CONSULTATION FOR FACE: What to Expect, Step by Step
My approach? It all starts with a skin health check.
For me, the most important aspect of your initial consultation is evaluating your skin’s health. From there, we’ll talk about your perceived imperfections and options for correcting them
Some patients want to skip this part of the consultation and cut straight to the “how to wake up glowing” segment. But with thousands of new cases of skin cancer being reported each year, a skin health check is key. Even if you’ve never sunbathed and think you have a pretty good handle on protection, you’re not immune to the potentially devastating effects of daily sun exposure. I can honestly say that all my patients, including the ones who resist at first, end up grateful to have learned the true health of their skin.
Considering aesthetic enhancement
This is usually the part that gets patients most excited. So I’ll be up front about my take on aesthetic enhancement: Less is usually more. If you get a natural-looking result, without any telltale signs of having had something “done,” you’ll never go wrong.
That said, not all procedures are indicated for all patients. We’ve all heard about people having bad experiences – sometimes facing lifetime of scarring or worse – because due diligence wasn’t performed. Though many aesthetic enhancement procedures can be relatively fast, simple, painless, they’re still medical procedures and should be addressed as such.
Once I know your goals, we can discuss the best strategy for achieving them. Sometimes, non-invasive procedures such as a Fraxel laser treatment, or simply an excellent, personalized skincare regime, are all that’s needed. Or you might want to step up to more invasive procedures, such as a Precision Lift or a CO2 Resurfacing. Often, a combination of treatments – in which each step fixes different concerns – offers the most impact. Either way, I want my patients to understand all their options: I don’t believe in recommending only the most aggressive procedures (which, though they may provide “home-run” results, are often the most costly).
Step 1. Into the Looking Glass
After taking a thorough history, I hand over a mirror and ask, “What’s bothering you?” so you can show me exactly which areas you’d like to change. This exchange sounds simple enough, but it’s hugely important. While I consider myself to have a good aesthetic eye, your main concern may surprise me. For example, I have one elderly patient with significant lines around her eyes and bags underneath, but what troubled her most were the fine lines on her upper lip. The shaded glasses she wore on a regular basis covered her eyes so she didn’t care how they looked!
Step 2. Let’s Talk Aging
Before exploring treatments, we look at how your particular face and skin are showing the years. (While no one escapes this inevitable slide, we all age at different rates and in different ways.) A thorough explanation in front of the mirror will help you address your detailed concerns without losing sight of the big picture.
- What happens to texture and tone
If you’re serious about anti-aging, stick with using a topical antioxidant and broad-spectrum sunscreen everyday. That’s because several negative things happen to skin over time, and sun exposure hastens every one. First, skin begins to lose its luminosity and smoothness. With less light reflecting from its surface, dullness takes hold. Stubborn sun spots appear and broken blood vessels may form, particularly on the nose, cheeks, neck and chest. (Want a clear picture of the havoc that UV rays can wreak on tone? Simply compare those areas to skin from a never-exposed zone, such as your breast or buttock.) Lines begin to develop. Some, such as horizontal creases across the forehead, “crow’s feet” on the sides of the eyes and “squint lines between the brows, are exacerbated by motion in these areas. Smoking, past or current, worsens lines above the upper lip. And sunlight turns skin crepey under the eyes.
What we can do to help:
I’m a big fan of the new ActiveFX laser, the gold standard for fixing almost everything from fine lines to deeper creases, sun spots to sagging skin. This non-ablative laser produces similar results to more aggressive, ablative lasers, such as the CO2, without the downtime associated with them. In the high-tech, anti-aging arsenal, it’s a truly remarkable weapon. If you want gentler options, you might consider Fraxel lasers (which are great for evening out skin tone and texture and minimizing pores) or IPL (which can erase broken blood vessels and brown spots).
Motion lines are best treated by botulinum toxin (Botox, Dysport or Xeomin). It’s a chemical that blocks the connection between the muscle and the nerve, thereby decreasing the offending motion and the wrinkles it triggers. At a minimum, a customized, at-home skin care regimen – which may include peptides, antioxidants and retinoids – can help brighten skin and soften the appearance of fine lines, age spots and enlarged pores. And sunscreen – the ultimate anti-ager – is key. The right skin care will ward off further damage, help you maintain your new and improved complexion, and pave the way for smoother, younger-looking skin.
