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    Prejuvenation: Preventing Fine Lines and Wrinkles

    Dr. Kate Kottwitz, MD 12/03/2021
    As a plastic surgeon, friends and family frequently ask me: When is the right time to start using Botox? I love this question because it always leads to one of my favorite topics — Prejuvenation!

    Prejuvenation refers to starting treatments to prevent aging rather than just treating the signs of aging. Prejuvenation treatments can be divided into three categories: skin care products, injectables, and laser treatments.
    Skin care:
    One of the best things you can do to prevent facial aging is to start skin care in your early 20s. I recommend a facial cleanser, a vitamin C product, and a retinol product (as long as you're not pregnant or breast feeding). In addition, everyone should be using some sort of SPF product every morning — even if you’re not planning to go out in the sun! Sun damage will make your skin age quicker.

    There are many different skin care lines out there, so it can be difficult to determine where to start. I personally like the ZO skin care brand. There is a lot of scientific data behind their products and they also have many products to treat different skin problems such as melasma or rosacea.

    I equate skin care to your daily workout. You're not going to see a change over one day or even one week. Over time, however, you will see changes, and these changes will last long term. A good skin care regimen will be beneficial to your skin health over many years. It's never too early to start!
    Injectables can be divided into two categories: neuromodulators and fillers. Neuromodulators or neurotoxins include Botox and Dysport. Both of these products work in a similar fashion. They are botulism toxins that prevent motion of muscles. When is the best time to start using these? I recommend starting these before you get a static wrinkle. Everyone makes wrinkles when you make a facial expression and move your facial muscles. A static wrinkle refers to a wrinkle that stays when your face is relaxed. Originally, neuromodulators were created to treat these static wrinkles. However, with prejuvenation, the goal is to prevent that wrinkle from ever forming. Therefore, starting a neuromodulator in your 20s and 30s can help prevent these wrinkles from forming.

    When I treat patients with neuromodulators, I treat specifically to the patient’s anatomy and only use the minimal amount needed. I believe that neuromodulators should be tailored to each patient. I also recommend treatment every three to four months or when you start to see motion of the muscles return. What I have found is that if you treat consistently over time, you will require less of the neuromodulator and be able to go a longer time period between treatments.
    Fillers are used to add volume to different facial areas. As you age, volume descends (thank you gravity!). One of the first places you see volume change is in the midface or cheek area. It is difficult to recognize this, as most patients see the changes in their lower face and want to add volume to these areas (such as marionette lines or nasolabial folds). However, adding too much volume to these areas can make the face look funny, as it is not normal to have a large amount of volume there. It's amazing what adding a small amount of volume to the midface or cheek area can do! It can give the illusion that the marionette lines and the lower face have been treated. In addition, adding some volume underneath the eyes in what is called the tear trough area, can make the patient appear to have less dark circles/shadowing and look less tired.

    Many people in their 20s do not need volume in these areas, and I am often treating the lips, nose (liquid rhinoplasty) or augmenting the jawline. It is when you enter your 30s that you may benefit from some additional volume in your cheeks or under-eye area. Once again, starting with a little bit of filler and slowly adding over many years will give you a more natural appearance than treating when you have severe loss of volume in these areas.

    I find that some patients fear filler because social media has shown us a lot of “botched” or unnatural results. However, adding small amounts of volume in certain places on the face can change proportions in a very subtle and natural way. My goal is for you to leave my office and have your friends and family comment that you look well rested or that your skin looks great. They notice a change, but they can't tell exactly what you've done!

    Common filler products include Juvederm and Restylane. These companies make different types of filler, and it can be confusing on which one you should use where. Depending on what areas you need treated, I can recommend the proper type of filler. Fillers can last anywhere from nine months to two years depending on where the filler is injected and which type of filler is utilized.
    3 syringes of filler (tear trough, cheeks, and lips)
    Laser Treatments:
    So you've been putting in your time at home with skin care and you've been keeping your appointments for your Botox and the occasional filler. What else can you do to help prevent aging and keep you looking younger?

    Well, you are in luck! Deaconess has recently acquired some amazing new laser technology called the Sciton laser. This laser has multiple ways to help rejuvenate the skin. These options include:
    • BBL (broadband light) - This laser can treat brown spots, areas of hyperpigmentation, facial spider veins, and areas of redness. It also provides antiaging benefits to the skin. It is performed without any numbing medication and there is no downtime. You can have it done on your lunch break! There have been studies that have shown patients that routinely undergo this procedure can change the expression of genes associated with aging. Long term studies have shown patients appear to age slower. It is recommended to have three to five BBLs in your first year. After the first year, only one to two BBLs per year are needed for upkeep. It is amazing technology! I love seeing areas of sun damage flake off and disappear.
    • Halo - The hybrid fractional laser, or Halo, is a combination ablative and nonablative treatment. What that means is you can have the benefit of an ablative laser without the same downtime! The Halo helps treat fine lines, wrinkles, sun damage, areas of hyperpigmentation, pore size and improves the overall texture of the skin. It is performed with topical anesthesia. Afterwards, you feel like you've had a sunburn, but this improves in a few hours. Swelling can be expected in the first 24 hours. Peeling occurs in the first 48 to 72 hours. By day four and five, you begin to notice the Halo glow! This treatment is great to do on a Friday so you have the weekend to recuperate. One to two Halo treatments are recommended per year.
    • TRL - The Tunable Resurfacing Laser is great for those with deeper wrinkles, especially around the eyes and mouth. This is an ablative laser, so there is longer downtime compared to the Halo. It requires both topical and injectable anesthesia. For those that want big results and have the time to recuperate, it is a great option. For those that are looking for a prejuvenation option, however, I would recommend they start with BBL and Halo.

    I hope you've learned something from this information on prejuvenation. I'm passionate about promoting a good skin care regimen, appropriate use of neuromodulators/fillers, and occasional laser treatments to help prevent the appearance of aging and improve the appearance of your skin.
    If you're interested in any of the above procedures, please schedule a consultation with me, and we can discuss which options are best for you.

    In addition, if you are reading this and you feel like you're too late and beyond the prejuvenation phase, don't worry — I have many surgical options that can be used in combination with nonsurgical options to help with aging. I look forward to seeing you!
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