“I want to look like me, just better.” Those are the words of one of our patients who so elegantly and simply defined her wants. I believe she also captured the essence of facial rejuvenation. I rail against the “FOX TV” expressionless foreheads and monster lips that scream Botox and fillers. An understanding of the aging face, characterized by volume loss, is absolutely essential to providing the best treatment options. We refer to the parts of the face as aesthetic units, each with its own unique character and requirements. As we now have more options than ever for non-invasive and subtle treatment of the aging face, knowing which injectable product will provide the best solution to every area is critical to great outcomes.
FOREHEAD – Forehead wrinkles are best treated with muscle relaxers, which block the release of the neurotransmitter acetylcholine. This freezes the muscles that cause the skin to wrinkle in the forehead, and creates an aesthetically pleasing smooth new look to the forehead. Botox and Desport are both temporary in duration and need to be injected every four months to maintain maximum correction

BETWEEN THE EYES – Glabellar frown lines, between the eyebrows, often called “ the elevens” or “nickel slots” are caused by contraction of the skin by the corrugator and procerus muscles. Botox is a perfect solution to these problems as well as the “crows feet” on the sides of the eyes,

UNDER THE EYES- Hyaluronic acid fillers such as Restylane or Juvederm are the treatment of choice to replace volume loss that appears over time, causing the face look older and tired. Hyaluronic acid is naturally occurring substance in many foods like sweet potatoes leafy veggies, citrus fruits and even red wine. It also occurs naturally in our body. There are studies to show that injecting hyaluronic acid also increases hydration to the skin by attracting water to the filler. Some suggest that injecting fillers may actually encourage the body to make more of its own hyaluronic acid in response to the injection

CHEEKS – Skill and finesse are needed to correctly replace volume in the upper face and restore the youthful contour of the cheek and cheekbone area.  Hyaluronic acid products including Voluma and more long acting volume replacement injectable work well in this area. Understanding the facial anatomy, and the location of the arteries veins and nerves in the face, is essential to preventing complications
THE LOWER FACE- There are numerous HA products that have a role in this aesthetic unit.  Correction of the “smile line” or nasolabial folds from the nose to the upper lip, softens the face and blunts the jowl that results as these lines deepen and loose volume. Marionette lines are folds, that extend downward from the sides of the mouth to the chin, making the mouth look stern, sad or angry. Correcting these lines also blunts lower faces jowls and makes the mouth and lower face look brighter and happier.

THE LIPS Studies have shown that when we look another person in the face, the first thing that our eyes focus on is the mouth. The lips and mouth are a very important aspect of the first encounter. As the aging process continues the lips become thinner and roll inward, showing less teeth in smile and conversation. The face appears more stern. Oral commissures, where the corners of the mouth turn downward contribute to an angry or grumpy appearance. The Judicious and conservative use of fillers in the lips is an important part of restoration of the youthful appearing in the aging face. Fillers in younger patients also have a role in making the elements of lip, cupids bow and vermillion, appear more beautiful, sensuous and inviting.

THE NECK- The area under the chin develops fullness over time, referred to as sub mental sagging. Kybella is a relatively new injectable recently approved by the FDA for treating the ‘double chin’ by dissolving the fat in that area. One caveat, the treatments can be uncomfortable and uneven appearance has been reported. Some success has also been reported using this injectable for “ off label “ fat deposits elsewhere. So…. stay tuned.

The results of using a combination of fillers and Botox definitely produce a “wow” effect, and are a quick way to brighten the face, or take away years of aging.
While the process may appear easy, there is a very long learning curve to becoming excellent with injectables and achieving reliable and safe results.  Beware of who does your fillers!! Complications, while unusual, can and do occur and can be devastating. Fillers placed incorrectly can interfere with circulation to the skin and areas of the face. Filler is also an implant that has the potential to become infected if absolute sterile technique is not used. Fillers should always be done in a physicians facility, with all of the necessary equipment and medications to treat any complication immediately should one occur. In our facilities, all injectables are done by Plastic Surgeons only. We believe this is the best way to assure excellent results with ultimate safety.

The New Old Age: How the body ages and how to keep it young — Longwood Seminar from Harvard Medical School on Vimeo.

Laser resurfacing is a proven way of enhancing the appearance of your skin. It not only reduces wrinkles, age spots, acne scars, and unwanted hair, it will also tighten the skin and improve tone.

Because lasers can do so much, and there are so many competing products and promises on the market place, it can be difficult to choose the best treatment.  It is very important to be informed, but it is also easy to be overwhelmed.

So, before you get lost on the Google information highway, lets step back from the hype and confusion and focus on some important things that you need to know when considering facial rejuvenation.

