There is an anti-aging revolution occurring in healthcare today and that you are the main beneficiary. Nowhere in the field of anti-aging medicine are the breakthroughs and technological advances more exciting, more relevant and more readily available for immediate application and benefit to you than in the field of facial rejuvenation. Better, the most exciting, effective new discoveries are non-surgical methods for facial rejuvenation. Yes I said non-surgical and I said effective. How do we change from that radiant 16 year old with smooth glowing fresh skin to the 40 something who is beginning to see her mother looking back at her in the mirror to the 65 year old with hooded eyes, puffy lower eyelids, jowls, and loose skin folds hanging under the chin. Let’s review and clearly understand what these changes are that we must look for, recognize and then take steps to correct. Skin Texture Changes (Surface Irregularities) The aged facial skin looks dry when compared to a child’s skin. Over half of the crucial natural skin moisturizing agent Hyaluronic Acid is lost by the time we turn 50 and you cannot replace HA by taking a pill or applying it to your skin. Loss of hormonal support during menopause accelerates this change. Dry aged skin loses its glow, looks dull, almost grey. The aged skin is wrinkled and rough and pore size is enlarged. Uneven pigmentation, brown spots, and red spots (Pigment and Blood vessels) Uneven pigmentation and over growth of blood vessels are characteristic of aged facial skin. These blemishes are a protective and inflammatory response of the skin to years of exposure to ultraviolet light from the sun and injury from free radicals released by harmful agents in our environment and diet. Fine Lines and Wrinkles Fine lines and wrinkles are classic signs of facial aging. Static wrinkles are those that are present in the skin when the face is at rest. These wrinkles are caused by the loss of collagen in the deeper layers of the skin. Collagen is destroyed by UV light from the sun and free radicals from other sources. As the collagen disappears volume is lost beneath the skin and the skin wrinkles. This is not unlike the way a grape wrinkles after drying to produce a raisin. Dynamic wrinkles are those that you see when the face is moving- frown lines, laugh lines, worry lines, and crow’s feet. These lines are actually caused by the pull of the facial muscles beneath the facial skin. Dynamic wrinkles can become static wrinkles after years of repeated pulling by the facial muscles. Deep Facial Lines Deep facial lines are those lines around the mouth called the Nasal-labial fold line and the Marionette lines. These lines are different from wrinkles in that they are caused by a combination of the pull of the facial muscles and loose sagging skin. As the face ages, the skin becomes loose and falls over the line created by the facial muscle pull, for example the smile line. Loose skin The skin of the aged face has lost it’s elasticity and has become loose. The cheek has fallen and created loose skin on the jaw called jowls. The skin beneath the jaw on the neck is also hanging down, a phenomenon called the turkey wattle. What Is Facial Rejuvenation The definition of rejuvenate is to make young or youthful again or restore to an original or new state. True facial rejuvenation requires correction of all of the above facial aging changes for the face to be made young or youthful or restored to an original state. The 6-step program mis designed to address all aging changes without surgery. The 6-Step Non-Surgical Facial Rejuvenation Program The 6-step facial rejuvenation program consists of the following 6 steps: 1. Exfoliation 2. Stimulation of new collagen formation 3. Removal of abnormal pigment and blood vessels 4. Relaxation of lines of facial expression 5. Fill deep facial lines 6. Skin tightening The 6-Step Program In Action- How it’s Done Step 1-Exfoliation I start all of my patients on an exfoliation routine consisting of topical exfoliating creams and microdermabrasion or superficial chemical peels with glycolic or salicylic acid. The latter peels are no down time procedures, you leave the office a little pink but with a refreshed glow. The exfoliating creams I use are Retin A® or Tazarotine®, although for patients with sensitive skin I use Vitamin C topically. For patients with more severe aging changes I use a deper form of exfoliation called MicroLasaerPeel®. This procedure goes deeper than a Microdermabrasion® and is more effective, but you leave the office quite red and need 4 to 6 days for your skin to look normal. This is a great improvement over laser resurfacing, which goes much deeper and requires many weeks of recovery. MicroLaserePeel® does not lighten the skin or leave demarcation lines as does laser resurfacing. Many physicians use deeper chemical peels with TCA, but I prefer the MicroLaserPeel® because of its accuracy and reliability. Step 2- Stimulate New Collagen Formation After deep exfoliation, this is the most important step for removal of static facial wrinkles and fine lines. This step is also the most time consuming and tedious and requires patience on your part. There is no quick non-surgical way to remove visible facial wrinkles. Laser resurfacing can quickly and effectively remove facial wrinkles but I consider laser resurfacing a surgical procedure and the prolonged recovery and down time make laser resurfacing unacceptable for most people. While the topical creams mentioned above and deep exfoliation stimulate new collagen production, additional stimulation is required. Several new laser techniques, IPL, and radiofrequency machines can stimulate the skin to form new collagen in the deeper layers without producing damage to the skin surface. These techniques are called non-ablative, meaning they do not remove the surface skin cells as is done in laser resurfacing, which is an ablative technique. Consequently these non- ablative