Surgical and Non-Surgical Options for Anti-Aging

article by Meredith McKinnie

Since we all want to look and feel our best, BayouLife spoke with three local experts on how to minimize and/or reverse the visual effects of aging. We explored surgical and non-surgical options at various price points. From basic skincare to cosmetic procedures, skin care maintenance is key to a youthful appearance.  

Megan Gimber, FNP at The Medical Spa by St. Francis Medical Group
As certified ZO Skin Health experts, the team at The Medical Spa suggest the medical-grade products for baseline skin care. ZO products are available for all skin types and help restore skin to a healthy state. During consultations, The Medical Spa experts look deeply at your skin and the results of a skin quiz to determine your wants and desires. Then they customize a skin care regime tailored specifically to each patient. Typically patients begin with a low-dose retinol, which comes in all different types and strengths. When it comes to retinol, patients may walk, jog, or run – depending on skin sensitivity and tolerance. Naturally, using a heavier dose of retinol results in more visible effects. Those with sensitive skin typically start with a lighter dose and adjust as needed. Taking baby steps by applying retinol only a few days a week and in certain spots can help desensitize the skin. During a consultation, be specific about what skin issues you are noticing. Some examples include: skin elasticity, wrinkles, pigment changes, neck area changes, and jowls around the mouth – this being a common one as we begin losing bone density and collagen and gravity starts pulling downwards. Consultations are always free and include a plan of care that considers your price range. Plans can be structured around a 12-month time frame or even as short as a 6-month period. Moving beyond baseline skin care, The Medical Spa offers a variety of treatments at various price points to target a range of existing skin issues and preventative care. Some patients elect to do a 3-step chemical peel which requires a few days of downtime. The in-office treatment can improve the signs of aging and combat skin discoloration. 

Microneedling is a popular procedure that stimulates collagen production. It works by creating micro wounds all over the face and neck areas which allows collagen to repair and regenerate. Microneedling helps with skin texture, pigmentation, and treats the appearance of wrinkles and fine lines. One option is Legend Pro which has radio frequency (RF) built into the treatment. The procedure uses TriPollar RF thermal energy and RF-assisted ultra-thin electrodes to tone the muscle layers of the face and neck. The second microneedling option is Rejuvapen, which also stimulates collagen production but without radio frequency. Similar to SkinPen Microneedling, though not as aggressive as Morpheus 8, Rejuvapen involves some red light therapy. Both Legend Pro and Rejuvapen treatments involve one day of minimal downtime – meaning no products should be applied to the face. The Medical Day Spa team recommends microneedling in a 3-series session for the most visible results, with one session every four weeks. Again, the procedures are catered to each patient’s preferences and skin care needs. 

The Legend Pro can be used alone for RF for a volumetric application to tone and tighten loose skin and to reduce sagging and cellulite. Using a glycerin-base conductor on the skin, the heat waves stimulate the collagen to rebuild. Patients are able to target specific areas. The procedure can be performed on the arms, legs, and abdomen or wherever cellulite accumulates, though the most common areas treated are the neck and jowls. As for results, patients can expect tightness and firmness from the treatment which The Medical Spa experts compare to a hot stone massage. The team recommends 4-6 sessions for optimal results, followed by two maintenance treatments over the next six months. One session lasts about 20-25 minutes, and patients can expect before and after pictures.

Other treatment options include Botox and Dysport, which are neurotoxins used  to diminish wrinkles. The noninvasive injections temporarily relax facial muscles and smooth the surface of the skin. Botox and Dysport are primarily used to treat lateral canthal lines (crow’s feet and laugh lines), forehead wrinkles and frown lines between the eyebrows. If a patient is medically approved, Botox can be used to treat headaches. Other treatment results with Botox and Dysport  include slimming jaw lines, unclenching jaws, lip flips, and lifting eyebrows.

Fillers are popular procedures at The Medical Spa as well. Juvederm and Restylane, both facial fillers, use gel made with hyaluronic acid that can be placed in the lips to add volume or placed in the upper face (cheek area) to fill in from lost bone density. The gel can also be placed in the chin, the jowl area, nasolabial folds, or in the jawline to create balance in the face, to lessen sagging, and sharpen the jawline. Though the effects are not permanent, the changes can last for several months up to a year.

