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Part 1 of a 3-Part Interview: Patient, Know Thyself!
by Raeanne Rubenstein

Recently. Dish caught up with the always delightful Dr. Deborah Sherman in her very busy office in Nashville, TN. We snuck away to a quiet spot on another floor, so I could catch up on the recent advances in skin care and surgical procedures since last we spoke, about a year ago.

Not surprisingly, a lot may have changed, but the very basics have stayed the same. Here’s what Dr. Sherman had to say:

First and foremost, before you do anything else, you have to go to a doctor that you trust, who has integrity, who’s honest and is well trained and experienced. Once you find this person, then you can come up with what your treatment goals are, what you are willing do, and then the doctor can speak to you about your treatment options, depending on your skin type. That way you don’t waste money on the creams you buy at Walgreens or Walmart, and then you also are not doing treatments at spas or in doctor’s offices that you don’t really need.

Because no two wrinkles are alike, it’s important to get a facial analysis. When one comes to me for a facial analysis, we talk about your skin type and we find out by analyzing your face if you’re a sinker, a sagger, or a squeezer. Because these wrinkles are different, then we can come up with a treatment for sinking, sagging, squeezing and what’s right for your type of skin.

For saggers: you might have excess skin above the eyes, and below the eyes; along the jaw line we call them jowls. Creams won’t work on that. So nothing short of surgery will take care of sagging skin. Sometimes that’s done through a hidden incision eyelid tuck, a hidden incision brow lift, sometimes a mini lift. It depends on what layers of the skin are involved, and this will determine what procedure we will perform and what the level of downtime is and what the risk and benefits are. And even with that we try to get someone on a good skin care regime so their skin is healthy going into surgery. If you’re skin is in Olympic form, it can perform better as it heals.

When it comes to sinkers: Many of us loose tissue after the age of 35 and so we start to have facial expressions that form from repeated movements, just like a piece of paper. It can start to crease and that crease starts to lose collagen and we break collagen bonds, Elastin, Hyaluronic Acid which are building blocks of skin. A short way of saying it is just H.A. So H.A. is just a building block of skin. It’s actually a natural sugar. It’s in our joints, it’s in our vitreous, and it’s a piece of the recipe of skin that gives it freshness, and plumpness. Babies have tons of it. When we’re born, we start out like we’re a brand new couch- plenty of stuffing and then after age 30-35 we start to loose some of that.

We not only lose our stuffing, we lose our bones, so as things start to sink, creams won’t work for that. Botox doesn’t work for that. It’s got to be filled in with some type of replenishing, refilling substance. We call that a cosmetic injectable. Of the cosmetic injectables, we have permanent, semi-permanent, we have dissolvable. But the majority of the fillers that are used, 85% or more, are made of HA.

I’ll mention some fillers by name briefly: like Hylaform Plus, Restylane, Captique, and the next generation is supposed to be Juvederm. That would be a great topic for your Health Bits & Bites section that talks about new treatments, because that has a special gel formulation that gets a more natural look and feel in the face. So we’re still on fillers. Now we want to move onto squeezers, right?

Squeezers: probably the most common wrinkle is the area between the brow or the area around the eyes called “Crows Feet”, because those are the muscles that contract, and often they get stuck in overdrive, especially in the area between the brow that we call that the 11 (eleven). So will a cream work better than Botox in that area? The answer is NO! No matter what claims those cosmetic company’s ads might make, a cream cannot penetrate the deep muscle that causes the action. Only Botox – a cosmetic- a purified protein, can go to that neuromuscular junction and tell it to relax, puts into temporary time out for 4 months, and then we lose the 11. We lose the squeeze factor and once more the brow communicates a more restful and relaxed facial message.

NEXT MONTH: Part 2. What to expect in the Doctor’s office? Wrinkle Creams, do they work? Good skin care regimen at home! / Issue 82 - September 2971
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