Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

As we age, there are a number of internal and external forces that contribute to the development of facial lines and wrinkles, sagging, and changes in pigmentation and texture.  Our skin cells no longer hold the moisture or retain the elasticity that they did when we were young. Free radicals attack the skin cells to initiate damage. Prolonged sun exposure, over the course of a lifetime, and damaging UV rays are the primary culprit.  Cigarette smoking, living in large cities, exposure to pollution, and poor dietary habits all contribute.

Fortunately, over the last 20 years, there have been significant breakthroughs in skin care and facial rejuvenation. Most skincare products now contain moisturizers, sunscreens, antioxidants, anti-inflammatory agents, and vitamin nutrients to help replenish the skin.  Patients are taking better care of their skin, no longer relying on “iodine and baby oil” as a tanning oil.  A beautiful bronze tan at age 20 doesn’t translate to a beautiful bronze tan at age 60.  There are over-the-counter skin care products that also help in exfoliating the skin including low-concentration glycolic peels.  Many patients also use vitamin C and retinoic acid products such as Renova.

Patients that I see in my office consultations vary from those with fine lines and mild skin damage to those with severe damage and deeper lines.  For the more superficial problems such as fine wrinkles and mild pigmentation changes, patients will respond to chemical peels and microdermabrasion.  The chemical peels vary in strength from the milder glycolic acid peels to the more invasive TCA (trichloroacetic acid) peels.  For patients with more severe skin problems, we offer fractional CO2 laser treatment and erbium laser treatment.  These allow penetration into the deeper layers of the skin in order to promote collagen growth as well as treat the more superficial problems.

For forehead lines and crow’s feet, Botox has become the standard to relax the muscles and diminish these lines.  For lines around the mouth and to augment soft tissue that’s diminished in the cheeks, dermal fillers such as collagen (Evolence) and hyaluronic acid (Juvederm, Restylane) are the treatment of choice.