Global Approach to Natural Beauty

The adage 'an ounce of prevention is worth a pound of cure' holds particularly true for the aging process. From your mid-20s to mid-30s, it's crucial to avoid excessive sun exposure and other skin stressors, such as smoking, to prevent premature aging in your upper-30s and beyond. Additionally, maintaining good sleep habits, engaging in regular exercise, and a healthy diet are fundamental.

I also frequently advise patients to sleep on their back whenever possible. Spending hours overnight with your face pressed against a pillow in a face-down or side position can exert pressure on your face. This can lead to premature wrinkles, skin folds, and even facial asymmetry.

From age 25 to 35 is also a great time to get started on an effective anti-aging skin care routine. Products selected should stress prevention and reversal of signs of aging.

• Sunscreen: It is important to choose a truly broad spectrum sunscreen that protects well against Ultraviolet A (not just Ultraviolet B that is measured by SPF).  As there is no standardized measure for UVA protection, knowing your products is important.  Some of our favorites such as Elta MD UV Clear are found on our online store, The DLG Store.
• Retinoids: This is a good time to start using a retinoid.  Retinoids boost collagen production, elastin production, and increase cell turnover, thereby treating fine lines and wrinkles, as well as discoloration.  Options include milder retinol products such as La Roche Posay Redermic R that are available over-the-counter, or prescription tretinoin products.
• Vitamin C: Products with Vitamin C brighten skin tone and produces more even pigmentation.  One option we love is iS Clinical Super Serum Advance Plus.
• Hyaluronic Acid: HA containing products add immediate hydration to skin, temporarily smoothing skin texture and making skin more plump.  An option our patients love is Good Housekeeping Award winner ISDIN Hyaluronic Concentrate Serum.

For our younger patients, we emphasize the importance of selecting procedures that promote the regeneration of both collagen and elastin. Collagen, the most abundant protein in the skin, provides structure and firmness, while elastin, another crucial protein, gives our skin its elasticity, stretch, and the ability for the skin to return to its original shape. Increasing these proteins, that are naturally plentiful in youthful skin, is the main goal of our anti-aging procedures to achieve the most natural-looking results. Unfortunately, the more powerful devices and lasers best suited for maximizing collagen production operate at temperatures too high for elastin regeneration. Although these are often used for older patients in need of enhanced collagen production, we typically recommend avoiding them for patients younger than 35. Using procedures that produce both collagen and elastin in proportions that are natural in our skin is the best method to maintain natural looking rejuvenation results.

Some procedures we might recommend:

• PicoWay Resolve (~3 treatments/yr): PicoWay resolve is a special type of rejuvenating laser.  It uses picosecond lasers that produce less heat than older resurfacing lasers, producing less thermal damage to surrounding skin.  The two advantages of this are lower downtime, as well as production of elastin in addition to collagen leading to the most natural appearing results. PicoWay also improves skin tone by treating hyperpigmentation.
• Radiofrequency (~4 treatments/yr): RF devices such as TempSure Envi (NOT RF microneedling)  are a great way to produce collagen and elastin throughout your skin.  As an added benefit they also increase hyaluronic acid production in your skin, resulting in a dewey and glowing appearance.
• Regenerative Aesthetics (~3 treatments/yr): Some of the most exciting advancements in cosmetic dermatology over the last few years have been in the field of regenerative medicine. Our first foray into this field started with PRP (platelet rich plasma) treatments, harnessing the power of growth factors circulating in a patient’s own blood to stimulate rejuvenation. Now, we've advanced to using even more potent treatments, including exosomes and growth factor solutions derived from cell cultures in laboratories. These cutting-edge solutions harness our body's inherent self-regenerating capabilities and can be delivered through injections or microneedling directly into the skin.
• Medical Microneedling (~3 treatments/yr): Microneedling is a powerful way to activate collagen and elastin production without using an energy based device. Microneedling must be done by an experienced physician.  Like most procedures, if it is done too aggressively or without proper technique, you could end up harming the skin.
• SKINVIVE (~2 treatments/yr): SKINVIVE is the newest injectable aesthetic treatment to hit the US market. It is a hyaluronic acid based product that is not a filler, but is instead a new type of injection called a skin booster.  SKINVIVE can be thought of as similar to injecting a very effective and long lasting serum under your skin.  It produces smoother and more hydrated skin, and increased glow.  It is our “icing on the cake” skin texture treatment.  Everyone can benefit from SKINVIVE injections as an addition to their planned aesthetic regimen.

The main concerns we address regarding skin tone are hyperpigmentation and redness. Since different causes of skin tone issues necessitate tailored treatments, we'll highlight some of our preferred methods for tackling general skin tone problems.

