As we get older there are cumulative changes to the skin surface (first dimension), as well as the deeper tissues which loose volume and strength (second dimension). The proportions of the face change, with sagging of tissues (third dimension). There is a redistribution of fat, with zones of volume loss (especially the upper face) and others have accumulation of unwanted fat (especially the lower face).

Not a single anti-ageing treatment addresses all of these dimensions in one.

The key to any treatment is a natural result and the aim is restoration, not the creation of new face.

There are fourth dimensional biological treatment options that may help get better results.


How do you address the first dimension, the skin surface?

With age the skin surface gets non homogenous with irregular pigmentation, wrinkly, dehydrated, containing broken capillaries and a rough surface.

This is our treatment ladder to address the skin surface, in order of invasiveness:

-A foundation to any anti-ageing treatment is a good skin care program to stimulate cell turnover and to re-boost healthy skin. See more

-A short-cut to more lengthy cosmeceutical skin care is mesotherapy, which is a minimally-invasive treatment to boost skin hydration and short-cuts the skin barrier by injecting key ingredients directly into the skin. This immediately plumps up the skin. See more

Photorejuvenation uses a special flash lamp (IPL) to harmonize facial skin pigmentation, treat broken capillaries and boost the skin’s light reflection. See more

Botulinum toxin helps to relax muscles of facial expression and reduces dynamic wrinkles mainly, orange skin on the chin and may relax the muscles that pull down the jawline. See more

Hyaluronic acids can help erase fine and coarser wrinkles by injecting directly into the skin. See more

Thread treatments may help strengthen the skin surface. See more

Collagen induction therapy with a dermaroller can help thicken the skin by stimulating collagen production. See more

Micro-fat grafting can be used as a more permanent filler and can be injected into skin creases (SNIF)

Resurfacing procedures can either use heat (lasers), chemicals (chemical peel) or mechanical energy (dermabrasion) to resurface the skin to stimulate the formation of new skin. Skin injury, as well as consequent healing, have to be done in a controlled fashion. See more

How do you treat the second dimension, the redistribution and often loss of volume associated with ageing?

Hyaluronic acids can help fill voids and recontour the ageing face. A “liquid facelift” may help achieve a more rejuvenated face.

-Volumizing the face is a great indication in early signs of ageing or with moderate signs.

-With advanced signs of ageing more product is necessary and this is a more difficult situation to treat. Fillers and injections may also aggravate the situation because fillers may accentuate heaviness and sagging. The product may also not stay as long.

Micro-fat grafting is a more permanent and surgical treatment of facial volume restoration.

Facial implants may be used to help restore volume to certain areas of the face (chin, temple, midface). This is especially effective in restoring facial balance in patients that have underdevelopment of certain areas, e.g. the chin. A chin implant in a patient with a small chin has a great impact on facial balance and has rejuvenating effects (often great improvement in neck contour or jawline contour).

How do you address the third dimension, the sagging of tissues and laxity?

-Thread treatments may help redistribute volume and give a temporary lift. Threads are two-dimensional vectors that aim to treat a three-dimensional problem. Threads are unpredictable in their efficacy and length of stay
-Energy-based devices may help tighten the deeper tissues under the skin surface of the face and especially the neck. Usually, these treatments use radiofrequency or high-focused ultrasounds in these treatments.
-Rejuvenation Surgery aims to relocate tissues, recontour facial tissues, remove excess skin, remove excess accumulations of fat and inject fat into areas that need volume restoration. This may include a temporal lift to lift the eyebrows, recontour the eyelids with blepharoplasty and / or a face and neck lift.

Is there a fourth dimension to a rejuvenation treatment?

Biologicals are currently available regenerative techniques; the choice will depend on the location and on the nature of skin damage.

-Biologicals for bio-revitalization include platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and stem cell rich nanofat injections. See more

-Bio-modulation with light therapy using special LEDs can help boost the energy powerhouse of the cells and have different therapeutic effects. See more

What is prejuvenation and what can be done to help prevent signs of ageing on the face?

The best way to protect and prevent your skin from signs of aging is to start early with a “prejuvenation” program.

Step 1: the first step is a good skin care regimen to stimulate cell turnover and to re-boost healthy skin

Step 2: Photoprotection. The easiest, most effective and most inexpensive anti-aging regimen anyone can use is one that provides protection from the sun. Regular use of sunscreens will not only protect your skin from skin cancer, but will also help prevent fine wrinkles, sun-induced brown spots, and the overall loss of collagen that lead to visible signs of skin aging.

Step 3: Retinoids and antioxidants. There are many categories of “anti-aging” products, most products focus on protecting against UV rays, absorbing damaging free-radicals (e.g., anti-oxidants like vitamin C, vitamin E, green-tea), and/or stimulating collagen formation. Collagen is the major protein backbone of the skin that gives it structure, resilience and ultimately helps plump up the skin and smooth out wrinkles. Retinoids are the most effective of the topical agents available for stimulating collagen. They stimulate skin cell turnoever and diminish signs of photodamage. It makes sense to start using effective topical agents at the first signs of photoaging, which is often in the 20’s or 30’s.

Step 4: Neuromodulators for prevention and softening of wrinkles

Lines and wrinkles on the upper face form over time due to repetitive folding of the skin that occurs with everyday use of the muscles of facial expression. Early use not only helps treat current wrinkles, but has been shown to help prevent deeper, more fixed and less treatable lines over time.

Step 5: Soft tissue fillers

As we age we begin to show signs of “volume loss” in our face. Fillers can target early areas of volume loss, especially around the midface.

Step 6: Skin tightening procedures

Early use of the radiofrequency procedures (beginning in the mid 30’s for example) can help even our younger patients not only achieve visible tightening of the skin, but induce preventative tightening of collagen in the skin for decades to come.