The “Youthful” Aging Face Part 2: The Art of Combination Therapy

In our last blog on The “Youthful” Aging Face Part 1, you learned the aging factors, the specific bone and tissue changes in the face, and the three ways the face ages:

Tone and Texture — pores, pigment and polish
Lines and Hollows — wrinkles and volume loss
Sags and Bags — tissue laxity

When you visit our Newport Beach plastic surgery office for a facial rejuvenation consultation with Dr. Anton, the first questions he will ask is, “What is it about your face that bothers you the most?” Some people are most bothered by a hanging neck, others miss their youthful cheekbones and some don’t like the brown spots that seem to get worse after every summer. It is essential that a patient communicates clearly with his or her plastic surgeon about what it is that they see when they look in the mirror. After understanding how you view your face, Dr. Anton then addresses those concerns and all other aspects of your face that can improve your aesthetic appearance and balance.

“Youthful” Aging Requires a Strategy… And a Budget

Most of our patients begin to notice the early signs of aging in their mid-thirties. They aren’t exactly sure what has changed in their face, but they know their skin doesn’t have the same glow or isn’t as elastic, and the smile lines around their eyes are noticeable even when they aren’t smiling. When the first signs of aging show up on your face, you can ignore it and deal with it later, or implement an anti-aging plan of action – one that focuses on combination therapy and outlines future surgical options.

There are two basic approaches for treating the aging face. One is surgery and the other is office procedures, including skin care. One is not a substitute for the other. A facelift won’t repair sun damage or stimulate collagen. Fillers won’t lift the neck and jowls. Skin care products won’t reverse fine lines and wrinkles. Surgery addresses sags and bags.

Office procedures focus on treating Tone and Texture, Lines and Hollows. The key is finding the skin combination therapy that’s right for you and your budget. Below we’ve outlined how to treat Tone and Texture, Fine Lines and Hollows with combination therapies available at Anton MD Aesthetics.

I. Tone – Uneven pigment, melasma, red and brown spots.

Aging Factors: Environmental, Hormones, Genetics

Combination Rx: Products/Peels/Lasers

Uneven pigment can add years to your facial age. When your goal is improving pigment, the most important thing to remember is consistency and time. Pigment issues never really disappear, but you can abate it with the right combination therapy and prevent it from getting worse by applying sunscreen every day.

Skin Care Products
Frequency – 2xs/daily
Everyone over the age of puberty should invest in good skin care products. You can spend a lot of money on your products, but dollars spent don’t necessarily yield better results. Invest in medical grade products with a brightening/lightening agent likeazaleic or kojilac acid. Try: CORE Brighten Up weekly pads – a once a week treatment for diminishing sun damage.
Peels Before and After
Example of Peels Before and After
Chemical peels
Frequency – 1/2xs/year
You can expect 3-5 days of moderate to heavy sloughing followed by redness, possible dryness and maybe some light breakouts. Most deep peels follow with a home care regime. You will see significant improvement in tone and moderate improvement in texture. The best news is today’s peels are safe and effective for all skin types.
Frequency – 3-5xs/year
Intense Pulse light – sometimes referred to as photo-facial –treats red and brown spots except for melasma. After treatment there can be some minimal swelling and redness. Facial dark spots draw to the surface and appear like coffee grains before washing away. Good for fair to medium skin types.
CO2 Laser
Frequency – 1-4 treatments for maximum results
For lighter complexions, fractionated laser can help even the skin tone. It can also cause hyperpigmentation on certain skin types. After care products like CORE Illume Plus are essential for treating post laser skin to avoid hyperpigmentation.

II. Texture – fine lines, ruddy complexion, acne scarring

Aging Factors: Environment, Genetics, Hormones, Diet

Combination Rx: Products/Monthly facials/Microneedling/Lasers/Injectables

Who doesn’t want baby smooth skin after 40? We can’t promise that but you can greatly improve the look and feel of your skin with these therapies:

