10 Things Your Dermatologist Can Do to Make You Look Younger, Faster
The most effective fix for droopy skin, radio-frequency waves, requires a bit of fortitude: It burns like the devil. Treatments such as Thermage work by delivering sound waves deep into the skin, causing microscopic fissures that stimulate collagen production, which in turn firms up loose and sagging areas (face, jowls, neck, knees, and so on). The results are impressive— most patients see significantly tauter skin within six months—but the procedure can be hard to take. "Some of my patients find radio frequency too painful, even with heaps of medication," says dermatologist Howard Sobel. For those of us whose pain thresholds land somewhere between moderate and mouse-door level, there's an easier alternative. Sobel recommends the nonablative eTwo laser, which directs a much milder combination of radio frequency and infrared-light pulses into the skin. "The results are comparable to Thermage but not as painful," says Sobel, who recommends three sessions spaced one month apart.
A new hyaluronic acid filler, recently approved by the FDA, can diminish the tiniest and most superficial of lines. And that's big news. "Belotero Balance spreads out evenly instead of clumping up like other fillers, so you don't have to inject it deep into the tissue," says Fredric Brandt, a dermatologist with offices in New York City and Miami. The small particles and malleable texture make it possible to smooth shallow lines instantly while maintaining a bump-free surface. "It's perfect for filling in fine lines around the lips and even crow's-feet," says Brandt. And because the needle only penetrates the skin's top layers, there's far less bruising involved.
One common sign of aging is as plain as the nose on your face. Actually, it is the nose on your face. "The nose flattens and widens as we age," says dermatologist Jody Comstock. "One of the quickest and easiest ways to look younger is to reshape it with a filler." A hyaluronic acid filler (Perlane, Juvéderm, Restylane) injected right into the dorsum (the bony line straight down the center) slims the nose and even corrects bumps and imperfections. Doctors can also add a tiny dose of Botox under the tip for a more youthful profile. "Your nose becomes more hooked as you age, which drags down the entire face," says Brandt. "Botox lifts it up and takes off years in about ten minutes."
Neck muscles can start to enlarge and protrude as we age, resulting in the appearance of thick, tight cords. And as if that weren't hard enough to swallow, "the muscles in the neck and the superficial muscles of the face are connected to one another," says Brandt. "That means your neck actually pulls your face downward." It's a depressing thought with a surprisingly easy fix (that doesn't involve buying stock in a turtleneck emporium). "I relax the neck muscles with Botox," says Brandt. "It softens the wrinkles, gets rid of the cords, and lifts the face. Basically, it's a nonsurgical face-lift." Botox breaks down every three to four months, so repeat visits are necessary.
Sclerotherapy—the procedure that can eliminate spider veins and the leaky blood vessels that cause them—was once the literal equivalent of rubbing salt in a wound. "Before, we had to use a saline solution that stings and is extremely painful," says dermatologist Amy Forman Taub. But the latest alternative procedures, which involve injecting veins to inflame them, close them, and allow the body to absorb them, have made real advances in the past few years. "Newer detergent-like drugs such as Asclera and Sotradecol are just as effective as saline but don't cause as much discomfort," Taub says. (Doctors use a tiny needle "the width of a strand of hair," says dermatologist Arielle Kauvar.) "It's a very quick, very effective procedure that covers a lot of territory," says Taub. There's no downtime, but that doesn't mean there are no side effects: There is often bruising, some redness, and a bit of swelling in the veins, which compression stockings can help minimize. Sometimes patients see brown staining from inflamed veins that can last for several months.
When your face makes contact with an open kitchen-cabinet door, there are two things that will help ease the imminent black-and-blue (and purple and yellow) mark. The first is cursing like a sailor. The second is dialing your dermatologist. "It takes about 48 hours for a bruise to develop fully," says Brandt. "At that point, a patient can come in, and we'll treat it with a simple V-Beam vascular laser. The procedure takes only 20 seconds, and the bruise will fade by the end of the day." Who the hell knew?
Next to perkier breasts and a better butt, we yearn for smooth, round, plump...earlobes. Yes, you heard that correctly. "Skin sags as we age, and the earlobes are no exception," says Brandt. "And because so many women wear heavy earrings, the lobes are often the first thing to droop." To plump them up, Brandt recommends a hyaluronic acid filler. "A tiny shot in each lobe gives your ears an immediate lift that can last from six months to a year," he says.
We all know injectable fillers virtually erase wrinkles. But what happens when the thing you want to erase is the injectable filler itself? "I see patients with fillers that were put in the wrong place all the time," says Comstock. "A botched job can make the face appear off balance." If you use a high volume of long-lasting filler, like calcium hydroxylapatite (Radiesse), you're out of luck—it lasts for a year and can't be removed easily. But with hyaluronic acid fillers (Perlane, Juvéderm, and Restylane), there's a simple exit strategy. Dermatologists can inject an enzyme that can dissolve hyaluronic acid within 24 hours. "Your body will actually metabolize it, so there's no trace of it in your system," says Comstock. When it's time to give fillers a second chance, show the dermatologist a picture of yourself in your 20s. "It's critical to know where a person's soft tissue was originally in order to replicate it correctly," says Comstock.
If you ever needed an excuse to justify paying for smoother, brighter skin, this is it. Photodynamic rejuvenation, a treatment that doctors use to eliminate sun damage on the face, legs, and arms, combines pigment-busting Intense Pulsed Light with a topical drug (amniolevulinic acid) that destroys abnormal and precancerous cells. "Patients with moderately to severely sun-damaged skin look transformed after two or three sessions," says Taub. Equally exciting: New research shows that the nonablative fractional laser—a treatment that can lighten clusters of pigment on the face and chest—could have major health benefits as well. "It shows real potential as a remedy for precancerous cells," says Robert Anolik, a clinical assistant professor of dermatology at both NYU School of Medicine and the Weill Cornell Medical Center of Cornell University. Anolik recently participated in a study published in the Journal of the American Academy of Dermatology on fractional lasers as a therapeutic option. "Patients who received three or four treatments displayed an 86.6 percent reduction in precancerous cells at six months," says Anolik. "We also found tremendous improvement in their skin tone and fine lines."
Trichloroacetic acid (TCA) peels—one of the most effective methods of removing sun damage and hyperpigmentation—leave behind scabs that take about two weeks to heal. But patients can skip over that rough patch with a new TCA peel released by Glytone this year. "It has 25 percent trichloroacetic acid and a delivery system that bypasses the very outer layer of skin," saysJeannette Graf, an assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York City. "It removes damage without injuring the top of the epidermis, so there's zero scabbing." And while patients do experience dryness and mild flaking for a week, the long-lasting and immediate results are well worth it. "Most of the time, one treatment is all it takes to achieve a significantly brighter and more even complexion," says Graf.
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