Episode 10: Change How Your Face Ages Forever - Part 1

Foreign.

Hey, it's Dr. Rob. Welcome to my Dr. Rob Solutions podcast. Today we're going to do part one of a talk I gave in Sundance about facial aging. Title of the talk is change how.

Your face ages forever.

Just trying to convey how I think of facial aging. I'm to get right into it. There's a lot of things before you ever discuss the skin, and just some basic things are you can't outrun a bad diet. You can't pick your parents, so your genetics are what they are. And I don't feel like you could eat enough collagen or elastin to offset what happens after the age of 35 as we start to lose collagen. So facial aging specifically, as I think of it, traditionally, is in three zones. So the third above the line drawn from the nasal area to the the ear, then between the line there and the jawline, and then below that to the clavicles for your neck. And so facial aging, to me specifically, is about the bones, the muscle, the fat, and the skin. We often don't talk about bones as part of the aging process, but your bones do undergo resorption. There are specific genetic reasons why people will have more resorption than others. It also lends itself to why certain people are more prone to osteoporosis. So there is bone resorption. You can lose volume that way. Muscle. So we don't often really speak about muscle a lot in terms of facial aging. But you, especially around the eyes, can have hypertrophy of the muscle. You'll also see people who smile and are very expressive with facial expressions, with their facial expressions have more lines, and that's because they're animating more aggressively or more frequently, if you want to think of it like that. And many times people will create hypertrophy. You've seen people with very, very large jaw muscles, masseters from clenching and grinding as well. The fat of the face is interesting because over time we lose it. There are very, very specific compartments of fat in the face. But many times we just see deflation, and we kind of commonly see it in the mid face. We also see exposure of the fat pads around the eyes, giving us a puffy appearance. And then finally, of course, what everybody sees most frequently in facial aging is the skin, whether it's lines, wrinkles, folds, saggin of the tissues, jowling. All of those things become, you know, part of the what we see in terms of facial aging. When I think of treatment options in my clinic, as it stands now, I'm Very rooted in understanding exactly, you know, what are the root drivers of not just inflammation, but anything that can just increase a patient's day to day swelling, which affects the turgor in their tissues. If anybody's familiar with hydrafacial, hydrafacial can allow more fluid to be instilled into the tissues and give it a very shiny, tense appearance. So it's great, you know, in terms of giving that look that you may want for an event, it's not going to last. As you increase the turgor or the fluid retention in the skin, you can make it look smoother and tighter. I often, as I mentioned, consider genetics in every aspect my care plans. I know enough about genetics now that I can listen to people and understand frequently how their genetic patterns are both as it relates to their detox pathways, their hormone metabolism and sleep. Air quality and water quality are extremely important in terms of skin health and overall wellness. Air quality, like folks to use air filters that filter down to.003 microns water quality would prefer people not to drink out of plastic at all. If possible, use metal and or glass. And then for diet, you know, very specific as it relates to our diets in terms of if you're a plant based person, if you're a carnivore, if you're paleo, if you're like fasting. I just follow these axioms for my clients. Specifically is I want you to cut out gluten and dairy and all processed foods and sugars that aren't coming from food sources naturally in order to really improve your overall wellness prior to any procedure. Also, as you entertain doing facial treatments of, of a certain kind, you should always have skin care that works for you. And there are proprietary products that have ingredients that actually do this. Some reduce pigmentation, some increase collagen production, and we use these in our practice commonly. Others actually reduce fat. So there are these products that actually go out of their way to have specific actions through specific mechanisms in the skin and things. I do open the skin. So it's a common thing for me to have created an opening in the skin and then that will in essence give the product a entry into the skin versus having to go through a hair follicle. Say we'll get back to the show.

In a moment, but I wanted to.

Share something that I think can really help you.

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You can have access to it as well.

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Order to be absorbed.

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So what are the treatment plans or things that we can create? And we'll start kind of basic things like I said with skin care, using products that help tighten the skin or build collagen. Currently we use products like elastin and then line products from my private line that help promote collagen synthesis. Synthesis. That is one way to help with your skin. That can be done each and every day to help tighten the skin. Of course, having an appropriate cleanser and moisturizer for your skin type is important. Using sun protection is important as basic tenets of skin care. Understanding that people are listening to me want to know about agents we use. So muscular blocking agents reduce the appearance of fine lines. And these can be in the glabella, which are affectionately known as the 11 lines. It can be our forehead lines, it can be our crow's feet. And those are probably the most common areas. Bunny lines on the nose. So these are all from muscular action like I mentioned previously. And the common substances used for muscular blocking are Daxify, Xeomin, Dysport, Botox.

They all work.

They all work slightly differently and have different compositions. And I'm not here to endorse any of them. Sorry. These are the muscular blocking agents that we use as part of the component of a treatment plan. So next would be a volumizing agent. So volumizing agents are fillers. A filler as it relates to my practice and my personal preferences on this are I use fillers to volumize once I believe the skin has been tightened or is tight enough. I do not like over volumization and I specifically prefer to use a hyaluronic acid filler. The reason is reversible. I don't like to use anything, especially on a new patient that's not reversible because they may have never had filler. They may really want a subtle change. In fact, after it's done, even though it was according to their preferences, they may not like it and want it reversed. And that can be done with hyaluronic acid fillers. Sculptra is a product that was brought to market for HIV atrophy in the mid face in 2005, I believe, and has been around and does help produce more collagen synthesis. The newest HA filler on the market is resistant hyaluronic acid and that is from Revance. This product has particular chemical structure that allows it to stretch when you smile or animate. And then finally, the original filler is fat. And I don't utilize a lot of fat in facial treatments in my practice. One, it's not reversible. Fat's a large molecule. So it's more in my practice suited for somebody getting augmentation with a facial surgery like a mid face lift or a facelift, then it would be more useful in that setting for volumization. Now there are other substances that we use in conjunction, not for volumizing, but we use the patient's own stem cells for injections and that helps with age reversal as well. And have a brief discussion about non invasive elements that treat the face. I have a couple different types in my practice. We have one that uses focused ultrasound, which is Softwave. It's been FDA cleared and we like the results of Softwave and its non invasive nature to contour the face, even around the eyes and cheeks. And sometimes there's not a lot of good methods, but Softwave is definitely a product that we use in that setting. In addition, we have a non invasive product by Inmode called Evoke. You can treat the cheeks and jowl area as well as the chin and jawline using Evoke and that uses bipolar radio frequency. We've used these technologies. They work. The preferences are based on patient selection and interview of them, baseline of how much skin laxity they have, and then other parameters as I've previously discussed. And that really is going to be part one of my talk. I'll pick it up. Part two, we'll discuss next minimally invasive procedures. All right.