REFRESHED AT ANY AGE: Let’s Explore The Most Common Skin Rejuvenation Techniques


Do you purposely not smile to avoid crows’ feet? Is your bathroom counter cluttered with drug store creams? We all know aging is a natural process and we can’t completely run from it. But who says we can’t age gracefully? Let’s keep people guessing on our age and look refreshed daily. Skin is our largest organ-it protects us from the environment, helps to regulate our temperature, providing us with tactile sensations as we explore the world around us. Wrinkles, sun spots, sagging skin and increased fat deposits all combine to give people the impression of increased age and lower vitality. Chronic sun damage allows those tell tale signs of aging to unveil themselves even more. Thankfully there are many ways to allow your inner vitality to shine through, by exploring simple non-surgical techniques that reverse the skin aging processes. There are cosmeceuticals (creams, lotions, gels, serums), fillers (Restylane, Perlane, Juvederm, Radiesse, Sculptra, Artefill, etc.), light-based procedures (laser, IPL, LED, infrared) and botulinum toxin injections (Botox, Dysport)-let’s explore each of these skin rejuvenation techniques.


Botox – Botox has become the most widely used wrinkle treatment due to its fast and predictable results. The clostridium botulinum toxin type A was originally discovered in 1817 after victims consumed contaminated sausage and home canned goods. This bacteria’s toxin works by paralyzing all muscles in the body, including eventually the muscles of respiration. Thankfully, due to the advancements in food processing, consuming the botulinum toxin type A is not as likely. During World War II, the toxin was isolated in its pure form in order to study its effects. However, it wasn’t until the 1970s when an ophthalmologist successfully used the isolated pure toxin to treat disorders of the eye muscles. The botulinum toxin was injected into the muscles surrounding the eyes, which causes controlled paralysis of the muscles. In the 1980s, ophthalmologist Jean Carruthers noticed that patients in whom she had treated with the botulinum toxin experienced a pleasing side effect; reduced wrinkles and frown lines. Her husband Alastair Carruthers, a dermatologist, began injecting the botulinum toxin to treat facial frown lines, thus beginning the cosmetic wonder of Botox injections! How does Botox work? Botox and Dysport use the purified toxin mixed with a saline solution and injected with a tiny needle about the size of an insulin syringe.


The face is treated prior to the procedure with a topical numbing agent further decreasing any discomfort during the injections. The controlled botulinum toxin injection temporarily paralyzes the muscles injected causing a noticeable reduction in wrinkles and frown lines for a more youthful and worry free expression. A typical treatment usually lasts approximately 3 months and each treatment you receive allows the collagen in your skin to unfold and the wrinkles disappear. After each Botox injection the muscle fibers are slightly weakened and the collagen takes a little more time to reform the wrinkle, allowing your body to inherently retrain your facial muscles to relax. An example of retraining after a series of botulinum toxin injections is, if you commonly furrow your brow while concentrating, after treatment, you learn to do so without firing those brow muscles, leaving your forehead looking younger and more refreshed. How much does Botox cost? Most physicians offering Botox charge $10-13 dollars per unit for the forehead or frown lines; a typical male may need approximately 20-30 units and a female 15-20. Crows feet or smile lines typically need 6-10 units per eye.


Light Therapy – We commonly use light to enhance our natural beauty and improve our sense of wellbeing. Basking in the sun’s rays can add a little bronzing to our skin, improve our mood and increases our bodies stores of Vitamin D, which is necessary for bone, skin and mood health. Unfortunately the UVA damage from the sun can cause aging and skin cancer. From studying the pros and cons of light exposure however, has come the wonder of intense pulsed light therapy or IPL and the use of lasers. IPL uses concentrated visible light, filtering out all unnecessary light, including damaging UV rays, concentrating certain wavelengths of light for a multitude of skin lightening and tightening treatments. IPL includes popular treatments such as photofacials, hair removal, photodynamic therapy for acne and treatment for rosacea.

Popular laser treatments include: hair removal, resurfacing of wrinkled skin, and treatment of unwanted pigmentation (brown and red spots). The differences between these two types of therapies are:

1. Cost-laser resurfacing can run in the thousands of dollars range whereas IPL is in the hundreds.

2. Lasers consist of one concentrated wavelength of light whereas IPL used a range of wavelengths, thereby treating a broader range of issues in one session.

3. Lasers have the ability to penetrate deeper into the skin, especially when fractionated, so they are better than IPL at getting rid of wrinkles and very deep pigmentation.


How does IPL work? Areas of discoloration and dilated blood vessels or spider veins react quickly to IPL treatments such as the photofacial. The pulsed light and heat blows away those spider veins and areas of redness instantly causing a clearer complexion. The heat generated during the treatment causes collagen and fibrin formation, which reduces the appearance of fine lines and wrinkles over time. When ultrasound is combined with the IPL treatment, the effect of tightening the skin is enhanced. This natural tightening can be highly desirable for areas under the neck, the arms, thighs, belly and hands. IPL can be a great option for those wanting to have radiant firmer skin without the more drastic forms of plastic surgery. Depending on the type of IPL treatment received, you may be able to return to work the next day with a broad-spectrum sunscreen. For more intensive chemical peels, you may want to schedule in one to three days off to allow your skin time to recuperate.


