Appendix 1

Beyond Home Care

For twelve chapters, you have been reading about my approach to looking younger. Restoration and rejuvenation instead of renovation are the way to go. I am glad to say that a shift is happening in the world of cosmetic procedures. Advances in technology have made minimally invasive procedures more and more effective. They are less expensive, they require significantly less time for recuperation, and the risk of complications from the procedures is much lower than from surgery. Even so, the procedures are only as good as the professional performing them. That is why it’s so important to find a board-certified dermatologist to guide you on a path that is right for you.

Everyone wants to get in on the action in this lucrative field, because the demand is so high. From aestheticians and nurses at medi-spas to physicians who have not specialized in dermatology, unqualified people everywhere will be selling you hard on neurotoxins, fillers, and laser resurfacing with the promise of firming, toning, and lifting the skin. Do not allow yourself to become a victim. One size definitely does not fit all when it comes to anti-aging. You need to have an experienced and careful dermatologist guide you through the morass of products and treatments, tailoring an individualized program for you.

In planning the most effective way to treat patients, I have to use the six dimensions of aging to determine the best treatment approach for each individual. I have to take into account what a patient wants to achieve, what is motivating the patient to change, what the patient expects from the treatment, and how much effort that patient is willing to put into an anti-aging program. It makes no sense to plan a multi-step regimen and a long-term treatment plan if there is no way a particular patient will be compliant.

When we work with patients, our approach is holistic. I cannot treat the skin without trying to pinpoint underlying causes for the skin problems and helping patients to resolve them. Lifestyle corrections are a big part of treatment plans. The stories that follow will show you how much can be accomplished through skin care and medical rehabilitation.

A BRIEF OVERVIEW OF PROCEDURES

After you have reaped the benefits of the Lancer Method program, you might be interested in taking the improvements a step further by supporting your good work with minimally invasive in-office procedures. These rejuvenating procedures range from chemical peels to laser resurfacing, from fillers to radio wave and ultrasound skin tightening. Your dermatologist will adjust the many, complex settings of the treatment equipment, determine the correct blend of chemicals for your chemical peel, perform laser work, and properly inject fillers and neurotoxins. The proper use of injectables is an art form. No one but your dermatologist should perform a procedure that penetrates your skin. Though they may be medically knowledgeable, nurses, physician’s assistants, and aestheticians should not be giving you fillers or neurotoxins. In my office, I am the only one to do these procedures. In some instances, such as radio wave or ultrasound skin tightening, I set the equipment for the specific patient right before the procedure is to begin. A nurse may perform the treatment, but I do check in regularly to oversee the procedure. Do not accept anything less from your physician. Your doctor has to be directly involved every step of the way.

I will not be using brand names in the procedure descriptions, mainly because technological advances are happening at such a rapid pace, with equipment and procedures constantly being superseded by the “newest” advances. My office is inundated with salespeople and elaborate mailings exclaiming about the latest breakthrough techniques. Cosmetic surgery for anti-aging purposes is about to become obsolete, and this is progress worth applauding in my opinion. Here is a rundown of non-invasive treatments available right now.

Microdermabrasion

This is a quick and easy way to revitalize your skin in less than thirty minutes. It works for all LES types. A minimally abrasive instrument is used to sand the skin, removing the thick, uneven outer layer. The mild abrasion is followed by vacuum suction to remove the loosened dead skin cells. Microdermabrasion is used to treat sun damage, age spots, superficial pigmentation, fine lines, wrinkles, stretch marks, mild acne scars, blackheads, whiteheads, and clogged pores. The technique stimulates collagen production and leaves your skin looking fresh and vibrant. There is no downtime or recovery period, but your skin will be more sensitive to sun exposure after this procedure, so be sure to use sunscreen immediately following a microdermabrasion session.

Skin Tightening

Without damaging the skin’s surface, pulsed light therapy (also known as phototherapy) heats the epidermis and dermis and stimulates the formation of collagen. Skin tightening is the result.

Radio frequency and ultrasound can also be used to firm, tighten, and lift the skin without injuring its surface. These therapies address the foundational layer of skin that lifts and supports the outer layers.

In each case, energy—from radio frequency, ultrasound, or light—heats the fibrous tissue in the dermis and subcutaneous levels. The heat breaks down collagen and elastin and causes these fibers to contract. This shrinking results in tightening, firming, and subtle lifting. The body’s natural wound-healing response kicks in, and more collagen is produced.

