Do injectables slow down the aging process—or just minimize the signs we already see?
Doctors insist they actually s-l-o-w it down. Injectable fillers that plump or add volume, such as Restylane or Juvéderm, inflate a problem area like deep wrinkles or sunken skin, keeping fine lines from turning into deep grooves and minimizing sagging and jowling. “Fillers build scaffolds under the skin, providing a support system for the skin above it—and this effect is cumulative,” says Amy Wechsler, MD, a dermatologist in New York City. Injectables in a second category—those that minimize muscle movement, such as Botox and Xeomin—also put aging in slow-mo because when used regularly, they prevent fine lines from ever forming, says Wechsler.
SPF 30 is the better option, according to nearly every doctor interviewed for this story. “SPF 30 gives you excellent protection, even if you skimp a little in your application,” says Elizabeth Tanzi, MD, a Washington, D.C., dermatologist.
“Think of SPF in your makeup as a complement to your daily sunscreen,” says Heidi Waldorf, MD, a dermatologist in New York City. But it’s not enough on its own because “it wears off easily and we often forget to put it on our ears or neck, which needs protection, too,” says Waldorf.
What is the simplest routine to follow and still see results?
Most experts agree on a few key things: In the morning, everyone needs a broad-spectrum sunscreen to protect skin, plus an antioxidant product to battle free radicals. These can sometimes be found in combination—try Estée Lauder DayWear Advanced Multi-Protection Anti-Oxidant & UV Defense SPF 50 ($39; esteelauder.com) or Aveeno Positively Radiant Daily Moisturizer SPF 30 ($15; drugstores). Then, at night, experts recommend some kind of chemical exfoliant. The gold standard is a retinoid, such as an over-the-counter retinol cream or a prescription-strength tretinoin like Retin-A. Skin too sensitive for that? Use an over-the-counter glycolic acid cleanser or an alpha-hydroxy-acid cream such as Mario Badescu Glycolic Foaming Cleanser ($15; mariobadescu.com) or SkinMedica AHA/BHA Face Cream ($40; skinmedica.com). If your definition of simplicity encompasses the occasional in-office treatment, consider Botox, Dysport or Xeomin; all of these injectables minimize muscle movement and “provide smooth, predictable results on everyone time and again,” says Heather Woolery-Lloyd, MD, a cosmetic dermatologist in Miami.
The most effective solution, says Waldorf, is to have a doctor inject a filler such as Restylane or Belotero into the tear troughs under the eyes. This diminishes dark circles in three ways: It plumps hollows caused by fat loss below the lower lid; it lessens shadowy contours; and it hides blue blood vessels beneath the skin. If the skin under the eyes is also discolored or darker than the rest of the face—more common in women of color—Waldorf may treat the areawith a resurfacing -laser such as Fraxel Dual as well(it can run you $750 to $1,500 per treatment). If you prefer to treat dark circles at home, try products that contain moisturizing ingredients like hyaluronic acid or glycerin, combined with ingredients that exfoliate and trigger collagen production, such as retinoids or peptides. They’ll plump the skin and promote the shedding of dead skin cells (which, accumulated, can make the area appear darker).
Why do I have acne, and what is the most effective treatment?
At least a quarter of women ages 35 to 55 have acne. Though adult acne can be the result of a hormonal imbalance (just as in your teen years), it’s usually cyclical rather than chronic, flaring premenstrually or during timesof increased stress. It also usually crops up along the jaw, chin and neck, whereas teen acne is typically diffused across the entire face. Wechsler says her first plan of attack for adult patients who are either pre- or perimenopausal is oral birth control, because it evens out hormone levels and decreases the amount of testosterone released by the ovaries (excess testosterone is often the culprit in breakouts). Beyond managing hormone levels, “adult acne treatment should focus on killing bacteria and cleaning out pores,” says Fredric Brandt, MD, a cosmetic dermatologist with practices in Manhattan and Miami. Most dermatologists agree that topical exfoliants, such as prescription-strength retinoids like Retin-A or salicylic acid pads, are the most effective options, because they accelerate the sloughing off of dead skin cells (pre-venting pore clogging) and minimize bacteria build-up. Brandt also mentions two in-office treatments that may complement the effects of exfoliants: a strong glycolic or salicylic acid peel, and the Isolaz laser, which uses a cleansing suction mechanism plus broadband light to deep-clean pores and kill bacteria. Prices start at $200. Finally, Brandt has had good results with a new Rx treatment, Aczone, that eliminates bacteria and prevents inflammation.
