The typical dermatologist visit begins with a simple question: What brings you here today? Or sometimes, with cosmetic dermatologists, it’s the more pointed: What bothers you most about your appearance? (These keen-eyed cosmetic dermatologists specialize in elective procedures designed to make us look younger/fresher/tauter, as opposed to diagnosing and treating specific skin disorders, like acne or rosacea.) The doctor is, of course, aiming to assess our priorities — which “flaw” do we perceive to be most in need of correction?
While the savviest of skin nerds may offer up not just perceived problems (fallen cheeks and smile lines, say), but appropriate solutions (“Voluma, please, here and here“), the majority of people will dutifully, and perhaps sheepishly, report their concerns and accept their doctor’s prescribed fix. According to top cosmetic dermatologists, however, furthering the standard dialogue with some smart questions of your own can not only fine-tune your treatment plan and make your results last longer (the dream!), but head off disappointment and save you cash, too. Bring these conversation-starters to your next appointment.
What do you think?
“Patients don’t see themselves objectively. They look in the mirror every day, and a variety of things can bother them—big or small—but surprisingly, it’s often a minor line or spot. Because it bugs them, they tend to fixate on it, and it becomes a bigger frustration as time goes by. But when other people look at you, they don’t see these fixations. Instead, they perceive facial contour, overall skin tone, and dynamic lines [that form from facial expressions]. Cosmetic dermatologists are trained to study your overall cosmetic appearance. It can be difficult at times to point out new problems in an unsolicited way, because you don’t want to make someone feel uncomfortable or insecure. So I love when patients ask me what I think, because it opens the door to having this discussion. And addressing issues before they become fixations can save you money in the long run. Maybe you weren’t thinking about getting Botox, but I explain that by preventing dynamic lines, you ultimately reduce the appearance of deeper or more permanent wrinkles in the future. This could save you the substantial cost of laser resurfacing down the road. Or maybe filler wasn’t on your radar, but I tell you that when it’s done expertly, it elevates the cheeks, improving the jaw line and jowls, and can help stave off a face-lift for years, or forever. Another reason to ask your doctor for his or her opinion: The science is changing so rapidly. In addition to being a very busy cosmetic dermatologist in New York City, I’m also a researcher, participating in a number of clinical trials and bringing new science into my practice every day. I may be able to recommend something helpful that even the most informed patient hasn’t heard about yet.” —Robert Anolik, a clinical assistant professor of dermatology at the NYU Langone Medical Center in New York City
What’s your aesthetic?
“Since the passing of my dear friend and colleague, Dr. Fredric Brandt, I’ve inherited a large number of his patients, which is an honor, but not one I enjoy, because I miss him deeply. In the course of treating these people, I’ve come to realize that I wish first-time patients would ask me about my aesthetic, so I could tell them that what I’m known for is maintaining a very natural and unadulterated look over the long-term. After being treated by me, you will not feel frozen-solid, or filled up to the high heavens — and if that’s not the sort of dermatologist you’re looking for, then we should end the relationship with the consultation, so we don’t waste time, or risk disappointment. I take care of many of the world’s most famous and beautiful faces. I maintain these models and actors all throughout their careers, making them appear as though they never age. What I don’t do is over-treat. I’ve had two or three notable patients comment that when they used to go to other injectors — not necessarily Dr. Brandt — they used to feel like they really “got their money’s worth,” because they left so “pumped up.” Another mother-daughter duo wanted their foreheads completely frozen, which is just so far from my aesthetic. These are things I will not do.” —Macrene Alexiades, an associate clinical professor of dermatology at Yale University School of Medicine in New Haven, Connecticut
Could my diet be affecting my skin?
“So many people don’t realize that they can get more out of their in-office procedures by making small changes to their diets. I had a patient whose main complaints were fine lines, wrinkles, and rough skin texture. We did a series of resurfacing procedures, including both the Fraxel laser and the Endymed Intensif, which is a microneedling-radiofrequency hybrid device. After the first series of treatments, her skin looked incredible, and she was getting compliments everywhere she turned. I asked her to return every six to 12 months for maintenance treatments, because although the procedures had turned back the clock, time keeps on ticking and upkeep is crucial. She showed up at my office only four months later, ready for more! I was surprised to find that her skin was already reverting back to its original dehydrated, unhealthy state. So, I sat down with her, and asked her to walk me through her typical day: exercise, diet, the whole thing. Turns out, she was drinking smoothies every morning with skim milk, a known trigger of inflammation in the skin. To the milk, she added bananas and mangos — two sugar-laden fruits. She ate a protein bar for lunch, and its main ingredient was milk-derived whey protein — another pro-inflammatory skin saboteur. I had her swap skim for almond milk; replace half the banana with greens, like kale, spinach, and celery; and sub in a plant-based protein bar. From that point on, she lost weight, felt more energized, and the rate of her skin-aging slowed significantly, so she only needed maintenance treatments once a year. Now she has a gorgeous, healthy glow, and it only took a few dietary tweaks.” —Whitney Bowe, a clinical assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai Medical Center in New York City
How can I slow down the signs of aging?
