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What is the most direct route to facial beauty? The answer to that absolutely would be healthy and vibrant skin, hands down. We have lights and lasers, radiofrequency and ultrasound, peels and masks galore, but my patients always want to know what is the one best everyday thing they can slap on their faces to ensure the most benefit to their skin. While the one best topical product would be sunscreen (now don’t roll your eyes just because you’ve heard that ten thousand times – it’s true!), there is pretty much a consensus among those of us who devote our careers to faces that some incarnation of a “retinoid” (the original was Retin-A) is right up there next to sunscreen for preservation of your skin’s vitality.
What is so great about retinoids? First of all, they rev up the turnover of skin, so the outer (essentially dead) layer of cells that can make us look opaque and pasty thins out while the deeper layers become thicker and more springy due to the stimulation of collagen. They also act as an anti-inflammatory and break up some of the stickiness of the cells that plug up our pores. The net result is that after about four weeks or so of regular use, the skin starts to look more plump, clear and luminous. With consistent use of a retinoid over time the skin tends to age more slowly, as studies have shown and as I’ve seen in patients who have used a retinoid for decades. PS – It’s never too late to start. Just remember that because of the more rapid exfoliation of the top layer, you’ll be more sensitive to the sun, so always use a good broad-spectrum sunscreen and reapply at least every hour or two.
The most common reason I hear for people not using a retinoid is that it makes them red and flakey. Other people will tell me that they use one every once in a while on a wrinkle or a blemish. While some formulations are so strong that they are best used for spot treatments, the anti-aging benefits of the retinoids are seen with consistent use over the entire face (with the exception of the upper lids). Retin-A was developed about 45 years ago and we’ve come a long way since then in offering formulations for just about everyone. Your physician or aesthetician can help you find the right one for your particular skin.
Also remember that most skins need to build up a tolerance to a retinoid. We advise our patients to start using one every third night for about two weeks, every other night for two weeks and then nightly. To help your already overburdened brain keep track, start on a date that’s divisible by 3, like the 9th or the 21st; later go to evens or odds. At the end of any month with an odd number of days, anything goes! If you already have a good retinoid that’s still too strong, you can dilute the concentration with a little moisturizer or serum.
by Holly Barbour
Almost every week, a new patient will say something to the effect of, “I want to look better, but I’m so afraid of looking ‘worked-on’”. While there are unfortunate examples of what I call “The Look” all around us, it’s important to know that the sort of overdone, vaguely alien appearance that most of us want to avoid never ever needs to happen. Nor do we need to sacrifice a significant improvement for a natural appearance. We can have the best of both worlds -- really.
It goes without saying that extensive training in the head, eyes/eyelids and neck is imperative for a physician who is going to perform any eyelid, facelift or filler procedures. Additionally, aside from performing the procedures well, the physician needs to make an even more basic assessment of just which procedures need to be performed! As basic as that sounds, there are, for instance, facelifts done when the skin is wrinkled and volume has been lost from the face. In these cases, the lift may be OK technically, but the patient still looks tired, weathered or even a bit flattened out. In other cases, fillers may be given as a “lift” when the problem is gravity and a real lift needs to be done.
Fortunately in many cases revision procedures can be done to correct suboptimal results, although they may need to be “staged”, that is, done over time. In some cases involving fillers, I’ve just seen the patient periodically until a poorly placed or overdone filler starts to wear off. Then we start “tweaking” until eventually the effect is what we want.
The most beautiful and natural looking results require the physician to have a distinct talent, an “eye” for beauty. This, like any artistic talent, is inborn and includes, but goes beyond, technical expertise and training. But when your “work” is done well, it won’t look done; you’ll just look great and people will say things like, “You look wonderful! Did you change your hair?”
Oculofacial Plastic Surgeon, Sarasota, Florida
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