Miami Herald (FL)
April 29--In our youth-obsessed society, looking young is more important than ever. But going under the knife is not always desirable.
No worries: dermatologists and plastic surgeons now have a repertoire of treatments to keep lines, wrinkles and saggy skin at bay.
There are neurotoxins like Botox and Dysport, dermal fillers like Restylane, Juvederm, Belotero and Sculptra, as well as light and laser treatments like Photofacials and Fraxel to improve the tone and texture of your skin.
It all begins with taking care of your skin and preventing sun damage, said Dr. Leslie Baumann, a board certified dermatologist who heads the Baumann Cosmetic & Research Institute in Miami.
"Consistent daily skin care is the most important thing that you can do to have good skin. The trick is knowing what products to use for your skin," said Baumann, author of The Skin Type Solution and a Miami Herald columnist. "The good news is that you do not have to break the bank by buying expensive skin care products."
Preventing aging means using sunscreen every day. Daily sunscreen with an SPF as little as 5 has been shown to decrease your lifetime exposure to UV rays by 50 percent, said Baumann, who recommends using at least an SPF of 15.
"Your dermatologist can help you find a sunscreen with active ingredients to treat your other skin issues," she said. "For example, sunscreens can contain antioxidants, depigmenting agents, glycolic acid and anti-inflammatories. Your sunscreen should work for you and do more than just block the sun."
Incorporating antioxidants in your diet, through supplements or by applying them topically, is also an important preventative method. Topical antioxidants she likes are green tea, idebenone, ascorbic acid, argan oil, oxofullerane and resveratrol.
Applying retinoids is also key, to both prevent and treat wrinkles.
"In my opinion everyone should be on a retinoid," Baumann said. "Using a retinoid has been proven over and over to improve wrinkles and to prevent them."
To further turn back the clock on the appearance of aging, many patients choose injectables.
The starting point is often a neurotoxin or Botulinum Toxin Type A, such as Botox, Dysport, or a new entrant, Xeomin, said Dr. Adam Rubinstein, a board-certified plastic surgeon with an office in Aventura.
"We live our lives moving our facial muscles, and the facial muscles fold the skin over and over again, and create new wrinkles by doing that," said Rubinstein, who is also host of a radio show on aesthetics, wellness and beauty -- New Reflections on Voiceamerica.com, which is live from noon to 1 p.m. on Saturdays.
"The best way to use neurotoxins is to use it as a preventative treatment," he said. Such injections can help smooth the lines between the eyebrows, in the area of the crow's feet and on the forehead.
While complications are extremely rare, injections in each area carry their own risk, Rubinstein said.
"You need to choose your doctor carefully," said Rubinstein, who recommends choosing a board-certified plastic surgeon or dermatologist, because anyone with a medical license can buy injectables and inject them.
"If you go to the wrong person with not enough training or experience, you're putting yourself in a position to potentially have a higher risk of complications or simply not be satisfied with your treatment," he said.
Dermal fillers, such as Restylane, Perlane, Juvederm and Belotero, which are made of hyaluronic acid, are frequently used to fill in lines of the face and add volume.
Rubinstein said he also likes to use Sculptra, which uses poly-L-lactic acid to stimulate a patient's own tissue to grow, resulting in a natural look.
Unlike many other fillers, Sculptra requires at least two treatments, spaced out at least four to six weeks apart. The results are longer lasting than many other fillers, he said.
"It adds bulk and volume for people who have hollow cheeks, poor cheekbones or hollow temples," Rubinstein said.
"Temples are one of the most neglected places in the facial aesthetic. If you look at older people they have hollow temples," he said. "If you inject Sculptra into that area and get some added volume, you can very subtly improve their youthful look in a way that no one can really tell -- it just makes them look younger and fresher."
For fine lines, Belotero is a relatively new injectable.
"Belotero has revolutionized the treatment of fine lines such as crow's feet and smokers lines," Baumann said. "My male patients love it because it gets rid of their forehead lines without the tell-tale frozenness of Botox, Dysport, Xeomin."
Light and laser treatments can also be used to give patients a more youthful appearance, and are very effective at eliminating sun damage and stimulating new collagen, said Dr. Leyda Bowes, a board-certified dermatologist whose practice -- Bowes Dermatology -- is in Coconut Grove.
"It's a non-invasive way to reduce the damage from the past and also proactively stimulate new collagen to make the skin look plumper, smoother and tighter," said Bowes, who completed a two-year laser fellowship at Harvard Medical School's Department of Dermatology.
Patients in their 30s and 40s can benefit from a Photofacial, which uses intense pulsed light (IPL), and is a popular, non-invasive treatment that requires no downtime, she said.
"This being Miami, with the sun exposure, we do have a lot of patients who come in because they don't see their complexion as being bright -- they have not only sun spots but blood vessels, diffused redness on their face, also fine wrinkles and enlarged pores," Bowes said.
Often patients receive three or four IPL treatments, one month apart for the first year, then once a year after that for maintenance, as needed.
"The total effect of the IPL treatment is smoother skin with minimized pores and a complexion that is very even, very bright," she said. "It's very powerful, but very safe and this is why they call the procedure the Photofacial. Patients will come back saying the texture is smoother and pore size smaller."
Katherine Amiguet, a pharmaceutical sales representative who lives in Coral Gables, has had three Photofacials since December, which she said have reduced the redness and eliminated dark spots on her skin, as well as reducing pore size and fine lines. "I'm a professional, I'm a mom, and I have to look good for my job because I am in and out of doctors' offices," said Amiguet, 44.
"I've been getting compliments," she added. "They say, 'What have you done to your face, you look really good!' "
Another popular treatment that can benefit patients in their late 40s and up is Fraxel, a laser treatment co-developed by Bowes' husband, Dr. Dieter Manstein, and Dr. Rox Anderson.
"While it doesn't involve cutting or needles, it does have a recovery time, a day or two with redness and swelling," Bowes said. "But the results, in terms of minimizing lines, improving and reducing deeper wrinkles and tightening, are very significant.''
Fraxel gets its name from fractional photothermolysis, which means that with every treatment, the area treated is 15 to 25 percent of the surface area of the skin, depending on whether the patient has milder or deeper wrinkles and lines.
"What it does is that it creates small microscopic columns of selective or controlled damage to aging skin," Bowes said. "These areas are in turn replaced with new, younger collagen and elastic fibers, with time. In a period of weeks to months, patients start to see smoothening of the texture and reduction of deeper wrinkles."
Because a fraction of the skin's surface is treated at a time, Bowes recommends multiple treatments -- two to five -- allowing the patient to be the judge.
Yolanda Florin, 62, got her first Fraxel treatment a few weeks ago to improve the fine wrinkles around her mouth and in the corner of her eyes, as well as the deep wrinkles on her forehead.
"It helped my fine lines and the texture of my skin," said Florin, who lives in Miami Beach. She plans to have a second treatment after the summer. "To me, it's fantastic, and there was no pain."
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