Some procedures we might recommend:

• PicoWay Resolve (~3 treatments/yr): In addition to generating collagen and elastin, the PicoWay Resolve laser is an excellent choice for addressing hyperpigmentation.  In addition to treating hyperpigmentation from sun damage and aging, PicoWay is also an excellent option to treat melasma and hyperpigmented scarring.
• IPL (~1-3 treatments/yr): Intense Pulse Light is a very versatile treatment that can treat excess redness from broken blood vessels, veins on the face, acne, and rosacea, while also treating brown hyperpigmentation. Patients with lighter skin tones can often benefit from periodic IPL treatments to even out their skin tone.
• Chemical Peels (~1-3 treatments/yr): In our office we offer a variety of chemical peels using different mixtures of acids. The VI Peel is one of our favorites and is a great option for patients who want to treat skin pigment, while also improving skin texture.
• HydraFacial MD (~5-10 treatments/yr):  We can customize HydraFacial treatments to offer some minor benefit to patients who want to improve pigment and skin inflammation causing redness.

In addition to improving the skin, optimized face and neck rejuvenation requires that we also address underlying structures such as muscle, bone, and fat. Overuse of muscles such as those in the forehead, and around the eyes, causes them to overdevelop in relation to the thinning skin and fat, producing dynamic wrinkles in areas such as the forehead and crow’s feet.  Loss of muscle and bone in the mid face creates issues such as deepening nasolabial folds and hollows under the eyes.

Some procedures we might recommend:

• Botox or Daxxify (~2 treatments/yr): Neuromodulators such as Botox and Daxxify are used to relax overused muscles that cause dynamic wrinkles.  Primary areas of treatment include between the eyebrows, around they eyes, and the forehead.
• Fillers: Fillers are ideally used to add volume in precise locations in order to combat the volume loss that occurs with aging. If they are added correctly, the results look completely natural and can be very impressive.
• EMFACE: EMFACE is a great device to build muscle tone back up in key facial muscles that support our skin. EMFACE is the perfect addition or alternative to facial fillers, and produces a completely natural result as it is working with your own muscles.

*Note: In order to have the most natural appearing rejuvenation results it is important to address all aspects of face and neck aging.  That is why we stress our Global Approach to Natural Beauty. We understand that there may be practical limitations in terms of cost and time that may not allow this to be a possibility for everyone. We only mean to present here the ideal face and neck rejuvenation plan.

We customize our Global Approach to Natural Beauty to each individual’s specific needs.  But an example yearly protocol could include:

• 2 sessions of Botox or Daxxify
• 3 sessions of PicoWay Resolve or Medical Microneelding with Growth Factors
• 2 sessions of SKINVIVE
• +/- Filler or EMFACE as needed for volume loss

Choosing appropriate skincare remains an important part of anti-aging from age 35 to 45.  For these patients we sometimes recommend stronger actives and richer moisturizing ingredients than for younger patients.

• Sunscreen: We have a variety of broad range sunscreens that we recommend for patients. At our online store, The DLG Store, you will find lots of great sun protection products that will not only protect against skin cancer, but have anti-aging benefits as well. ISDIN has two great sunscreen products you should consider.
• Retinoids: Prescription tretinoin products should be strongly considered.
• Vitamin C: Using ferulic acid in combination with Vitamin C gives it a boost in activity. Patients and staff love SkinCeuticals C E Ferulic product.
• Hyaluronic Acid: Serums that contain HA are a great option to add hydration before a moisturizing step. The SkinCeuticals product mentioned above also has hyaluronic acid as an ingredient.
• Moisturizer: Moisturizers help to add a little plump and smoothness to skin for immediate, but temporary, improvement of appearance. Revision Skincare D.E.J Face Cream is a fan favorite moisturizer that does not go on too heavy.

To combat accelerated skin aging in our upper-30s to mid-40s we need to generate more collagen.  For maintaining and improving skin texture we add more robust collagen boosters to typical rejuvenating procedures that produce collagen and elastin.

Some procedures we might recommend:

