Page 23 - BCMS ONline directory

COSMETIC MEDICINE

to stay indoors. Peak hours are typically 10 a.m. to 2 p.m., although lines and jowling. Non-surgically
in Texas the sun can remain pretty intense until well past 5 p.m. Pro- we can correct this by re-
tective covering includes UV-protected clothing such as long-sleeved filling lost volume in
shirts, broad-brimmed hats (that cover the ears), UV-protected sun- the midface/cheek
glasses (to help prevent cataracts), and darker and tighter weaved and/or directly
clothing. You can seek shade with umbrellas and trees as well. The into the na-
best advice regarding sunscreen is that any sunscreen you will wear solabial folds
consistently is better than nothing. In general, you should look for and mari-
SPF of 30 or more, ideally with zinc oxide as an active ingredient. onette lines.
No matter which sunscreen you use, while outdoors you should Fillers can be
reapply every two hours; more frequently if you get wet or sweat. generically
The appropriate amount to use is one ounce for whole body appli- divided into
cation. Most bottles are 4-8 ounces, which means a bottle should hy a l u r o n i c
only last for 4-8 applications… not all summer long! As for pollu- acid (HA)
tants, you can certainly try to live greener, but will still be exposed based or non-
to environmental pollutants. The best thing you can do is use skin HA based. Al-
care that has good anti-oxidant benefits; the most common being though one advantage
products containing vitamin C. If you currently smoke cigarettes, of the HA-based fillers is
either stop for the many health reasons beyond skin aging or stop that any unforeseen side ef-
reading this article any further. Time is the only variable we have no fects or asymmetries can be reversed
control over, but there are several options to try and reverse some with hyaluronidase. Ask your injector whether they have the
of the aging effects of time. hyaluronidase on site. If not, go elsewhere.
If sunscreen is not part of your daily regimen it’s time to start When it comes to devices, it seems there is always something big-
making it a priority, not only for skin cancer prevention but also for ger and better on the horizon. The perfect device that tightens tissue
premature skin aging. There are several options to combat skin aging with no pain and no downtime doesn’t exist as of now. What does
and achieve skin rejuvenation. The first step is retinoid application. exist are ablative and non-ablative lasers. Ablative (such as CO2 or
Retinoids have been proven to normalize keratinization of the epi- Erb:YAG) lasers give better results but with some pain and down-
dermal layers and increase collagen and elastic fibers for firmer, time. Newer technologies include radiofrequency devices, mi-
tighter skin. The higher the concentration, the better the results, croneedling with or without PRP, combination radiofrequency with
however you may experience more irritation and side effects. Next, microneedling, focused ultrasound, electromagnetic impulses, and
you can utilize different combinations of antioxidants and growth IPL (photofacials). Old school chemical peels can be very effective
peptides. In addition to collagen and elastic fiber breakdown, brown for skin tightening as well but are limited due to downtime from
spots and dilated capillaries age our skin. There are many skin peeling/sloughing and pigmentary issues during summer months.
brighteners and lighteners such as hydroquinone, kojic acid and aza- Clearly there are numerous options available in the quest for the
leic acid, just to name a few. There are also several medical grade fountain of youth. The ideal answer is a combination of approaches
skin care products available on the market that provide patients im- including prevention with sunscreen, a good skin care regimen in-
provement in the appearance of brown spots. Capillaries are most volving a tolerable retinoid and other modalities such as botulinum
improved with vascular lasers. toxin, fillers, lasers or other skin tightening devices. The limitations
Repetitive movement will eventually add lines and wrinkles to cer- include the starting canvas, downtime and budget. Patients should
tain areas of the face. The main areas are the vertical scowl lines seek out a board-certified physician to help customize a treatment
between the brows, the horizontal lines of the forehead and radiat- strategy based on desired outcomes, timeline and budget.
ing crows feet on the sides of the eyes. These are best addressed by
botulinum toxin. Not all botulinum toxins are equal and not all in- Dr. Thushan DeSilva is a board-certified dermatologist practicing since 2000
jectors are equal so be sure and do your research. and a member of the Bexar County Medical Society. He is a member of the
Gravity keeps us on the ground but also causes some facial fea- San Antonio Dermatology Society and served as president from 2009 to 2011.
tures to go south, creating deepened nasolabial folds, marionette Dr. DeSilva opened DeSilva Dermatology in Boerne in 2017.

visit us at www.bcms.org 23