No time is needed to recuperate from skin tightening treatments, which are usually performed in a series for optimal results. Your skin will continue to tighten for up to six months after the treatments as the collagen-building process continues. The ultimate lifting and toning occur during the three-month period following the treatment as new collagen is created. Ultrasound therapy has the additional benefit of allowing the physician to see the layers of tissue being targeted during treatment.

Laser Resurfacing

Ablative laser therapy is used to remove top layers of the epidermis to produce smoother, fresher skin. The laser triggers new cell growth and damage repair. Non-ablative laser treatments that are more precisely targeted are used more frequently today.

Laser therapy now uses concentrated, pulsating beams of light aimed at irregularities in the skin. The process removes unwanted, damaged skin in a very precise manner one layer at a time. People with LES IV or more should be very cautious about having laser treatments, as they can cause permanent discoloration.

Laser Fractionated Restoration is a treatment we use at Lancer Skincare. With this new therapy, only a fraction of the skin receives the laser light. The laser directs closely spaced, microscopic beams to the trouble spots while preserving normal healthy skin between the laser spots. The preservation of healthy skin results in rapid healing. Laser resurfacing can improve fine lines and wrinkles around the eyes, forehead, and mouth, sun damage, age spots, acne or chickenpox scars, and enlarged oil glands on the nose.

CO2 laser resurfacing delivers very short pulsed light energy or continuous light beams. This type of laser removes thin layers of skin with little damage to surrounding tissue.

Erbium laser resurfacing is used to remove superficial and moderately deep lines and wrinkles on the face, but can also be used on the neck, chest, or hands.

Lasers are also used for hair and tattoo removal and for treating broken blood vessels.

Do not let anyone who is not an experienced physician do laser work on your skin. There are many different types of lasers. The machines have to be set for frequency, energy, fluence, power, penetration, beam configuration, depth of penetration, and diameter of the beam. You need a specialist who knows how to set up the equipment in the right way for your skin.

Chemical Peels

One of the least invasive ways to improve the appearance of your skin, chemical peeling, uses chemical solutions to improve and smooth its texture by removing damaged outer layers. Your doctor will use a formula that has been adjusted for your needs. The concentrations of the chemicals result in light, medium, or deep peels.

  • Light peels improve uneven pigment, dryness, acne, or fine wrinkling. This level of peel offers a light exfoliation. The chemicals often used are alpha and beta hydroxy acids, glycolic acid, lactic acid, salicylic acid, and maleic acid, which are all mild. You will need up to six treatments for the full benefit of a light peel.
  • Medium chemical peels are used for uneven skin tone, acne scars, and deeper wrinkles. This type of peel will remove skin cells from the epidermis and the upper part of the dermis. A combination of trichloroacetic acid and glycolic acid is used. The skin of the treated area may turn red or brown after the peel and take up to six weeks to heal.
  • Deep chemical peels have dramatic results. They are used for deep facial wrinkles, sun damage, scars, blotchiness, and pre-cancerous growths. Phenol is often used to penetrate to the lower dermal layers. You will need a local anesthetic and a sedative to manage discomfort. There is an eight-week pre-treatment period that may include the use of a prescription medication derived from vitamin A. After the chemicals are neutralized, the treated area is covered with a soothing gel. The area will be swollen and uncomfortable. The swelling will go down in two weeks, but your skin may be red for up to three months. The good news is that the benefits from one treatment can last for years.

Neurotoxins

The best-known neurotoxin, botulinum toxin, more commonly known by its brand name, Botox, has changed the way the world looks at cosmetic procedures. More than 3.3 million treatments with botulinum toxin were done in the United States in 2012. This substance is the most popular way to reduce facial wrinkles, smoothing crow’s-feet, frown lines, forehead furrows, and skin bands on the neck. The neurotoxins used are derived from bacteria that have been purified. When injected, the neurotoxin blocks muscular nerve signals, which weakens the muscle so that it cannot contract and thus diminishes unwanted wrinkles.

Using neurotoxins well is an art and a science. There are forty-three muscles in your face. The person giving you the injections has to understand and pinpoint the correct spots to optimize your treatment. For example, for jawline firming, I often inject small amounts of Botox on either side of the jaw, which might seem counterintuitive. When the jaw muscles relax, the cheek muscles pull up in a rubber band action, which lifts the sag along the jaw. You need an artist and an architect to sculpt and balance the supports of your face to fight aging. Otherwise, you might end up looking as if you have come out of deep freeze with a face that does not move.