• PicoWay Resolve (~3-5 treatments/yr): PicoWay Resolve represents a revolutionary approach in rejuvenating lasers. It operates with picosecond lasers, which generate minimal heat compared to traditional resurfacing lasers, thereby reducing thermal damage to the surrounding skin. This approach has two significant benefits: it minimizes downtime and supports the production of elastin alongside collagen, yielding results that look exceptionally natural. Additionally, PicoWay is effective in improving skin tone by addressing hyperpigmentation.
• Non-Ablative Fractional Laser Resurfacing (~3 treatments/yr): Fractional resurfacing lasers such as ResurFx are powerful enough to produce significant collagen that can reverse fine lines and wrinkles.  They can be combined with IPL treatment in what is called a PhotoFractional treatment to treat hyperpigmentation and redness while also improving skin texture.
• Radiofrequency (~4 treatments/yr): RF devices, including technologies like TempSure (NOT RF microneedling), offer an effective solution for stimulating collagen and elastin production throughout the skin. Additionally, they enhance the skin's natural hyaluronic acid production, providing hydration in addition to skin rejuvenation
• Regenerative Aesthetics (~3-5 treatments/yr): In recent years we have had groundbreaking advancements in cosmetic dermatology, particularly within the field of regenerative medicine. Initially, most of our treatments involved PRP (platelet-rich plasma) treatments, utilizing the natural growth factors found in a patient's own blood to foster skin rejuvenation. Today, our repertoire has expanded to include even more potent regenerative treatments, such as exosomes and specialized growth factor solutions derived from laboratory cell cultures. These advanced solutions, designed to tap into the body's innate self-healing abilities, can be either injected directly or delivered via microneedling into the skin, offering a cutting-edge approach to skin care.
• Ultherapy (~1 treatment every 2 yrs): Ultherapy uses micro focused ultrasound to heat specific depths of skin to tighten and lift without downtime.
• Medical Microneedling (~3-5 treatments/yr): Microneedling offers a potent method for stimulating collagen and elastin production, serving as a non-energy-based alternative to traditional treatments. It's important that microneedling is performed by an experienced physician to ensure safety and effectiveness. Improper technique or overly aggressive treatment can lead to adverse effects on the skin, underscoring the importance that these treatments are performed by experienced physicians.
• SKINVIVE (~2 treatments/yr): SKINVIVE is the latest breakthrough in injectable aesthetic treatments in the US market. This innovative product, based on hyaluronic acid, is a novel category of injections known as skin boosters. SKINVIVE is akin to delivering a highly effective, long-lasting serum directly beneath the skin, enhancing smoothness, hydration, and a radiant glow. Dubbed our "icing on the cake" for skin texture improvement, SKINVIVE injections are a valuable addition to anyone's aesthetic routine, offering universal benefits. Literally EVERYONE can benefit from SKINVIVE.

By the time most patients with lighter skin tones have hit their mid 30s, significant sun damage has caused uneven skin tone, sun spots, and broken blood vessels.

Some procedures we might recommend:

• PicoWay Resolve (~3-5 treatments/yr): The PicoWay Resolve laser not only excels in stimulating collagen and elastin production but is also the best choice for  tackling hyperpigmentation issues. It effectively addresses not just hyperpigmentation caused by sun damage and aging but also conditions like melasma and hyperpigmented scars, making it a versatile tool in improving skin tone.
• IPL (~3 treatments/yr): Intense Pulse Light (IPL) therapy is a highly versatile treatment. It is capable of addressing a wide array of skin concerns. It can reduce excess redness caused by broken blood vessels and visible veins on the face, and offers relief from acne and rosacea symptoms. IPL is also great for reducing brown hyperpigmentation spots. Regular IPL treatments are a necessity for maintaining even skin tone in most patients with lighter skin tones.
• Chemical Peels (~3-5 treatments/yr): We provide an array of chemical peels, each formulated with a unique blend of acids tailored to specific skin concerns. Among these, we favor some of the VI Peels as our favorites.  Peels such as the VI Peel Precision Plus are particularly effective for patients who are both looking to address skin pigmentation issues and also desire an improvement in skin texture, offering comprehensive benefits for a rejuvenated complexion.
• HydraFacial MD (~5-10 treatments/yr):  HydraFacial treatments can improve hyperpigmentation and even redness with regular treatments.

In addition to improving the skin, optimized face and neck rejuvenation requires that we also address underlying structures such as muscle, bone, and fat. Overuse of muscles such as those in the forehead, and around the eyes, causes them to overdevelop in relation to the thinning skin and fat, producing dynamic wrinkles in the forehead and crow’s feet.  Loss of muscle and bone in the mid face creates deepening nasolabial folds and hollows under the eyes, and as the loss of volume progresses marionette lines and even worsening of double chin and softening of jawline becomes evident.

Some procedures we might recommend:

• Botox or Daxxify (~2 treatments/yr): Neuromodulators such as Botox and Daxxify are used to relax overused muscles that cause dynamic wrinkles.  Primary areas of treatment include between the eyebrows, around they eyes, and the forehead.
• Fillers: Fillers are ideally used to add volume in precise locations in order to combat the volume loss that occurs with aging. If they are added correctly, the results look completely natural and can be very impressive.
• EMFACE: EMFACE is a great device to build muscle tone back up in key facial muscles that support our skin. EMFACE is a great addition or alternative to facial fillers, and produces a completely natural result as it is working with your own muscles. EMFACE Submentum treatment can also treat double chin.

*Note: In order to have the most natural appearing rejuvenation results it is important to address all aspects of face and neck aging.  That is why we stress our Global Approach to Natural Beauty. We understand that there may be practical limitations in terms of cost and time that may not allow this to be a possibility for everyone. We only mean to present here the ideal face and neck rejuvenation plan.

We customize our Global Approach to Natural Beauty to each individual’s specific needs.  But an example yearly protocol could include:

• 2-3 sessions of Botox or Daxxify
• 3 sessions of PicoWay Resolve or Medical Microneelding with Exosomes or PhotoFractional Treatments
• Ultherapy every few years and/or yearly EMFACE
• 2 sessions of SKINVIVE
• Additional Filler as needed for volume loss

Choosing appropriate skincare remains an important part of anti-aging after the age of 45.  For these patients we sometimes recommend stronger actives and richer moisturizing ingredients than for younger patients.

