Aging Optional!

Aging Optional!

Getting older…inevitable, Aging OPTIONAL!

Looking your best at any age can be as simple as setting daily regimen for health skin.  As we age, our skin gets thinner, becomes more dry and pigmentation irregularities become more apparent.

Here are a few ways to slow down the aging process and prevent premature aging changes.

“I firmly believe that our skin reflects our overall wellbeing.  Health habits and lifestyle show on the outside how we are on the inside.  Sun protection, healthy eating habits, and general skin care goes a long way to keeping your youth”

-Board-Certified Plastic Surgeon Samuel Shatkin Jr., MD FACS

Keys to looking your best

Proper sun protection.  It is well known that sun exposure causes premature aging.   Radiation from the sun creates damage to the cells.  Pigmentation changes make your skin look older as well.  Protection year-round with avoiding direct exposure and using sunscreen with a UPF of 30 or higher can go a long way to fend off the effects of the sun.

Hydrate-Hydrate-Hydrate!  Applying a good moisturizer (or moisturizing sunscreen) can lock in the moisture.  Apply it immediately after shower or cleansing to retain the water in the skin.  Reapply moisturizer as needed throughout the day.

Be easy on your skin.  Many people think that aggressive scrubs and frequent washing can help keep skin healthy.  This could not be further from the truth.  Use gentle cleansers on the skin.  The more you wash the skin the more you remove the natural oils that escape through the skin surface.  If you use a scrub, try to limit it to 1-2 times per month.  Also, use hypoallergic, non-comedogenic and fragrance free products on your skin, whether they be cleansers, or moisturizers.

woman wrinkles before and after skin care products and procedures

Avoid the sun and tanning beds!  Sun and tanning beds emit radiation in the form of Ultraviolet rays.  This causes damage leading to wrinkles and skin spots.  If you prefer a “tan” on your skin, self tanner creams work well and cause no damage.

Lifestyle is critical.  A well balanced diet including colorful fruts and vegetables, as well as helath protein products like salmon and help to protect and repair the body and the skin.  A good weekly regimen of exercise can improve your circulation and help to boost your immune system.  Other lifestyle habits include avoiding smoking and limit alcohol consumption as these will add to aging changes and texture irregularities.

Antiaging skin products.  At a younger age, products with glycolic and alpha-hydroxy fruit acids can help to turn over the skin and prevent buildup of the dead layers.  As we age, skin products with Vitamin A derivative called retinol can help to penetrate the skin and repair and rejuvenate from the inside out.  Starting with a lower concentration of retinol every other day and then increasing to daily use at night can help to turn the clock back on aged skin changes.

Botox Brow Lift

Botox Brow Lift

What is a Botox brow lift?

On a daily basis, we get patients calling our office to schedule their “Botox Brow Lift”.  I perform surgical brow lifts which I physically lift up the muscles and skin of the forehead to lift the sagging eyebrows and tighten the skin. The surgical brow lift is certainly a more permanent result and can more dramatically lift up the forehead and brows, but it is a more involved procedure that requires recovery and downtime. The surgical brow lift is great for someone with significant sagging, needing a more significant longer lasting result.

A “Botox Brow Lift” is a technique that we have refined to give a temporary lift to rejuvenate the brow and forehead by relaxing specific muscles.  What is unique about our procedure is that by understanding the anatomy of the facial muscles and their effect on animation, we can selectively weaken the ‘pull down’ muscles around the eyes and brow, thus allowing the ‘pull up’ muscles to work with less opposition, thus giving a relaxed ‘uplift’ of the eyebrows. We perform the “Botox brow lift” with 3 different neurotoxins, Botox, Dysport and Jeuveau, all of which have similar properties.

Location, Location, Location. Which muscles are targeted?

When we first started performing Botox injections, patients would come in to relive tension in the “11’s” between the eyebrows.  After injecting the early adopters of Botox, back in the late 1990’s, I noticed that not only did the 11’s improve, but the medial eyebrows appeared more relaxed and lifted!  Understanding the anatomy of the face literally from the inside out from surgical procedures I perform to rejuvenate the face, such as eyelift and facelift, gave me the concepts of targeting the ‘pull down’ muscles to let the lifting muscles work unopposed.  Studying the effects of injection of certain muscles allow us to truly customize our results to create a youthful, relaxed look that few will identify as someone who had Botox injections.  Between the eyebrows, we relax the corregator and procerus muscles (‘pull down’) muscles, to allow the frontalis forehead muscle to lift the brows.  I began injecting the outer part of the eyes, just below the brow ‘tail’ in the orbicularis oculi muscle, a circular muscle around the eye, which relaxed the muscles that pull down of the outer eyelid and brow which causes ‘crows feet’ lines radiating away from the corners of the eyes.