“I wish more people would ask about treating wrinkles as soon as they start seeing them — at least by age 30 — because once those lines are deeply set into the skin, we can improve them, but reversing them altogether becomes difficult. Early intervention with proper cosmeceuticals and small concentrations of neuromodulators, like Botox, can literally prevent lines from developing. See, we treat wrinkles in two ways: First we strengthen the skin foundation with collagen-building retinoids, so the skin can better resist wrinkling. Healthy, plump skin bounces back after being folded. But with age and sun exposure, the collagen and elastin proteins that keep skin smooth and firm begin to weaken, the skin folds more readily, and lines get etched in. The second way to thwart wrinkles is to stop skin folding at the source by injecting key muscles with neuromodulators. By preventing the muscles from contracting, we keep the overlying skin smooth, staving off creases. And the earlier you treat, the better your results will ultimately be.”—Joshua Zeichner, the director of cosmetic & clinical research in dermatology at Mount Sinai Hospital in New York City
How often do I have to be treated to stay looking my very best?
“People are very fixated on how long the effects of certain treatments last — like Botox, filler, and laser. What they don’t realize is that the longevity of a treatment result involves so many factors — most of which have more to do with the individual patient than the treatment itself. The same dose of neuromodulator could last six months on a 35-year-old but only three months on a 60-year-old, and the degree of efficacy can differ drastically. People often compare their results to those of friends, and have similar expectations. Generally, I see my 30- to 40-year-olds two times a year; 40- to 55-year-olds three times a year; and 55-plus patients four times a year. I tell them that keeping up cosmetically is just like exercise, nutrition, or hair color: The best results come from small, consistent efforts. You want to be “touching up your roots,” so to speak, not waiting for your color to grow out completely. So I like to use small amounts of a treatment, so it seems every time is a minor touch-up. This gives the most natural result for any cosmetic procedure.” —Paul Jarrod Frank, a clinical assistant professor of dermatology at Mount Sinai Hospital in New York City
What products should I use to maintain these results?
“I know someone is serious about making a real change in her skin when she asks me about at-home skin care. While filler and toxin injections give an immediate fix, a daily regimen is an equally important part of one’s commitment to better skin. The two go hand-in-hand, really. Filler, for instance, can physically replace lost volume and stimulate your own collagen production, but caring for your skin with proven anti-aging products before and after injections can make that collagen growth more successful. Also, healthy skin heals faster and bruises less. My favorite anti-aging ingredients — retinoids, antioxidants, growth factors, and peptides — provide a daily stimulation of collagen and cell turnover, which helps make skin brighter, smoother, and quicker to heal.” —Joely Kaufman, an assistant professor of dermatology at the University of Miami Miller School of Medicine
How much is too much? (And will you stop me from crossing that line?)
“This is a tough topic with no straight-forward answer, but we certainly don’t want anyone looking like a caricature of herself. Given that my name is stamped on my patients’ faces when they walk out of my office, it’s my duty to remain true to my aesthetic of youthful aging while maintaining a certain facial harmony. There’s a line between doing small things to improve someone’s confidence, and doing lots of things to completely change who they are — and I’m very careful not to cross it. Consider the lip obsession taking over those in their early twenties: I call lip augmentation the gateway procedure. It’s understandable to enhance lips if their size doesn’t fit the composition of someone’s face. I have a young patient who first came in with paper-thin lips that disappeared when she smiled. After several spaced-out sessions, we achieved beautiful, soft lips that fit her face, and most importantly, looked natural. A few months after we achieved our goal, she came in asking for more definition in her cheeks. Now, this is someone who already has enviable cheekbones, and was clearly not a candidate. Since we’d built a trusting relationship, I said, No. At first, she was taken aback, but eventually realized I was looking out for her best interest. A good cosmetic dermatologist is one who says, No, more often than, Yes.” —Shereene Idriss, an associate clinical professor of dermatology at Mount Sinai Hospital in New York City
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How can you make this a more comfortable experience?
“For me, managing a patient’s comfort level during a procedure is of paramount importance, and not enough people ask how we can ease their pain or anxiety during cosmetic treatments. Although lasers and injectables can have some inherent discomfort associated with them, we have so many tools to decrease pain, ranging from topical and oral anesthetics to advanced skin-cooling devices. Modern advances in pain management make the minimally invasive and non-invasive procedures virtually painless and much more accessible for those who can’t tolerate discomfort.” —Arash Akhavan, an assistant clinical professor of dermatology at Mount Sinai Hospital in New York City
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