• Sunscreen: We have a variety of broad range sunscreens that we recommend for patients including EltaMD UV Elements Broad-Spectrum SPF 44.
• Retinoids: Prescription tretinoin products should be continued.
• Vitamin C: Vitamin C Serums are a great option for helping to prevent and treat hyperpigmentation.  iS Clinical Super Serum Advance Plus is one of our favorites.
• Hyaluronic Acid: Serums that contain HA are a great option to add hydration before a moisturizing step. SkinCeuticals H.A. Intensifier is an option with very high and effective HA concentration.
• Moisturizer: Moisturizers help to add a little plump and smoothness to skin for immediate, but temporary, improvement of appearance. A rich moisturizer that many of our patients like is SkinCeuticals Triple Lipid Restore.

To combat accelerated skin aging from age 45-55 we need to generate more collagen.  For maintaining and improving skin texture we add more robust collagen boosters to typical rejuvenating procedures that produce collagen and elastin.

Some procedures we might recommend:

• PicoWay Resolve (~5 treatments/yr): PicoWay Resolve represents a revolutionary approach in rejuvenating lasers. It operates with picosecond lasers, which generate minimal heat compared to traditional resurfacing lasers, thereby reducing thermal damage to the surrounding skin. This approach has two significant benefits: it minimizes downtime and supports the production of elastin alongside collagen, yielding results that look exceptionally natural. Additionally, PicoWay is effective in improving skin tone by addressing hyperpigmentation.
• Non-Ablative Fractional Laser Resurfacing (~5 treatments/yr): Fractional resurfacing lasers such as ResurFx are powerful enough to produce significant collagen that can reverse fine lines and wrinkles.  They can be combined with IPL treatment in what is called a PhotoFractional treatment to treat hyperpigmentation and redness while also improving skin texture.
• AcuPulse CO2 Fractional Resurfacing Laser (~1 treatment every 3-5 years): CO2 Laser is the strongest of the fractional resurfacing lasers, with the most robust collagen generation of all the laser devices.  This translates to great skin tightening and smoothing of wrinkles.  If our patients in the mid-30s to mid-40s have premature wrinkling we will sometimes recommend AcuPulse, otherwise we will wait until age 55+ for this one.  AcuPulse has a long recovery of about 7-10 days of solid downtime.
• Radiofrequency (~4 treatments/yr): RF devices, including technologies like TempSure (NOT RF microneedling), offer an effective solution for stimulating collagen and elastin production throughout the skin. Additionally, they enhance the skin's natural hyaluronic acid production, providing hydration in addition to skin rejuvenation
• Regenerative Aesthetics (~5 treatments/yr): In recent years we have had groundbreaking advancements in cosmetic dermatology, particularly within the field of regenerative medicine. Initially, most of our treatments involved PRP (platelet-rich plasma) treatments, utilizing the natural growth factors found in a patient's own blood to foster skin rejuvenation. Today, our repertoire has expanded to include even more potent regenerative treatments, such as exosomes and specialized growth factor solutions derived from laboratory cell cultures. These advanced solutions, designed to tap into the body's innate self-healing abilities, can be either injected directly or delivered via microneedling into the skin, offering a cutting-edge approach to skin care.
• Ultherapy (~1 treatment every 1.5 yrs): Ultherapy uses micro focused ultrasound to heat specific depths of skin to tighten and lift without downtime.
• Medical Microneedling (~5 treatments/yr): Microneedling offers a potent method for stimulating collagen and elastin production, serving as a non-energy-based alternative to traditional treatments. It's important that microneedling is performed by an experienced physician to ensure safety and effectiveness. Improper technique or overly aggressive treatment can lead to adverse effects on the skin, underscoring the importance that these treatments are performed by experienced physicians.
• SKINVIVE (~2 treatments/yr): SKINVIVE is the latest breakthrough in injectable aesthetic treatments in the US market. This innovative product, based on hyaluronic acid, is a novel category of injections known as skin boosters. SKINVIVE is akin to delivering a highly effective, long-lasting serum directly beneath the skin, enhancing smoothness, hydration, and a radiant glow. Dubbed our "icing on the cake" for skin texture improvement, SKINVIVE injections are a valuable addition to anyone's aesthetic routine, offering universal benefits. Literally EVERYONE can benefit from SKINVIVE.

By the time most patients with lighter skin tones have hit their mid 40s, significant sun damage has caused uneven skin tone, sun spots, and broken blood vessels.

