Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,
First of all, thank you for investing your time in this wonderful forum and I am sure I am not alone when I say that it is very much appreciated! Okay, now to the point. I am 44 (45 in a few wks) and am told my skin looks good for not ever having anything done to it (botox, facelift, etc). I the last few years, I have noticed some loss of skin elasticity & fine lines (around my eyes and mouth) becoming more noticable. I have, what I consider, a deep forehead crease, that bothers me and some light acne scarring (scarring only in a few spots, not all over). I have sensitive skin & I am prone to redness (flushing). What would be your recommendation on procedures...should I do the pixel and/or botox, just botox, microdermabrasion??? What is the downtime for pixel?

Thanks again for your time.

Hi,
Sounds as if aging has not hit you too hard, but you want some maintenance and reversal of aging. Here are my tips in decreasing order of importance:
1. sun avoidance- I know this is obvious but it really isn't. Most people think they can slather on some glycolic acids and be okay. STAY OUT OF THE SUN. Even the sun exposure you got 20 years ago is still crippling and destroying your collagen. In particular UVA rays lead to CHRONIC damage to the skin that last years and at times takes years to begin to fragment your collagen. Accordingly, wear a hat and a good SPF 30 at least and put it on at least 30 minutes before going outside to let the chemical block take effect. Avoid the sun between 10 am and 4 pm when UVB is the worst.
2. BOTOX- Believe it or not, Botox is the NEXT most important anti-aging treatment in front of skin care, way in front of skin care. A lot of people use Botox to look a bit better in the short run but that is inconsequential. Good Botox really shuts down wrinkles, reverses deep wrinkles (see my before and after photos) like the one on your forehead and around your eyes and even around the mouth more than any other treatment (read my Botox learning module to understand how I view the skin like a shirt and how Botox helps keep the shirt smooth by hanging it on the wall). Also, I have a new theory of how MY Botox works. Since I am injecting typically 12 to 20 injections into the forehead and 16 injections around the eyes, I see over a period of a few months to years that besides wrinkles fading there is a qualitative change to the skin texture (read my micro Botox blog in the LFP blog section to understand this better). I am one of the few people that takes the time to put that many injections and that is the only way you are going to see those long term benefits. Unlike other places where one injection hurts, I can do 20 to 30 and you won't feel them. Botox also breaks bad habits. For example, if you are a browlifter, you will create an unnecessary line in your forehead. After 2 to 3 rounds of Botox, you will literally forget how to do that and your lines will start fading away.
3. Daily skin care (there are a lot of good products out there) that blend vitamin C (that can actually penetrate the skin), alpha and beta hydroxys, moisturizers, pH balanced cleansers, etc. (see my skin learning module under resources on my site for more detailed information.)
4. okay, here is where treatments like the pixel, plasma, laser, etc. come into play. i would say that someone like you who does not have a lot of damage, this is the least important option. however, if you had a lot of sun damage that needs to be erased, then i would put this option behind Botox and in front of daily skin care. If it is really bad skin, then almost in front of Botox but you still need skin care and Botox. I hope all this makes sense. (Whoops, forgot to answer your question on pixel downtime. It depends on how much sundamage you have and at what setting. Generally 3 to 5 days of stripey brown the first time, then 1 to 2 days or fewer the next few rounds.)
Best,
sml

Dr. Lam,

Thank you so very, very much for your reply. I am just floored by your detailed response...I never expected such thoroughness. I did mean to mention in my original question that I do use Sunscreen.

I have booked a consult/botox with you for this coming Monday so we can discuss further and you can have a first hand look.

Thanks so very much and I look forward to meeting you! I look forward to looking a little younger and more refreshed for my birthday on Dec. 9th!

Happy Early Birthday! My answers are detailed so that they can help not only you but hopefully other readers. Also, as you know, this is my passion! Look forward to meeting you.
Best,
SML