Aging in general


Facial AgingThe most common things a plastic surgeon hears is, "what can you do for me?" In our opinion, this is best addressed by explaining the some of the cause and effect relationships that dictate how old or attractive we appear to others. 

Aging is basically just a build up of genetic errors in our cells when they reproduce. As we get older the number of errors in cell reporoduction increase while our ability to recover from accumulated cell damage decreases. Genetics play a role in this process, but the number of errors is dramatically increased by environmental factors like sun exposure, alcohol and tobacco abuse, antibiotics, and even stress.

Sun exposure before age 20  however, is actually the leading cause of skin discoloration and of wrinkle formation later in life. Early sun related aging is characterized by the breakdown of elastic fiber proteins, which cause skin to lose its strength, making it more likely to sag and wrinkle. For this reason we feel that Sunscreen should be used as a first line of defense for every person interested in maintaining a more youthful appearance. Keep in mind however that Sunscreen works through a chemical effect, which is generally lost after two hours. If you don’t re-apply, you aren’t protected.

At any age skin discolorations and shaddows created by the peaks and valleys of fine lines and wrinkles are the leading factors in the way our age and beauty are determined by others. In fact, an even skin tone offers others strong instinctual clues about a person’s health and reproductive capability. Research actually shows that an uneven or blotchy skin tone can add 10 to 12 years to a person’s age.

For this reason, we feel that peels, lasers, and IPL treatments offer a great means for addressing a variety of age related issues which can be seen in the following images.

Chemical peels come in a wide variety of strengths. As a result, they have a wide varaiety of considerations to be made in a risk and reward trade off. Generally OTC peels will have very little downtime, and patients can expect a gradual 10% to 15% improvement in complexion per peel treatments. Stronger peels like 35% TCA peels however, can give a near 100% improvement in complexion if patients have no aversion to a two week downtime. Peel prices are also a great bang for the buck with most of our treatments less than $500.

Most patients however, choose to treat complexion issues with laser and IPL as results and downtime can be customized to anyones needs. These treatments offer outstanding results with far less recover than any other option for improving complexion issues, and are often done in packages to mitigate downtime almost entierly. Please see our laser pricing list for more information.

Laser Genesis

Genesis is a gentle, but effective laser treatment that sets the gold standard for treating redness. Genesis also targets excess redness, large pores, uneven skin texture, and fine lines and wrinkles. There is minimal discomfort with treatment and only a small amount of temporary redness and swelling after the treatment, so there is no real downtime. A series of 3-4 treatments is recommended for the best result, and results from treatment will continue to improve for several months due to collagen production in the skin.


This IPL (intense pulsed light) treatment addresses uneven pigmentation, redness, sun damage, and surface imperfections on the face and upper body, including the neck, chest, arms, and hands. The treatment takes less than one hour (including time to apply numbing cream, if desired). Dark spots will temporarily darken and then flake off, with improvement in skin within 1-2 weeks and the full benefit after a few months.


Cutera’s Titan Laser technology lifts and tightens sagging skin and jowls without the downtime and risks of surgery. We often use Titan laser treatment in combination with other procedures and medical-grade products as part of a non-surgical facial rejuvenation. Combining treatments like this is an important part of our skilled and artful layering approach. 

Pearl fractional

Renew sun damaged and wrinkled skin: Patients of any age with sun damage, uneven skin texture, brown spots or wrinkles will benefit from a physician-directed Cutera Pearl laser treatment. The Pearl creates smooth skin texture and softens fine lines and wrinkles on the face, neck, upper chest and hands. Your Pearl treatment will result in luminous, smooth and clear skin. 


Sclerotherapy is a fairly quick microinjection procedure that does not require any pain medication or anesthesia. Abnormal veins are treated by injecting a solution called a sclerosant, sealing the vein off from the rest of the vein network in your leg, allowing the body to naturally redirect the blood flow to healthy veins.

Complexion issues however are only part of the story when it comes to aging. Age 14 to 24 years the period of life when the face is considered to be at its “attractive peak”.  The bony structure in the face is strong and supportive,  the soft tissues are plump, and the skin is tight and even in tone. This is actually quite important in helping us find mates. Unfortunately, bone mass and skin collagen begin to decline after age 24, and this decline becomes more rapid after menopause due to the significant effect of low estrogen.

- Motor wrinkles (from moving your facial muscles) form, first in the brow.
- Years of squinting may lead to the appearance of crow’s feet.
- Hormonal changes and sun exposure can lead to skin discoloration.
- Prevent sun damage with a good SPF and avoidance of sun between the hours of 10 and 2
- Develop a skin care regimen to control breakouts and minimize pigmentation and fine lines.
- Use Retinol products 1-2 times per week
- Consider a peel if you have a significant amount of sun damage

-    Lines begin to deepen in areas of expression (glabella, crow’s feet)
-    Fine lines and wrinkles become more noticeable.
-    Broken blood vessels develop.
-    Nasal folds begin to form and cheeks flatten slightly.
-    Regular facials including microdermabrasion and exfoliation will help keep skin looking bright and refreshed.
-    Use Retinol products 3-4 times weekly to increase collagen levels, shed dead skin cells, minimize pore size, and decrease the appearance of fine lines and wrinkles
-    Chemical peels or laser can be used to treat discoloration as well as fine lines and wrinkles.
-    Neuromuscular agents (like Botox or Dysport) and fillers (like Sculptra, Juvederm, or Restylane) can be used to treat wrinkles and folds.

-    Lines begin to appear around the upper lip, as muscle motion continues to damage collagen and decreased fat under the skin makes wrinkles even more pronounced.
-    Lines on the forehead, around the eyes, and around the mouth deepen, especially for those who worshipped the sun or smoked.
-    Excess eyelid skin develops as the brow settles, the eye socket begins to shrink, and skin elasticity decreases.
-    Decreased volume in the cheeks changes the appearance of the lower eyelid, causing a tired appearance
-    Increase frequency of Retinol products and add a night cream and anti-oxidant skin care product.
-    Address lines and wrinkles around the mouth with a combination of Botox, filler, and peels or laser.

50’s and beyond
-    Loss of estrogen makes skin drier, leading to more lines and wrinkles.
-    Jowls and sagging of the neck develop.
-    Earlobes become larger.
-    Increase Retinol use to daily.
-    Based on your anatomy and skin quality, you can attempt laser tightening or elect for surgical tightening, including facelift and necklift.
-    Volumizing with fillers is essential to avoiding a “pulled” look.