In January, The Medical Spa is offering new products like SKINVIVE, a microdroplet injectable that hydrates the skin. Using hyaluronic acid, SKINVIVE creates a glowing effect while addressing texture changes and dullness, as well as improving skin smoothness and hydration. The procedure is minimally invasive and specifically targets the cheeks and jowl areas of the face. Another new product is Sculptra, an FDA approved collagen stimulator that is injected in different areas of the face to build collagen over time, with the effects lasting up to two years. Sculptra can reverse visible signs of the aging process and is comparable in price to traditional facial fillers.

For more information about The Medical Spa by St. Francis Medical Group, follow the company on Facebook and Instagram. You will find giveaways, specials, and new product announcements. Alle’ products (Botox, Juvederm, and SKINVIVE) and Aspire products (Dysport, Restylane and Sculptra) offer reward points that can be used toward the purchase of additional products. Call Megan Gimber, FNP and The Medical Spa team today. 

Dr. Timothy Mickel, MD, FACS, Board-Certified Plastic Surgeon at Mickel Plastic Surgery
Audrey Hepburn once said, “beauty is being the best possible version of yourself, inside and out.” And just as the inner beauty of spiritual health requires discipline and long-term commitment, so does looking your best on the outside. Since 1990, Dr. Timothy Mickel and the rest of the team at Mickel Plastic Surgery have specialized in doing just that – helping you look your best. There is no “one-size-fits-all” approach – age, skin type, sun exposure, concomitant medical problems and the patient’s desires all play a role. That’s why training, expertise, and decades of experience matter. To address these individual needs, Mickel Plastic Surgery offers a full range of services from non-invasive medical aesthetics to injectables like Botox and fillers to minimally invasive office procedures to surgical facial rejuvenation. But no matter the patient’s age or needs, Dr. Mickel feels that the foundational step in turning back the clock is simple. It all starts with good skin care.

Natalie Todd, a licensed aesthetician who has worked with Dr. Mickel for her entire 25-year career, spearheads medical aesthetics at Mickel Plastic Surgery and is a certified expert in the ZO Skincare program. Natalie and Dr. Mickel introduced the ZO program to this area in 2007 because it offers medical grade products centered around retin-A and its cousin, retinol – basic building blocks of skin health that should be part of everyone’s skincare regimen. Moreover, the cleansers, toners, pigment equalizers, skin brighteners and sunscreens that make up the rest of the ZO line are all designed to complement each other, working together to give your skin a radiant, youthful glow.  In addition to Natalie, almost everyone at Mickel Plastic Surgery – Dr. Mickel; his office manager, Hope McLemore; his Patient Care Coordinator, Rachel Spires; one of his nurses, Ashley Haynes, RN – is a certified ZO “expert.” They understand the products and will not only take the time to explain why they work and how to use them, but will be available to answer questions, help you through the adjustment phase of the new regimen and fine tune it as necessary to give you the best result.

At the initial skincare consultation, Natalie will aggressively exfoliate your skin and cleanse the debris from your pores by performing a Hydrafacial, a procedure that essentially power washes your face. She then examines your skin under magnification, stripped clean of make-up, dirt and dead skin cells, and can more accurately determine the products and services that will best suit your needs. These other aesthetic services might include microneedling, dermaplaning or laser hair removal.  And since Natalie has worked under the direction and supervision of Dr. Mickel for over two decades, she has become highly skilled at more aggressive treatments such as Fraxel laser resurfacing, which addresses fine lines and wrinkles, skin texture and mild laxity; and Lumecca IPL, which not only improves skin texture, but also treats uneven pigmentation and broken capillaries on the face.

Aging, however, is more than skin deep. It involves laxity of all the tissues of the face, allowing gravity to eventually make everything go south. There is also a tendency to lose some of the fatty fullness of the face as we age, compounding the effects of gravity. Fortunately for us, Dr. Mickel has a range of options to help us address these typical, predictable aging changes.