Some procedures we might recommend:

• PicoWay Resolve (~3-5 treatments/yr): The PicoWay Resolve laser not only excels in stimulating collagen and elastin production but is also the best choice for  tackling hyperpigmentation issues. It effectively addresses not just hyperpigmentation caused by sun damage and aging but also conditions like melasma and hyperpigmented scars, making it a versatile tool in improving skin tone.
• IPL (~3 treatments/yr): Intense Pulse Light (IPL) therapy is a highly versatile treatment. It is capable of addressing a wide array of skin concerns. It can reduce excess redness caused by broken blood vessels and visible veins on the face, and offers relief from acne and rosacea symptoms. IPL is also great for reducing brown hyperpigmentation spots. Regular IPL treatments are a necessity for maintaining even skin tone in most patients with lighter skin tones.
• Chemical Peels (~3-5 treatments/yr): We provide an array of chemical peels, each formulated with a unique blend of acids tailored to specific skin concerns. Among these, we favor some of the VI Peels as our favorites.  Peels such as the VI Peel Precision Plus are particularly effective for patients who are both looking to address skin pigmentation issues and also desire an improvement in skin texture, offering comprehensive benefits for a rejuvenated complexion.
• HydraFacial MD (~5-10 treatments/yr):  HydraFacial treatments can improve hyperpigmentation and even redness with regular treatments.

In addition to improving the skin, optimized face and neck rejuvenation requires that we also address underlying structures such as muscle, bone, and fat. Overuse of muscles such as those in the forehead, and around the eyes, causes them to overdevelop in relation to the thinning skin and fat, producing dynamic wrinkles in the forehead and crow’s feet.  Loss of muscle and bone in the mid face creates deepening nasolabial folds and hollows under the eyes, and as the loss of volume progresses marionette lines and even worsening of double chin. Above the age of 45 the structural changes typically have become as big of a factor in aging as the loss of collagen and elastin in the skin.

Some procedures we might recommend:

• Botox or Daxxify (~2 treatments/yr): Neuromodulators such as Botox and Daxxify are used to relax overused muscles that cause dynamic wrinkles.  Primary areas of treatment include between the eyebrows, around they eyes, and the forehead.
• Fillers: Fillers are ideally used to add volume in precise locations in order to combat the volume loss that occurs with aging. If they are added correctly, the results look completely natural and can be very impressive.
• EMFACE: EMFACE is a great device to build muscle tone back up in key facial muscles that support our skin. EMFACE is a great addition or alternative to facial fillers, and produces a completely natural result as it is working with your own muscles. EMFACE Submentum treatment can also treat double chin.

*Note: In order to have the most natural appearing rejuvenation results it is important to address all aspects of face and neck aging.  That Is why we stress our Global Approach to Natural Beauty. We understand that there may be practical limitations in terms of cost and time that may not allow this to be a possibility for everyone. We only mean to present here the ideal face and neck rejuvenation plan.

We customize our Global Approach to Natural Beauty to each individual’s specific needs.  But an example yearly protocol could include:

• 2-3 sessions of Botox or Daxxify
• 3 sessions of PicoWay Resolve or Medical Microneelding with Exosomes or PhotoFractional Treatments
• EMFACE (series of 4 per year)
• 4 sessions of TempSure per year
• Ultherapy (once every 1.5-2 years)
• 2 sessions of SKINVIVE
• Additional Filler as needed for volume loss

Choosing appropriate skincare remains an important part of anti-aging from age 55 to 65.  For these patients we sometimes recommend stronger actives and richer moisturizing ingredients than for younger patients.

• Sunscreen: We have a variety of broad range sunscreens that we recommend for patients including EltaMD UV Elements Broad-Spectrum SPF 44.
• Retinoids: Prescription tretinoin products should be continued.
• Vitamin C: Vitamin C Serums are a great option for helping to prevent and treat hyperpigmentation.  iS Clinical Super Serum Advance Plus is one of our favorites.
• Hyaluronic Acid: Serums that contain HA are a great option to add hydration before a moisturizing step. SkinCeuticals H.A. Intensifier is an option with very high and effective HA concentration.
• Moisturizer: Moisturizers help to add a little plump and smoothness to skin for immediate, but temporary, improvement of appearance. A rich moisturizer that many of our patients like is SkinCeuticals Triple Lipid Restore.

To combat accelerated skin aging in our mid-50s and up we need to generate significant collagen in addition to elastin.  For maintaining and improving skin texture we add more robust collagen boosters to typical rejuvenating procedures that produce collagen and elastin.

Some procedures we might recommend:

