Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding ZO Skin Health Evaluation for Proper Skin Care, Anti-Aging, Wrinkles, Fine Lines and Folds

Q. I am 31 and looking for something that will prevent fine lines and wrinkles and lay the foundation for future skin treatments. Do I need Botox for crows feet? What is the best filler for nasolabial folds? What could I do to decrease pores, esp on nose? What would I ask for for best results with microneedling (ie what products are best?)

A. The beginnings of facial skin laxity start when skin repair diminishes and passive skin aging relaxes downward. The skin stretches and elongates developing 5 growing “waves” at points of attachment such as the:

  1. hooding along the eyes,
  2. lower eyelid / cheek junction or tear trough / nasojugal fold
  3. nasolabial fold,
  4. lateral mouth commissure and marionette folds,
  5. jowls and neck.

Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend.

  1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle. 
  • Exfoliation is best for this using: 
  • microdermabrasion, 
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis, 
  • Some lasers and chemical peels. 

2. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of: 

  • fillers (Restylane and Juvederm), or 
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells. 
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis 
  • PRP (platelet rich plasma) and micro-needling is a promising new technique for dermal firming and dermal/epidermal rejuvenation.
  • ThermiSMOOTH for non-surgical controlled heat skin tightening, or ThermiTIGHT for minimally invasive, dermal skin tightening. 
  1. The next layer or fat also thins or droops with age and maybe: 
  • filled (Restylane and Juvederm), fat grafting or 
  • redraped (Silhouette InstaLift Suture Suspension, short-scar, traditional, endoscopic face / neck / brow lifts / cheek) 

4. The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with

  • Botox or similar injectable muscle relaxers like Dysport. 

5. Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include: 

  • implants
  • structural fillers, particularly like Radiesse (bone mineral) 
  • volumizing gel fillers like Juvederm and Restylane 
  1. Don’t forget to protect your skin from the elements!
  • UV blockers, anti-oxidants, pigmentation control and acne / oil reduction will maintain your skin rejuvenation efforts. 

Consult with a Certified ZO Skin Health Specialist! Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon with great experience and understanding Team to evaluate your needs and find a plan that works best for you. 

I trust this helps. All the best!

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ZO Skin Health

This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

Give us a call at  410.602.3322  or email and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Frederick.

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