw line widens and the upper face narrows. The “triangle of youth” becomes the “pyramid of age.”  The skin’s “envelope” becomes loose over too little underlying structure leading to sagging, a flat and aged appearance and with jowls.

Adding to this is loss of volume in the lips as they become thinner and roll inward. Loss of bone around the mouth compounds the collapse of the mouth. Both cause a pinched and wrinkled mouth with radiating lines.

So basically, everything is falling. Cosmetic dermatologists call this deflation and descent.

And let’s not even talk about anything below the neck.

In the past, the looseness of the skin and the sagging was treated with a face lift alone, But that often lead to a gaunt, skeletonized, “caught in a wind-tunnel” look. The loss of volume needs to be corrected for a natural, rejuvenated appearance.

In any individual patient, either the volume loss or the looseness may predominate. But often it is a combination of both. If so, the problem of loss of volume and loose skin both need to be corrected. Although some patients certainly require a surgical face lift, we see many patients who successfully receive volume replacement only, or volume replacement combined with non-surgical tissue tightening with Thermage, sometimes called Therma-Fill. We will talk about this aesthetic option later.

Volume loss changes occur over time in us all, but may occur earlier in some than others. Of course, smoking or sun damage to collagen and elastic fibers cause the face to fall quicker and increases severity of facial lines. Individuals who have lost a great deal of weight, runners, and very thin individuals often show these changes earlier than others. I have a saying, “At a certain age, you have to choose between your face and your butt.” But actually you don’t– if you are willing to restore the lost fullness to your face.

So what on earth are we going to do?

Next: What we are going to do.

So now we move on to the next step of a cosmetic dermatologist’s anti-aging skin rejuvenation plan of Repair, Relax, Restore, Resurface, Re-drape.

Relax Muscle Action–Reduce Lines

We all have characteristic facial expressions which often run in families. Many patients tell me “my mom (or dad or grandmother) have horrible frown lines.  I am starting to get them too and I am afraid mine will be just as bad–help!” Characteristic facial expressions are set early in life, usually by 5 or 6 years old and sometimes even earlier. Once set in childhood they are very difficult if not impossible to change.

Frowns are often not due to anger as is commonly supposed but rather concentration. Unfortunately others subconsciously perceive the frowner as being angry. Patients say “I am so tired of people asking me why am I mad–it makes me mad”. Many people have what are called “hyperexpressive faces” and have a lot of frown activity, forehead expression and even crunch their noses up during animation (called bunny crunch or wolf lines). This gives horizontal forehead lines, frown lines and lines leading down from the bridge of the nose onto the cheeks.  Smiling or squinting leads to crow’s feet at the corners of the eyes. At first these lines appear only during expression. Over the years they become permanent, occur at rest and get deeper and deeper.

Now we are able to relax the muscles that cause these lines and reduce the angry, stressed or tired appearance. Injections of pharmaceutically prepared  botulinum toxin (Botox or Dysport) are used to treat the specific lines on the upper face that muscle related such as frown lines, forehead lines, and crow’s feet.  A “Botox brow lift” will lift the eyebows opening up the upper eyelid and reduce hooding. Some lines under the eyes can be improved. You look more rested and less stressed or angry.

In the lower face and neck Botox or Dysport are also used for anti-aging. Injections in the chin reduce muscle activity that leads to dimpling and to reduce the turn down of the corners of the mouth that occurs with age. They are also used to treat a “gummy smile” where the upper lip rises up too far with smiling showing more of the upper gum than is desirable. The muscles at the outside of the jaw which enlarge with teeth grinding can be slimmed. Bands of muscle in the neck can be softened reducing “cords” and improving the jowls.

• All in all Botox and Dysport have been great additions to our anti-aging treatments, allowing both reversal of signs of aging and prevention of progression. And contrary to the ads, nothings “better than Botox”.

Next–questions and answers about Botox and Dysport.

DCL Super Sheer Sunscreen

Labor Day marks the end of the summer fun and the beginning of fall responsibilities. This seems like an appropriate time for me to begin belaboring the obvious point–protect your skin from the sun. I am a dermatologist. You came to my blog. This should come as no surprise. There is a reason dermatologists nag at you about sun exposure. Not only is there overwhelming scientific evidence about the dangers of unprotected sun (like unprotected sex), but the throughout the course of our careers we see firsthand the unpleasant effects–wrinkles, saggy skin, spots, roughness, crepe-like skin, dilated blood vessels, large pores, cobblestoning, cysts, and ultimately skin cancer.

