By Marcela Ramirez, NP
Not only do I get this question numerous times when I am seeing my cosmetic dermatology patients in Houston, but also at social gatherings–where I quickly become pretty popular once people find out what I do. How can one truly prevent certain signs of aging while also aging gracefully? To simplify this answer, I like to categorize it by decade. Here is what I recommend:
In your 20s:
- SUNSCREEN PEOPLE, SUNSCREEN! Listen to your mom on this. If there is only one thing you do in this decade to help with aging of the skin, it should be to wear sunscreen every day, all day. If you are going to be outside for extended periods of time, then reapply the SPF every 2-3 hours, wear a hat, and try to look for the shade. The sun has been scientifically proven over and over again to break down collagen, leading to more wrinkles as we age. Also, it causes those pesky brown spots that we try to cover up with heavy foundation starting in our 30s. Don’t forget the most important reason to wear SPF is for skin cancer prevention! We carry a number of different sunscreens that are easy to apply, non-greasy, and very well priced. Nowadays, sunscreens can be found with tint which can help give a healthy glow without making you look pasty. Some even contain antioxidants! It is worth exploring all the options since there has been so much innovation in the last few years.
- Ideally, start a good skin regimen. There are plenty of scientifically backed skin products these days and they work! There is no such thing as a magic cream, but several clinical studies (some of which we performed in our office) have proven that starting a good skin regimen at an early age will help in maintaining healthier, more vibrant looking skin long-term.
- Don’t pick up a smoking or vaping! If you have, then quit now! Not only does it get harder and harder to quit the longer you smoke, but it takes a toll on your whole body, including your skin. Beyond the known links to cancer, lung, and heart disease, smoking is associated with premature skin aging. I always say I can spot a longtime smoker by how his or her skin looks: dull, jaundiced and wrinkly. It is particularly noticeable around the mouth.
In your 30s:
Keep on doing everything I told the 20-year-olds to do–plus a little extra!
- People in their 30s often get shocked and a bit offended when I mention the “B” word because they think that is something their moms do, but BOTOX® Cosmetic really helps combat skin aging. Starting at an earlier age helps to prevent the skin folds from getting deeper and deeper. Think about it. Your face is full of muscles, and just like any other muscles, they get stronger with frequent use. These facial muscles start to create lines in the face that over time are etched in, thus creating wrinkles. When BOTOX is injected into specific muscle areas, the movement of those muscles is relaxed and regular contractions cease. This prevents those creases from deepening over time and even begins to ease even the appearance of lines. So doing a bit of BOTOX every 4 to 6 months earlier in life will help one age more gracefully over the years and decades to come. BOTOX has been safely used for over a decade all over the world in the crow’s feet, between the brows, and forehead lines. We also use it in a number of off-label ways with beautiful results. For example, we can soften very square jaw lines and improve gummy smiles. Visit our gallery to see all the areas that can be treated very effectively!
- Because we live in sunny Texas, early signs of skin aging from the sun will start to appear in our 30s. Most common are brown spots, redness and fine lines. Photofacials, also called intense pulsed light (IPL) treatments, can reduce skin pigmentation and help prevent worsening of low-grade sun damage. The light used in this treatment is absorbed by the pigmented areas and helps bring the pigment up to the surface of the skin so that it can flake off in a few days. Similarly, the light can shrink facial blood vessels, thus reducing redness. IPL also helps stimulate collagen, which improves the appearance of fine lines and wrinkles. Over the long term, multiple IPL treatments can really make a difference in skin texture and pore size.
- In our 30s we start to lose collagen, fatty tissue, and bone support in the face. One of the first areas you will notice is the undereye area, also known as the tear trough. It creates a tired, hollow, and shadowed appearance which we know as dark circles or bags. A great way to combat this is through a 2-pronged approach. I like to start with injectable hyaluronic acid filler to inflate the hollowness and then recommend eye creams to brighten the skin. The results are dramatic and my patients absolutely love it! They leave our clinic with a new swagger in their step and looking refreshed and rejuvenated.