Skin Care Products
Frequency – 1x/daily
When skin ages, cellular turnover slows down, making skin dull and lifeless. To bring back your skin’s vibrancy, you need products that will exfoliate, brighten, tighten, smooth and polish. We packaged a powerful hydroxy acid, anti-oxidants, 4 brighteners, peptides and B3 (niacin amide) into one CORE product—LÜX. Used nightly, it will address texture, pore size, sun damage and collagen production. Good for all skin types but rosacea.
Frequency – Monthly
There are many kinds of facials, ones that feel good all over and ones that get down to business. You need a facial that includes an exfoliation either manual, like microdermabrasion or dermaplane, or chemical such as a light glycolic or salicylic acid to help boost cellular turnover and stimulate collagen. You won’t reverse skin damage, but you can slow it down. Good for all skin types.
Microneedling Before and After
Example of Microneedling Before and After
Frequency – Every 6-10 weeks for 6 sessions
The microneedling devices today are far superior to the dermal rollers of the past in terms of skin penetration. Microneedling works by creating small puncture wounds to the skin. These “injuries” are enough to initiate the wound healing cascade which stimulates collagen growth. It is an ideal treatment for acne scarring, large pores, and fine lines. Good for all skin types.
CO2 fractionated laser
Frequency – 1-4 treatments for maximum results
Unlike the old CO2 lasers that completely ablated the skin, fractionated technology splits the light into a smaller array of pixels so it treats a smaller percentage of the skin. This means less downtime and risk, but also less of a dramatic result. Plan on 5-7 days of hiding out under a big sun hat after treatment. CO2 laser treats fine lines but won’t wipe out those deeper wrinkles. It can improve uneven pigment if you are not a sun goddess to begin with. Maximum results aren’t notice
able for up to 3 months. Good for fair to medium skin types (1-3 on Fitzpatrick Scale).
Injectables–Fillers and Botox
Frequency – 1-3xs/year
Fillers are like the fountain of youth in a syringe plus minimally invasive and generally no downtime – rarely, light bruising may occur that is easily concealed with makeup. In the injectable family, there are neuromodulators like Botox/Xeomin and Dysport that freeze muscles and prevent or erase (temporarily) fine lines in the face. There are also dermal fillers including fat (see below) that can smooth adult acne scars and other irregularities.

III. Lines and Hollows – deep wrinkles, nasal labia folds, sunken cheeks and temples

Aging Factors: Gravity, Genetics, Hormones

Combination RX: Products, Injectables and Surgery

A full face is a youthful face. This changes as we age and fat pads slip and slide leaving folds, hollowed areas and loose skin.

Skin Care
For any woman over 45, there is one must-have-you-won’t-look-fabulous without product – topical Hyaluronic acid (the same active ingredient that’s in fillers). Applied daily, a product like the CORE Raindrops helps your tissues retain moisture and that gives you plumper, less wrinkled skin, smoother skin
Injectables Before and After
Example of Injectables Before and After
Frequency – 1-3xs/year
Fillers and fat are for enhancing cheeks, lips, nasal labial folds, temples, tear troughs, perioral lines, jawlines, and even ear lobes. Synthetic dermal fillers come in two varieties: HA (hyaluronic acid) and non-HA. HA fillers dissolve when you inject hyaluronidase into the treated area. Non-HA fillers cannot be dissolved but over time are metabolized into the body. All dermal fillers, with the exception of Artefill, are temporary and will be metabolized over time.
Perlane, Juvederm (XC), Restylane, Belotero – HA (hyaluronic acid) fillers are used for adding volume to cheeks and lips, softening deep and fine lines, and creating “lift” in the upper face and jawline. They are basically all the same with the exception of Belotero, which is suited for very superficial lines like those pesky lip lines. Average price is $500/vial. Average 2 vials per treatment.
Voluma –The newest addition to the HA filler family and touted as lasting longer (up to 2 years per injection). It is the only FDA-approved filler for creating volume in the cheeks. Because its consistency is thicker than other fillers it can also create a “lift” by strategically injecting a bolus (round mass) at certain points in the face. Average price is $800/vial. Average 2 vials per treatment.
Radiesse – A non-HA filler that works similarly to Voluma, except that it can’t be dissolved with hyaluronidase.
Sculptra – A non-HA filler that replenishes volume loss by stimulating the growth of your own natural collagen. Great for filling in the hollows of the temples, chin wrinkles and marionette lines (those little lines that form at the corner of the mouth and turn downward).
Fat – Suctioned from one area of the body like the flanks, refined to remove water and fluids, optimized occassionally with PRP (platelet rich plasma) then injected into the face. If fat injections sound like having your cake and eating it too, you need to know they aren’t as predictable as synthetic fillers in terms of duration and can be more costly.

The most significant difference with all the injectables is your injector. You want only an MD or RN who has skills, training, and an exceptional aesthetic sense of balance. It is optimal that your injector is supervised by a plastic surgeon so that when its time for surgery those options can be addressed. You also want someone confident and competent enough to tell you when to step away from the Botox and filler before your face begins to look like a frozen T.V. dinner or a Macy’s Thanksgiving Day float.

Call our office at 949-722-1967 or fill out our online contact form to schedule your skin care consultation with our Medical Aesthetician.