Evaluating Your Options And Choosing What’s Best For You.
As a part time English professor who lives in a house on several woodland acres in Massachusetts, complete with two ponds and expansive Rower beds, Randy sounds like she shouldn’t have a care in the world. She has a loving partner, two dogs, and a passion for gardening. a form of outdoor exercise that keeps her in touch with the earth and its they then. Her face speaks another story, belying het current lifestyle and making her look older than she really is. That’s because most of the damage to her skin was done decades previously and is just now coming to fruition, a kind of unfortunate payback for time spent burning the candle at both ends. Her birthday age is fifty-nine, but her Skin Age is sixty-five. She exemplifies what’s possible on a beauty budget between $500 and $3,000 or more.
In her first appointment with me, I told her that smoking. sun, stress, and sleep deprivation were all major factors in her health, and so are reflected in her skin. She was very open with me about the fact she had smoked for thirty years, before stopping in 2000. “I taught at a school in Massachusetts for eight years mat was so understaffed, we had to work almost round the dock to keep it going.” she shared. “What kept me going was coffee, cigarettes, and five hours and forty minutes of sleep per night:’ She knew this figure exactly because her schedule wouldn’t let her sleep any longer. Add to that the sun exposure she received from years spent swimming outdoors and the years of gardening, and one can easily explain the lines and wrinkles, the crow’s feet, the sagging skin, and the broken capillaries on her nose and cheeks. “My skin is a fairly accurate index of some of my activities;’ she says. “I was a smoker and a drinker and a person who spent, and still does spend, considerable time outside, all of which don’t always register well on one’s face. And though I wouldn’t call this a high-stress time in my life, like anyone I’ve experienced relationship breakups, deaths, losses, and disappoint ments- all of those personal stressors that, if one is lucky enough to have a good long life, one undergoes:’ Plus, she hasn’t had the luxury of a natural peaches-and cream complexion to hide behind.”Lovely skin doesn’t run in my family-it’s not one of our generic strong points,” she admits.
So, when Randy walked into my office one day in 2007, she was a virtual canvas of things to fix. After interviewing and examining her, I had plenty of good news: Randy didn’t have any suspicious growths or signs of skin cancer, and she seemed to have put all of her unhealthy, beauty-busting habits behind her. Randy gets eight hours of sleep every night and uses sunscreen every day, though I reminded her to apply it to the back of her neck, an area that’s vulnerable when gardening. I could sense that she had a good handle on the stress in her life, too- you get better at managing it with experience. It’s the stress she has accumulated up to now that has taken a physical toll.
I started with my usual question, asking what she would like to change about her face, or what bothered her in particular. She gave me carte blanche, declaring, “You’re the doctor!” Using a mirror in front of her face, I encouraged her to share what she didn’t like when she looked in the mirror, and a few
specifics came spilling out. “I don’t like these marionette lines,” referring to the creases from her mouth to chin, “and the fact that I don’t have that youthful wide-eyed look anymore, maybe because the skin on my eyelids droops, making one eye kind of squinty. And there are lots of fine wrinkles on my face, which don’t show up in dim light but in good light look all creased, like badly ironed fabric;’ Randy said.
To help soften the crow’s feet under her eyes, the horizontal worry lines on her forehead, and the vertical scowl lines between her brows, we decided to try Botox. This purified form of a muscle-paralyzing substance helps stop the expressive movements that etch in lines and crevices in the first place. Batox can also be used to lift the face in certain places by relaxing the underlying muscles that pull the skin down, which is how I made further improvements. I injected a little Botox into the depressor muscles that drew down the corners of her mouth; to even out her eyelids and make her face symmetrical, I injected Botox in certain spots above her eyebrows. Everyone’s face is asymmetric, with more muscle movement on one side than the other, and so I adjusted the dose of Borax accordingly, to sculpt and correct while performing the injections.
A different substance was needed to smooth out the lines and folds that ran from her nose to the mouth, and from her mouth to the chin. To bring these creases up to the level of the skin, I injected a filler called Perlane, which contains hyaluronic acid, a natural component of skin that thins as we age. And though Randy was a cosmetic-surgery virgin, she didn’t flinch at the needle as it plumped up the lines on her face. Of course it helped that Randy’s skin was prepped beforehand with a topical anesthetic, a 30 percent lidocaine cream that I have especially compounded for my patients at a pharmacy. (Compare that to a ready-made tube of what most doctors use, Emla, which contains only 4 percent lidocaine.)
To even out Randy’s skin tone and refresh its texture, I painted on a mild 20 percent salicylic acid peel, which removed the top layer of dull, poreclogging dead skin cells. After three minutes of ring ling, the acid self neutralized, and Randy’s face was aglow. To cool things off she was given some ice packs as she left, pressing them to her face as she sat on the train home to Massachusetts. Was she self conscious? “Not at all she says, laughing. “There are a lot stranger sights on a train in New York, let me tell you:’ About two weeks later, after the slight bruising from the Perlane shots had faded and the flakiness from the peel had cleared, revealing fresh new skin, Randy began the at-home regimen I had prescribed: a twice-weekly applicarion of Renova (tretinoin cream .02 percent) to help treat surface fine lines, wrinkles. and brown spots.
Two months later, in September, Randy returned for a follow, up visit. This time I addressed the redness on Randy’s cheeks and nose, wielding a pulse-dye laser called the V-Beam to erase the squiggly little red blood vessels called
Randy donned a pair of goggles, held a squishy stress ball in each hand, and listened to me explain what would happen-a sound, a flash, and a pinprick of hear with each zap of the laser. I talked to Randy through the entire procedure, which only took a few minutes.
After the laser work, I took a good long look at Randy’s face and decided to inject a little more Perlane in her nose to-mouth lines and a little morc Botax in her crow’s feet. Such tweakings and touch-ups are an essential part of the dermatologist’s art, as it’s safer to undertreat a new patient than over treat. A few weeks later, after the lasered areas on Randy’s face had healed, she was a new woman with a new and improved visage, one that jibed with her inner sense of self “Even as I’ve aged, I’ve always felt young, but lately I’d been looking in the mirror and thinking, ‘Oh, my god, is that me!’ And now, I look and I think, ‘Oh hi! That’s me! I look good! I look friendly.’” And while she’s happy that the wrinkles are softer and the redness is diminished, she is most pleased that the squinchiness around her eyes is gone. “That’s delighted me the most, that my eyes look more symmetrical:’ The effects are manifold: Because she feels good about the way she looks, she says, she chooses her clothes more carefully. and pays more attention to her hair. “I suddenly want to do everything I can to give myself a good outward appearance:’
Randy’s partner also thinks she looks wonderful, as do her fellow professors and her students. They have been privy to the transformation, as Randy isn’t shy about having had some work done, and has been open from the start to questions from the curious. In fact, she has found herself in the unlikely position of being an authority on cosmetic dermatology, at least in the leafy confines of her college campus. ”A woman I work with wants to know everything,” Randy says, laughing. “She checks out my face up close every day, watching as the lines disappear. And a retired art history professor came up to me and pointed to his marionette lines, saying, ‘I just want to get rid of these; how do I do that!’”