• Don’t get hung up on brand names, new gadgets, great deals, groupons, the latest article in Cosmo, or the newest “med spa” in your mall. The cosmetic world is full of ‘great new ideas’ that ended up with bad results and unhappy patients.  I love a great deal as much as anyone. But your face is not the place to go with the lowest cost option.  First, focus on your goals; what problems you want to address and what are the results you can reasonably expect to achieve.  Second, find a plastic surgeon you trust and respect to help you to tailor the best treatment options for your skin type.

• Who performs your laser treatments will have a profound effect on your results. In the hands of a highly trained plastic surgeon, lasers are a safe and easy way to improve your appearance.  But in the hands of a poorly trained practitioner, laser treatments can be dangerous, lead to bad outcomes, or simply waste your time and money. Choose the person to perform you procedure based upon experience, training, qualifications and trust.

• Different lasers are optimal for different treatments. If you aren’t being treated with the best laser for your skin and goals, you won’t get the best results. A professional with a long track record of success and access to numerous devices can choose the correct tools and treatment for you specific needs. Remember, if all you have is a hammer, everything looks like a nail.  Your plastic surgeon will have different lasers available and work with you to pick the right one for you

• Having dark skin tones is no longer a contraindication to laser treatments. While it is true that darker skin tones can experience pigment changes, there are now lasers that can safely treat darker skin types including Hispanic, Asian, Middle Eastern and African American without affecting tone.  It is critical, however, to be certain that the correct device is used for those skin types. Your plastic surgeon will know what treatment is appropriate and safe for you.

• Plan on having multiple treatments. While a single treatment will address patient needs in some cases, multiple procedures will often be part of the treatment plan to achieve the best results.  This trade-off comes with no down time and excellent long-term results.  Treatments should be custom designed for each patient.

• Depending upon the procedure you choose, you may have some down time. Some treatments may require you to make adjust your social and work schedule for a few days. It is important to have a discussion with your Plastic Surgeon regarding the timing of your procedure and your tolerance for down time.  Our office offers evening and weekend hours to help you heal on your own time and get back to work and play quickly.

• Certain medications and underlying medical conditions will affect the way your skin reacts to laser treatments. Your Plastic Surgeon will always take a detailed medical history, including any medications or medical supplements that might affect your recovery. Some acne medications can lead to poor healing or scaring following laser treatments.  Over the counter medications including aspirin and non-steroidal anti-inflammatories can lead to bleeding. If you are prone to cold sores, laser treatments may lead to an outbreak.  Your physician will want you to take medications before and after your treatment to help prevent post treatment cold sores and the problems associated with them.  Cigarette smoking, diabetes and other chronic medical conditions can also delay healing and adversely impact outcomes.  Your plastic surgeon will have a detailed discussion with you before your procedure and chose the best treatment for you.

Laser and light-based treatments can be a very safe, easy and effective way to maintain youthful appearance, healthy skin, and rejuvenate the aging face.  Our team has been an international center of excellence in facial rejuvenation for over two decades.

Please contact our offices at The Mount Auburn Hospital in Cambridge Massachusetts or The Beth Israel Deaconess Hospital in Milton Massachusetts (www.rochmanmd.com) or WorldPath Health (www.worldpathmedicine.com) and schedule a consultation to learn what options are best for you

The association of youth and beauty is universally accepted in society. The desire for beautiful skin color and texture, absence of wrinkles, lustrous hair has fueled huge growth in the cosmetic and surgical industries. Women who possess a youthful appearance are consistently rated more attractive than older appearing women. Studies on skin texture and color have demonstrated that humans have a preference for younger appearing skin that is viewed as both healthier and more attractive.

In the current cauldron of political correctness, it may seem impolitic to say, but facial wrinkles, spots, saggy skin and aging faces discriminate based on skin color. White, Black, Latino, Middle Eastern, Asian are all different skin types, which  develop lines, laxity and loss of volume  in different ways and at different rates.  Indeed, the aging process transcends politics and national borders.  It’s how we battle back that makes the difference.

Aging is a complex process that reflects biological, environmental and genetic influences. Deeper pigmented, darker skin has characteristics that make its aging process unique.  The thicker and more compact dermis  makes facial lines less noticeable.   Increased  concentration of the pigment melanin  also make the skin more vulnerable to pigment changes and scaring.  It is critical to understand the unique structural and functional differences among ethnicities, and to have the appropriate modalities for various skin types, both of which are essential to treat the signs of again. Over the past 20 years we have specialized in rejuvenation of the aging face, and the unique requirements of patients from around the globe

**Here is the simple truth about White skin; the Irish, English, Scandinavian “peaches” complexion is going show more signs of aging.  Blame the sun, and the fact that light skin has very little pigment, or melanin, to protect against it.  UV rays from the sun break down collagen, and cause wrinkles that start as early as your 20’s.  Your skin produces pigment to protect itself.  Along with that come the dark spots.

And the skin cancers.  I have seen many young people in there 20’s with their first skin cancer.