Why are Botox brow lifts so popular?

Besides the fact that everyone wants to look more youthful and relaxed, there are plenty of models and celebrities wanting to accentuate the outer brow arch with makeup and Botox.  This brow fullness and arching has become very popular.  The internet has created a yearning for the open eyes and raised eyebrows.  When I first started doing injectables, over 25 years ago, most of my patients were generally older.  They were looking to fill in valleys and reduce lines.  Now, many of the younger patients are coming in to change the look or shape with fillers and Botox.  We also get young patients that use the injections as “Pro-juvenation” treatments to prevent lines from developing.  These procedures have become so popular, that we now have 3 different injectors, however, most of the injections are done by Michelle, our Physician Assistant, who has become expert at assessing and customizing treatment plans.  She also is one of our lead instructors in our Aesthetic Learning Academy where we train other health professionals to perform these aesthetic procedures.

How long does Botox brow lift last?

When it comes to Botox, there is good news and bad news.  The bad news it is not permanent, that is also the good news.  When we perform Botox injections, we have specific goals in mind.  If a patient is undergoing this for the first time, they may decide that it is not right for them.  I recall, many years ago, I performed Botox on one of the local TV personalities.  They wished for less frowning and softening of the 11’s.  It turned out the person decided the expressions and animations were important for their career, so with subsequent injections, we reduced the treatment in some spots over others.  With that being said, the overwhelming majority of patients love the injections so much that they set their calendar well in advance when they expect the Botox to be wearing off, so they can maintain the relaxed, youthful, less tired/angry look.  Generally, the Botox injections last between 3-6 months, with the average around 4 and one half months.  Longevity of the injections are both patient dependent as well as dose dependent.  If we notice the injections are lasting less than 3 months, we will bump up the dosing on their next visit.

How much does a Botox brow lift cost?

Our office charges by the number of units we use for the injection.  I feel this is the most fair way.  Some patients with stronger muscles will need more, others less. Generally, for the Botox brow lift, we would use injections between the brows and under the outer part of the brow.  The cost would range from $400 – $750.  We participate with the rebate programs, and most patients get the rebate discounts obtained from prior treatments.  Also, when seeking out a Botox provider, be sure they are using FDA approved neurotoxin, and beware of the low cost ‘Dilutox’. You may not be getting what you expect.

What else about Botox brow lift?

With the COVID-19 pandemic, wearing masks in public hides most of our face.  The one area that is usually left exposed is the eyes and the forehead.  Perhaps that is why the Botox brow lift is so popular now. 

Stay safe, wear your mask, and consider rejuvenating your eyebrows with Botox.

Summer is Gone!

Summer is Gone!

But some of the skin changes are still there! And this is a perfect time to consider reversing these issues. You may see more brown spots, visible blood vessels, texture irregularities or fine lines and wrinkles. The good news, winter is a perfect time to correct some of the damage. Here are a few strategies I recommend.

Protect from the sun. Even though it is winter, you are still susceptible to the sun rays. Sunscreen in the winter can protect from sun reflecting off the pavement or snow. Besides protecting you from new exposures, it can also give your skin an opportunity to heal and reverse some of the damage. It is always good to wear a sunscreen or sunblock year round.

Support your skin with an antioxidants. Topical skin care with vitamin C, vitamin E, green tea, and resveratrol (one of my favorites!) can provide antioxidants that can help skin cells repair their DNA and fend off free radical damage from sunshine, pollution, and the body’s metabolism. I take antioxidants orally every day in the form of vitamin supplements. Using skin products with antioxidant properties and vitamin supplements allows our skin to heal from the outside in and the inside out!

The B vitamin called nicotinamide (vitamin B-3) found in this B-Complex supplement, has been shown in human studies to lower the risk of skin precancers and non-melanoma skin cancers. Resveretrol, vitamin C and CoQ 10 among others offer the ability to repair damage to skin.