I know you have heard all of this before. Some of you even believe me. Some of you are trying to protect yourselves. Recent studies have shown that fear of wrinkles outweighs fear of skin cancer in leading people to reduce sun exposure. I can’t tell you how many times I see a person who looks 20 or more years older than they need to look. And it is almost always due to chronic, day to day sun exposure. And those who smoke and do sun have more than double the damage.

You don’t like sunscreen. I know. You think it is greasy. I know. It smells like sunscreen. I know. The kids hate it. I know. Wear it anyway. Use clothing as protection. Don’t try to tan. Be reasonable.

There are sunscreens that are actually quite nice. Surprise– we sell one. Try DCL-Super-Sheer-Sunscreen-SPF-50. We chose it because it is quite nice, non-sticky. You won’t be able to tell you have it on.

Here is the rundown :

• Avoid sun between 10-4.
• Stay in the shade whenever possible and keep infants under 6 months of age out of the sun. Infants’ temperature regulation ability is inadequate. Sunscreen will absorb through their thin, permeable skin. So keep them in the shade.
• Wear protective clothing-long-sleeve shirt, wide brimmed hat, pants, and UV protective sunglasses.
• Anyone over the age of 6 months should use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 that protects against both of the sun’s harmful ultraviolet rays:  UVA and UVB.
• Look for Zinc Oxide, Titanium Dioxide, Avobenzone or Mexoryl.
• Apply enough-one ounce to whole body. Put on twice the amount you think you need. That means a 6 oz tube should last 6 applications, not 6 years.
• Apply 30 minutes before sun exposure.
• Sunscreen effectiveness is reduced after about 2 hours. Reapply every 2 hours for regular sunscreen, every hour if in the water or toweling off.
• Use a waterproof sunscreen when you swim outdoors.
• Don’t keep it in your car. Sunscreen breaks down in the heat. When it turns to a liquid mess, throw it away.
• Make up with SPF less than 15 is not adequate.
• No sunscreen screens out all rays, you cannot use it as an excuse to stay out longer.
• Realize that an SPF 30 does not give twice the protection of SPF 15.  SPF 15 absorbs 93 percent of the sun burning rays, and SPF 30 has 97 percent absorption. SPF doesn’t measure UVA protection.
• Take special precautions when the National Weather Service’s daily ultraviolet (UV) radiation index predicts UV exposure levels of moderate and above (5 – 10+) or near surfaces that reflect the sun’s rays, such as water, snow and sand.  Whenever possible, stay inside or in the shade.  Use a high-SPF sunscreen.
• If there are any changes in the size, color, shape, or texture of a mole, the development of a new mole, any crusted, bleeding, scaly, “pearly”, or red bumps, or any other unusual changes in the skin, see your dermatologist immediately.

The bottom line is that you won’t regret it. Especially when you look 10 years younger than your best friend. So quit complaining and wear your damn sunscreen.

Elaine Cook MD

Welcome to the SkinTreatment.com blog, opinions and observations of board certified cosmetic dermatologist and creator of  Dr Elaine’s Advanced Skin Treatment skin care line, Elaine Cook M.D.  I’ve been specializing in Dermatology for 27 years, the last 15 of which have been devoted to the practice of cosmetic dermatology, the development of my own skin care  line, and running SkinTreatment.com. This blog represents the summation of the knowledge and experience I have gathered over the years seeing countless patients and developing multiple prototypes for our skin care products. Some of the medical stories happen over and over again, some are more unusual. Some are purely cosmetic. Some are symptoms of underlying medical disease. All are important. All affect peoples lives.

I plan on discussing a variety of topics. Among them: the so-called “cosmetic” skin problems–acne, melasma, rosacea, aging skin, wrinkles, spider veins, cellulite, stretch marks, hair loss, age spots, sun spots, discoloration and more. I will also discuss the cosmetic procedures used to remedy these problems: Botox, Juvederm, Restylane, Sculptra, Laser, Fraxel  Laser, Intense Pulse Light Photorejuvenation (IPL), Thermage, Therma-Frax (also called Fraxage), Sclerotherapy, Chemical
Peels and the various other light-based treatments such as LED and blue light. Finally, I will be using my understanding of the skin in health and disease and my experience developing my own skin care line as a basis to discuss anything and everything about skin care products.

Basically, I will be discussing whatever I want on any given day.