The good news for this skin type is that we can be more aggressive with laser and other anti-aging treatments, since light skin does not absorb as much laser energy and we don’t have to worry about hyperpigmentation,

The essentials for your skin type;

• Sunblock, sunblock, sunblock.  At least SPF 30 or greater, every day, re-applied every 3 hours or so.
• Good anti-aging skin care regimen. We have designed an anti-aging and anti-pigment protocol unique to this skin type. There are others, but there is also a lot of junk.   Make sure you are investing in quality.
• Quit smoking. It is the fast track to wrinkles, and worse.

**“Black is beautiful” has never been more true than when talking about aging skin types. You can smile and laugh and squint all you want because you wont even begin to see wrinkles until your 50”s.  The increased melanin, which gives the skin its deep pigment, along with thicker dermis and prolonged keratinocyte life, protects it against wrinkles, often for many decades.

Increased pigment, however does lead to uneven skin tone.  The pigment cells are larger and can react dramatically to minimal irrigation with dramatic color irregularities and scaring   Volume loss is also a telltale sign of aging in people with this skin type

Things to think about include topical skin care regimens, which include bleaching and fading creams, and fillers for volume replacement.

** Middle Eastern Skin types are blessed with extra pigment in the skin, so that lines don’t show up until well into your 40’s 50’s or even later.  I have seen many women with this skin type who never develop permanent wrinkles

But when in comes to skin, no one gets a free ride.  Folks with Middle Eastern skin have also been exposed to Middle Eastern sun…. This skin type has a good chance of developing dark blotches from enhanced sun exposure, dryness, irritation, and hormonal changes.  UV exposure also leads to breakdown of collagen and volume loss at an earlier age.

There are many new modalities now available to treat this skin type.  I use the E-matrix Sublative Laser, designed specifically to treat this skin type. It is important to maintain the skin tone with regular light/laser based peels to continue to correct and improve dark spotty skin.  We also create a personally designed skin care program of products to treat pigmentary changes and keep acne under control. I recommend a multi-tiered approach to early volume replacement and maintenance with products determined by specific location.  And of course, don’t forget the sunblock.

**The Asian paradigm for beautiful skin is pale and silky.  And while many Asian women want lighter, radiant and luminous skin, this skin type is actually thicker; with more pigment producing cells that fair skin.  Asian skin is prone to prominent dark spots, very uneven skin tone especially around the cheeks and forehead, melasma that makes the skin look dusty and dull.  This skin type is also prone to raised round keratoses that may require early surgical intervention. Because of the facial contour, volume loss is common.  I recommend appropriate custom designed skin care regimen, control of acne, Syneron EPL and RF based therapy, specifically programed to Asian skin, and volume replacement when it becomes necessary

Pigments in Latina skin can be as varied as the cultures. There are light skinned Latinas who age more like Caucasians, and very dark pigmented Latinas whose skin ages like black skin.  The universal complaint is discoloration of the cheeks, chin, upper lip and forehead.  According to one survey up to 66% of women will develop some form of melasma during pregnancy.  Sunscreens are important, but melasma is not just from UV radiation so it is important to use a sunblock that contains zinc oxide or titanium dioxide.

Home remedies to correct pigment changes are often used, and generally a bad idea.  Lime and lemon based treatments can cause a toxic reaction when applied to sun exposed skin, and lead to severe hyperpigmentation.   Cocoa Butter is very thick and occludes the pores, leading to acne and further scarring and pigmentation.  Plus, they don’t work to lighten the skin

Across all skin types, across all continents and cultures, the aging process includes photo damage, volume redistribution, and loss of connective tissue and wrinkling of the skin. As life expectancy continues to increase, almost doubling over the past century, and as youthful appearance has become more pivotal to personal success and wellbeing, appearance continues to become of increasing concern.  Our global cultures are now intermixed.  Society has become more heterogeneous.   Ethnic differences are clearly evident every day, in every culture.  Dark Skinned individuals have firmer smoother skin than those with lighter skin of the same age, however aging does occur in all cultures with regard to pigment, wrinkles, volume loss and laxity

When seeking plastic surgical rejuvenation of the aging face our patients know we have been caring for the international community for over two decades, and offer a comprehensive knowledge of the functional principles of ethnic and aging skin, and can property care for aging skin of all populations.

Guy M  Rochman MD

Assistant Professor of Surgery, Harvard Medical School

Chief, Division of Plastic Surgery, Beth Israel Deaconesss Hospital Milton

CEO, WorldPath Health

HealthGrades, a US company that provides information about over 3 million health care providers recently announced the recipients of the 2016 HeathGrade Quality Awards,

Guy Rochman MD received The Outstanding Patient Experience Award for 2016.   Dr. Rochman also received the Outstanding Patient Experience Award in  2014 and 2015 making this the third year in a row that he has been recognized for Quality and Excellence by the prestigious comprehensive  physician rating organization.