Products for your skin- (

Nutrition for your skin- vitamin A cream. Creams, gels, and serums derived from vitamin A (retinoids) have been proven to reverse signs of sun damage and age, including fine lines, wrinkles, spots, and sagging. Over time, retinol and retinoid creams help to thicken the epidermis and improve collagen and elastin fibers in the deeper layer of the skin, the dermis. Because retinolic acid (marketed as Retin-A) can be harsh on the skin expecially during the dry winter months. I suggest using creams with retinol as a therapeutic ingredient which is milder to the skin and can gently and gradually help to turn the clock back.

Chemical Peels- Creams and serums containing alpha hydroxy acids (such as glycolic acid) or beta hydroxy acids (such as salicylic acid) can improve the skin’s tone, smoothness, and texture while reducing acne breakouts and large pores. Chemical peels done in an office can be a good ‘jump start’ towards reversing summer damage. I recommend the use of customized layered PCA chemical peels that we offer at the Aesthetic Associates Centre. We utilize Recorcinol, Hydroquinone, Vitamin A, C and alpha hydroxy peels to help exfoliate, refine and smooth the complexion. These peels create a controlled flaking of the skin over 2-4 days, after which the skin looks smoother, brighter and with more even tones.

Shed the light on your skin. Another option to improve summer damage is with light therapy. Intense Pulsed Light (IPL) devices, such as the Cynosure Icon (we have 2 such devices, at our main office and the Tres Aurae Spa) are great ways to freshen up your skin by fading tan spots and reducing visible blood vessels. Lasers with longer wavelengths, such as Picosure 755nm or Cynosure 2940nm can ablate the surface irregularities with one or a series of treatments.

If you are looking to reverse some of the skin conditions caused by fun in the sun and summer activities, let my Aesthetic Skin Care team assist in finding the right combination of office and home treatments to repair and restore!

Anatomy of Aging

Anatomy of Aging

There are many ways that our face changes over time. Skin descends, volume disappears, muscles sag and relax, bone structure is resorbed. Here are some interesting images of mother and daughter to help you understand the process. Let us help you turn the clock back by addressing some or all of these issues as you age. We can also be proactive in preventing changes too!

How your mother ages can provide a glimpse into how your face may change over time.
As we age and lose facial volume, the contour of the face changes, causing shadow patterns to develop while youthful highlights fade. We’re going to see these changes, layer by layer, starting with the skin.
AS WE AGE, facial bone changes, soft tissues (like fat-pads) deflate and fall due to gravity, and skin sags and droops downward. Facial fat-pads shift, while the
fat-pads beneath the chin can increase in prominence, causing fullness between the neck and chin, also known as a double chin, and jowling.
• Youthful skin is soft, supple, smooth, and well hydrated
• As we age, we lose moisture, collagen, and elastin, which can lead to sagging
• Sagging skin may lead to the formation of dynamic and static wrinkles
DYNAMIC WRINKLES—formed by everyday, repetitive facial movements, such as smiling , laughing, frowning, or squinting.
STATIC WRINKLES—dynamic wrinkles that are gradually etched into the skin overtime since the skin is no longer able to bounce back as it did in our youth.
MANY FACTORS IMPACT THE WAY OUR SKIN AGES. Some people experience premature – onset aging of their skin, and potentially, at a fast rate of progression.
• A less firm and sunken face compared to our youth
• Hollows to form beneath the eyes
• Lines around the nose and mouth (“nasolabial folds”)
• A sagging jawline and jowls
• Increased fullness under the chin (“double chin”)
FACIAL VOLUME in the entire face decreases with age, leading to an overall deflated look.
That’s when more wrinkles, folds, and sagging of skin appear.
A goal for facial rejuvenation is to restore FACIAL VOLUME , which helps to decrease the appearance of wrinkles and folds.
AS WE AGE, loss of facial fat, combined with gravity and repetitive muscle activities(eating ,laughing ,smiling, frowning, etc), can lead to deep wrinkles in the face.
FACIAL MUSCLES ALSO GET WEAKER OVER TIME. The loss of muscle tone and thinning skin can give the face a loose, sagging appearance. Our jawline loses its contour, and our chin profile becomes less defined.
• Full and high cheeks
• Defined brow bones
• Less sunken eye areas
BONE STRUCTURE gives us our unique facial shape and contour.

Treatment options include general and specific skin care for the surface, volumizing with fillers, relaxing muscles that create dynamic wrinkles with Botox, and lifting sagging tissues where needed with surgery. We study the anatomy of your face and create custom solutions to rejuvenate!