- The Sagging Face
Eventually, gravity takes hold. Eyebrows begin their downward drift. Below the eyes, fat can bulge into “bags,” making you look perma-tired. Your face and cheeks can also droop, creating deeper nasolabial folds (the creases between the sides of your nose and corners of your mouth), marionette lines, and jowling along the jaw line. The neck can become loose, developing vertical bands or a pocket of fat underneath your chin.
What we can do to help:
One of the latest techniques is the Precision Face Lift. Powered by the Cynosure Triplex laser, it helps tighten the lower face and neck area. A small incision is made, just large enough to insert the laser-containing cannula. Excess fat beneath the skin is melted and removed, and the skin is lasered from beneath to stimulate collagen production and tightening.
Neck liposuction is also a fairly simple procedure that can offer a tremendous improvement, giving you back a youthful, crisp jaw line. Yet another alternative for those who want to improve jowling, tighten up the neck area and/or elevate the eyebrows? Thermage. This treatment signals cells to produce new collagen over time, making it ideal for lifting and tightening the skin with no downtime at all.
Thermage’s lifting effects have made it a favorite treatment of famous beauties like actress Gwyneth Paltrow and model Linda Evangelista. But many normal people (myself, included!) love this procedure for its youth-holding powers.
Just want to maintain the skin you have and prevent sagging? The new Forma laser uses radiofrequency in a gentler, milder way to keep your inner collagen machine humming along.
- The Sinking Face
If you’ve ever seen a caricature of an old witch, you’ll notice that her face looks sunken and hollowed out. That’s because sometime around age 35, weight begins to vanish from our faces (though not, as we’d prefer, from our buttocks and hips!). Nasolabial folds stem from a combination of sagging and sinking. Cheekbones become more prominent, taking on an angular aspect, and the chin turn pointier. Meanwhile, our lips begin to lose their sexy fullness. This is where the Catherine Deneuve line about a woman having to choose between her fanny and her face comes in: Up to now, in order to keep our faces looking taut and toned, most of us have had to maintain a higher percentage of body fat than we’d like. But no longer. Now you can enjoy a youthful face and a trim, fit body, too.
What we can do to help:
Sinking-related issues can often be fixed with injectable fillers. Many people worry about which type of filler to use. For me, that’s often less important than where the filler injected. I use an arsenal of different fillers, depending upon a patient’s specific needs. But where and how much I choose to inject is what matters most. The goal is always to replace lost volume and restore your face to its naturally pretty, youthful contours.
Making a plan
At this point, we determine your ideal procedure or procedures. Sometimes a single procedure, either small or more aggressive, will help you achieve your desired goal. Other times, it may take a combination of procedures to get you there in a beautiful, natural-looking way. We’re always here to work with you and help you get the results you want. Occasionally, a patient will ask for laser resurfacing, when what she really wants to address are deep nasolabial folds and sunken cheeks. After discussing the aging process in the mirror, she’ll understand why laser resurfacing won’t correct that problem, but something like fat injections will. Other times, a young patient may ask for laser resurfacing when all she needs is good skin care and a gentle peel or two.
While keeping your concerns paramount, I’ll occasionally offer suggestions if I feel they’ll make a significant difference to your outcome. But ultimately, you make the call. I never “sell” procedures to my patients, a rule that they appreciate. The point is: Once I’ve shared my extensive knowledge and understanding of all the available technologies, it’s your job to process the information and decide what’s best for you. The best decision is an educated one that lends you peace of mind.
Rest assured: For me, safety is paramount. I’m proud to say that I alone perform every procedure in my office. (I’ve seen way too many problems that stemmed from patients being put in the hands of inadequately trained personnel.) Before deciding on any procedure, you’ll learn about the risks involved, the healing process and the long-term expectations
For now, I encourage you to browse this site, look at “before and after” images, and read about the various procedures on offer. While you’re at it, click on links to see me discuss the latest procedures on popular TV shows, or to review articles on safety and choosing the right physician. I truly hope that, after doing so, you’ll feel excited to set up a visit with me so we can get you on the right path to beautiful, healthy skin!
Karyn Grossman, MD, is a Harvard-trained, board-certified dermatologist in Santa Monica, CA, and Manhattan, specializing in cosmetic dermatology. Her areas of expertise include the precision (a.k.a. the “60 minute non-surgical facelift” or the “no scar facelift”), lipotransfer, liposuction, laser resurfacing, face and dermal fillers, chemical peels and other non-surgical treatments.