News & Features



Forget The Facelift: Step 4


by Doris Day, M.D.
Doris J. Day, M.D.

Doris J. Day, M.D.



Step 4- Ageless Skin Without Surgery: Botox and Beyond

Doris Day, M.D. is a New York City dermatologist and author (with Sondra Forsyth) of "Forget the Facelift," a new book in which Dr. Day tells readers how to turn back the clock with her own program for ageless skin. In the four steps, Dr. Day explains ways to improve your skin from the inside out. Here, exclusively to readers of CosmeticSurgery.com News in the final of four monthly installments, Dr. Day tells how to plan for beautiful, healthy skin without surgery.

The goal of having beautiful skin requires a multi-step approach for the most natural and rejuvenating results. We have talked about the critical importance of skin care, diet, stress management and exercise. And in the previous installments, I guided you, step-by step, through the maze of skin care products, ingredients and information. Now we arrive at the exciting concept of enhancing and accentuating beautiful, healthy skin without surgery.

This is a very exciting time in the world of cosmetic procedures because we have the technology to offer non-invasive treatments that rejuvenate the skin. However, it is essential to remember that having procedures without following the rest of the steps, leads to skin that may look smoother, but will not necessarily look younger.

For instance, consider wrinkle erasers like Botox and other soft tissue fillers. Before you have any procedure, even non-invasive ones, it is important to review your goals and your concerns with your doctor. There is so much advertising, information on television and in magazines, I meet people daily who ask about products without really knowing if those very same products would be beneficial. While it is useful to review treatments you have read about, it is more useful to have a thorough discussion regarding your skin and what you would like to improve or enhance. Your doctor will make recommendations based on the best evidence available. It is also useful to bring up treatments you may have heard or about, as part of a complete discussion.

When I mention botox to new patients the most common response I hear is: “But isn’t that a poison?” My answer is that botox is a drug and that ultimately all drugs are poisons if they are used improperly. Botox is a purified protein and probably one of the safest drugs on the market. Since its FDA approval over 15 years ago, it has a safety profile that remains the envy of many other drugs.

The newest FDA approval for botox is for excessive sweating (hyperhidrosis). The results are life changing. Usually, by the end of my discussion, the conversation goes, not if the patient is going to have botox treatments, but where and how the injections are administered. In Forget the Facelift, I offer a comprehensive review of who is a good candidate for botox treatments, who should never have botox treatments and what you can expect from your treatment, from start to finish. It is important to understand that the results are not immediate, but require two to three weeks to get the full effects. I also offer techniques to help your botox treatment last longer.

When it comes to soft tissue fillers, you should know there are three basic types of fillers, permanent, semi-permanent (one year or longer) and temporary (less than one year). I review both categories with the majority focus on the temporary fillers. I believe the current gold-standard for temporary soft tissue filler is Restylane. It has dominated the market and is becoming the filler most commonly used in studies and protocols against which newer fillers are evaluated. Before any filler procedure, it is important to review with your doctor any medications you are taking and any other procedures you have had in the area being treated. It is also essential to review your expectations and the cost of the procedure. While filler procedures are generally considered to be non-invasive, there is often some swelling and bruising after the procedure that can last from a few days to a week or so. Make sure to take into consideration any upcoming events and plan the procedure at least two weeks prior to those events in order to ensure the ideal results. In Forget the Facelift, I review what you can expect from the fillers and how you should plan your treatment.

In the middle category of the semi-permanent fillers, I focus on my favorite product of that category, Sculptra. This product is excellent for adding back volume. Even after a facelift, the skin can look smoother but still needs volume and elasticity to look younger. I review in detail how Sculptra helps add your own collagen back to your skin for natural looking contours and softened lines. As with all fillers, the results are technique-sensitive.

The final category of permanent fillers is currently dominated by the controversial product silicone. Proponents of silicone injection point out that in well-trained hands there is only a 1% chance of an adverse reaction; however, if you are that 1% you are stuck with the problem and possibly disfigurement for a lifetime. With all the new fillers available, I make it clear that silicone is not my first choice.

In other rejuvenating treatments, mesotherapy has made some headway in media and public attention. However, in my review of mesotherapy, I have found that more studies regarding safety and efficacy are needed. There is also no standard set of ingredients used in different settings, so it is even more difficult to evaluate the treatment as a whole.

Chemical peels play a major role in skin maintenance and rejuvenation. The word “peel” is a misnomer since there is usually no visible peeling after the most commonly performed chemical peels. In this section of the book, I review in detail different levels and types of peels, superficial, medium and deep, how they are done, general cost, and results you can expect. I believe that chemical exfoliation of the skin is a very useful tool in our armamentarium of non-invasive skin treatments. Lasers and light/energy-based devices have catapulted non-invasive skin rejuvenation to a whole new level. It seems that practically every day there is a new device designed to tighten and renew skin with little to no down-time. There are also devices that help reduce the redness of rosacea, the brown spots of sun-damage, and the wrinkles of time and sun. In general, the less down-time you have, the greater the number of treatments you will need. In this final section of the book I review the newest devices on the market, the results you can expect and the number of treatments you might need.

My experience has been that it is the sum of how you take care of your skin that shows the most, not any single cosmetic procedure. My goal in writing this book was to offer comprehensive information to educate the reader about the many facets of creating and maintaining beautiful skin and to inspire you to follow my guidelines. The results are beautiful, natural, and lasting.




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