For patients in their late 30’s up to the early 60’s who desire an aggressive approach but are not yet ready to have a facelift or eyelid surgery, Dr. Mickel offers several other non-surgical options. Some treatments use radiofrequency energy to heat the collagen in the skin and underlying fatty tissue, causing it to thicken and contract which results in skin rejuvenation and tightening. These include Morpheus8, a microneedling radiofrequency technique used on the skin surface, and Accutite treatments, which apply the radiofrequency energy to the fatty tissue and underside of the skin, melting fat and tightening the skin from the inside out. While the skin tightening and textural improvement of Morpheus8 treatments can stand alone, the combination of Morpheus8 and Accutite is synergistic and is much more powerful. These treatments can improve the face, neck, jawline and in some patients even the lower eyelids. Dr. Mickel personally performs the Accutite treatments under local anesthesia with light oral sedation. The first of three Morpheus8 treatments is done at the same time as the Accutite treatment, with the subsequent two treatments done at six to eight week intervals by either Natalie or his nursing staff.

Ellacor is a procedure that has been nicknamed the “non-surgical facelift” because it actually removes skin. The concept is similar to microneedling, using a device with hollow needles that removes thousands of tiny cores of skin with each of three treatments spaced two to three months apart. These tiny holes heal without a scar, resulting in skin tightening and improvement of the cheeks, jowls, jawline, and neck. As with Accutite, these treatments are done by Dr. Mickel under local anesthesia with oral sedation. Ellacor is a great option for someone who is not ready for, or who simply does not want, a surgical facelift.  Platelet rich plasma (PRP) or exosomes, both of which contain growth factors and other substances that facilitate healing and rejuvenation, are frequently applied after Ellacor, Morpheus8, laser resurfacing or microneedling to enhance the results.

For patients who are ready to have surgical rejuvenation, Dr. Mickel has 33 years of experience with upper and lower eyelid surgery, browlift and face/neck lift. Over the past several years, he has added fat grafting to most of his facelift surgeries to enhance the results by restoring facial volume and by providing an additional rejuvenative effect from the stem cells contained in the injected fat. Most people think that facelifts and other facial cosmetic surgical procedures are for older patients, but Dr. Mickel says that it makes sense to consider surgery as soon as you begin to be bothered by extra skin or muscle bands in your neck, jowl fat collections that interrupt the flow of your jawline, loss of fullness over your cheekbones, skin excess of your upper eyelids or any of the other typical changes of age. For some patients this is as early as the mid 40’s, for others it may be the early 60’s – mostly depending on your genes. The overriding concept is the younger you take the surgical plunge, the better. Younger patients are healthier, have better skin quality and heal more quickly.  Furthermore, the result will not be as obvious to everyone if you have your facelift at age 49, when aging changes are early, as it would be if you wait until you are 69, when aging changes are full-blown.  Surgical anonymity may or may not be an issue for you, but either way, Dr. Mickel feels strongly that the goal is to give you a fresher, younger, rejuvenated look – not make you look pulled, weird, or operated on.    

So having read this far you can appreciate that navigating the sea of options for facial rejuvenation can be challenging. Having an expert, well-trained guide who has decades of experience with the full range of procedures and techniques is invaluable in charting the course that is best for you. To learn more about surgical and nonsurgical options to combat aging, contact Dr. Mickel and his staff at Mickel Plastic Surgery.

Caitlin Robinson, MD, FAAD, FACMS at Louisiana Mohs & Skin Surgery Center
As a double board-certified dermatologist and Mohs micrographic dermatologic surgeon, Dr. Caitlin Robinson has been expertly trained in how to keep your skin healthy and looking its best. She stresses 3 must-have components to a skin care regimen to prevent the effects of aging and sun damage: an antioxidant serum, sunscreen, and a topical retinoid. Other products may be beneficial as well, but these three are crucial to maintain skin health and beauty over a lifetime.

Starting in the morning, the first step is to apply an antioxidant serum to clean skin. Antioxidant serums consist of various components, such as Vitamin C & Vitamin E, to prevent free radical damage to your skin. These serums can help prevent environmental damage caused by UV radiation & pollution and can help make the skin appear more radiant and youthful. However, not all antioxidant serums are created equally. Dr. Robinson recommends the Skinceuticals line of antioxidant serums, as these have been thoroughly scientifically tested for effectiveness. There are three serums to choose from — CE Ferulic (for most skin types), Phloretin CF (for skin prone to discoloration), and Silymarin CF (for acne-prone skin).

After applying an antioxidant serum, one should apply sunscreen to the face, neck, ears, chest, and all other exposed areas. Dr. Robinson recommends a minimum SPF of at least 30 or an optimal SPF of 50 or higher. Sunscreen should be applied daily, even in the winter and on days not spent working outside. One should also remember to reapply regularly. On a regular day where one receives a minimal amount of sun exposure, she recommends reapplying sunscreen at least once at midday. Powder brush-on sunscreens can be helpful for this midday application.