Yes, but when you drink it matters, says Cornelia Zicu, skin-care director at Red Door Spa. “If you drink eight glasses of water between noon and 5 pm, you’ll visit the bathroom many times and lose minerals on each trip,” she says. Instead, Zicu suggests drinking eight glasses a day on this schedule: Down the first two as soon as you wake up, then sip five or six throughout the day. Note: Most dermatologists say drinking water is not a substitute for applying moisturizer, but the two in tandem are quite effective.
Which celebs do patients cite as aging-well role models?
Jennifer Aniston has a youthful glow that people covet,” Woolery-Lloyd says. Other admired stars: Halle Berry, Gwyneth Paltrow and Julianne Moore. “The goal for most patients is to look like a well-rested version of themselves, and these celebs illustrate this aesthetic,” says Elizabeth K. Hale, MD, a New York City dermatologist.
An artist has a palette of colors; likewise, a doctor needs enough choices that she can match the right filler to the right area,” explains Tanzi. The main distinction among fillers is “how ‘thick’ they are,” says Woolery-Lloyd—as well as how immediate and long-lasting the results are. For example, more viscous fillers like Radiesse fill in deep lines, replace lost volume and promote your skin’s own collagen production. Although you’ll notice immediate improvement, you won’t realize the full benefit for several weeks. Results typically last a year or more. Meanwhile, “thinner” fillers like Belotero or Juvéderm deliver “immediate gratification,” Hale says, but last only six to 12 months. Then, within each class, specific fillers work better in certain spots. “For instance, Belotero is especially thin and best used in fine lines, particularly around the lips,” Woolery-Lloyd says. But the success of injections is subjective, so look at a doctor’s before-and-after photos to be sure you like her work.
Unscented VS. fragrance free: What’s the difference?
In theory, when companies label a product fragrance free, they have not added perfume (any odor is the natural scent of the ingredients). Unscented, meanwhile, is supposed to mean a product has no smell at all, either natural or added. However, Stacy Maklin, cofounder of the Campaign for Safe Cosmetics, says if you’re avoiding fragranced products because of allergies, you should still scan the ingredients list for the word fragrance, perfume or parfum; the FDA does not regulate the terms fragrance free and unscented, and companies may be liberal with their interpretation of them.
How do you get rid of tiny red spots (cherry angiomas)?
"These can be found anywhere on the body but are common on the torso,” Waldorf says. “Wherever you have them, treating them is straightforward.” One zap of vascular laser light like the Vbeam will destroy the mole-like cluster of blood vessels. The cost depends on how many are treated, but Waldorf says prices start at $200.
There are three ways to tighten up without going under the knife, and each involves heating the skin to stimulate collagen production, says Woolery-Lloyd. Ulthera uses ultrasound technology; Thermage, radio frequency; and Titan treatments, infrared light. Regardless of which technology you try, Hale says to “expect 10 percent tightening immediately, but it takes at least 100 days to see real results and about six months for collagen to restructure itself.” None of these treatments involve downtime, but they’re pricey: Ulthera averages $2,600 per treatment (you’d need one or two); Thermage averages $2,000 per treatment (one is standard); and Titan averages $1,000 per treatment (plan on two or three). Another approach some doctors take is the use of dermal fillers, such as Perlane or Restylane, to subtly plump the cheeks;this pulls the skin taut—and provides a subtle lift to the lower half of the face. Prices start at $400 to $500 per vial, and most patients need one to four vials.
The trent is toward less invasive procedures,” says Meghan O’Brien, MD, a New York City dermatologist—and most experts concur. Some of the hottest research involves stem cells as wrinkle fighters, and fat reduction without surgery. “Stem cells will likely become a mainstream anti-aging treatment,” she says. This may even mean injecting or topically applying our own stem cells to improve the look of our skin. As for the body, Woolery-Lloyd says to expect lasers and injections that eliminate fat. “We have a few technologies on the market now, but we’re in the early stages. The need is so great, this will be among the next big things,” she says.