• PicoWay Resolve (~5-10 treatments/yr): PicoWay Resolve represents a revolutionary approach in rejuvenating lasers. It operates with picosecond lasers, which generate minimal heat compared to traditional resurfacing lasers, thereby reducing thermal damage to the surrounding skin. This approach has two significant benefits: it minimizes downtime and supports the production of elastin alongside collagen, yielding results that look exceptionally natural. Additionally, PicoWay is effective in improving skin tone by addressing hyperpigmentation.
• Non-Ablative Fractional Laser Resurfacing (~5 treatments/yr): Fractional resurfacing lasers such as ResurFx are powerful enough to produce significant collagen that can reverse fine lines and wrinkles.  They can be combined with IPL treatment in what is called a PhotoFractional treatment to treat hyperpigmentation and redness while also improving skin texture.
• AcuPulse CO2 Fractional Resurfacing Laser (~1 treatment every 1-2 years): This is the strongest of the fractional resurfacing lasers, with the most robust collagen generation of all the laser devices.  This translates to great skin tightening and smoothing of wrinkles.  If our patients in the mid-30s to mid-40s have premature wrinkling we will recommend AcuPulse, otherwise we will wait until age 55+ for this one.  AcuPulse has a long recovery of about 7-10 days of solid downtime.
• Radiofrequency (~4 treatments/yr): RF devices, including technologies like TempSure (NOT RF microneedling), offer an effective solution for stimulating collagen and elastin production throughout the skin. Additionally, they enhance the skin's natural hyaluronic acid production, providing hydration in addition to skin rejuvenation
• Regenerative Aesthetics (~5 treatments/yr): In recent years we have had groundbreaking advancements in cosmetic dermatology, particularly within the field of regenerative medicine. Initially, most of our treatments involved PRP (platelet-rich plasma) treatments, utilizing the natural growth factors found in a patient's own blood to foster skin rejuvenation. Today, our repertoire has expanded to include even more potent regenerative treatments, such as exosomes and specialized growth factor solutions derived from laboratory cell cultures. These advanced solutions, designed to tap into the body's innate self-healing abilities, can be either injected directly or delivered via microneedling into the skin, offering a cutting-edge approach to skin care.
• Ultherapy (~1 treatment/yr): Ultherapy uses micro focused ultrasound to heat specific depths of skin to tighten and lift without downtime.
• Medical Microneedling (~5 treatments/yr): Microneedling offers a potent method for stimulating collagen and elastin production, serving as a non-energy-based alternative to traditional treatments. It's important that microneedling is performed by an experienced physician to ensure safety and effectiveness. Improper technique or overly aggressive treatment can lead to adverse effects on the skin, underscoring the importance that these treatments are performed by experienced physicians.
• SKINVIVE (~2 treatments/yr): SKINVIVE is the latest breakthrough in injectable aesthetic treatments in the US market. This innovative product, based on hyaluronic acid, is a novel category of injections known as skin boosters. SKINVIVE is akin to delivering a highly effective, long-lasting serum directly beneath the skin, enhancing smoothness, hydration, and a radiant glow. Dubbed our "icing on the cake" for skin texture improvement, SKINVIVE injections are a valuable addition to anyone's aesthetic routine, offering universal benefits. Literally EVERYONE can benefit from SKINVIVE.

By the time most patients with lighter skin tones have hit their mid-50s, significant sun damage has caused uneven skin tone, sun spots, and broken blood vessels.

Some procedures we might recommend:

• PicoWay Resolve (~3-5 treatments/yr): The PicoWay Resolve laser not only excels in stimulating collagen and elastin production but is also the best choice for  tackling hyperpigmentation issues. It effectively addresses not just hyperpigmentation caused by sun damage and aging but also conditions like melasma and hyperpigmented scars, making it a versatile tool in improving skin tone.
• IPL (~3 treatments/yr): Intense Pulse Light (IPL) therapy is a highly versatile treatment. It is capable of addressing a wide array of skin concerns. It can reduce excess redness caused by broken blood vessels and visible veins on the face, and offers relief from acne and rosacea symptoms. IPL is also great for reducing brown hyperpigmentation spots. Regular IPL treatments are a necessity for maintaining even skin tone in most patients with lighter skin tones.
• Chemical Peels (~3-5 treatments/yr): We provide an array of chemical peels, each formulated with a unique blend of acids tailored to specific skin concerns. Among these, we favor some of the VI Peels as our favorites.  Peels such as the VI Peel Precision Plus are particularly effective for patients who are both looking to address skin pigmentation issues and also desire an improvement in skin texture, offering comprehensive benefits for a rejuvenated complexion.
• HydraFacial MD (~5-10 treatments/yr):  HydraFacial treatments can improve hyperpigmentation and even redness with regular treatments.

In addition to improving the skin, optimized face and neck rejuvenation requires that we also address underlying structures such as muscle, bone, and fat. Overuse of muscles such as those in the forehead, and around the eyes, causes them to overdevelop in relation to the thinning skin and fat, producing dynamic wrinkles in the forehead and crow’s feet.  Loss of muscle and bone in the mid face creates deepening nasolabial folds and hollows under the eyes, and as the loss of volume progresses marionette lines and even worsening of double chin.

Some procedures we might recommend:

• Botox or Daxxify (~2 treatments/yr): Neuromodulators such as Botox and Daxxify are used to relax overused muscles that cause dynamic wrinkles.  Primary areas of treatment include between the eyebrows, around they eyes, and the forehead.
• Fillers: Fillers are ideally used to add volume in precise locations in order to combat the volume loss that occurs with aging. If they are added correctly, the results look completely natural and can be very impressive.
• Biostimulatory Fillers: Unlike hyaluronic acid based fillers, biotstiumlatory fillers such as Sculptra and Hyperdilute Radiesse add more uniform and subtle volume when injected properly and stimulate the production of collagen and elastin.
• EMFACE: EMFACE is a great device to build muscle tone back up in key facial muscles that support our skin. EMFACE is a great addition or alternative to facial fillers, and produces a completely natural result as it is working with your own muscles. EMFACE Submentum treatment can also treat double chin.