In your 40s, 50s, and 60s:
I group these different decades into the same category, even though typically a 60-year-old has more obvious signs of aging than a 40-year-old. I believe that starting to do some of the same age-defying tricks at a younger age will help slow the aging process as we progress through the latter decades.
- We will always recommend a good skin care regimen for every decade. Some of the components of your regimen do change as the effects of the glory days of our youth begin to make their appearance. Sun spots, uneven, blotchy skin, and rough texture from beachy summers and cumulative sun exposure emerge. In our office, we have a way to see exactly what your skin needs, we take several pictures with our Visia® Machine which shows us what is happening not just on the surface but also below the surface. Then we tailor a regimen with scientifically backed products with only the highest quality of ingredients that consist of growth factors, retinoids, and antioxidants.
- To address pigmentation and texture concerns of aging, we offer some great options. Best for wrinkles, pores, lines and brown spots are our non-ablative fractionated resurfacing lasers. A series of several treatments is usually enough to produce radiant, healthy, smoother skin.
- Fillers are our good trusty friend when it comes to restoring the natural proportions and contours to the face. Small amounts of strategically placed filler can lift the cheeks, soften lines around the mouth, and fill sunken temples and under-eye hollows. Filling vertical lip lines and adding subtle volume to the lips with hyaluronic acid fillers give the mouth a more youthful appearance.
- Continuing with BOTOX Cosmetic to soften wrinkles around the eyes, between the brows, and on the forehead and we also use Botox to give a quick neck lift and relax the vertical bands that age the neck. Again, the results can be quite dramatic with just Botox and my patients are fans of this off-label area. Sometimes we have to pair this with some skin tightening treatments to get even better results.
- For sagging and lax skin, we offer two excellent, no downtime procedures for Houston patients: Thermage® and Ultherapy®. Thermage utilizes radiofrequency energy to tighten loose skin on the face and neck while Ultherapy employs focused ultrasound energy to lift and tighten the face, neck and décolleté. Both no-downtime procedures stimulate the skin to produce its own collagen, which also improves wrinkles and texture. You have likely seen these in the media quite a bit since both of these procedures are favorites of famous actors. Jennifer Aniston has been vocal for a while now about getting an annual Thermage as her “yearly maintenance”. About a month ago, Christie Brinkley also admitted to her beauty secrets, and they included 2 Ultherapy treatments and a competitor of BOTOX called XEOMIN®. Check out her interview here. If you would like to try our simulator and see how Ultherapy could work for you, you can try it here. These treatments are really wonderful nonsurgical ways of improving collagen but the best results are when you combine them with VOLUMA®, a filler that lifts the cheeks and jowls further. These treatments, depending on laxity, may need to be performed more than once, like with Christy or yearly like Jennifer does for best results.
The best way to know what you really need is to come see me for a complimentary consultation. Everyone ages differently and what is true for you might not be true for everyone else. I always recommend bringing a favorite selfie of yourself of when you were younger so we can talk through the changing elements and get you the results you would like to see. The good news is that we have solutions that fit every wallet, so don’t get scared off thinking you can’t afford any of these things. You will be surprised how easy and accessible they can be, plus we even offer Care Credit: it’s a no-interest payment plan which makes some of the more expensive things we offer in-office very affordable!
About Marcela Ramirez, MSN FNP-C, Nurse Practitioner
Marcela is a nurse practitioner at Suzanne Bruce and Associates. Before becoming a nurse practitioner, Marcela had been a practicing nurse specializing in cosmetic dermatology at our office since 2003. With nearly 15 years of cosmetic experience, Marcela has injected over 57,000 units of Botox and close to 600 Filler treatments during her career. Marcela obtained her nurse practitioner degree from the University of Texas Health Science Center in Houston in March of 2015, where she also received her Bachelor of Science degree in nursing with high honors in May 2003. She graduated from Texas A&M University with a Bachelor of Science in Health in 1999. She was personally trained by Dr. Suzanne Bruce and some of the leading laser and cosmetic trainers in the industry. Marcela is a member of the American Academy of Nurse Practitioners and the Dermatology Nurses Association.