Microdermabrasion – The focus for many of these treatments is to efficiently exfoliate your skin. Typically we can have approximately 40 layers of dead skin on our faces! Removing this thick dead skin layer allows the vibrant healthy skin cells to glow. How much does Microderm cost? Treatments of the face, neck, décolleté, hands and arms vary depending on the size of the area treated and the type of IPL treatment used. Microdermabrasion costs from $60-120 per treatment. Chemical peels can range from $150 for a simple treatment to a few hundred dollars for a much more extensive peel. Photofacials may cost approximately $300 to $500 per treatment. Most IPL treatments respond the best with a series of three to five treatments to see the best long-term results of refreshed and rejuvenated skin.


Injectable Fillers – Looking in the mirror at that deep crevasses between your eyes, or etched in creases that punctuate your mouth? Small wrinkles that appear in our late 20s and 30s deepen as the collagen matrix under our skin dehydrates. This process causes our skin to sag, fine lines to appear predominant and deep set wrinkles to add years to our face, neck, décolleté and hands. Also, those cherub like rounded cheeks and smooth hands of our childhood begin to degenerate, as cheekbones become predominant, temples a little sunken and hands show each ligament, tendon and bone. A general rule of thumb for looking younger is to not show off your skeleton underneath! Injectable fillers work magic in this arena, adding needed volume and shaping to key areas of your face and hands. The effects of the fillers are accumulative, therefore people will notice you look younger, but why or how can be a secret between you and your doctor. How do the fillers work? Hyaluronic acid fillers such as Perlane, Restylane and Juvaderm use the naturally occurring hyaluronic acid that is found in high amounts in soft connective tissues, the fluid surrounding the eye and the skin and joint cartilage. These fillers may last from six to nine months allowing you to enjoy that refreshed look for much longer. Receiving a second treatment at around four to six months can greatly extend the life of the filler. Hyaluronic acid fillers can also be a great option for first time patients, as injecting an enzyme called Hyaluronidase can quickly and easily dissolve the hyaluronic acid-if you are not happy with the results, the filler can be dissolved! Calcium hydroxylapatite fillers such as Radiesse provide a longer lasting option to smooth moderate to severe wrinkles and folds. The calcium hydroxylapatite (CaHA) is a smooth form of calcium, which is identical to the mineral in bones and teeth.


CaHA stimulates the skin to gradually produce more collagen, creating subtle results over time; therefore the results from one injection can last for up to a year. Even with these subtle and lasting results, you won’t be able to hide your treatment from your dentist as the CaHA shows up as white lines wherever injected in x-rays! Scupltra was originally placed on the market to increase volume for patients with HIV-related subcutaneous fat loss. Sanofi-Aventis, the manufacturer, continues to offer a sliding scale program to provide this treatment for qualified recipients. Recently, Scupltra was approved for aesthetic use as a reliable and long lasting injectable filler. The solution is Poly-L-lactic acid, a biodegradable, biocompatible synthetic material that has been used as absorbable suture material for decades. The solution creates a controlled micro-reaction on the cellular level, which builds collagen and thickens the skin. Sculptra is ideal for deep nasolabial folds, marionette lines in the forehead and sunken cheeks and temples. This treatment builds over time therefore a series of three to six treatments is recommended for the greatest results. What is the cost? Hyaluronic acid fillers, Perlane, Restylane and Juvaderm typically cost around $300 to $700 per syringe. Radiesse, calcium hydroxylapatite filler cost $935 and Scupltra is approximately $800 per vial. There are differences between each type of filler and you and your doctor will decide which is the best option to achieve the greatest results.


Cosmeceuticals – Our skin is our first defense against the environment and it is essential for skin health to protect and repair our skin daily. General skin care guidelines such as decreasing sun exposure, proper hydration, avoiding cigarette smoke and eating a diet rich in antioxidants will support vital skin health and promote graceful aging. For topical defense a full-spectrum sunscreen with UVA/UVB protection should be applied daily-especially after any aesthetic procedures. Antioxidants taken internally have many preventative and anti-aging benefits; topically they have similar effects. The potent antioxidant Vitamin C-ester serum can be applied to the face, neck, décolleté, arms and hands to revitalize environmentally damaged skin. Vitamin C-ester increases collagen formation, reduces fine lines and wrinkles and lightens skin pigmentation. As we age, the loss of collagen, accumulation of fat deposits and decrease in skin elasticity can cause not only facial wrinkles but loosens skin under the chin and neck commonly called “turkey neck.” Cosmeceuticals, such as Nectifirm targets this specific area helping to smooth and tighten the chin and neck. Nectifirm uses a blend of lipopeptides and natural extracts, which increase collagen production and stimulates fibroblasts to make the skin thicker, firmer and smoother. Visible lifting and tightening of this problem area can be seen in approximately seven weeks. ( By Darren A. Farnesi MD – For more articles from Rage visit )