*Note: In order to have the most natural appearing rejuvenation results it is important to address all aspects of face and neck aging.  That is why we stress our Global Approach to Natural Beauty. We understand that there may be practical limitations in terms of cost and time that may not allow this to be a possibility for everyone. We only mean to present here the ideal face and neck rejuvenation plan.

We customize our Global Approach to Natural Beauty to each individual’s specific needs.  But an example yearly protocol could include:

• 3 sessions of Botox or Daxxify
• 3 PhotoFractional Treatments per year
• 5 Sessions of PicoWay or 4 sessions of TempSure
• Consider AcuPulse CO2 Laser
• Ultherapy
• EMFACE
• 2 sessions of SKINVIVE
• Biostimulatory Fillers and/or Regenerative Aesthetics with Exosomes
• Additional Filler as needed for volume loss

Choosing appropriate skincare remains an important part of anti-aging over the age of 65.  For these patients we sometimes recommend stronger actives and richer moisturizing ingredients than for younger patients.

• Sunscreen: We have a variety of broad range sunscreens that we recommend for patients including EltaMD UV Elements Broad-Spectrum SPF 44.
• Retinoids: Prescription tretinoin products should be continued.
• Vitamin C: Vitamin C Serums are a great option for helping to prevent and treat hyperpigmentation.  iS Clinical Super Serum Advance Plus is one of our favorites.
• Hyaluronic Acid: Serums that contain HA are a great option to add hydration before a moisturizing step. SkinCeuticals H.A. Intensifier is an option with very high and effective HA concentration.
• Moisturizer: Moisturizers help to add a little plump and smoothness to skin for immediate, but temporary, improvement of appearance. A rich moisturizer that many of our patients like is SkinCeuticals Triple Lipid Restore.

Over the age of 65 it becomes very important to make use of exosomes, growth factor solutions, and other regenrative aesthetic techniques as our bodies are less able to generate collagen and elastin due to naturally diminished growth factors.

Some procedures we might recommend:

• PicoWay Resolve (~5-10 treatments/yr): PicoWay Resolve represents a revolutionary approach in rejuvenating lasers. It operates with picosecond lasers, which generate minimal heat compared to traditional resurfacing lasers, thereby reducing thermal damage to the surrounding skin. This approach has two significant benefits: it minimizes downtime and supports the production of elastin alongside collagen, yielding results that look exceptionally natural. Additionally, PicoWay is effective in improving skin tone by addressing hyperpigmentation.
• Non-Ablative Fractional Laser Resurfacing (~5 treatments/yr): Fractional resurfacing lasers such as ResurFx are powerful enough to produce significant collagen that can reverse fine lines and wrinkles.  They can be combined with IPL treatment in what is called a PhotoFractional treatment to treat hyperpigmentation and redness while also improving skin texture.
• AcuPulse CO2 Fractional Resurfacing Laser (~1 treatment every 1-2 years): This is the strongest of the fractional resurfacing lasers, with the most robust collagen generation of all the laser devices.  This translates to great skin tightening and smoothing of wrinkles.  If our patients in the mid-30s to mid-40s have premature wrinkling we will recommend Accupulse, otherwise we will wait until age 55+ for this one.  AcuPulse has a long recovery of about 7-10 days of solid downtime.
• Radiofrequency (~4 treatments/yr): RF devices, including technologies like TempSure (NOT RF microneedling), offer an effective solution for stimulating collagen and elastin production throughout the skin. Additionally, they enhance the skin's natural hyaluronic acid production, providing hydration in addition to skin rejuvenation
• Regenerative Aesthetics (~10 treatments/yr): In recent years we have had groundbreaking advancements in cosmetic dermatology, particularly within the field of regenerative medicine. Initially, most of our treatments involved PRP (platelet-rich plasma) treatments, utilizing the natural growth factors found in a patient's own blood to foster skin rejuvenation. Today, our repertoire has expanded to include even more potent regenerative treatments, such as exosomes and specialized growth factor solutions derived from laboratory cell cultures. These advanced solutions, designed to tap into the body's innate self-healing abilities, can be either injected directly or delivered via microneedling into the skin, offering a cutting-edge approach to skin care. Because at this age our body has significantly diminshed growth factors, regenerative aesthetic techniques become particularly important.
• Ultherapy (~1 treatment/yr): Ultherapy uses micro focused ultrasound to heat specific depths of skin to tighten and lift without downtime.
• Medical Microneedling (~5-10 treatments/yr): Microneedling offers a potent method for stimulating collagen and elastin production, serving as a non-energy-based alternative to traditional treatments. It's important that microneedling is performed by an experienced physician to ensure safety and effectiveness. Improper technique or overly aggressive treatment can lead to adverse effects on the skin, underscoring the importance that these treatments are performed by experienced physicians.
• SKINVIVE (~2 treatments/yr): SKINVIVE is the latest breakthrough in injectable aesthetic treatments in the US market. This innovative product, based on hyaluronic acid, is a novel category of injections known as skin boosters. SKINVIVE is akin to delivering a highly effective, long-lasting serum directly beneath the skin, enhancing smoothness, hydration, and a radiant glow. Dubbed our "icing on the cake" for skin texture improvement, SKINVIVE injections are a valuable addition to anyone's aesthetic routine, offering universal benefits. Literally EVERYONE can benefit from SKINVIVE.
• Facelift and/or Neck Lift Surgery: For some patients, the amount of laxity and the number of treatments necessary to treat it, gets to the point where the most logical step is to undergo a surgical lift.  Despite the very high cost and long recovery from these procedures, patients need to realize that they do not solve all aspects of facial aging.  After undergoing a facelift, patients will have to continue to address structural, skin texture, and skin tone issues to maintain as natural of an appearance as possible.