The third important step in a skin care routine is a topical retinoid, typically applied in the evening. Retinoids are vitamin A derivatives and work by increasing cell turnover rate in the skin. In doing this, they can improve the appearance of fine lines and wrinkles, improve the appearance of pigmentation, and decrease pore size. Importantly, regular use may also decrease incidence of skin cancer. Retinol is a certain type of retinoid found mostly in over-the-counter products. To ensure potency and effectiveness, Dr. Robinson typically recommends obtaining a prescription retinoid from your dermatologist. Retinoids can initially cause peeling of the skin, so it is important to incorporate this product gradually and alongside an effective moisturizer, such as Skinceuticals Triple Lipid Restore.  

It’s never too early to start caring for your skin. Dr. Robinson suggests sunscreen daily for all age groups and retinoids/antioxidants as early as teenage years.

While budgetary concerns can keep people from investing in skin care products, Dr. Robinson insists you can get started without spending a lot of money. Board-certified dermatologists are highly qualified to answer questions about skin care and can provide recommendations for all budgets.

In addition to skin cancer treatment and surgeries, Louisiana Mohs & Skin Surgery Center offers non-surgical cosmetic skin treatments to keep your skin healthy and beautiful. Besides injectables, the office offers chemical peels, intense pulsed light (IPL) treatments, and microneedling. Each of these treatments targets and treats the skin in different ways to provide rejuvenation that will help to fight effects of aging and can help prevent the need for surgical intervention later in life.

Chemical peels, a time-tested dermatological procedure, offer a versatile solution for skin enhancement with minimal downtime. This treatment involves the application of a chemical solution to the skin, causing controlled exfoliation and encouraging the regeneration of new, healthier skin cells. The benefits are extensive, ranging from improved skin texture and tone to the reduction of fine lines, wrinkles, acne, and certain types of dark spots. Dr. Robinson tailors the treatment to each patient, ensuring a personalized approach to achieve optimal results. Peels can range from superficial to deep. Most patients will start with a superficial to medium-depth peel. Dr. Robinson uses slightly deeper peels to treat acne scars and for prevention of skin cancers in heavily sun damaged skin. When patients come in for a chemical peel, they can expect a few layers of chemical peel agents to be applied to the face in stages to see how the skin responds. Patients will experience some tingling and maybe a touch of discomfort, but overall the procedure is typically tolerated quite well. After the procedure, one can expect minimal redness and swelling. Peeling starts approximately 48 hours afterward and can last for several days up to a week.  The results can last for months following the procedure but are sustained and improved with repeated treatments.

Dr. Robinson offers intense pulsed light (IPL) therapy to treat sun damage, age spots, and blood vessels in the skin (such as rosacea), promoting a more even skin tone. IPL works by filtering an intense beam of broad-spectrum light to target either melanin (pigment) or hemoglobin (red blood cells) in the skin. The procedure involves minimal discomfort, with most individuals describing a sensation akin to a rubber band snapping against the skin. Downtime is typically brief, characterized by temporary redness or mild swelling that subsides within a day. The versatility of IPL makes it a great option for those seeking a gentle yet effective approach to address common skin imperfections and to boost collagen production.

Dr. Robinson also offers microneedling using the highly effective MicroPen EVO device. Microneedling involves the use of fine, sterile needles to create controlled micro-injuries on the skin’s surface, with the primary aim of stimulating collagen and elastin production. The treatment leads to improvements in skin tone, reduction of fine lines and wrinkles, and an overall smoother complexion. Following the procedure, patients typically experience mild redness and swelling for a day or two. This minimally invasive approach is helpful for those interested in a non-surgical method to enhance skin texture and tone. Dr. Robinson recommends regular microneedling sessions to promote continued collagen and elastin production over the years.

Regardless of the treatment type, Dr. Robinson recommends a series of at least three treatments for maximal results. She also stresses the importance of having a well-trained, experienced provider guiding these types of treatments to ensure effectiveness and safety. With her years of extensive training in procedural dermatology, you can trust Dr. Robinson to help you make the best decisions for the continued health and vitality of your skin. For a dermatologic consultation, contact Dr. Robinson at Louisiana Mohs & Skin Surgery Center.