techniques are no down time procedures meaning that after a treatment you are pink but recover quickly within hours. There are many different brands of machines that can perform non-ablative stimulation of collagen formation often called photorejuvenation. I prefer one called Lasergenesis® because it is easy, painless, and effective. IPL is also effective and is very useful in patients who have a lot of pigment and abnormal blood vessels, but IPL is stronger, involves contact of the machine to the skin and must be used with caution by a person who is trained and experienced in its use. Collagen stimulation is a lengthy process. Effective results that you can see in the mirror, that is fewer wrinkles, requires at least 5-7 treatments and 5-7 months for the benefit to be visible. But, it took 30-40 years to form those wrinkles, so removal in 7 months without surgery and down time is pretty good. Step 3- Removal of Abnormal Pigment and Blood Vessels Although creams and exfoliation can remove many light brown spots and the lasers and IPL used in step 2 remove smaller vessels, more aggressive therapy is needed for removal of darker pigment and brown spots and larger vessels. There are many non-ablative lasers available for removing pigment and blood vessels. While these lasers are non-ablative they do leave a reddish mark which is visible for a day or two and easily covered with make up. I have used a laser called the Versapulse® for many years which works very well, but new Versapulse® lasers are so expensive that they are rarely being manufactured today. A newer laser called the Coolglide® is very effective for larger blood vessels. Today, the IPL is the choice for combined pigment and smaller blood vessels that appear as a flush similar to Rosacea. The above therapies are effective and results are visible in about six weeks. Usually 2 or 3 treatments are needed. Step 4- Relaxation of Muscles of Facial Expression Botox® is a revolutionary new drug which effectively removes dynamic lines and wrinkles caused by the muscles of facial expression. The frown lines, worry lines, crow’s feet, and bunny lines all may be lessened or removed by the injection of Botox®. Lipstick lines, the fine wrinkles around the lips may also be lessened with Botox® but only small amounts can be used, otherwise the lips will be weakened. There are several new “peptides”, one of which is acetyl 3 hexapeptide, which when applied topically as a cream are reported to have a Botox®-like effect in reducing fine lines. Eventually these agents will be perfected, be more effective and possibly make Botox® injections unnecessary. You may read more about how these muscle relaxing, wrinkle removing agents work in Chapter 7, No Down time Facial anti-aging Procedures. Step 5- Fill Deep Facial Lines and Contour Deformities Soft tissue fillers such as Radiesse®, Restylane®, your own fat and other fillers can be injected into the skin beneath a deep facial line to plump the line and camouflage the line. They may also be used to plump the aging lip and to fill contour deformities caused by facial aging. These fillers are temporary and must be repeated every 6 months to a year. Fat injections can last longer and if done properly may not need to be repeated. Remember however, the filler techniques are a camouflage, not a correction. Step 6- Skin Tightening Skin tightening is a very important component of any facial rejuvenation process. Prior to the past year or two, a face-lift was the only option for tightening facial skin. However new technologies using Infrared, Radiofrequency, and combined 1319/1064 wavelength laser energy are showing promising results as non-surgical skin tightening methods. Two of these methods, Thermage®, which uses radiofrequency energy, and Titan®, an infrared device have been used for 2 years and results are improving. These methods are not a non-surgical face-lift as so often advertised, so do not be misled. They can however tighten skin by as much as 30% in properly selected patients. There have been complications with Thermage® consisting of depressions in certain areas of the facial skin so knowledge and experience with the use of these machines is very important. As with other non-surgical facial rejuvenation techniques skin tightening requires multiple treatments and takes time to see the final result, often 5 months. As with the other laser and photo techniques above skin tightening is achieved by stimulating the deeper layers of the skin to remodel and form new collagen, a process which takes time, usually 5 to 6 months to see your result. Non-surgical skin tightening is most useful for younger patients who are beginning to have loose skin in the neck, along the jaw-line, and in the cheek. Older patients with severe facial sagging can be improved but results will be less impressive. The 6-step facial Rejuvenation Program is a carefully structured method for the application of revolutionary new methods to obtain effective non-surgical rejuvenation. This program takes time, but the results are visible and real after about 7 months, the same time frame most people spend using creams and diets only to end up seeing no difference in their face. Remember, it took a lifetime for your face to age, does it make sense that this damage can be reversed overnight-of course not. The non-surgical facial rejuvenation program is expensive. These new technologies are costly and of course you need to be treated by a qualified physician. However, with the six-step program you get what you pay for, facial rejuvenation without the risk, discomfort, and expense of surgery. If you total the cost of your skin creams, facials, fad diets, and spa visits and save this money for the 6-step program many of you will be very close to covering the cost. For those of you who already have facial rejuvenation treatments in a doctors office, the 6-step program will produce better more effective results and save you money.