Baljeet K. Purewal, MD
Cosmetic Oculofacial Plastic Surgeon, Fresh Face + Eye
We’ve all seen women — a certain radiant friend, a woman on the street, a star on the silver screen, who just seem to age in reverse (Lucy Liu, Angela Bassett, Jennifer Aniston, and Cate Blanchett all come to mind). While genetics are certainly at play, there’s also a lot of science behind how some people are able to seemingly stop the hands of time when it comes to their skin health and appearance. So what’s the science, and how can we take the best of what these women know and practice and apply to our own skincare? Will we enjoy the same results?
20 years ago as a young doctor just beginning in New York City, I saw a number of fairly young women (and some men) regularly getting treatments that I thought were designed for someone much older. What I quickly learned was that these patients already knew that one of the secrets to keeping their youthful appearance was to maintain the health of their skin BEFORE it began to break down and show signs of aging. Those treatments I had dismissed as something for the 45+ crowd were actually a lot more effective when used as part of a proactive regimen of holistic skin health (but don’t despair — they still work wonders no matter what age you begin receiving them). So how and why were these treatments akin to a fountain of youth? To understand that, let’s dive into the science behind them…
Most signs of aging (particularly on the face) can be attributed to a few underlying causes:
● Lost elasticity
● Breakdown of collagen
● Loss of subcutaneous fat
● Slowing skin cell turnover
● A weakening of the SMAS (superficial muscular aponeurotic system — the tissue that is one of the most important structures of the face)
The most effective anti-aging treatments, those that I saw patients receiving proactively, are treatments that address the causes of aging by maintaining and improving the health of our skin at the structural level. When we make use of these treatments as a regular course of taking care of our health, the signs of aging and the subsequent need (or desire) for surgical intervention in the form of a facelift can be delayed by decades. Here are a few of our favorites based on what causes they address:
Upper epidermis (surface skin) treatments best for increasing skin cell turnover, improving elasticity, and stimulating collagen production in the upper layers of the skin:
● Chemical Peels
● Hybrid Fractional Laser (HALO is our favorite)
● Photofacial (BBL is our favorite)
● Neurotoxin Injections (Botox is still our favorite)
● Microneedling
This group of treatments will help treat fine lines and wrinkles, sun-damage related age spots, scarring, enlarged pores, and leave your skin looking smooth and refreshed.
Deeper treatments aimed at treating causes of aging at the deeper dermis layer are best for stimulating collagen production at a deeper, foundational level, strengthening the SMAS (foundational muscle structure that holds everything up), and restoring fullness associated with subcutaneous fat:
● Dermal Fillers (Juvederm, Radiesse, Volbella, etc.)
● Ultrasound (Ultherapy is our favorite)
● Radio Frequency
Many of these treatments only need to be used once every couple of years (Ultherapy, HALO) to get lasting results because they rebuild the underlying structures. Others, like hyaluronic acid, are typically used every 12 – 18th months and Botox every 4-6 months. However, getting Ultherapy, BBL, HALO or Radio Frequency treatments often greatly reduces or eliminates the need for fillers and neurotoxins. Chemical peels can be used several times a year, but we highly recommend focusing those treatmentsin the fall and winter when you’ll have less daily sun exposure.
It’s worth noting that there are a few concerns that contribute to an aged appearance that truly do warrant a surgical approach as they aren’t effectively treated through therapies alone. One area, in particular, in the eyes. If you are bothered by drooping or baggy upper eyelids that are a result of excess skin, there is a simple procedure called a blepharoplasty (also known as an eyelid lift). A blepharoplasty requires no anesthesia, is performed in-office, and has very little downtime. An eyelid lift can have a very dramatic effect on your appearance. A lower blepharoplasty used to correct a baggy, puffy undereye area, is a little more involved as it requires anesthesia. However, it is also a very fast, simple fix with little downtime. You’ll be shocked by the dramatic difference a blepharoplasty procedure can have.
We can’t halt the aging process, but there are many treatments that continue to evolve every year that dramatically slow and some times reverse the underlying causes that contribute to an aged appearance. When used in combination, these therapies are the secret to how some women (and men) seemingly age in reverse. I am so grateful to have learned these “secrets” at the beginning of my career allowing me to help thousands of patients restore their youthful, natural glow. In fact, many of my patients in their 40s and 50s no longer even wear makeup and feel like they look younger and have healthier skin than they did in their 20s and 30s.