By the time most patients with lighter skin tones have hit their mid-60s there is significant sun damage has caused uneven skin tone, sun spots, and broken blood vessels.

Some procedures we might recommend:

• PicoWay Resolve (~3-5 treatments/yr): The PicoWay Resolve laser not only excels in stimulating collagen and elastin production but is also the best choice for  tackling hyperpigmentation issues. It effectively addresses not just hyperpigmentation caused by sun damage and aging but also conditions like melasma and hyperpigmented scars, making it a versatile tool in improving skin tone.
• IPL (~3 treatments/yr): Intense Pulse Light (IPL) therapy is a highly versatile treatment. It is capable of addressing a wide array of skin concerns. It can reduce excess redness caused by broken blood vessels and visible veins on the face, and offers relief from acne and rosacea symptoms. IPL is also great for reducing brown hyperpigmentation spots. Regular IPL treatments are a necessity for maintaining even skin tone in patients with lighter skin tones.
• Chemical Peels (~3-5 treatments/yr): We provide an array of chemical peels, each formulated with a unique blend of acids tailored to specific skin concerns. Among these, we favor some of the VI Peels as our favorites.  Peels such as the VI Peel Precision Plus are particularly effective for patients looking to address skin pigmentation issues and desire an improvement in skin texture, offering comprehensive benefits for a rejuvenated complexion.
• HydraFacial MD (~5-10 treatments/yr):  HydraFacial treatments can improve hyperpigmentation and even redness with regular treatments.

In addition to improving the skin, optimized face and neck rejuvenation requires that we also address underlying structures such as muscle, bone, and fat. Overuse of muscles such as those in the forehead, and around the eyes, causes them to overdevelop in relation to the thinning skin and fat, producing dynamic wrinkles in the forehead and crow’s feet.  Loss of muscle and bone in the mid face creates deepening nasolabial folds and hollows under the eyes, and as the loss of volume progresses marionette lines and even worsening of double chin. Above the age of 65, volume loss is the leading cause of aging that we must deal with.

Some procedures we might recommend:

• Botox or Daxxify (~2 treatments/yr): Neuromodulators such as Botox and Daxxify are used to relax overused muscles that cause dynamic wrinkles.  Primary areas of treatment include between the eyebrows, around they eyes, and the forehead.
• Fillers: Fillers are ideally used to add volume in precise locations in order to combat the volume loss that occurs with aging. If they are added correctly, the results look completely natural and can be very impressive.
• Biostimulatory Fillers: Unlike hyaluronic acid based fillers, biotstiumlatory fillers such as Sculptra and Hyperdilute Radiesse add more uniform and subtle volume when injected properly and stimulate the production of collagen and elastin.
• EMFACE: EMFACE is a great device to build muscle tone back up in key facial muscles that support our skin. EMFACE is a great addition or alternative to facial fillers, and produces a completely natural result as it is working with your own muscles. EMFACE Submentum treatment can also treat double chin.

*Note: In order to have the most natural appearing rejuvenation results it is important to address all aspects of face and neck aging.  That Is why we stress our Global Approach to Natural Beauty. We understand that there may be practical limitations in terms of cost and time that may not allow this to be a possibility for everyone. We only mean to present here the ideal face and neck rejuvenation plan.

We customize our Global Approach to Natural Beauty to each individual’s specific needs.  But an example yearly protocol could include:

• 3 sessions of Botox or Daxxify
• 5 sessions of PicoWay Resolve or 4 sessions of TempSure
• 5 PhotoFractional Treatments with exosomes or Medical Microneedling  with Exosomes
• AcuPulse Laser
• EMFACE (series of 4 per year)
• Biostimulatory Fillers +/- exosomes
• Additional Filler as needed for volume loss
• 2 sessions of SKINVIVE