As of Wednesday, October 2, 2013
DEAR DOCTOR K: I’m 65 and my face is starting to look old. Can you recommend nonsurgical treatments to take a few years off my face?
DEAR READER: Our faces age along with the rest of us. The difference is that our face is the part of ourselves that we look at most often — and that others look at most often. Some people accept these changes; others fight them every step of the way. But there’s also a middle road for people who prefer to make relatively small tweaks that can make a noticeable difference.
When we’re young, fat plumps up our forehead, temples, cheeks, and areas around our eyes and mouth. With age, that fat loses volume. Features that were round may sink. Skin that was smooth and tight loosens and sags. Facial bones also change. Our upper jaw, lower jaw and cheekbones shrink. Less bone contributes to looser skin. And, of course, there are the wrinkles. (I’ve put an illustration of common facial changes on my website, AskDoctorK.com.)
Many nonsurgical treatments can give your face a more youthful appearance. I was really dubious about this, but I’ve learned I was wrong. And I didn’t learn this just from my dermatologist colleagues — I learned it from my patients:
— Sun protection. Protecting your face from the sun is the single best way to keep it looking youthful. Use broad-spectrum sunscreen that protects against both UVA and UVB light, and wear a wide-brimmed hat when you’re outside. My dermatologist colleagues say to do this “whenever you’re outside, even for a minute.” What I recommend, and what I do myself, is to use sunscreen and a hat whenever I know I’ll be outside for more than 10 minutes a day. (I’ll bet I get mail from dermatologists telling me that’s too lenient.)
— Creams and lotions. Moisturizers may temporarily make wrinkles less noticeable. Exfoliant creams can remove dead skin cells that don’t slough off as readily as they used to. Prescription creams containing retinoids reduce wrinkles and liver spots caused by sun exposure.
— Botulinum toxin (“botox”) injections partially immobilize facial muscles to smooth out expression lines on the forehead and between the brows. They are safe, but you should find a doctor who has considerable experience doing them.
— Dermal fillers treat lines created by lost collagen and fat. Prime treatment locations are the pair of lines that extend from the nose to the corners of the mouth, and another pair that extends from the corners of the mouth to the chin.
— Laser treatments can home in on liver spots. They’re also used for wholesale facial resurfacing. The uppermost skin layers are stripped away, and with them, wrinkles from sun damage and acne scars. Smoother layers of tissue replace the old, damaged layers.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.