Fillers

Large-volume fillers are the latest in facial rejuvenation, but I am not talking about goldfish lips. New technology and a better understanding of the aging face have advanced the use of fillers to restore the shape of the face. Sunken cheeks, jowls, and protruding bones add years to your face. I always say that after age twenty-five, facial fat diminishes. Fillers can restore the volume that decreases with age. There are many fillers on the market, some suitable for treating fine lines and wrinkles and others more appropriate for a larger correction. Here are some of the popular large-volume fillers:

  • Fat transfer takes fat from one area of your body, processes it, and redeposits it in the desired location. You are using your own natural fat and stem cells, so your body will not reject the filler substance. This procedure may have unpredictable results and can be lumpier than desired.
  • Collagen fillers were the first type of dermal fillers on the market to be used in aesthetic procedures, particularly for lip injections. Collagen fillers are derived from human skin or animals, namely, cows and pigs. Patient self-derived collagen is available, but this process of collagen transfer is infrequently used.
  • Hyaluronic acid is found throughout the body. Attracting water, this acid hydrates and plumps the skin. These popular fillers are used in a thin version for fine lines and lip augmentation. Thicker versions are used for more extensive procedures. When this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost elasticity or volume. Hyaluronic acid brings water to the skin’s surface, keeping it supple and fresh-looking.
  • Calcium hydroxyapatite spheres suspended in a gel stimulate the growth of collagen and improve the skin immediately upon their injection. This filler, the heaviest of dermal fillers, is a good choice for deep lines. Calcium hydroxyapatite contains small particles that act as a scaffold. Your own collagen grows on that scaffold, and eventually the particles dissolve.
  • Polylactic acid is used extensively for facial volume replacement. The product is administered in a series of injections over several months and works deep in the dermis to replace lost collagen. The effect can last two years.
  • Polyalkylimide is a synthetic material often used for such deep wrinkles as nasolabial folds or depressed scars and to enhance cheekbones and the jawline. It is not used for fine wrinkles. You receive a local anesthetic, and the material is injected under your skin and molded into place. A thin layer of collagen slowly forms around it over the course of about a month. A large volume can be used, and it is stable. It can also be removed if necessary.
  • PMMA is used to treat medium to deep wrinkles, folds, and furrows, to augment thin lips, and to fill out pitted scars. The PMMA microspheres are suspended in a solution of purified collagen gel. PMMA is the longest-lasting filler. A number of injections are needed to create volume, taking up to three months to reach full effect. PMMA can sometimes be visible under the skin. This product is also difficult to remove.

Once again, you need a highly skilled doctor to inject your face with fillers. You cannot imagine some of the disasters I have been asked to fix. Some people come to my office looking like a Picasso painting for all the wrong reasons. The risks include:

  • Acne
  • Rejection of filler material
  • Under-or overcorrection of wrinkles
  • Bruising
  • Asymmetry
  • Itching
  • Infection at injection site
  • Redness
  • Rashes
  • Sensitivity
  • Swelling
  • Temporary numbness
  • Temporary paralysis of facial muscles
  • Migration of filler material
  • Clumping that results from facial movement or natural aging
  • Anatomic distortion

In my opinion, fillers should not be permanent. The way your body absorbs the fillers and how your face continues to age will determine how often you need to repeat treatments.

Dermabrasion

This procedure is a more invasive form of refinishing the skin’s top layers through controlled surgical scraping. A physician uses a wire brush or a diamond wheel with rough edges to remove the upper layers of skin. A local anesthetic is used for the procedures. The process injures the skin, causing it to bleed and stimulating the healing process. The treatment softens the sharp edges of surface irregularities, making the skin appear smoother. Dark complexions—from LES IV to V—may become permanently discolored or blotchy after this treatment, so it is not right for everyone. If you have sensitive skin, you could experience flares. Dermabrasion is used to reduce scars, including deep acne scars, remove pre-cancerous growths, and smooth out fine facial wrinkles, such as those around the mouth. It is essential that an experienced board-certified physician perform this treatment.

Recovery and healing time depends on the size and depth of the treated area. In general, the regrowth of skin takes from five to eight days. The new skin will be pink or reddish and takes about six to twelve weeks to fade.

Your dermatologist might suggest using a combination of treatments to rejuvenate your skin. Remember to start slow and build up from the least invasive treatments to more intense procedures.