Spring into Beauty

Spring into Beauty

Spring into Beauty


“Beauty is what health and happiness look like on the outside”. This may be an old quote but is just as true today as when it was written. (Good Housekeeping 1916) So for my spring into beauty tips, here are some simple choices that can help you look your best!


  • Start every day with sun protection. The best and scientifically proven way to keep your skin looking its best thought your life is using good sun protection and religiously applying it daily. Even when the sky is cloudy, UV rays can penetrate to affect your skin. Changes that occur include dehydration, loss of elasticity and breakdown of collagen. When you are younger, the changes are less noticeable, but trust me when I tell you that you will pay the price later in life with the aging changes, not to mention the increased risks of skin cancer.


  • Use the right skin care. There are many creams and lotions on the market, and when you look at the shelf, you wonder what is best. I suggest starting with a skin care analysis from a health professional. Aestheticians and Cosmetologists, particularly when they work as a team with Plastic Surgeons or Dermatologists, know best how to customize treatments to your skin type and needs. In addition, over-the-counter products may be sufficient to keep your skin moist and protected, but they lack the ability to truly “turn the clock back”. For most individuals with normal type skin, I recommend three main ingredients. One, serums that contain antioxidants like Vitamin C will help to brighten your skin. Two, to help increase cell turnover and stimulate collagen renewal, a product for nighttime should include retinoid (vitamin A), and three, use an alpha hydroxyl acid product either in solution form or cream to help remove the top dead layer of skin cells.


  • Want radiant skin that glows? Ever hear the expression we are what we eat? Well guess what? Take it literally. Go for items that are nutrient dense, like fruits, vegetables, whole grains, nuts and healthy lean protein like fish. If you struggle taking in plenty of vegetables, consider taking vitamin supplements. Vitamin D deficiency is rather common, particularly following a long winter, and supplements can help to boost your levels. If you prefer meat to fish, take Omega 3 fish oil to keep your skin glowing. It works by reducing inflammation and can even help with skin problems like acne and psoriasis. Not only will eating well improve the way you look on the outside, but these same choices help on the inside, and are beneficial for aging changes like menopause and heart health.


  • De-stress. – You will show all those worry and stress signs on the surface of the skin. Frowns, lines and wrinkles are accentuated when you don’t take the time to reduce anxieties. Do things you enjoy, like reading, meditation, hobbies, or other activities particularly outdoors, like walking or playing golf. The fresh air and fitness will help keep you mentally and physically fit and improve your outlook.



  • Enjoy life! – I recently saw the Carol King Musical-Beautiful. To paraphrase her lyrics for that popular song, “You have to get up every morning with a smile on your face…people gonna treat you better, You’re gonna find yes you will”. I find that people are most beautiful when they smile. Have the right attitude towards life and surround yourself with people you like. If you find beauty in the world, beauty will find you!

Follow these simple tips to Spring into Beauty.




“Wow, You Look Great!”

“Wow, You Look Great!”

I have been in practice since 1989, and it is common for patients coming in for facial rejuvenation (or any plastic surgery procedure for that matter) to comment, “I don’t want the Hollywood look”, or something to that effect. Achieving a natural look particularly with cosmetic facial surgery is what is referred to as both the science

wow you look greatand the art of plastic surgery. The goal should be to turn the clock back. Patient will often bring in photos of themselves as a younger age to share with me what they are hoping to achieve. Occasionally, an elderly patient will bring in a portrait ofhimself or herself from when they were 20, hoping to regain that look. If the surgeon attempts to gain that look, it is almost certain the patient will have an over pulled, flattened facelift, not the natural lifting and redrapping which is desirable. When I attend our national meetings, and see lectures from many of the top plastic surgeons in the industry, we see results with a natural rejuvenation. That to me is the mark of a surgeon looking to rejuvenate, not totally change the look of someone’s appearance. The skills of a board certified Plastic Surgeon give one the tools to create the natural look, but it is up to the surgeons themselves to execute a more youthful result without creating a distorted change. When I first started in practice, I had the unique opportunity to work with my father, both a skilled surgeon and mentor, who had that aesthetic eye to create harmony and beauty in natural way. Learning first hand from such an expert has given me an ideaperspective on recreating a youthful appearance to help the patient achieve the look they desire. Some patients may be hoping for that “Hollywood look”, but I would much prefer a complement, “wow, you look great”.